Parasternal Short Axis
A selection of echo clips of the heart in the parasternal short axis view are shown below. Can you describe what you see? Is there any pathology present? Or is the clip normal?
Clip 1
A 38 year old lady suddenly looses consciousness during an emergency LSCS. There is no palpable pulse and chest compressions are in progress. A FoCUS scan is performed during pulse check. What is seen and what could be the diagnosis?
This parasternal short axis view shows a severely dilated RV, small LV and flattening of the interventricular septum. The LV is D shaped, indicating RV pressure and volume overload. There is no pericardial effusion present. The findings are consistent with acute cor pulmonale. Possible causes include acute pulmonary embolism and amniotic fluid embolism. What other echo features are seen in acute pulmonary embolism?
Clip 2
Following a liver resection, a 60 year old man is hypotensive and tachycardic in PACU. The nurse calls you over to review him. You obtain a PSAX view of the heart. What could be going on here?
The LV is hyperdynamic. The LV end systolic area is small, and the LV walls appear to coalesce in end systole. The end-diastolic area is also reduced. These findings are consistent with hypovolaemia. The patient responds well to a fluid bolus. What other echo findings would be consistent with hypovolaemia?
Clip 3
A 70 year old man is in the emergency department. He was brought in hypotensive, short of breath and complaining of sudden onset chest pain. Which echo view is this and what is seen?
This is a parasternal short axis view at the lecel of the aorta. The long axis of the pulmonary trunk and its bifurcation are seen on the right of the display. The proximal ascending aorta is seen centrally in its short axis. There is a saddle thrombus present. The diagnosis is acute pulmonary embolism. Whilst you are performing the scan, his BP falls to 60 systolic. There is no response to 20mcg IV adrenaline. What will you do?
Clip 4
Compare the 2 echo clips above. What is the visually estimated EF of the first clip? How about the second clip?
The first heart has an LV that is dilated and contracting poorly. The visual EF is 55%. How can you quantitatively evaluate LV systolic function?
Clip 5
A 60 year old man presents with vague chest pains, palpitations and fever. He complains of reduced effort tolerance. What is the likely diagnosis?
The PSAX view is at the the level of the mitral valve. The mitral valve is abnormal. There is a mass attached to the posterior MV leaflet. This could be a vegetation. There is a likelihood of infective endocarditis.
Clip 6
A 69 year old man is admitted to the ICU following PEA arrest, from which he was successfully resuscitated. He is currently intubated and mechanically ventilated but has recurrent episodes of PEA arrest. What are the FoCUS findings? Would you initiate thrombolytic therapy for acute pulmonary embolism based on these FoCUS findings?
This is a PSAX mid-papillary view. There is significant RV dilatation and RV hypertrophy, with flattening of the inter-ventricular septum indicating RV pressure and volume overload. The presence of RV hypertrophy likely indicates that this is chronic. Further history, echo views and investigations should be obtained to determine the cause of PEA arrest. Thrombolytic therapy is not indicated based on these FoCUS findings.
