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Author: Admin | 2025-04-27
As tamponade or pulmonary embolism. In this section, we will show you how to use cardiac ultrasound to help you in your daily practice.Central Venous Pressure (CVP) EstimationUltrasound of the Inferior Vena Cava (IVC) can be used to estimate the central venous pressure (CVP) of a patient by looking at the size (diameter) and collapsibility of the IVC. This is especially useful when you are trying to evaluate fluid tolerance or the presence of venous congestion in your patients. Here is a simplified and practical table you can use to interpret your IVC findings.IVC SizeIVC CollapsibilityInterpretation (CVP)>50% collapsibility0-5 mm Hg (Low CVP)>50% collapsibility6-10 mm Hg 1.5-2.5cm11-15 mm Hg >2.5cm16-20 mm Hg (High CVP)Adapted from Kircher et al.The caveat about IVC measurements is that it just gives you a static measurement to estimate the central venous pressure. So all of the limitations of using CVP will also pertain to IVC measurements.We find it most useful when the IVC either estimates a low CVP or high CVP. The measurements in between can be considered indeterminate and more advanced hemodynamics measurements should be obtained to assess for venous congestion and fluid responsiveness (change in cardiac output)Left Ventricular Function/ Ejection FractionPatients with Systolic Heart Failure also known as “Heart Failure with Reduced Heart Function (HFrHF)” will commonly present with shortness of breath, orthopnea, paroxysmal nocturnal dyspnea (PND), exercise intolerance, irregular heartbeats, and edema in the bilateral upper and lower extremities. This is usually accompanied by cardiogenic pulmonary edema and B-lines on ultrasound.One of the most commonly used surrogates in assessing systolic function in these patients is done by measuring the Left Ventricular Ejection Fraction. For a more COMPLETE tutorial on qualitative and quantitative evaluation of Ejection Fraction Click HERE. Ejection fraction (EF) in percentage is defined as: EF(%) = SV/EDV x 100Where SV: Stroke Volume and EDV: End Diastolic VolumeEjection fraction (EF) is basically a percentage, of how much blood the left ventricle pumps out with each contraction. For example, an ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is pushed out during each systolic contractionHyperdynamicNormalMildly ReducedModerately ReducedSeverely ReducedEjection Fraction>70%55-69%45-54%30-44%Measuring Ejection Fraction on ultrasound can be approached either qualitatively or quantitatively. In this post, we will go over the qualitative technique to assess ejection fraction.Qualitative Approach to Assessing Ejection Fraction:Look at how well the left ventricle walls are moving. Are they coming close
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