Advanced Bedside ECHO for Dyspnea

In this lecture from our Ultrasound Grand Rounds, Dr. Matthew Tabbut, MD and Dr. Ziad Shaman use a case to discuss the use of bedside ultrasound on patients with dyspnea.
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This is the official account of the Case Western Reserve University & MetroHealth Medical Center Emergency Medicine Ultrasound Division. Videos are not medical advice or views/policy of these institutions.

[@Pav_11]

Congrats from Italy, I’ve just finish to see your beautiful lessons after a tough sheet this afternoon. I’m a pulmonary & critical care physician who loves POCUS and your lessons guys are brilliant and inspiring. Good job

[@MetroHealthEmergencyUltrasound]

Thanks

[@udayakumarramachandran9551]

Excellent discussion and teaching. Congratulations.
My questions: Can we do angle correction in pulsed doppler to assess mitral E velocity?. I notice that the LV imflow is sometimes at an angle and such correction will give the true E velocity

[@MetroHealthEmergencyUltrasound]

Great question. It would be machine dependent. If the machine doesn’t allow then you need to adjust your window to optimize the Doppler angle.

[@udayakumarramachandran9551]

Also want to know if we can angle correct CW dopppler sampling in eccentric TR jets to get a close to true TR velocity

[@MetroHealthEmergencyUltrasound]

Same as previous response. Machine dependent.

[@matt234111]

Excellent thanks!

[@MetroHealthEmergencyUltrasound]

Glad it was helpful!

[@gokulsagar5744]

Thank you for really nice case and discussion.
I had a question about the last scenario where you have RV failure in this same patient with AS , LV Diastolic dysfunction and high pressure pulmonary edema who is intubated. Would you not reach for peripherally squeezing pressors that do not have too much affect on the HR (considering you want time for LV to fill to pump against the fixed LV afterload of the Av) Eg Phenylepherine or metaraminol to buy time to figure out the cause rather than Volume?

[@MetroHealthEmergencyUltrasound]

Generally agree that one has to support the patient until they are able to figure out the cause of the RV failure. Because of inter-ventricular dependence, RV pressure overload will result in compromised LV function and fill. Using a balanced vasopressor (with inotropic properties) or trying to stretch the LV with volume (even though you will stretch the RV at the same time) should work better in theory.