and welcome back everyone i'm serge and i'm cern and now we're going to show you how to do cardiac point of care ultrasound dr boyson arguably our favorite yeah second favorite for me because of the kidneys but favorite place to scan i really like the lungs but the heart's also fascinating to look at dr shloop and penny's going to volunteer here for us we tend to scan our patients in a standing position or the position the most comfortable so we're going to go ahead and do this like we would in real life we're going to see how we can scan penny penny's interested in the gel we're going to see how we can scan penny in a standing position with the limb extended a little bit forward here this right limb should open up a nice cardiac window for us to be able to take a look at the heart so right now we're going to start with our probe in short axis surge has the uh he's down near the apex of the heart with the sternum is and we have a couple of options here you can either try to go dorsal within this rib space or even try to jump a rib space cranial and see where that takes us there we go we've jumped to rib space cranial and you can see that we're now on that mitral valve so we're just at that level of the fish mouth doctor that's correct why because it looks like a fish mouth doctor boys absolutely so that is our mitral valve and we know now once we see that mitral valve if we have that and we fan a little bit towards dorsal that drops us right there onto that left atrium ratio now on that left atriatic ratio that we see here we are not cardiologists we're not radiologists we're not looking for exact measurements we're looking for a subjective estimation is that left atrium enlarged yes or no can we get two times the width of the air here in the left atrium and in this case we can't normally it's about 1.5 to 1.6 to 1 left atrial slightly bigger than the aorta depending on the species we're scanning so this looks perfectly normal we've got a nice left atriolitic ratio and we can say then very quickly that we don't have congestive heart failure because our left atrium is not enlarged correct and same thing in our cats we can also do this and see how many of those aortic circumferences we can fit within the left atrium normally it's about two and a half when we get left atrial enlargement secondary congestive heart failure that left atrium gets very enlarged we can usually fit three and a half to four aorta circumferences in the left atrium or we can get more than double the width of the aorta in that left atrium and that was a nice short axis for you dr schlub let's have a look at the long axis four chamber now for the four chamber we want to go back to that mushroom and you want to hit that mushroom relatively well you don't want to be too far that might actually be just perfect right there and i'm going to rotate the probe dr boison and we'll see what we got so we're going to rotate the probe 90 degrees and now we're in long axis and we can see the four chambers we get the left ventricle the left atrium the right ventricle and the right atrium and we can rotate that a little just to expand that left ventricle a little bit there we go and there we have the four chambers view you can see the left ventricle there we can see the right ventricle a little bit in the near field but we're looking for obvious changes with right sided heart failure so we might see pulmonary attention for example that right ventricle is larger than the left ventricle and that right ventricular free wall is larger than that left ventricular free wall uh and the insufficient septum will sometimes deviate a little towards the left side with right heart pulmonary hypertension or right heart changes that's our four chamber long axis view of the heart and one last thing team when you're looking at that heart remember to recognize those chambers we have left ventricle there and right on top we have the right ventricle and around it is going to be that pericardial sac so as long as you know your heart chambers you're not going to mistaken anything for pericardial effusion exactly and you'll see that we don't have the perfect window we got a little bit of lung coming in we got some rib shadow there but again we're not cardiologists we're looking to answer yes no binary questions is that left latrium enlarged yes no is that right ventricle and large lifts no exactly and that is our cardiac point of care ultrasound you
