Lecture Notes on Advanced Critical Care Echocardiography
Introduction
- Speakers: Dr. Paul Mayo, Dr. Yonatan Greenstein
- Objective: Discuss advanced critical care ultrasonography (ACE) training and certification
- Context: Addressing clinicians moving from basic to advanced echocardiography
Certification Overview
- National Board of Echocardiography: Offers an ACE certification
- Examination: High stakes board exam in January 2019
- Requirement: Demonstrate full capability in advanced critical care echo image sets
- Learning Curve: Full exam takes 20-30 minutes initially, then 8-11 minutes with experience
Examination Components
General Considerations
- Preparation: Mastery of goal-directed echocardiography required
- Comfort and Equipment: Ensure physical comfort and equipment setup before scanning
- Ambidextrous Skill: Ability to scan with both hands
- Probe and Gel: Handling techniques for effective scanning
Probe Manipulations
- Terms:
- Angling: Moving probe angle
- Tilting: Adjusting tomographic plane angle
- Rotation: Turning probe without altering angle
- Moving: Physical movement of the probe
Image Acquisition
Parasternal Long Axis View
- M-Mode: Evaluate LV size, EPSS measurement
- Color Doppler: Check for mitral regurgitation and aortic insufficiency
Right Ventricular Inflow View
- Assessment: Angling probe medially
- Tricuspid Valve: Evaluate for regurgitation
Parasternal Short Axis View
- Levels: Papillary muscle, mitral valve, aortic valve levels
- Color Doppler: Check for valve regurgitation
Apical Views
- Four Chamber View:
- Diastolic Function: Measure e/a wave ratios with Doppler
- Tissue Doppler Imaging (TDI): Assess e prime and a prime
- Five Chamber View: Measure LVOT VTI for cardiac output estimation
- Other Views: Apical two chamber and three chamber for complete assessment
Subcostal Views
- Subcostal Long Axis: Suitable for tricuspid valve assessment
- IVC and Hepatic Vein: Evaluate inflow, typically with limitations due to gas
Special Measurements
- Tap Systolic Excursion (TAPSE): Assesses RV function
- MAPSE and S1 Velocity: Assess LV function, using M-Mode and Doppler
- Pulmonary Venous Inflow: Measured but not part of standard diastolic evaluation
Conclusion
- Transesophageal Echocardiography: Not yet required for ACE certification but future potential
- Overall Goal: Prepare for full image set acquisition and board examination
These notes provide a comprehensive overview of the advanced echocardiography lecture by Dr. Paul Mayo and Dr. Yonatan Greenstein, focusing on the preparation, certification, and examination techniques required for ACE certification.