ð åèç
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è â Modalities
- TTE (standard non-invasive)
- TEE (better posterior + atria + endocarditis + dissection + obese / COPD)
- Stress echo (ischemia evaluation)
- 3D + strain (early dysfunction, chamber accuracy)
- POCUS (bedside ICU + ED)
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è â TTE Standard Views
- PLAX (parasternal long axis)
- PSAX (parasternal short axis)
- Apical 4C / 2C / 5C (apical views)
- Subcostal (IVC, all 4 chambers alternative)
- Suprasternal (aortic arch)
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è â EF Categories
- HFrEF: †40%
- HFmrEF: 41-49%
- HFpEF: ⥠50%
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è â Severe Aortic Stenosis (AS)
- Peak velocity > 4 m/s
- Mean gradient > 40 mmHg
- Valve area < 1 cm²
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è â Diastolic Function Parameters
- E/A ratio
- E/eâ ratio (estimates LV filling pressure; > 14 = elevated)
- Tissue Doppler eâ
- Grades 1-3 (impaired â pseudonormal â restrictive)
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è â TEE Indications
- Endocarditis (especially prosthetic + posterior valves)
- Pre-cardioversion AF (LAA thrombus)
- Aortic dissection
- Embolic source workup
- Intraoperative (cardiac surgery + structural interventions)
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è â Strain Imaging (GLS)
- Normal GLS: -18% to -22% (more negative)
- Detects early LV dysfunction (before EF drops)
- Cardio-oncology: chemotherapy cardiotoxicity
- HFpEF: reduced GLS despite normal EF
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è â Tamponade Echo Signs
- RA collapse during diastole
- RV collapse early diastole
- IVC plethora (no inspiratory collapse)
- Doppler respiratory variation (> 25% MV inflow + > 40% TV)
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è â HCM Echo
- Asymmetric septal hypertrophy (septum/free wall > 1.3)
- LVOT obstruction with SAM (systolic anterior motion)
- Dynamic with Valsalva
- MR often
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è â Amyloidosis Echo
- Concentric LVH (disproportionate to HTN)
- âSparklingâ texture
- Apical sparing on strain (pathognomonic cherry-on-top)
- Diastolic dysfunction
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è â POCUS Indications
- Cardiac arrest, shock, acute dyspnea, trauma, volume status
- Becoming standard EM + ICU + IM training
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è â McConnellâs Sign
- RV free wall akinesis + apical sparing
- Acute PE diagnostic