A new systematic review and meta-analysis provides further support for incorporating POCUS into the early evaluation of patients with suspected acute aortic dissection. Across 11 included studies, bedside ultrasound demonstrated a pooled sensitivity of 86% and specificity of 84%, with diagnostic performance more favorable for Stanford Type A dissection. Visualization of an intimal flap was the most specific finding, while other echocardiographic findings can provide complemen

When an intimal flap is identified, distinguishing the true lumen from the false lumen can help confirm the diagnosis and guide interpretation. The false lumen is typically larger, expands during diastole, and often demonstrates spontaneous echocardiographic contrast ("smoke") due to slower blood flow. In contrast, the true lumen is usually smaller and expands during systole as blood is ejected from the left ventricle. 📖 Goldstein SA, Evangelista A, Abbara S, et al. Multimod

Transesophageal echocardiography (TEE) provides several important advantages over transthoracic echocardiography (TTE) during cardiac arrest. Because the probe lies immediately behind the heart, TEE consistently produces higher-quality images while avoiding many of the limitations of TTE including obesity, positive-pressure ventilation, and poor acoustic windows. TEE also obviates obstacles to transthoracic imaging such as defibrillator pads, active chest compressions, and me

Normal left ventricular (LV) filling during diastole occurs when the myocardium relaxes easily and accepts blood compliantly. Early diastolic filling accounts for approximately 70–80% of LV filling, while left atrial (LA) contraction contributes the remaining 20–30%. With diastolic dysfunction, the myocardium becomes stiff and non-compliant (such as from long-standing hypertension). This leads to elevated LV filling pressures, increased LA pressure, and LA enlargement. When t

An elevated E-point septal separation (EPSS) does not always indicate reduced left ventricular ejection fraction. EPSS may also be increased when anterior mitral valve leaflet excursion is mechanically restricted, such as in mitral stenosis or severe aortic regurgitation (see above). Reference: 📖 Massie BM, Schiller NB, Ratshin RA, Parmley WW. Mitral E point septal separation: a reliable index of left ventricular performance in coronary artery disease. Am Heart J. 1977....