POCUS

RV and LV Size Assessment in Critical Care Echocardiography    Which Views are Used? Echo View LV Assessment RV Assessment Best Use Parasternal Long Axis (PLAX) Excellent Limited LV size, wall thickness Apical 4 Chamber (A4C) Excellent Excellent Compare RV vs LV RV-focused A4C Moderate Best RV dimensions Subcostal 4 Chamber Good Good ICU patients, […]

Mitral Annular Plane Systolic Excursion (MAPSE)  MAPSE (Mitral Annular Plane Systolic Excursion) measures the distance the mitral annulus moves toward the LV apex during systole. Unlike LVEF, which mainly reflects radial shortening, MAPSE reflects longitudinal myocardial fiber contraction i.e (LV) longitudinal systolic function, making it particularly sensitive for detecting early LV systolic dysfunction. It is

L.V Dysfunction Diastolic Dysfunction Grades(Pulse Wave Doppler) Grade Filling Pattern LAP Typical Findings Normal Normal relaxation Normal Normal E/A ≥0.8 Grade I Impaired relaxation Normal E/A <0.8 Grade II Pseudonormal Elevated E/A 0.8–2 Grade III Restrictive Markedly elevated E/A ≥2 Diastolic Dysfunction Grades(Tissue Doppler) Average E/e′ Interpretation LV Filling Pressure <8 Normal Normal LAP/LVEDP 8–14

RVSP / PASP  Definitions Parameter Definition RVSP Peak systolic pressure generated by the RV during systole PASP Peak systolic pressure within the pulmonary artery during systole Normal physiology RV systolic pressure ≈ PASP because there is almost no pressure gradient across a normal pulmonary valve Therefore,RVSP ≈ PASP (if pulmonary valve is normal). If pulmonary

TAPSE (Tricuspid Annular Plane Systolic Excursion)  TAPSE is used to assess right ventricular (RV) longitudinal systolic function. In critical care, TAPSE is particularly useful because the RV contracts predominantly in the longitudinal direction, making longitudinal annular excursion an excellent surrogate of global RV systolic performance. Definition TAPSE = Distance (mm) that the lateral tricuspid annulus

VExUS (Venous Excess Ultrasound Score) VExUS is a point-of-care ultrasound (POCUS)-based scoring system used to quantify systemic venous congestionand predict organ dysfunction (especially congestive nephropathy) in critically ill patients. It integrates: IVC size (macro congestion) Doppler patterns in venous systems (micro congestion transmission) Why VExUS? (Core Concept) Traditional markers (CVP, edema, weight gain) are: Late