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0 · Transoesophageal Echocardiography • LITFL • CCC
1 · Hypovolemic and septic Shock
2 · Echocardiography in shock management
3 · Assessing dynamic fluid
4 · "Kissing Ventricles" in Hypovolemia (via TTE)
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Short Axis Mid Papillary View (0º) – LV function, RWA, RV function, tamponade . When hypovolemia is severe, 2D views can be impelling when they show . When hypovolemia is severe, 2D views can be impelling when they show .
In profound overt hypovolaemia, preload is insufficient to allow adequate cardiac filling and both ventricles appear small and hyperkinetic; this finding is useful in predicting a fluid-responsive state. 10 In severe cases of hypovolaemia the LV .
Complete occlusion of the left ventricular cavity (i.e. in which the ventricular walls “kiss” each other) is a sign of inadequate return to the left.
Short Axis Mid Papillary View (0º) – LV function, RWA, RV function, tamponade (can look at this view and get a lot of information. kissing sign = decreased preload, collapsing ventricle = decreased after load, RWA = ischaemia, pericardial fluid .
When hypovolemia is severe, 2D views can be impelling when they show collapse of the left ventricular walls at end‐systole, the so‐called “kissing walls”. implies elevated left atrial pressures and further fluid is not necessary . When hypovolemia is severe, 2D views can be impelling when they show collapse of the left ventricular walls at end‐systole, the so‐called “kissing walls”. Conversely, fixed bowing of the atrial septum into the right atrium throughout the cardiac cycle implies elevated left atrial pressures and further fluid is not necessary (Fig. 3 ).
In profound overt hypovolaemia, preload is insufficient to allow adequate cardiac filling and both ventricles appear small and hyperkinetic; this finding is useful in predicting a fluid-responsive state. 10 In severe cases of hypovolaemia the LV is seen to collapse in systole, referred to as ‘kissing-ventricles’.Images by Genevieve Carbonatto Hypovolaemia ,”kissing” ventricular walls in PLAX view. Posterior wall of LV and IVS come together in systole
Is the LV contracting normally? In a patient with normal cardiac function, the walls of the LV should contract equally towards the middle of the ventricle. This PLAX view shows globally reduced contractility of the LV. The LV should contract > 30% in systole at the level of the papillary muscles.
Identify relevant left and right ventricular abnormality/presence of pericardial or pleural fluid. In the acute situation a basic study reveals immediate results allowing initiation of therapy. A follow-up advanced study for refining the diagnosis and tailored hemodynamic assessment. The lumen of the LV may even be obliterated and the ventricular walls are seen to be “kissing” (Fig. 11a, b) . The IVC collapses, and the size becomes less than 2 cm with >50 % collapsibility (Fig. 12 ). Parasternal long axis view → measured LV outflow tract diameter and recorded the presence or absence of “kissing” LV walls (systolic obliteration of the left ventricle) Apical 5-chamber view → measured LVOT velocity time integral (VTI). 5 measures at 2 different times and took the highest one.
Complete occlusion of the left ventricular cavity (i.e. in which the ventricular walls “kiss” each other) is a sign of inadequate return to the left. Short Axis Mid Papillary View (0º) – LV function, RWA, RV function, tamponade (can look at this view and get a lot of information. kissing sign = decreased preload, collapsing ventricle = decreased after load, RWA = ischaemia, pericardial fluid . When hypovolemia is severe, 2D views can be impelling when they show collapse of the left ventricular walls at end‐systole, the so‐called “kissing walls”. implies elevated left atrial pressures and further fluid is not necessary .
When hypovolemia is severe, 2D views can be impelling when they show collapse of the left ventricular walls at end‐systole, the so‐called “kissing walls”. Conversely, fixed bowing of the atrial septum into the right atrium throughout the cardiac cycle implies elevated left atrial pressures and further fluid is not necessary (Fig. 3 ).In profound overt hypovolaemia, preload is insufficient to allow adequate cardiac filling and both ventricles appear small and hyperkinetic; this finding is useful in predicting a fluid-responsive state. 10 In severe cases of hypovolaemia the LV is seen to collapse in systole, referred to as ‘kissing-ventricles’.Images by Genevieve Carbonatto Hypovolaemia ,”kissing” ventricular walls in PLAX view. Posterior wall of LV and IVS come together in systole Is the LV contracting normally? In a patient with normal cardiac function, the walls of the LV should contract equally towards the middle of the ventricle. This PLAX view shows globally reduced contractility of the LV. The LV should contract > 30% in systole at the level of the papillary muscles.
Identify relevant left and right ventricular abnormality/presence of pericardial or pleural fluid. In the acute situation a basic study reveals immediate results allowing initiation of therapy. A follow-up advanced study for refining the diagnosis and tailored hemodynamic assessment. The lumen of the LV may even be obliterated and the ventricular walls are seen to be “kissing” (Fig. 11a, b) . The IVC collapses, and the size becomes less than 2 cm with >50 % collapsibility (Fig. 12 ).
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lv kissing|Assessing dynamic fluid
