Echo-of-the-Day

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AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.

Echo-of-the-Day Information

The Echo-of-the-Day is a presentation of 1 or more video loops to present an important topic in echocardiography. Please reveiw the image or video loops and then answer the questions below. After you have answered the questions you can view the explanation and obtain CME credit (if available).

You can change the size and the format of the image or video loops by using the links below the image or video loop.

= MP4 Video	= Ogg Video
= WebM Video	= GIF Image
Image/Video Sizes	= JPG Image
1X = 200x150 pixels 2X = 400x300 pixels	3X = 600x450 pixels 4X = 800x600 pixels

Loop Text Key
Preop	Preop TEE or TTE
Intraop	An Intraop TEE
IntraopPreOp	Intraop TEE or TTE before Operation
IntraopPostOp	Intraop TEE or TTE after Operation
IntraopEnd	Intraop TEE or TTE at End of Anesthesia
Post Op	Postop TEE or TTE

Echo of the Day Information Table

IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE

Pulmonary Vein Flow Patterns

Case#: 129

AMA CME Units: 0.25 Units
Estimated Time: 15 minutes.

Presentation:
An 80 yo male with the following Doppler scan was obtained in the operating room.

Loop(s):

Case Discussion

As a person ages, the Doppler pulmonary vein flow pattern changes from diastolic dominance to systolic dominance. A 30 yo will have a diastolic velocity greater than a systolic velocity. The diastolic and systolic velocities equalize around 50 years old. Elderly patients have a systolic dominance of their pulmonary vein flow pattern.

This Doppler scan exhibits systolic suppression which is abnormal for this patient.

Causes of systolic suppression of the pulmonary vein pattern are high LAP, mitral regurgitation, atrial fibrillation, pacemaker, and mechanical ventilation. Since the A wave velocity is low, mitral regurgitation is unlikely. The rhythm indicates that atrial fibrillation or a pacemaker is not present. Therefore, the most likely cause is an elevated LAP from a stiff LV or diastolic dysfunction.

CME Section

Please answer the following questions correctly to obtain your CME.

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.

The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.