Each Course presents a General Subject composed of several video classes grouped here, to meet those interested in a specific topic. Click on a video lesson to see a summary of the topic. These concepts are important to understand the different situations considered “obvious”; “common sense” or “rational”, which may be totally wrong.
IMPORTANT GENERAL CONCEPTS
Problems with ALL Measurements (15 min)
What is a normal value? A given cavity may be enlarged even though it is in the mean of the normal value in a population. Why is it so difficult to be sure about the size of a cardiac structure?
LV and RV systolic function
LV Systolic Function Evaluated by M-mode Echocardiogram I (12min)
Various modalities for evaluating LV systolic function by M-mode echo
LV Systolic Function Evaluated by Bidimensional Echocardiogram II (17min)
Various modalities for evaluating LV systolic function by 2D echo
Simple ways for assessing LV systolic function (8min)
Not everything needs to be high mathematics or unreal geometric precepts. There are data from the one-dimensional echo that give good information about systolic function of the VE.
Evaluation of LV Systolic Function with Doppler (21min)
Let us see how Doppler evaluates LV systolic function.
Evaluation of LV Systolic Function using Spectral Tissue Doppler (6min)
See here the use of Tissue Doppler to analyze LV systolic function. It is not a bad method.
Assessing RV Systolic Function (9min)
See how assessing RV systolic function is complicate. We will use the visual aspect of the contractility of the walls, the systolic fraction of reduction of the RV cavity area, the TAPSE, and the S’ wave of the tricuspid annulus tissue Doppler and the flow in the supra hepatic vein.
Cavities Overloads
Left Atrial Overload (16 min)
How to know if a left atrium cavity is enlarged or not.
LV Systolic Overload (18 min)
So simple with subjective evaluation … So complicated and not accurate when using formulas without considering the various variables in biology that cannot be considered “as in normal temperature and pressure, STP” of physics.
Left Ventricular Dilation - Volumetric Overload and Dysfunction Dilation (9min)
Usually an easy to perform. The problem is to call it Eccentric Hypertrophy.
RV Systolic and Diastolic Overload (11min)
One of the causes of paradoxical movement of the interventricular septum. Diagnosis is generally easy.
Pulmonary Hypertension
Evaluation of Pulmonary Arterial Hypertension Initial Considerations (11min)
Diagnosis of pulmonary arterial hypertension. RV systolic overload. Pulmonary dilation. Pulse spectral Doppler. TAC analysis (pulmonary flow acceleration time). Supra hepatic vein flow. Spectral tissue Doppler. TAPSE. Myocardial Performance Index. Pulmonary Vascular Resistance.
Using the M-mode of the Pulmonary Valve (10min)
Using M-mode echo. Importance of the “A” wave, the horizontalization of the valve and its mid systolic closure.
Trying to Estimate the RA pressure with the IVC (7min)
The estimation of a right atrial pressure is of paramount importance to the evaluation of peak systolic pulmonary pressure. Can we really estimate it?
Acute Pulmonary Embolism (2.2min)
These are cases usually presenting with a stunned RV with hypokinesis of the walls. Hyperkinetic RV point (McConnell’s sign). A thrombus may be identified in the pulmonary artery by 2D echo but usually only by transesophageal echo. There may be high pulmonary pressure, but not always.
LV DIASTOLIC FUNCTION
Evaluation of LV Diastolic Function. The Basic and Simple. (11min)
Basic principles for understanding LV Diastolic function. Relaxation. Distensibility. Evaluation of EF Mitral Slope and Diastolic displacement of the Aortic Root.
Evaluation of LV Diastolic Function by Doppler - IVRT and Mitral Flow (23 min)
One of the main methods for evaluating LV diastolic function is mitral Doppler. Without knowing the perfect relation between the LA-LV gradients during diastole you will not understand the reasons for the mitral flow curve. See here how to do it and then the causes of errors.
Evaluation of LV Diastolic Function by Tissue Doppler (9min)
The evaluation of diastolic function by tissue Doppler is also widely used. It has its problems.
MITRAL STENOSIS
Echocardiographic diagnosis of mitral stenosis (7min)
It is one of the easiest diagnoses on echocardiography. Just the eyeball and the Doppler.
Assessment of the hemodynamic severity of a mitral stenosis by M-mode and 2D echo(10min)
Watch this class only after viewing the class on the diagnosis of mitral stenosis .
Assessment of the hemodynamic severity of a mitral stenosis by Spectral Doppler (7min)
Peak and mean gradients, which is the best? Pressure Half Time, is it trustful?
Assessment of the hemodynamic severity of a mitral stenosis by Color Doppler (9min)
The PISA method. Understand it in detail to trust it or not.
Assessment of the hemodynamic severity of a mitral stenosis by Continuity Equation (4min)
The Continuity Equation. Understand it in detail to trust it or not.
Valve evaluation for the best treatment: surgical vs balloon valvuloplasty (7min)
Here we will study when to indicate balloon valvuloplasty or surgery.
