Stephen Alerhand

Translating advanced critical care echocardiography and cardiac POCUS to the bedside for patient care
@SAlerhand

[Stephen Alerhand @EchoBridgeMD]

𝗘𝗰𝗵𝗼𝗕𝗿𝗶𝗱𝗴𝗲 𝗣𝗲𝗮𝗿𝗹 𝟭𝟯

Cardiac tamponade is one of the few reversible causes of cardiac arrest.

Recognize it. Drain it. Save a life.

#POCUS #Echo

[Stephen Alerhand @EchoBridgeMD]

𝗘𝗰𝗵𝗼𝗕𝗿𝗶𝗱𝗴𝗲 𝗣𝗲𝗮𝗿𝗹 𝟭𝟮

Cardiac tamponade depends more on the rate of fluid accumulation and pericardial compliance than on the size of the effusion.

It's not just how much fluid is present—it's how quickly it gets there.

#POCUS #Echo

[Stephen Alerhand @EchoBridgeMD]

𝗘𝗰𝗵𝗼𝗕𝗿𝗶𝗱𝗴𝗲 𝗣𝗲𝗮𝗿𝗹 𝟭𝟭

TAPSE provides a rapid quantitative assessment of longitudinal RV systolic function.

TAPSE < 17 mm suggests impaired longitudinal RV systolic function.

#POCUS #Echo

[Stephen Alerhand @EchoBridgeMD]

𝗘𝗰𝗵𝗼𝗕𝗿𝗶𝗱𝗴𝗲 𝗣𝗲𝗮𝗿𝗹 𝟭𝟬
Unlike a dilated aortic root, aortic regurgitation, or pericardial effusion, a dissection flap is a direct sign of acute type A aortic dissection.

Recognition should prompt immediate diagnostic confirmation and definitive management.

[Stephen Alerhand @EchoBridgeMD]

𝗘𝗰𝗵𝗼𝗕𝗿𝗶𝗱𝗴𝗲 𝗣𝗲𝗮𝗿𝗹 𝟵
A normal ECG doesn't always mean normal coronary perfusion.

A regional wall motion abnormality may appear before ECG changes or biomarker elevation.

Notice the akinetic posterior wall—a clue to acute myocardial ischemia.

[Stephen Alerhand @EchoBridgeMD]

𝗘𝗰𝗵𝗼𝗕𝗿𝗶𝗱𝗴𝗲 𝗣𝗲𝗮𝗿𝗹 𝟳

A pericardial effusion should be described by its hemodynamic impact, distribution, onset, and composition.

https://t.co/DWq3Ii0nHb

[Stephen Alerhand @EchoBridgeMD]

𝗘𝗰𝗵𝗼𝗕𝗿𝗶𝗱𝗴𝗲 𝗣𝗲𝗮𝗿𝗹 #𝟲

Interrogate a TR jet from multiple windows. Use the view with the most parallel Doppler beam

TR velocity is squared in the modified Bernoulli equation. Even small alignment errors can substantially underestimate PASP.

https://t.co/VMb1dG3yHm

[Stephen Alerhand @EchoBridgeMD]

𝗘𝗰𝗵𝗼𝗕𝗿𝗶𝗱𝗴𝗲 𝗣𝗲𝗮𝗿𝗹 #𝟱

𝗘𝗣𝗦𝗦: 𝗥𝗮𝗽𝗶𝗱 𝗕𝗲𝗱𝘀𝗶𝗱𝗲 𝗖𝗹𝘂𝗲 𝘁𝗼 ⬇️ 𝗟𝗩 𝗦𝘆𝘀𝘁𝗼𝗹𝗶𝗰 𝗙𝘂𝗻𝗰𝘁𝗶𝗼𝗻

As LV contractility ⬇️, MV opens less and LV dilates...⬆️ EPSS.

EPSS > 7–8 mm ⬆️suspicion for LV systolic dysfunction
📖 https://t.co/T7QApEyOR5

[Stephen Alerhand @EchoBridgeMD]

EchoBridge Pearl 4

McConnell's sign raises suspicion for acute PE vs chronic PH

Diffuse RV free wall hypokinesis & preserved apical contraction

Proposed mechanisms
- RV apical tethering to LV apex
- Acute RV remodeling
- Localized RV free wall ischemia
https://t.co/8LRIZVOnl3

[Stephen Alerhand @EchoBridgeMD]

EchoBridge Pearl #3

A dilated aortic root may suggest acute type A aortic dissection.

In PLAX, the normal aortic root has similar diameter to the LA and RV.

An aortic root > 4 cm is considered enlarged.

https://t.co/MRNgR3eIyw

#POCUS #Echo #EmergencyMedicine #CriticalCare

[Stephen Alerhand @EchoBridgeMD]

EchoBridge Pearl #2
• Right heart thrombus → long thin, free-floating "worm-like" mass
• Vegetation → oscillating, attached to valve/prosthetic material
• Cardiac tumor → broad-based attachment, possible invasion or Doppler vascularity
https://t.co/VMb1dG3yHm
@SAlerhand

[Stephen Alerhand @EchoBridgeMD]

EchoBridge Pearl #1

Not all RV free wall collapse suggests tamponade. The key question is when collapse occurs. M-mode can distinguish RV collapse during diastole (abnormal) and systole (normal) because of its superior temporal resolution.
https://t.co/DWq3Ii0nHb
#POCUS #Echo

[Stephen Alerhand @EchoBridgeMD]

Excited to launch EchoBridgeMD
@SAlerhand

Echo Pearls • Video Tutorials • Case Reviews • AEMUS & CCEeXAM Prep • Consulting

Translating advanced echocardiography and cardiac POCUS to the bedside for patient care.

https://t.co/fihgm86iAQ

#POCUS #Echocardiography