Case: Cardiac Ultrasound - Apical View
Case: Cardiac Ultrasound - Apical View
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Using the apical view and a phased array probe during bedside cardiac ultrasound examinations can enable clinicians to evaluate cardiac health, structures, & ventricular contractility. This view is ideal for identifying cardiomyopathy, pericardial effusion, and cardiac tamponade.
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<p begin="00:00:11.177" end="00:00:13.140" style="s2">- Hello, my name is Phil Perera</p>
<p begin="00:00:13.140" end="00:00:15.016" style="s2">and I'm the emergency<br />ultrasound coordinator</p>
<p begin="00:00:15.016" end="00:00:17.935" style="s2">at the New York Presbyterian<br />Hospital in New York City</p>
<p begin="00:00:17.935" end="00:00:20.602" style="s2">and welcome to Soundbytes Cases.</p>
<p begin="00:00:21.664" end="00:00:23.207" style="s2">In this module we'll continue our journey</p>
<p begin="00:00:23.207" end="00:00:26.643" style="s2">down the path of the four<br />cardiac examination views.</p>
<p begin="00:00:26.643" end="00:00:28.233" style="s2">Specifically in this module</p>
<p begin="00:00:28.233" end="00:00:30.275" style="s2">we're going to look at probe position C,</p>
<p begin="00:00:30.275" end="00:00:32.752" style="s2">known as the apical view of the heart.</p>
<p begin="00:00:32.752" end="00:00:34.040" style="s2">I hope you've been able to join me prior</p>
<p begin="00:00:34.040" end="00:00:37.314" style="s2">looking at probe position<br />A, the parasternal views,</p>
<p begin="00:00:37.314" end="00:00:41.331" style="s2">and probe position B the<br />subxiphoid views of the heart.</p>
<p begin="00:00:41.331" end="00:00:43.908" style="s2">So the apical view of the<br />heart is an excellent view</p>
<p begin="00:00:43.908" end="00:00:45.693" style="s2">and gives a great deal of information</p>
<p begin="00:00:45.693" end="00:00:47.101" style="s2">about our patient's heart</p>
<p begin="00:00:47.101" end="00:00:49.087" style="s2">as it shows all four chambers of the heart</p>
<p begin="00:00:49.087" end="00:00:50.769" style="s2">in relation to one another.</p>
<p begin="00:00:50.769" end="00:00:52.612" style="s2">Therefore, the apical view of the heart</p>
<p begin="00:00:52.612" end="00:00:55.154" style="s2">is preferred by cardiologists<br />as it shows the synergy</p>
<p begin="00:00:55.154" end="00:00:58.599" style="s2">of all of the chambers of<br />the heart to one another.</p>
<p begin="00:00:58.599" end="00:01:00.386" style="s2">Now let's take a look at a pictorial</p>
<p begin="00:01:00.386" end="00:01:03.571" style="s2">showing how to perform the<br />apical view of the heart.</p>
<p begin="00:01:03.571" end="00:01:05.650" style="s2">Preferably, you're going to<br />be using a small footprint</p>
<p begin="00:01:05.650" end="00:01:07.263" style="s2">phased array type probe</p>
<p begin="00:01:07.263" end="00:01:09.139" style="s2">that can easily get in between the ribs.</p>
<p begin="00:01:09.139" end="00:01:11.667" style="s2">Position the probe directly<br />underneath the left nipple</p>
<p begin="00:01:11.667" end="00:01:14.690" style="s2">at about the point of<br />maximal impulse of the heart</p>
<p begin="00:01:14.690" end="00:01:15.895" style="s2">with the probe indicator</p>
<p begin="00:01:15.895" end="00:01:17.915" style="s2">over towards the patient's right side.</p>
<p begin="00:01:17.915" end="00:01:19.059" style="s2">Now that's with the caveat</p>
<p begin="00:01:19.059" end="00:01:21.312" style="s2">that the ultrasound's screen<br />indicator is positioned</p>
