Linking To And Embedding "Basic Right Ventricle Assessment with POCUS" From UBC IM POCUS

Today, I review, link to, and embed UBC IM POCUS‘ Basic Right Ventricle Assessment with POCUS.

All that follows is from the above resource.

UBC IM POCUS

Apr 9, 2021

In this 20-minute video from Dr. Katie Wiskar, learn how to assess the right ventricle with basic cardiac POCUS – including RV size, function, septal kinetics, and other markers of pathology.

You can rapidly review this excellent video by rapidly stepping through it by freezing the timeline and quickly examining each slide.

1:21

1:50

3:24

RV size

3:32 – 3:38

4:21

RV and LV equal in size, hence RV moderately dilated.

4:45 – 5:06

Rule of Thirds

5:09

5:45 Normal

5:55

Abnormal

6:06

6:33

6:37

6:45 Parasternal short axis

6:57 Parasternal short axis – abnormal

7:05

7:14

7:33

7:56

7:59

8:39

8:51

9:00 –

9:03

9:17 Visually normal TAPSE motion. Normal TAPSE vertical motion is > 16 mm.

9:33

9:43 Be careful to not put the M-mode curser too far medially (don’t put it on the valve as you will get incorrect value).

10:09 We are actually measuring the vertical height of A which the machine will do for us. It is just easier to trace line A.

10:21 Put the cursor over the tricuspid annulus, not over the valve.

10:29 This lateral tricuspid annulus is hardly moving at all vertically, so it is abnormal. Remember, normal TAPSE vertical movement is > 16 mm.

10:39 A low measured TAPSE using M-mode.

10:50 – 11:39 The second part of assessment of RV function is assessment of the free wall.

11:38

11:55 Decreased RV free wall movement:

12:06

Septal kinetics

12:12 – 14:49

12:23

13:18: Note the abnormal bounce (13:15 –

13:41:

it is however very important to note that rv dysfunction overload is not the only thing that can cause septal dyskinesia.

So other common causes include conduction system abnormalities like bundle branch block and pacemakers. A post cardiac surgery state. Certain cardiomyopathies, constrictive pericarditis, mitral stenosis and others.

So as we progress towards actual flattening of the septum we can look for which phase of the cardiac cycle has the most pronounced flattening. So this is typically evaluated in a parasternal short axis view

13:46:

13:55:

And the classic teaching is that primarily diastolic flattening isassociated with rv volume overload whereas primarily systolic flattening is associated with rv pressure overload so here we have a

classic d-shaped septum in a parasternal

14:10:

short axis view

so you’ll note that in this case the

flattening is most prominent at end

diastole

suggesting primary rv volume overload

14:23

14:20 – 14:49

now really important to note here that

it’s fairly easy to be fooled and

overcall a d-shaped septum in your

parasternal short axis view if you’re

not

properly on axis so if your rotation is

off

you can falsely create the impression of

a more ovoid lv and a flattened septum

it’s crucial therefore to make sure

you’re properly on axis in your

parasternal short axis view

typically by optimizing your probe

rotation so if you’re at a pat muscle

level as we are here

making sure that you can clearly see

both pat muscles as nice symmetrical

kidney beans is a great check for this.

14:53 – 16:53 Describes how to measure free wall hypertrophy

15:09: For example, an acute PE in a patient with long-standing pulmonary hypertension from another reason.

15:28

16:22:

Again 14:53 – 16:53 Describes how to measure free wall hypertrophy.