echo pathology findings

patient has an echo and has heart failure ,

• 
  

How many thrombi are there ?

3

What is a mural thrombus

• Only exposed to 1 surface

• Flat & parallel to endocardium borer

What is a pituitary thrombus ?

• Exposed more than 1 surface

• Pitrudes into the left ventricle

What is a mobile thrombus ?

• Most dangerous

• Move independently as heart is contracting

• High risk for embolism

How can you tell between thrombus vs heavy trabeculated left ventricle ?

• Use definity or blood enhancing agent

• Look an thrombus echogenicity compares to ventricular myocardium

• Thrombus will have hyperchoic homogeneous w/ irregular margins

• What echo signs give red flags for thrombus ?

Severely decreased systolic dysfunction

Akintetic apex

Aneurysmal apex

Pseudo aneurysm

Thrombus will grow in areas where blood can slow down

If a embolism goes to brain what happens?

Cause a stroke or go to upper / lower extremity

What is right heart embolism : what can happen ?

Can go to lungs

Pulmonary embolism lead to cardiac arrest

You start an echo and you have a reduced systolic dysfunction I you don't notice anything what do you do?

Always use something that will enhance the blood

There is a routine echo for post myocardial infarction and had 3 stents , and has pain in throat : what can you see in sonographic findings?

• EF will be down - normal with three stents

• Plaque buildup

• Possible aortic dissection

Patient comes into emergency room complaining chest pain & SOB what will you see in the echo ?

• If heart is swinging think TAMPONADE

• Pulse wave and Continuous Wave on tricuspid / mitral valve

• Look for greater 25% variation tricuspid / mitral valve during inspiration & expiration

• Check to see if right atrium is collapsing after atrial systole collapsing same time ventricular diastole (1st echo sign of tamponade)

• Check subcostal view IVC ; dilated & mom compressible w/ tamponade

When can tamponade be diagnosed?

Clinically - use becks triad

Becks Triad= 1. Hypotension 2. Quiet heart 3.distended jugular vein

What can you hear with tamponade

W/ stethoscope hear muffled sounds due to having fluid around the heart

Pulses paradoxes is caused by ?

Tamponade

Means greater than 10% decrease in arterial systolic blood pressure

• What is tamponade ?

Rapid accumulation of fluid in pericardial sac the area b/t visceral pericardium aka epicardium & surus pericardium

• pressure increases rapidly the intrapericardial pressure increases normal right ventricular diastolic pressure

Patient is 11 years old who has tuberculosis came into emergency room with cough, dyspnea , sweating , and weight loss . What can you possibly see?

• Rhabdnomyomas (most common benign tumor in kids ) is associated with tuberculosis

• Main concerns are embolization and obstruction

What are 2D characteristics of Rhabdomyoma

• Multiple hyperechoic homogenous structures w/ binoculated look that protrudes into left or right ventricle

Most common cardiac benign tumor in adults

Myxoma

Normally found on fossil valves on left atrial side

But can also be seen on the right side

• Papillary fibroelastoma

• Second most common benign tumor in adults

• Most commonly found on left side of heart

• Patients will have flu like symptoms 1, fever 2, chills 3, night sweats

• Most common being in aortic valve and known to be on mitral valve

How can you rule out a thrombus vs a tumor or vegitation ?

Thrombus often will grow on areas low blood flow

Aortic valve blood flow can be steady

If big vegitation is found more likely find valvular destruction

What is cardiac fibroma?

2nd most common benign cardiac tumor found in children

Where can you see cardiac tumors ?

Left ventricular lateral wall or IVS