Quincke's Pulse in Severe Aortic Regurgitation Little physical exam finding for the end of the week! Quinke’s Pulse in chronic severe AI! Many of the physical exam findings relate to the high stroke volume, widened pulse pressure, and rapid arterial pressure drop associated with chronic AI! Dr. Jay Mohan, D.O. RPVI @DrJayMohan #Quinckes #Quinkes #Pulse #AorticRegurgitation #Diagnosis #PhysicalExam #Fingernails #Nailbed #Cardiology

Cardiac Murmurs and Maneuvers An algorithm demonstrating the effect of various maneuvers on systolic murmurs. TR, tricuspid regurgitation; PS, pulmonary stenosis; MVP/MR, mitral valve prolapse/mitral regurgitation; HOCM, hypertrophic obstructive cardiomyopathy; MR, mitral regurgitation; AS, aortic stenosis; VSD, ventricular septal defect. The effect of squatting on AS may be variable (decreased, no change, or even increased) depending on the relative alteration of preload and afterload. Dr. Jay Mohan, D.O. RPVI @DrJayMohan #Cardiac #Murmurs #Maneuvers #Heart #Cardiology #PhysicalExam #Diagnosis

Cardiac Maneuvers and Effects on Murmurs Valsalva Standing - Decr BIood Return to LV Laying Down, Squatting, Straight Leg Raise - Incr BIood Return to LV Hand Isogrip, Phenylephrine - Incr Afterload Amyl Nitrate - Decr Afterload Post PVC - Decr Afterload -> Incr Vol (Incr Diast Time) #Cardiac #Maneuvers #Effects #Murmurs #Cardiology #PhysicalExam

Aortic Measurements on Echocardiography Aortic annulus 1.4-2.6 cm Sinus of Valsalva 2.1-3.5 cm Sinotubular junction 1.7-3.4 cm Ascending Aorta 2.1-3.4 cm #Aortic #Aorta #Measurements #Echocardiography #echocardiogram #diagnosis #Cardiology

Normal Values echocardiographic ​​diastolic parameters - Velocities, Ratios and Durations #Diagnosis #Cardiology #Diastology #Normal #Parameters #Values #Diastolic

Echocardiography Right ventricular function can be assessed using several methods and echocardiography is generally the first‐line tool (Figure 1). TAPSE is most frequently used and has an independent prognostic value in HFpEF.4, 8, 23-25 The currently recommended lower limit cut‐off for TAPSE is <17 mm,12 although prior studies frequently used <16 mm. Fractional area change (with a lower limit of normal <35%12) is also commonly used, and is predictive of all‐cause mortality and heart failure hospitalizations in HFpEF. #Diagnosis #Cardiology #POCUS #Echocardiogram #RightVentricle #RightVentricular #RVDysfunction #Measurements #Criteria

Diastology - Diastolic Dysfunction Grading by Dr. Abhilash Koratala - NephroPOCUS @NephroP #Diastology #Diastolic #Dysfunction #Grading #Diagnosis #cardiology #grades

Diastology - Measuring Diastolic Dysfunction on POCUS #Diastology #Diastolic #Dysfunction #POCUS #Measurement #Cardiology #Diagnosis

Here’s a basic Diastology primer sheet I made before @sinaiemus echo session based on podcasts by @ultrasoundpod and @irenema99. Thanks to them for presenting this complicated topic simply. Much deeper dive here: http://asecho.org/wordpress/wp-content/uploads/2016/03/2016_LVDiastolicFunction.pdf - Dr. Stephen Alerhand @SAlerhand #Diagnosis #Cardiology #Echocardiogram #POCUS #Diastolic #Dysfunction #Diastology #Diastasis #EWave #AWave #EARatio #EPrime #Overview

Algorithm for Diagnosing Diastolic Dysfunction With Doppler Echocardiography 1. Determine the age of the patient 2. Are there complicating factors or is image quality poor? 3. Check for presence of diastolic dysfunction: 4. Analyze the mitral inflow pattern: E velocity, A velocity, E/A ratio, and E-wave DT 5. Grade diastolic dysfunction: 6. Assess for increased LV filling pressure (LVFP): #Algorithm #Diastolic #Diastology #Dysfunction #Echocardiography #Cardiology #Diagnosis #Grading #Classification #Assessment