<p begin="00:01:21.312" end="00:01:23.338" style="s2">toward the left of the screen.</p>
<p begin="00:01:23.338" end="00:01:24.419" style="s2">Now moving the patient</p>
<p begin="00:01:24.419" end="00:01:26.503" style="s2">into the left lateral decubitus position</p>
<p begin="00:01:26.503" end="00:01:28.997" style="s2">can improve imaging from<br />the apical view of the heart</p>
<p begin="00:01:28.997" end="00:01:31.166" style="s2">as it moves the heart closer to the probe</p>
<p begin="00:01:31.166" end="00:01:33.539" style="s2">and moves the lung out of the way.</p>
<p begin="00:01:33.539" end="00:01:35.851" style="s2">Thus, it's important to<br />consider moving the patient</p>
<p begin="00:01:35.851" end="00:01:37.040" style="s2">into this position</p>
<p begin="00:01:37.040" end="00:01:40.097" style="s2">when performing the<br />apical view of the heart.</p>
<p begin="00:01:40.097" end="00:01:42.009" style="s2">Now let's learn how to<br />interpret the images</p>
<p begin="00:01:42.009" end="00:01:43.284" style="s2">that we'll obtain.</p>
<p begin="00:01:43.284" end="00:01:45.033" style="s2">We see here a pictorial to the left</p>
<p begin="00:01:45.033" end="00:01:46.962" style="s2">and an ultrasound image to the right.</p>
<p begin="00:01:46.962" end="00:01:49.543" style="s2">As we're imaging from the<br />apical view of the heart,</p>
<p begin="00:01:49.543" end="00:01:51.009" style="s2">we're closest to the ventricles</p>
<p begin="00:01:51.009" end="00:01:52.654" style="s2">and in this image we<br />see the left ventricle</p>
<p begin="00:01:52.654" end="00:01:55.486" style="s2">to the right of the screen and<br />the right ventricle adjacent.</p>
<p begin="00:01:55.486" end="00:01:58.346" style="s2">The atria from the<br />apical view of the heart</p>
<p begin="00:01:58.346" end="00:02:01.831" style="s2">will be further away, thus<br />posterior to the ventricles</p>
<p begin="00:02:01.831" end="00:02:03.499" style="s2">and we see here the left atrium</p>
<p begin="00:02:03.499" end="00:02:05.104" style="s2">just below the left ventricle</p>
<p begin="00:02:05.104" end="00:02:08.321" style="s2">and the right atrium<br />below the right ventricle.</p>
<p begin="00:02:08.321" end="00:02:11.325" style="s2">We also see the valves, the<br />tricuspid valve to the left</p>
<p begin="00:02:11.325" end="00:02:13.252" style="s2">and the mitral valve to the right</p>
<p begin="00:02:13.252" end="00:02:15.888" style="s2">in between the left atrium<br />and the left ventricle.</p>
<p begin="00:02:15.888" end="00:02:17.729" style="s2">We can also appreciate the white lines</p>
<p begin="00:02:17.729" end="00:02:20.608" style="s2">surrounding the heart,<br />which is the pericardium.</p>
<p begin="00:02:20.608" end="00:02:22.202" style="s2">Now let's take a look at a video clip</p>
<p begin="00:02:22.202" end="00:02:24.960" style="s2">showing the apical view<br />of the heart in action.</p>
<p begin="00:02:24.960" end="00:02:26.815" style="s2">This is taken from a<br />medical student triathlete,</p>
<p begin="00:02:26.815" end="00:02:29.167" style="s2">so let's take a look<br />at that left ventricle.</p>
<p begin="00:02:29.167" end="00:02:32.312" style="s2">We see the left ventricle in<br />its more superficial location</p>
<p begin="00:02:32.312" end="00:02:34.173" style="s2">to the right of the screen.</p>
<p begin="00:02:34.173" end="00:02:37.441" style="s2">Notice the percentage change<br />from diastole to systole.</p>
<p begin="00:02:37.441" end="00:02:39.918" style="s2">Note the walls almost<br />touch with each heartbeat,</p>
<p begin="00:02:39.918" end="00:02:42.198" style="s2">indicating a good contractility.</p>