Mitral Regurgitation
Different causes for a mitral regurgitation. (6 min)
Here a general overview of the problem. Primary and secondary mitral regurgitation. Carpentier classification.
Rheumatic mitral regurgitation. (5 min)
Here is a look at Rheumatic lesion. First signs of rheumatic injury in a mitral valve. How to identify.
Mitral insufficiency of a degenerative nature. (5 min)
Frequent cause of mitral regurgitation. Mitral ring calcification
Mitral insufficiency due to papillary muscle dysfunction. (11 min)
We will study papillary muscle dysfunction, as well as the so-called mitral with a ‘seagull’ aspect , which also happens due to the poor location of the papillary muscles secondary to LV hypertrophy or even to the cavity dilation.
Mitral valve prolapse I (15min)
M-mode and 2D main sign of prolapse. Secondary signs seen in M-mode. This is a topic with many controversies. We will go deeper into this topic in the following classes.
Mitral valve prolapse II (4min)
Different causes for mitral valve prolapse.
Mitral insufficiency secondary to chordae rupture (17 min)
Chordae rupture. Generally easy to diagnose, mainly by transesophageal echo. Occasionally the M-mode echo is the first to show the diagnosis. Also papillary muscle and leaflet rupture
Assessment of the severity of mitral regurgitation using color Doppler (25min)
Assessment of the severity of mitral regurgitation using color Doppler. Initially let us explain the Coanda Effect. In this class we will assess the severity of mitral regurgitation by evaluation the regurgitant jet. Obtaining the vena contracta, and the overall aspect of the regurgitant jet. When assessing the hemodynamic severity of a regurgitation it is important to know how the apparatus controls alter the aspect of the regurgitant jet. It is not only the gain of the color, but also the gain of the echo, depth, PRF, Nyquist limit, etc.
Assessment of the severity of mitral regurgitation by using Continuity Equation (12min)
In this class we will assess the severity of mitral regurgitation by obtaining the area of the regurgitant orifice , the regurgitant volume and the regurgitation fraction. We will see how to obtain this data either by the continuity equation or by PISA.
Assessment of the severity of mitral regurgitation by using PISA (5min)
In this class we will assess the severity of mitral regurgitation by PISA. The PISA method is perfect under conditions of a hemodynamic laboratory, with flows, orifices, angles, etc., perfect. In biology, that is, in valves in living beings, it cannot work. See the physical reasons in the mitral stenosis classes. I do not waste time doing it on patients, but students must know the concepts perfectly.
Tricuspid valve
Diagnosis of lesions in the tricuspid valve (11min)
Moving now to the tricuspid valve, let us see how to diagnose the various pathological conditions that affect this valve.
Evaluation of the hemodynamic severity of the lesion of the tricuspid valve (11min)
Let us look at the different methods of evaluating the hemodynamic severity of a tricuspid stenosis or regurgitation.
Aortic Stenosis
How to Confirm Diagnosis of Aortic Stenosis (2min)
How to diagnose that there is aortic stenosis. Importance of Doppler
Defining the Valve Anatomy (2min)
In the adults the main conditions are rheumatic, degenerative and calcification of a bicuspid valve
Assessment of Severity of Aortic Stenosis part I - Echo Bi and Doppler (15min)
Several means of assessing the hemodynamic severity of aortic stenosis. Initially by 2D echo and Pulsed Doppler.
Assessment of Severity of Aortic Stenosis part II - cont. Doppler (10min)
Several means of assessing the hemodynamic severity of aortic stenosis. Color flow and continuous Doppler.
Assessment of the Severity of an Aortic Stenosis part III - area analysis (7min)
Several means of assessing the hemodynamic severity of an aortic stenosis. Evaluation of the area by the continuity equation and by the transesophageal echo planimetry.
Evaluate the Repercussion on the LV (12min)
Low flow, Low gradient, AS and reduced EF. Dimensionless Index. Dobutamine Test. Paradoxical low flow, low gradient severe AS with preserved EF
Aortic Regurgitation
Diagnosis of the Presence of Aortic Regurgitation (5min)
How to diagnose aortic regurgitation.
Define the Valve Anatomy (7min)
Many different causes for aortic regurgitation.
Evaluate the Severity of Aortic Regurgitation I (13min)
Aortic regurgitation is one of the cardiac injuries in which the echocardiogram presents the greatest number of different ways to assess its severity. Here with M-mode, 2D and Doppler
Evaluate the Severity of Aortic Regurgitation II (8min)
Evaluation by color Doppler and color Doppler M-mode
Evaluate the Severity of Aortic Regurgitation III (8min)
Evaluation by Continuity Equation. Regurgitant Orifice Area, Volume and Fraction
Aortic Aneurysm
Aortic aneurysms (7min)
Non dissection aortic aneurysm.
