To sum up…
Learn the 5Es!
- Other pathology (valvular, masses) may occasionally be obvious
- More in depth in advanced cardiac pathology
Large Left Atrial Myxoma
So in summary, when we are talking about basic pathology of the heart we want to learn the 5 Es. Those are effusion-is there a significant pericardial effusion and again watch out for that fatty tissue; is the ejection good or bad or somewhere in between, is it greater than 50% or less than 30%, is there any significant dilation of the right ventricle? Is the RV equal to or greater than the LV - that's equality. Exit is the thoracic aortic root dilated, which would go along with both aneurysm and possible dissection. One thing you'll note is that all four of those first E's can be gathered from a good parasternal long and short axis view. Often times I'll just do that if I'm not concerned about fluid status or the IVC. For the 5th E, or entrance, we want to look at the IVC, typically in a sagittal view and see whether it is really dilated or non-collapsable indicating fluid overload, or if it collapsed or partially collapsable indicating that they are susceptible to getting IV fluids, it may be helpful. So this image here shows something that should be pretty obvious if you've been looking at some echoes, and it’s this massive mass going from the left atrium through the mitral valve into the left ventricle; this could be a clot or could be endocarditis, in this case it was an atrial myxoma. So there is pathology that is certainly outside of the 5 Es, and we'll talk about some of this stuff in the advanced lectures, but if you keep your eyes focused on the 5 Es you're going to pick up a lot of pathology, it can be really helpful for patients. We think it’s a very reliable way to go through assessment of pathology in the heart. Thank you for taking the time to listen and we will go through some of these topics in more depth in the advanced 5 Es lecture.