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Archive for the ‘echocardiography’ Category

Simple tips in echocardiography : Where to look for coronary artery origin in short axis view ?

Posted in Cardiology - Clinical, cardiology -Therapeutics, echocardiography, Tutorial in clinical cardiology, tagged , , , , , , , , , , , , , , , on February 9, 2010| 1 Comment »

Imaging  coroanry artery is  generally  in the   domain of interventional cardiologists. MDCT has helped us to change that.

The  humble echocardiography can   identify the origin* of   coronary arteries   in  most   persons. The resolution power of modern day echocardiography is  2mm and the left main  ostium is >3.5mm in 99%  of population . If some body says one can’t  visualise the coronary artery by echo ,   it can only reflect their ignorance or lack of patience to get an optimal image. Of course technological limitations are there.

*  To be emphasised again , only the origin can be identified.

Can we identify ostial leftmain or proximal  left main disease  by echocardiography ?

It should be possible in  few .

Can we place  a doppler sample volume  within  the left main and measure coronary flow velocity ?

When obsterticians are able to  assess the  uterine artery flow  in a bulky uterus ,  it should be possible to do the same in  a coronary artery . Motion artifacts is the issue in the heart.  Micro sample voulme (<1mm) are expected in the future  that will make a non invasive coronary flow assesment a distinct possibility.

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A great website for learning Echocardiography : A gift from Duke university

Posted in echocardiography, tagged , , , , , , , on February 4, 2010| Leave a Comment »

  • Here is a site which has dedicated  resources for learning echocardiography .
  • The site has collection of various work shop and conference highlights
  • The basic echocardiography with classical line diagrams  would be very much useful for the beginners,

Cheers to duke university for sharing ! www.echoincontext.com

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Foundations in Echocardiography : It is only occassionally , “A great article ” that comes free of cost !

Posted in echocardiography, Great websites in cardiology, Top ten in cardiology, Uncategorized, tagged , on January 19, 2010| Leave a Comment »

A  humble  tribute to  Mr. Doppler : Let us  remember this  man ,  every time you hear that hissing  Doppler  signals   , as  we  put the Doppler probe inside the heart.

Doppler ‘s brief encounter with life

Gave us one of the greatest diagnostic tool .

Born in  1803 in Salzburg, Austria,  died  in Venice, Italy 1853

Click over the portrait to learn Doppler’s life

Read and enjoy yourself !

Doppler and his principle  : By Richard J. Bing, MD Professor of Medicine – USC (Em) – Director of Experimental Cardiology – Huntington Medical Research Institute Visiting Professor in Chemistry – California Institute of Technology – Calif – USA

http://www.dialogues-cvm.org/pdf/51/DCVM51_04.pdf Courtesy  Servier

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Beware of non infarct q waves : A women with an unusual pathological q waves

Posted in Cardiology - Clinical, cardiology -ECG, echocardiography, Uncategorized, tagged , , , , , , , , , , , , , on November 25, 2009| Leave a Comment »

Looks very much a infarct of  infero posterior territory is it not ?

Have a look at her 2D echo still picture . . .

Are you convinced ?

This women had normal LV systolic and diastolic function with no evidence of constriction.

The explanation for the asymptomatic pericardial thickening is due to a healed  chronic pericarditis .This sort of localised thickening in the posterior aspect is all the more likely following a loculated pericardial effusion.Tuberculosis is a very likely etiology.But this women do not have any markers for tuberculosis.Since she is symptomatic no treatment was offered.She is being followed up.

Discussion .

Q waves are not ” sacred waves” to diagnose myocardial infarction.It simply indicates the  direction of current flow is away from the  recording lead of the ECG .Any thing  electrically inert , that come in the interface between the heart and the recording electrode   can record a q waveWhat are the pathological entities that can produce q waves other than infarct ?

  • Fibrotic myocardium(DCM-Cardiomyopathy)
  • Myocardial Scars
  • Myocyte dis array(LVH, HCM)
  • Air,fluid in pericardium /pleural space
  • Pericardial thickening (As in this patient)
  • Electrical shortcircuits (WPW syndrome)
  • Rarely pure ischemia without necrosis can produce q waves (Electrically stuned myocardium)

Final message

Localised pericardial thickening is  a rare  (?unrecognised) cause for pathological q waves , that may mimic a MI.

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How to estimate right atrial pressure with echocardiography ?

Posted in echocardiography, Hemodynamics, tagged on November 3, 2009| Leave a Comment »

Estimation of right atrial pressure (Often referred to as  central venous pressure (CVP) is a common hemodynamic excercise both at the bed side and in echocardiographic lab. A venous catheter inside the right atrium is probably  the best way to measure it accurately .But, there are  practical issues  for  putting and maintaining a CVP catheter. ( & We also know , what happened to the concept of routine  swan  catheter in critically ill patients !).

A  rapid bed side echocardiography  can give us a fairly accurate estimation of RA pressure . We  don’t even need look into the heart , what you need is imaging the inferior vena cava , it’s size and it’s  behavior  with respiration  . You don’t require  a doppler probe either ! With these two parameters one can decode the mean RA pressure. This  modality is rarely used in the ICUs , it can be a simple aid to fluid management .

RA pressure echocardiography ivc collapse hepatic veins

ivc collapse ra pressure right atrial mean pressure

Shrewd clinicians would argue , we have a natural catheter inside the right atrium, ie the   internal jugular vein   This gives us a unique opportunity to study the moment to moment RV, RA pressure . And .  .  . yes ,  we know it but we rarely respect the neck veins !

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