<p begin="00:02:42.198" end="00:02:44.781" style="s2">We see the right ventricle to<br />the side of the left ventricle</p>
<p begin="00:02:44.781" end="00:02:48.247" style="s2">and the two atria posterior<br />to the ventricles.</p>
<p begin="00:02:48.247" end="00:02:50.848" style="s2">Notice the mitral valve<br />in between the left atrium</p>
<p begin="00:02:50.848" end="00:02:52.928" style="s2">and left ventricle and the tricuspid valve</p>
<p begin="00:02:52.928" end="00:02:54.242" style="s2">to the right side.</p>
<p begin="00:02:54.242" end="00:02:55.459" style="s2">Notice here the absence</p>
<p begin="00:02:55.459" end="00:02:58.792" style="s2">of any significant pericardial effusion.</p>
<p begin="00:03:00.251" end="00:03:02.942" style="s2">Let's contrast that last<br />clip from this patient</p>
<p begin="00:03:02.942" end="00:03:05.753" style="s2">who has a dilated cardiomyopathy,</p>
<p begin="00:03:05.753" end="00:03:07.113" style="s2">and as we look at that left ventricle</p>
<p begin="00:03:07.113" end="00:03:09.111" style="s2">from the apical view of the heart</p>
<p begin="00:03:09.111" end="00:03:10.826" style="s2">we see a very poor percentage change</p>
<p begin="00:03:10.826" end="00:03:13.001" style="s2">from diastole through systole.</p>
<p begin="00:03:13.001" end="00:03:15.653" style="s2">This is indicative of a<br />very poor contractility</p>
<p begin="00:03:15.653" end="00:03:17.093" style="s2">of this heart.</p>
<p begin="00:03:17.093" end="00:03:19.773" style="s2">We see the right ventricle to<br />the side of the left ventricle</p>
<p begin="00:03:19.773" end="00:03:21.909" style="s2">and the two atria posterior.</p>
<p begin="00:03:21.909" end="00:03:24.244" style="s2">Notice the sluggish movement<br />of both the mitral value</p>
<p begin="00:03:24.244" end="00:03:26.987" style="s2">and the tricuspid valve.</p>
<p begin="00:03:26.987" end="00:03:29.091" style="s2">We see a little bit of<br />pericardial effusion,</p>
<p begin="00:03:29.091" end="00:03:31.418" style="s2">that little black rim around the heart,</p>
<p begin="00:03:31.418" end="00:03:32.785" style="s2">also going together</p>
<p begin="00:03:32.785" end="00:03:35.774" style="s2">with this patient's cardiomyopathy status.</p>
<p begin="00:03:35.774" end="00:03:37.137" style="s2">Here's an interesting video clip</p>
<p begin="00:03:37.137" end="00:03:39.516" style="s2">of a patient who presented<br />with acute shortness of breath.</p>
<p begin="00:03:39.516" end="00:03:41.328" style="s2">What we notice here is the right ventricle</p>
<p begin="00:03:41.328" end="00:03:44.311" style="s2">and the left ventricle<br />closest to the screen,</p>
<p begin="00:03:44.311" end="00:03:47.199" style="s2">but we see here a very<br />large pericardial effusion</p>
<p begin="00:03:47.199" end="00:03:49.426" style="s2">circumferentially surrounding the heart.</p>
<p begin="00:03:49.426" end="00:03:51.444" style="s2">And notice the heart<br />swinging back and forth</p>
<p begin="00:03:51.444" end="00:03:53.151" style="s2">in all the pericardial effusion.</p>
<p begin="00:03:53.151" end="00:03:55.029" style="s2">This gives rise to the phenomenon</p>
<p begin="00:03:55.029" end="00:03:56.569" style="s2">known as electrical alternans</p>
<p begin="00:03:56.569" end="00:04:00.298" style="s2">or different sizes QRSs on the EKG.</p>
<p begin="00:04:00.298" end="00:04:02.505" style="s2">Here's a patient who was in bad shape</p>
<p begin="00:04:02.505" end="00:04:04.682" style="s2">and presented with acute<br />shortness of breath.</p>
<p begin="00:04:04.682" end="00:04:07.056" style="s2">We see a very large pericardial effusion</p>
