Findings in patient with endocarditis affecting the aortic valves

All 4 video clips are from the same patient

A, B, C are all apical views for optimal display of the pedunculated mass

D is the corresponding TEE mid-esophageal 4 chamber view

Findings in patient with endocarditis affecting the mitral valves

The video clips are from 4 different patients

A, B, C are all apical views for optimal display of the pedunculated mass

D is the corresponding TEE mid-esophageal long axis view with pedunculated mass on the anterior mitral leaflet

Video clips showing examples of pericardial effusion obtained in the subcostal 4-chamber view

Notice:

– S4CH views
– Pericardial fluid collection (white arrows)

Compression of the right sided cavities in diastole is not obvious in these video clips

Dilated, poorly functioning RV 2D echocardiography

The characteristics:

– RV dimension is increased
– Paradoxical interventricular movement
– LV is compressed by RV
–

Video clips showing examples of pericardial effusion obtained in the apical 4-chamber view

Notice:

– Apical views
– Pericardial fluid collection (white arrows)
– Compression of right atrium is obvious in image B and is a classical echocardiographic sign of tamponade, but not a prerequisite for a clinical tamponade syndrome

Video clips of the parasternal short axis view

Notice:

– Enlarged RV
– D-shaped left ventricle
– Paradoxial movement of the interventricular septum
– Arrows pointing to dilated right ventricle

Right ventricle enlargement and myocardial dysfunction are seen in right side myocardial infarction and pressure increase (pulmonary embolus and chronic pulmonary hypertension)

In acute enlargement the high pressure in the right ventricle will compress the left ventricle resulting in typical paradoxial interventricular septal movement and D-shape of the left ventricle

Video clips of the apical 4 chamber axis view

Notice:

– Enlarged RV (arrows)
– RV size >2/3 of LV size
– Paradoxial movement of the interventricular septum

Right ventricle enlargement and myocardial dysfunction is seen in right side myocardial infarction and pressure increase (pulmonary embolus and chronic pulmonary hypertension)

Often a tricuspidal regurgitation is seen on colour Doppler and continuous wave Doppler will disclose a RV pressure increase (advanced FATE level)

Video clips showing examples of pericardial effusion obtained in the parasternal long axis view

Notice:

– PLAX views
– Pericardial fluid collection (arrows)

Compression of the right-sided cavities in diastole is not obvious in these video clips

Cardiac tamponade is a clinical condition where the pericardial effusion compromises the cardiac function; it may become fatal

Every physician should be able to recognise the clinical characteristics and signs of cardiac tamponade:

– Cardiac tamponade is a CLINICAL diagnosis
– Cardiac tamponade is NOT an echocardiographic diagnosis
– Pericardial effusion can often be seen with ultrasound, but the sonographic size is not
important
– The clinical presentation is of paramount importance

If therapeutic evacuation of the pericardial effusion (pericardiocentesis) stabilises the haemodynamics of the patient, the diagnosis

In cases with pericardial effusion different echocardiographic and clinical characteristics are observed

2D echocardiographic characteristics:

– Pericardial fluid collection
– Compression of the right-sided cavities in diastole (often not present)

Clinical characteristics:

– 5 mm wide pericardial fluid collection is within normal range
– Badly tolerated in LV hypertrophy
– Badly tolerated in postoperative cardiac surgery
– Badly tolerated in rapidly developing pericardial effusion