Jeffrey Wagner
@drjeffmdmcr.bsky.social
Hospital Medicine at @CUMedicalSchool. Associate Editor @JGIM. Reader of methods & supp sections. Interested in EBM, clinical medicine, & POCUS. Opinions are my own
9/ Subcostal 4 + IVC views:
• Confirms A4C findings
• Better shows RA morphology
• IVC size/collapsibility (context clue for R-sided pressures)
• 360° pericardial view
• Confirms A4C findings
• Better shows RA morphology
• IVC size/collapsibility (context clue for R-sided pressures)
• 360° pericardial view
February 5, 2025 at 10:37 PM
9/ Subcostal 4 + IVC views:
• Confirms A4C findings
• Better shows RA morphology
• IVC size/collapsibility (context clue for R-sided pressures)
• 360° pericardial view
• Confirms A4C findings
• Better shows RA morphology
• IVC size/collapsibility (context clue for R-sided pressures)
• 360° pericardial view
8/ A4C view: McConnell's sign = RV free wall hypokinesis with preserved apical contractility. First reported in 41 pts (19 with acute PE) in 1996 by McConnell et al, of course. Check out the anatomical basis in Torrent-Guasp helical heart model which explains the anatomy behind this!
February 5, 2025 at 10:37 PM
8/ A4C view: McConnell's sign = RV free wall hypokinesis with preserved apical contractility. First reported in 41 pts (19 with acute PE) in 1996 by McConnell et al, of course. Check out the anatomical basis in Torrent-Guasp helical heart model which explains the anatomy behind this!
7/ PSAX: My favorite view in PE! At mid-ventricle level (ID those papillary muscles in the LV), look for:
• Septal flattening (RV pressure overload)
• RV:LV >1:1 (dilation)
• Paradoxical septal motion in systole
• Septal flattening (RV pressure overload)
• RV:LV >1:1 (dilation)
• Paradoxical septal motion in systole
February 5, 2025 at 10:37 PM
7/ PSAX: My favorite view in PE! At mid-ventricle level (ID those papillary muscles in the LV), look for:
• Septal flattening (RV pressure overload)
• RV:LV >1:1 (dilation)
• Paradoxical septal motion in systole
• Septal flattening (RV pressure overload)
• RV:LV >1:1 (dilation)
• Paradoxical septal motion in systole
5/ 🔍 My systematic POCUS approach: PLAX → PSAX → A4C → Subcostal 4 → IVC (+/- uJVP) Remember: One view is NEVER enough! Even suboptimal images can help, and you will improve your skills with repeated practice.
February 5, 2025 at 10:37 PM
5/ 🔍 My systematic POCUS approach: PLAX → PSAX → A4C → Subcostal 4 → IVC (+/- uJVP) Remember: One view is NEVER enough! Even suboptimal images can help, and you will improve your skills with repeated practice.