<p begin="00:04:07.056" end="00:04:09.578" style="s2">and let's look specifically<br />at the right ventricle.</p>
<p begin="00:04:09.578" end="00:04:12.535" style="s2">Notice that it caves in from diastole</p>
<p begin="00:04:12.535" end="00:04:15.382" style="s2">due to the high pressure<br />in the pericardial sac.</p>
<p begin="00:04:15.382" end="00:04:18.592" style="s2">Thus this is indicative of<br />advanced cardiac tamponade.</p>
<p begin="00:04:18.592" end="00:04:22.759" style="s2">This patient will need a stat<br />pericardiocentesis procedure.</p>
<p begin="00:04:25.040" end="00:04:26.718" style="s2">So in conclusion I'm glad<br />I could share with you</p>
<p begin="00:04:26.718" end="00:04:27.770" style="s2">this Soundbytes module</p>
<p begin="00:04:27.770" end="00:04:30.041" style="s2">going over the apical views of the heart.</p>
<p begin="00:04:30.041" end="00:04:31.377" style="s2">This is an often neglected view</p>
<p begin="00:04:31.377" end="00:04:33.227" style="s2">but one that gives a<br />great deal of information</p>
<p begin="00:04:33.227" end="00:04:34.776" style="s2">about your patients heart</p>
<p begin="00:04:34.776" end="00:04:36.529" style="s2">and really should be routinely integrated</p>
<p begin="00:04:36.529" end="00:04:38.969" style="s2">into the cardiac echo examination.</p>
<p begin="00:04:38.969" end="00:04:40.100" style="s2">It's best to move the patient</p>
<p begin="00:04:40.100" end="00:04:42.153" style="s2">into the left lateral decutibus position</p>
<p begin="00:04:42.153" end="00:04:44.930" style="s2">to optimize imaging from<br />the apical view of the heart</p>
<p begin="00:04:44.930" end="00:04:46.698" style="s2">to see all four chambers of the heart</p>
<p begin="00:04:46.698" end="00:04:49.021" style="s2">in relation to one another.</p>
<p begin="00:04:49.021" end="00:04:53.188" style="s2">So I hope to see you back<br />as Soundbytes continues.</p>
<p begin="00:00:13.140" end="00:00:15.016" style="s2">and I'm the emergency<br />ultrasound coordinator</p>
<p begin="00:00:15.016" end="00:00:17.935" style="s2">at the New York Presbyterian<br />Hospital in New York City</p>
<p begin="00:00:17.935" end="00:00:20.602" style="s2">and welcome to Soundbytes Cases.</p>
<p begin="00:00:21.664" end="00:00:23.207" style="s2">In this module we'll continue our journey</p>
<p begin="00:00:23.207" end="00:00:26.643" style="s2">down the path of the four<br />cardiac examination views.</p>
<p begin="00:00:26.643" end="00:00:28.233" style="s2">Specifically in this module</p>
<p begin="00:00:28.233" end="00:00:30.275" style="s2">we're going to look at probe position C,</p>
<p begin="00:00:30.275" end="00:00:32.752" style="s2">known as the apical view of the heart.</p>
<p begin="00:00:32.752" end="00:00:34.040" style="s2">I hope you've been able to join me prior</p>
<p begin="00:00:34.040" end="00:00:37.314" style="s2">looking at probe position<br />A, the parasternal views,</p>
<p begin="00:00:37.314" end="00:00:41.331" style="s2">and probe position B the<br />subxiphoid views of the heart.</p>
<p begin="00:00:41.331" end="00:00:43.908" style="s2">So the apical view of the<br />heart is an excellent view</p>
<p begin="00:00:43.908" end="00:00:45.693" style="s2">and gives a great deal of information</p>
<p begin="00:00:45.693" end="00:00:47.101" style="s2">about our patient's heart</p>
<p begin="00:00:47.101" end="00:00:49.087" style="s2">as it shows all four chambers of the heart</p>
<p begin="00:00:49.087" end="00:00:50.769" style="s2">in relation to one another.</p>
<p begin="00:00:50.769" end="00:00:52.612" style="s2">Therefore, the apical view of the heart</p>