Aortic Dissection aneurysms (22min)
Dissection aortic aneurysm. Also, postoperative. [/su_spoiler
Endocarditis
How to diagnose endocarditis I- two-dimensional echo (9min)
Diagnosing endocarditis with two-dimensional transthoracic echo is easy when the vegetation is large and there is a suggestive clinical picture. The problem is to distinguish small degenerative valve calcifications or thickening of vegetation. If there is no compatible clinical picture, the echocardiographer does not consider these findings to be vegetations. If there is a compatible clinical picture, these same findings are considered vegetations!!!!! Next class we will see how to make the differential diagnosis.
How to diagnose endocarditis II- one-dimensional echo (12min)
The diagnosis of endocarditis is easy when the vegetation is large and there is a suggestive clinical picture. The problem is to distinguish small degenerative valve calcifications or thickening from vegetation. This is where the one-dimensional echo comes in. If there is no compatible clinical picture, the echocardiographer does not consider these findings in 2D echo to be vegetations simply because there is no clinical indication. However, if there is a compatible clinical picture, these same findings are considered vegetations !!!!! Here’s how to make the differential diagnosis .
How to diagnose endocarditis III- transesophageal echo (6min)
The diagnosis of endocarditis is easy when the vegetation is large and there is a suggestive clinical picture. The problem is to distinguish small degenerative valve calcifications or thickening of vegetation. The transesophageal echo can be essential.
Endocarditis complications: abscess, chordae rupture, valve perforation, fistulas, etc. (11min)
To be seen after studying endocarditis diagnosis. Abscesses, rupture of valve leaflets, rupture of chordae, fistulas, etc.
Prosthetic Valves
Prosthetic Dysfunctions: Initial Considerations. (11min).
Initial considerations regarding prosthetic disorders. Panus vs thrombus vs vegetations. Abscess
Prosthetic Dysfunctions: Prosthetic and Periprosthetic Regurgitations . (12min)
Dysfunctions caused by rupture or calcification of biological prosthesis, thrombi, panus , endocarditis and dehiscence of sutures in biological and mechanical prosthesis.
Prosthetic Dysfunction: Stenosis, Other Causes (22min)
Prosthesis stenosis , how to diagnose: calcification, pannus, thrombus, mismatch , endocarditis. Mitral subvalvular aneurysm .
Thrombolysis for the Treatment of Prosthetic Thrombus: Usefulness of Echocardiography (5min)
What is the ideal situation for thrombolysis. How to differentiate from pannus fibrosus?
Pericardium
Pericardial Problems (14min)
In this class we have pericardial effusions, pericarditis, pericardial tap and tamponade.
Constricted Pericarditis (10min)
Easy diagnose to do if you get a subcostal view. Impossible to mistake with restrictive cardiomyopathy! Several Doppler signs.
Cardiac Tumors and Thrombi
Cardiac Tumors Part I: Benign Tumors . (16min)
Myxomas , rhabdomyoma , fibroids, thymomas , fibroelastomas , etc.
Cardiac Tumors Part II - Malignant Tumors (13min)
Angiosarcomas , rhabdomyosarcomas , various invasive or metastatic tumors.
Cardiac Thrombi (9min)
Diagnostic evaluation of cardiac thrombi.
Cardiomyopathies
Start of Myocardiopathy Classes: Dilated Form (11min)
Here the classes on cardiomyopathy begin. In this we see the dilated ones, including Chagas and LV Non-Compaction .
Hypertrophic cardiomyopathy (22min)
Among the cardiomyopathies, hypertrophic was the one that echocardiography helped most to understand its pathophysiology as well as its pathological anatomy. The class was a little long because the subject is long, but you can stop at any time and later go on to the point that was initially interrupted.
Restrictive cardiomyopathy: Amyloidosis and Endomyocardial Fibrosis (7min)
Restrictive cardiomyopathy . Amyloidosis and Endomyocardial Fibrosis. Generally easy to diagnose.
Coronary Disease
Echocardiographic Diagnosis of Presence of Coronary Obstruction. Part I (19min)
We start here with ischemic heart disease. Initially with the diagnosis of coronary obstruction. First part.
Echocardiographic Diagnosis of the Presence of Coronary Obstruction. Part II (8min)
How to diagnose the presence of ischemia. Second part.
Coronary Heart Disease Complications: Myocardial infarction (12min)
Now let us look at the complications of coronary heart disease. Initially myocardial infarction.
Right Ventricle Infarction (3min)
RV infarction is quite common, but not frequently diagnosed.
LV aneurysm (9min)
Diagnosis and assessment of LV aneurysms.
Risk Assessment Right After Acute Myocardial Infarction (10min)
We will evaluate the use of echocardiography to assess the patient’s risk right after an acute myocardial infarction.
Echocardiographic Assessment of Myocardial Viability (21min)
How to assess the presence of viable myocardium in patients with ischemic heart disease.
Takotsubo – Stress Heart (3min)
How to diagnose the Takotsubo disease
