POCUS Cardiac Exam
Note to teachers: you may want to break up this topic into a couple of sessions as there is a lot of information in the cardiac POCUS exam!
Clinical point-of-care questions:
(5 E's):
1. Is there Pericardial Effusion Present?
2. What is the Ejection fraction?
3. What is the Equality of the RV to LV?
4. How does the Exit appear? (Aorta)
5. How does the Entrance appear (IVC, volume?)
6. Is there wall motion abnormality?
Teaching objectives:
1. Demonstrate the 4 standard views of the cardiac exam (parasternal long, parasternal short, apical, subcostal)
2. In parasternal long view, evaluate for ejection fraction, equality of the RV to LV, and exit (aorta). *** On our 3-N US machine, probe marker goes to patient's right shoulder when in cardiac mode ***
3. In parasternal short view, evaluate for ejection fraction, and equality of the RV to LV. *** On our 3-N US machine, probe marker goes to patient's left shoulder when in cardiac mode ***
4. In apical (4-chamber) view, evaluate for pericardial effusion, ejection fraction, and equality of the RV to LV. ** On our 3-N US machine, probe marker goes to the patient's left in cardiac mode***
5. In subcostal view, evaluate for effusion and entrance (IVC). ***On our 3-N US machine, probe marker goes to patient's left when in cardiac mode ***
A few numbers:
-RV is normally 2/3 the size of LV
-EF can be assessed by E Point Septal Separation: EPSS <1cm ~ EF >40%
-Normal thoracic aortic root <4 cm
-IVC > 2.1 cm in diameter and <50% collapsible with sniff test is consistent with central venous pressure of 10-20 mmHg
Clinical case:
61 yo F with dementia who presents with 2 weeks of dyspnea, weakness, cough. Physical exam shows rales bilaterally, decreased heart tones, and JVD is difficult to assess. There is no lower extremity edema. How can you assess the 5 E's?
Videos:
Parasternal long view: https://youtu.be/H_3V9xlDMA0 (5 minutes) and https://youtu.be/uciGL4TaoaA (5 minutes)
Parasternal short view: https://youtu.be/B731sgCuZU4 (4 minutes)
Apical (4-chamber) view: https://youtu.be/4vBJoWP-zBM ( 5 minutes)
Subcostal view: https://youtu.be/ew6uJvZDhmw (5 minutes)
Entire cardiac exam overview: http://uscm.med.sc.edu/mods/11A1/player.html (7 minutes)
Want a deeper dive?
AEUS emergency echocardiogram part 1: https://vimeo.com/44570642 (27 minutes)
AEUS emergency echocardiogram part 2: https://vimeo.com/44575412 (27 minutes)