<p begin="00:00:52.612" end="00:00:55.154" style="s2">is preferred by cardiologists<br />as it shows the synergy</p>
<p begin="00:00:55.154" end="00:00:58.599" style="s2">of all of the chambers of<br />the heart to one another.</p>
<p begin="00:00:58.599" end="00:01:00.386" style="s2">Now let's take a look at a pictorial</p>
<p begin="00:01:00.386" end="00:01:03.571" style="s2">showing how to perform the<br />apical view of the heart.</p>
<p begin="00:01:03.571" end="00:01:05.650" style="s2">Preferably, you're going to<br />be using a small footprint</p>
<p begin="00:01:05.650" end="00:01:07.263" style="s2">phased array type probe</p>
<p begin="00:01:07.263" end="00:01:09.139" style="s2">that can easily get in between the ribs.</p>
<p begin="00:01:09.139" end="00:01:11.667" style="s2">Position the probe directly<br />underneath the left nipple</p>
<p begin="00:01:11.667" end="00:01:14.690" style="s2">at about the point of<br />maximal impulse of the heart</p>
<p begin="00:01:14.690" end="00:01:15.895" style="s2">with the probe indicator</p>
<p begin="00:01:15.895" end="00:01:17.915" style="s2">over towards the patient's right side.</p>
<p begin="00:01:17.915" end="00:01:19.059" style="s2">Now that's with the caveat</p>
<p begin="00:01:19.059" end="00:01:21.312" style="s2">that the ultrasound's screen<br />indicator is positioned</p>
<p begin="00:01:21.312" end="00:01:23.338" style="s2">toward the left of the screen.</p>
<p begin="00:01:23.338" end="00:01:24.419" style="s2">Now moving the patient</p>
<p begin="00:01:24.419" end="00:01:26.503" style="s2">into the left lateral decubitus position</p>
<p begin="00:01:26.503" end="00:01:28.997" style="s2">can improve imaging from<br />the apical view of the heart</p>
<p begin="00:01:28.997" end="00:01:31.166" style="s2">as it moves the heart closer to the probe</p>
<p begin="00:01:31.166" end="00:01:33.539" style="s2">and moves the lung out of the way.</p>
<p begin="00:01:33.539" end="00:01:35.851" style="s2">Thus, it's important to<br />consider moving the patient</p>
<p begin="00:01:35.851" end="00:01:37.040" style="s2">into this position</p>
<p begin="00:01:37.040" end="00:01:40.097" style="s2">when performing the<br />apical view of the heart.</p>
<p begin="00:01:40.097" end="00:01:42.009" style="s2">Now let's learn how to<br />interpret the images</p>
<p begin="00:01:42.009" end="00:01:43.284" style="s2">that we'll obtain.</p>
<p begin="00:01:43.284" end="00:01:45.033" style="s2">We see here a pictorial to the left</p>
<p begin="00:01:45.033" end="00:01:46.962" style="s2">and an ultrasound image to the right.</p>
<p begin="00:01:46.962" end="00:01:49.543" style="s2">As we're imaging from the<br />apical view of the heart,</p>
<p begin="00:01:49.543" end="00:01:51.009" style="s2">we're closest to the ventricles</p>
<p begin="00:01:51.009" end="00:01:52.654" style="s2">and in this image we<br />see the left ventricle</p>
<p begin="00:01:52.654" end="00:01:55.486" style="s2">to the right of the screen and<br />the right ventricle adjacent.</p>
<p begin="00:01:55.486" end="00:01:58.346" style="s2">The atria from the<br />apical view of the heart</p>
<p begin="00:01:58.346" end="00:02:01.831" style="s2">will be further away, thus<br />posterior to the ventricles</p>
<p begin="00:02:01.831" end="00:02:03.499" style="s2">and we see here the left atrium</p>
<p begin="00:02:03.499" end="00:02:05.104" style="s2">just below the left ventricle</p>
<p begin="00:02:05.104" end="00:02:08.321" style="s2">and the right atrium<br />below the right ventricle.</p>
<p begin="00:02:08.321" end="00:02:11.325" style="s2">We also see the valves, the<br />tricuspid valve to the left</p>
