DrPocusMD

40s pt few days s/p hepatic artery aneurysm repair. Developed hypotension, SOB, CP, incr lactate/trop. I was on cards consults, summoned for STAT echo showing normal cardiac fxn, no eff. FAST showed free fluid in Morison’s - CT revealing large IP hematoma w/ extrav, s/p successful ex-lap.
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IM, will be applying cardiology

50s pt with no PMHx transferred from OSH to us for cath. On arrival, TTE showed EF 18%, LAD-territory WMA, and 4×2 cm apical thrombus. LHC revealed 100% ostial LAD occlusion, not amenable to revascularization.
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35M. Advanced hypertensive heart disease with evidence of probable LVOT obstruction. Peak intracavitary gradient 110mmHg. Mild systolic anterior motion of MV.

Prior RCA infarct, pt floridly volume overloaded on exam. Massively dilated RV with very poor RV systolic fx. Severe TR.
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Autosomal dominant polycystic kidney disease.
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70s female. Pretty certain pt has a bicuspid aortic valve unless someone more experienced than me thinks otherwise?
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70M with NSCLC presenting with signs of SVC syndrome, + Pemberton sign. Large clot in R IJ extending from mandible to subclavian.
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Yessir good eye

Yeah it was classic pericarditis sharp/ positional pain

Dressler syndrome many weeks after large LAD infarct. Note the fibrinous deposits in the pericardium. No convincing evidence of tamponade. At least moderate MR.
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Pt with MRSA empyema with chest tube in place. Underwent spontaneous hemorrhage after 3rd round tPA dornase with large hemothorax, underwent VATS.
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Pt with recurring UTI’s with Staghorn calculus causing xanthogranulomatous pyelonephritis.
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Severe hydronephrosis R>L due to bladder outlet obstruction presenting w/ acute renal failure.

Can anybody guess this RUQUS diagnosis?
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80M admitted for COPD exacerbation. Cachectic with BMI 12. Noting vague back pain. Grossly visible pulsatile abdominal mass. Threw a probe on him. Couldn’t adequately measure outer wall: outer wall on my probe but knew it was >6cm. CT showing 8.5cm AAA completely occluding L iliac.
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Asymmetric non-rheumatic mitral stenosis. Restricted posterior leaflet due to mitral calcification and leaflet tethering. Severe LVH.

Correct. PH doesn’t always cause SAM but here there’s so much IVS bowing that it displaces blood posteriorly causing Venturi forces to suck the anterior leaflet over the LVOT. That plus the LVOT obstruction from RV dilation is a bad combo, the type who will code after just a small bolus of IVF.

End stage HF. Rheumatic mitral stenosis. S/p MVR/AVR and tricuspid annuloplasty. EF maybe 5%. Severe TR. LA standstill found to have LAA thrombus on TEE despite being therapeutic on warfarin.

Severe aortic stenosis. EF 25%. Incindentally found PFO.

POCUS success story. ~80m presented with mLAD occlusion s/p PCI. 24h after developed cp and new afib. I threw my probe on him and he had an effusion with echogenic material in pericardium - c/f free wall rupture. Taken to OR for exploratory thoracotomy. Weaned off all pressors/IABP. Discharged.

79M. SEVERE pulmonary hypertension. Occupational lung disease secondary to career upholstery business. RV severely dilated causing dynamic LVOT obstruction. Septal flattening in diastole and systole. Elevated RVSP ≥ 60 mmHg (estimated from TR jet velocity).
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#CARDIOLOGY

Late presenting MI with persistent LAD territory ST elevations. TTE showing large LV apical aneurysm.
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~70 yo female presenting with sudden onset central chest pain radiating to LUE. EMS EKG concerning for STE’s in precordial leads. Initial trop 2,200. Activated as STEMI. Cath revealing minimal CAD but ventriculogram showing obvious Takotsubo.

Severe TR. Vena contracta at least 6.5mm. Plethoric IVC. Vexus showing systolic flow reversal in hepatic veins, highly pulsatile portal vein, could not get a good renal vein tracing. Planned for TriClip.
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Failed MitraClip placed for mitral valve prolapse. 2 distinct MR jets. latrogenic ASD from atrial septal puncture failing to close with L→R shunting causing RV failure.
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#Cardiology

PEA arrest

The best way to evaluate a pacer wire with TTE: RV inflow view.
- Start with PLAX view
- Tilt the tail superior towards the L shoulder (with beam aiming towards the R hip)
- Often times you can subtly rotate the indicator clockwise to optimize the view
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The Bernoulli principle is timeless

Analyzing carotid stenosis: Using PW Doppler, measure PSV in the CCA and ICA. Analyze PSV in the ICA and calculate ICA: CCA ratio. The most important number to remember is ICA PSV > 125 is abnormal.
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