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Table 114.4

The Cardiac Scan in Cardiac Arrest/Shock: Appearances in the 2Ts and 2Hs Pathologies

Tamponade – cardiac
  • Echo free space around the heart (ends anterior to the descending thoracic aorta)
  • RV collapse during diastole
  • Heart ‘swinging’ during cardiac cycle
  • Dilated IVC with <50% collapse

Thrombosis – coronary

Direct results of myocardial infarction:

  • Regional LV wall-motion abnormality
  • Global LV dysfunction

Acute complications of myocardial infarction:

Thrombosis – pulmonary

Right ventricular dysfunction:

  • Right ventricular dilatation
  • Free wall hypokinesis
  • Paradoxical septal motion
  • D-shaped LV in parasternal short-axis view

Severe tricuspid regurgitation (with PASP <60 mmHg)

IVC dilated and unreactive

Thrombus may rarely be visible in the right heart or pulmonary artery

Hypotension

Signs of underfilling/hypovolaemic shock:

  • Markedly reduced end-diastolic chamber size reflecting reduced filling
  • Hyperdynamic wall motions of both ventricles with ventricular walls ‘kissing’ during systole
  • Flat inferior vena cava

Sepsis – as above +/–:

  • LV dilated and hypokinetic
  • RV dilated and hypokinetic

Cardiogenic causes:

  • LV global or regional dysfunction
  • Severe valve lesions such as severe aortic stenosis
  • Obstructed or regurgitant prosthetic valve
  • hypertrophic cardiomyopathy

Aortic dissection involving aortic root:

  • Severe aortic regurgitation
  • Dilated aortic root
  • Intimal tear sometimes visible
  • There may be associated cardiac tamponade
Hypoxaemia

Pulmonary oedema (Pleural fluid and B-lines may be visible also by cardiac probe):

  • LV global or regional dysfunction discussed above
  • Severe valve lesions discussed above
  • Sepsis discussed above

Pulmonary embolism – see above