<p begin="00:02:11.325" end="00:02:13.252" style="s2">and the mitral valve to the right</p>
<p begin="00:02:13.252" end="00:02:15.888" style="s2">in between the left atrium<br />and the left ventricle.</p>
<p begin="00:02:15.888" end="00:02:17.729" style="s2">We can also appreciate the white lines</p>
<p begin="00:02:17.729" end="00:02:20.608" style="s2">surrounding the heart,<br />which is the pericardium.</p>
<p begin="00:02:20.608" end="00:02:22.202" style="s2">Now let's take a look at a video clip</p>
<p begin="00:02:22.202" end="00:02:24.960" style="s2">showing the apical view<br />of the heart in action.</p>
<p begin="00:02:24.960" end="00:02:26.815" style="s2">This is taken from a<br />medical student triathlete,</p>
<p begin="00:02:26.815" end="00:02:29.167" style="s2">so let's take a look<br />at that left ventricle.</p>
<p begin="00:02:29.167" end="00:02:32.312" style="s2">We see the left ventricle in<br />its more superficial location</p>
<p begin="00:02:32.312" end="00:02:34.173" style="s2">to the right of the screen.</p>
<p begin="00:02:34.173" end="00:02:37.441" style="s2">Notice the percentage change<br />from diastole to systole.</p>
<p begin="00:02:37.441" end="00:02:39.918" style="s2">Note the walls almost<br />touch with each heartbeat,</p>
<p begin="00:02:39.918" end="00:02:42.198" style="s2">indicating a good contractility.</p>
<p begin="00:02:42.198" end="00:02:44.781" style="s2">We see the right ventricle to<br />the side of the left ventricle</p>
<p begin="00:02:44.781" end="00:02:48.247" style="s2">and the two atria posterior<br />to the ventricles.</p>
<p begin="00:02:48.247" end="00:02:50.848" style="s2">Notice the mitral valve<br />in between the left atrium</p>
<p begin="00:02:50.848" end="00:02:52.928" style="s2">and left ventricle and the tricuspid valve</p>
<p begin="00:02:52.928" end="00:02:54.242" style="s2">to the right side.</p>
<p begin="00:02:54.242" end="00:02:55.459" style="s2">Notice here the absence</p>
<p begin="00:02:55.459" end="00:02:58.792" style="s2">of any significant pericardial effusion.</p>
<p begin="00:03:00.251" end="00:03:02.942" style="s2">Let's contrast that last<br />clip from this patient</p>
<p begin="00:03:02.942" end="00:03:05.753" style="s2">who has a dilated cardiomyopathy,</p>
<p begin="00:03:05.753" end="00:03:07.113" style="s2">and as we look at that left ventricle</p>
<p begin="00:03:07.113" end="00:03:09.111" style="s2">from the apical view of the heart</p>
<p begin="00:03:09.111" end="00:03:10.826" style="s2">we see a very poor percentage change</p>
<p begin="00:03:10.826" end="00:03:13.001" style="s2">from diastole through systole.</p>
<p begin="00:03:13.001" end="00:03:15.653" style="s2">This is indicative of a<br />very poor contractility</p>
<p begin="00:03:15.653" end="00:03:17.093" style="s2">of this heart.</p>
<p begin="00:03:17.093" end="00:03:19.773" style="s2">We see the right ventricle to<br />the side of the left ventricle</p>
<p begin="00:03:19.773" end="00:03:21.909" style="s2">and the two atria posterior.</p>
<p begin="00:03:21.909" end="00:03:24.244" style="s2">Notice the sluggish movement<br />of both the mitral value</p>
<p begin="00:03:24.244" end="00:03:26.987" style="s2">and the tricuspid valve.</p>
<p begin="00:03:26.987" end="00:03:29.091" style="s2">We see a little bit of<br />pericardial effusion,</p>
<p begin="00:03:29.091" end="00:03:31.418" style="s2">that little black rim around the heart,</p>
<p begin="00:03:31.418" end="00:03:32.785" style="s2">also going together</p>
<p begin="00:03:32.785" end="00:03:35.774" style="s2">with this patient's cardiomyopathy status.</p>
