Episode 78: Echoing the RV with Matt Siuba

Introduction to Intensive Care Academy

A new educational platform called Intensive Care Academy (ICA) has been launched, focusing on critical care training. The ICA is a structured, video-based teaching platform featuring a foundations program with over 50 lessons designed for new critical care advanced practice providers, such as nurse practitioners and physician assistants. These lessons cover vital topics from diseases and treatments to diagnostics and procedures in critical care. Additional resources include exclusive audio podcasts and live Q&A sessions that provide ongoing support and learning opportunities for users.

Importance of the Right Heart

The right heart plays a critical role in overall cardiovascular health, yet it often receives less attention than the left heart. Understanding its function is crucial, especially in critically ill patients, where issues such as shock can arise. A case is outlined involving a patient in shock, which necessitates evaluating right heart dynamics using ultrasound techniques. Key parameters to assess include the size of the right ventricle, its contractility, and the movement of the interventricular septum.

Three Key Assessment Terms

When assessing the right heart using ultrasound, three crucial terms emerge: size, squeeze, and septal kinetics. The size of the right ventricle relative to the left is vital, typically following a ratio of one-third to two-thirds for healthy individuals. Additionally, understanding the squeeze can be evaluated through various metrics of systolic function, while septal kinetics assesses whether right heart dysfunction is significant enough to impact the motion of the septum. An early sign of potential cardiac failure includes changes in these movements, indicating the need for further investigation.

Evaluating Right Ventricular Function

TAPSI (Tricuspid Annular Plane Systolic Excursion) serves as a valuable tool for measuring right ventricular function, providing insights into both contractility and loading conditions. While it integrates various factors influencing right heart performance, it is essential to recognize that measurements like TAPSI can be reliant on preload conditions. S' is another measurement that directly gauges the tissue velocity of the tricuspid annulus, which may serve as a more precise indicator of contractile function. Both TAPSI and S' offer unique advantages, but consistency in measurement techniques is crucial for accurate patient assessment.

Monitoring and Treatment Considerations

Effective monitoring of right heart dynamics is essential for informing treatment decisions in critically ill patients. Clinicians are encouraged to evaluate not only static measurements but also how these measurements change in response to interventions. Recognizing the interplay between contractility and afterload provides a more nuanced understanding of right heart function, serving as a basis for targeted therapies. Strategies may include addressing high afterload conditions with pulmonary vasodilators or optimizing preload to improve cardiac output and overall patient stability.

Critical Care Scenarios

Episode 78: Echoing the RV with Matt Siuba

Episode guests

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Quick takeaways

Deep dives

Introduction to Intensive Care Academy

Importance of the Right Heart

Three Key Assessment Terms

Evaluating Right Ventricular Function

Monitoring and Treatment Considerations

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