A CLUE to the Problem

The Cardiovascular Limited Ultrasound Examination

N.Gibson , I. Ma

Disclaimer

• No vested interests or investments other than as a purchaser

Simple Approach

• Six areas of investigation• Validated with biochemical and angio data• 6-10 minutes with experience• Improved sensitivity compared to traditional

auscultation• Some experience and practice required – 30

minutes with medical students studied

Cardiac Probe Positions

1. Global LVEF

• Normal – Mitral Valve nears or hits the septum

• Abnormal – MV > 1 cm from the septum throughout the cardiac cycle

2. Is the Left Atrium enlarged

• Normal – LA<Ao at any time• Abnormal – LA always greater than Ao

3. Is there Pulmonary Oedema

• Appearance of Ultrasound Lung Comets (ULC’s) or Comet tails

• Normal - none• Abnormal - > three per field• B-lines, transect thefield completely and are

pleural based

Ultrasound lung comets.

Frassi F et al. Eur J Echocardiogr 2007;8:474-479

Copyright © 2007, The European Society of Cardiology

Ultrasound lung comets number increases with increasing dyspnoea severity.

Frassi F et al. Eur J Echocardiogr 2007;8:474-479

Copyright © 2007, The European Society of Cardiology

Date of download: 11/16/2012

Copyright © American College of Chest Physicians. All rights reserved.

“Ultrasound Comet-Tail Images”: A Marker Of Pulmonary Edema*: A Comparative Study With Wedge Pressure And Extravascular Lung Water

CHEST. 2005;127(5):1690-1695. doi:10.1378/chest.127.5.1690

Top, A: Typical comet-tail artifacts: hyperechogenic, coherent vertical bundles with narrow basis spreading from the transducer to the further border of the screen. This artifact is composed of multiple microreflections of the ultrasound beam. Bottom, B: Normal subject, with regular, parallel, roughly horizontal hyperechogenic lines due to the lung-wall interface.

Figure Legend:

4. Is There Pleural Fluid

5. Is the RV Increased

• Normal – RV < LV• Abnormal – RV > LV

6. Is the CVP Elevated

• IVC view• Lift subcostal probe to perpendicular• Normal – small and changes with respiration• Abnormal – large and may be static• Responsiveness with respiration may suggest

fluid responsiveness

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