by

Cardiac POCUS: Common Pathology

Cardiac POCUS: Common Pathology
by

Common PAtterns seen

1. LV Systolic Failure

LV systolic function is commonly determined with cardiac POCUS.

All 4 POCUS cardiac views should be used to evaluate LV systolic function.

The parasternal short axis view provides a doughnut view of the heart and is useful to visualize all 4 LV walls (anterior, inferior, septal and lateral).

LV systolic function can be estimated by looking at:

  1. The change in size between end-diastolic and end-systolic size of the LV. 
  2. LW wall thickening during systole
  3. Endocardial border excursion in systole

We can define LV systolic function into the following groups:

  1. Normal
  2. Mild to Moderate LV Systolic Failure
  3. Severe LV Systolic Failure

In Image 1, there is > 50% change between the end diastolic and end systolic sizes. LV wall thickening is seen in systole and there is good endocardial border movement.

Image 2 shows little change between end-diastolic and end-systolic LV size. LV wall thickening and endocardial border excursion are reduced.

Image 1: Normal LV systolic function seen in the PSAX view
Image 2: Severe LV systolic failure seen in the PSAX view

Right Heart strain

Right heart strain pattern can be seen in any cause of acute pulmonary hypertension and right heart failure. Examples include:

  1. Acute pulmonary embolism
  2. Amniotic fluid embolism
  3. Air/cement embolism
  4. Tension pneumothorax

Right heart strain POCUS Cardiac features:

  1. Dilated right ventricle (Normal RV is often 2/3 the size of the LV)
  2. Flattened interventricular septum giving rise to a D shaped LV. This is caused by acute pressure and volume increase in the RV, which pushes the interventricular septum into the LV.
  3. McConnell’s sign. Preserved apical contraction of the RV. Loss of RV free wall contractility.
Image 3: POCUS cardiac signs in acute right heart strain

Pericardial effusion / tamponade

Cardiac tamponade is a clinical diagnosis characterized by beck’s triad. Echocardiographic sign of cardiac tamponade include the following:

  1. Presence of a large pericardial effusion. This is seen as a hypoechoic area of fluid surrounding the heart.
  2. Diastolic RV collapse
  3. Systolic RA collapse
Image 4: POCUS cardiac signs of cardiac tamponade

Hyperdynamic LV

Causes of a hyperdynamic LV include the following:

  1. Hypovolemic Shock
  2. Distributive Shock (Vasodilatory)

In hypovolemic shock, the LV end-diastolic and end-systolic volumes are small. The LV walls collapse and obliterate the LV cavity is systole. This is called the “kissing ventricle” sign.