Brightness mode (B-mode) imaging is the first step in evaluating cardiac valves. A simple framework is to systematically assess three key features: 1. Excursion – How well do the valve leaflets open? 2. Coaptation – How well do the leaflets come together when closed? 3. Masses – Are vegetations, thrombi, tumors, or other abnormal structures present? Applying the same three-step approach to every valve helps ensure a complete and consistent examination. 🔗 Free subscription —

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

Yet another study adds to growing evidence that guideline-recommended hand placement for chest compressions may not correspond to the optimal anatomic target. In this prospective ultrasound study of 152 adults, investigators used transthoracic echocardiography to identify the left ventricular outflow tract (LVOT) and the ideal area of maximal compression (iAMC), then mapped these structures onto standardized external chest-wall coordinates relative to the sternum. The LVOT wa

In patients with cardiac tamponade, earlier point-of-care ultrasound (POCUS) in the emergency department is associated with a shorter time to pericardiocentesis. Prompt bedside diagnosis can expedite definitive treatment in this life-threatening condition. References: 📖 Eke OF, et al. Timing of pericardiocentesis and clinical outcomes: Is earlier pericardiocentesis better? Am J Emerg Med. 2022. 📖 Alerhand S, Adrian RJ, Long B, Avila J. Pericardial tamponade: A comprehensive