<p begin="00:03:35.774" end="00:03:37.137" style="s2">Here's an interesting video clip</p>
<p begin="00:03:37.137" end="00:03:39.516" style="s2">of a patient who presented<br />with acute shortness of breath.</p>
<p begin="00:03:39.516" end="00:03:41.328" style="s2">What we notice here is the right ventricle</p>
<p begin="00:03:41.328" end="00:03:44.311" style="s2">and the left ventricle<br />closest to the screen,</p>
<p begin="00:03:44.311" end="00:03:47.199" style="s2">but we see here a very<br />large pericardial effusion</p>
<p begin="00:03:47.199" end="00:03:49.426" style="s2">circumferentially surrounding the heart.</p>
<p begin="00:03:49.426" end="00:03:51.444" style="s2">And notice the heart<br />swinging back and forth</p>
<p begin="00:03:51.444" end="00:03:53.151" style="s2">in all the pericardial effusion.</p>
<p begin="00:03:53.151" end="00:03:55.029" style="s2">This gives rise to the phenomenon</p>
<p begin="00:03:55.029" end="00:03:56.569" style="s2">known as electrical alternans</p>
<p begin="00:03:56.569" end="00:04:00.298" style="s2">or different sizes QRSs on the EKG.</p>
<p begin="00:04:00.298" end="00:04:02.505" style="s2">Here's a patient who was in bad shape</p>
<p begin="00:04:02.505" end="00:04:04.682" style="s2">and presented with acute<br />shortness of breath.</p>
<p begin="00:04:04.682" end="00:04:07.056" style="s2">We see a very large pericardial effusion</p>
<p begin="00:04:07.056" end="00:04:09.578" style="s2">and let's look specifically<br />at the right ventricle.</p>
<p begin="00:04:09.578" end="00:04:12.535" style="s2">Notice that it caves in from diastole</p>
<p begin="00:04:12.535" end="00:04:15.382" style="s2">due to the high pressure<br />in the pericardial sac.</p>
<p begin="00:04:15.382" end="00:04:18.592" style="s2">Thus this is indicative of<br />advanced cardiac tamponade.</p>
<p begin="00:04:18.592" end="00:04:22.759" style="s2">This patient will need a stat<br />pericardiocentesis procedure.</p>
<p begin="00:04:25.040" end="00:04:26.718" style="s2">So in conclusion I'm glad<br />I could share with you</p>
<p begin="00:04:26.718" end="00:04:27.770" style="s2">this Soundbytes module</p>
<p begin="00:04:27.770" end="00:04:30.041" style="s2">going over the apical views of the heart.</p>
<p begin="00:04:30.041" end="00:04:31.377" style="s2">This is an often neglected view</p>
<p begin="00:04:31.377" end="00:04:33.227" style="s2">but one that gives a<br />great deal of information</p>
<p begin="00:04:33.227" end="00:04:34.776" style="s2">about your patients heart</p>
<p begin="00:04:34.776" end="00:04:36.529" style="s2">and really should be routinely integrated</p>
<p begin="00:04:36.529" end="00:04:38.969" style="s2">into the cardiac echo examination.</p>
<p begin="00:04:38.969" end="00:04:40.100" style="s2">It's best to move the patient</p>
<p begin="00:04:40.100" end="00:04:42.153" style="s2">into the left lateral decutibus position</p>
<p begin="00:04:42.153" end="00:04:44.930" style="s2">to optimize imaging from<br />the apical view of the heart</p>
<p begin="00:04:44.930" end="00:04:46.698" style="s2">to see all four chambers of the heart</p>
<p begin="00:04:46.698" end="00:04:49.021" style="s2">in relation to one another.</p>
<p begin="00:04:49.021" end="00:04:53.188" style="s2">So I hope to see you back<br />as Soundbytes continues.</p>
Brightcove ID
5752159405001
https://youtube.com/watch?v=4vBJoWP-zBM
Body
Using the apical view and a phased array probe during bedside cardiac ultrasound examinations can enable clinicians to evaluate cardiac health, structures, & ventricular contractility. This view is ideal for identifying cardiomyopathy, pericardial effusion, and cardiac tamponade.