The TTE questions are increasing in their number and the expected level of detail.
Somehow, the college has focused their echocardiographic interest on aortic stenosis. Of the six past paper questions which concern TTE data interpretation, two are about AS. Question 17.1 and Question 17.2 from the second paper of 2014 are perhaps more relevant, as the discussion revolves around the identification of peri-arrest findings on TTE images. Assessment of valve dysfunction (eg. severity staging of aortic stenosis) is covered in greater detail in the Cardiothoracic Intensive Care section, and no further time will be spent here on the TTE assessment of valvular disease.
Question 17.1 from the second paper of 2014 asked about the utility of TTE in cardiac arrest, and particularly which the most appropriate view is. The answer to the latter is inevitably the subcostal view; it would be insane to interfere with CPR by trying to shove the probe on the chest. The former is best answered in a "critically evaluate" pattern, even though the college question itself did not demand such depth.
An ideal resource for answering such a question would have to be this 2012 article by Price et al. In addition to this earlier article, Berg (2018) is worth reading for the pros and cons, as the paper comes from the more modern era during which the enthusiasm for intra-arrest ultrasound has somewhat cooled.
Question 17.2 from the second paper of 2014 asked for the candidates to identify characteristic abnormalities seen on the TTE during a cardiac arrest. A picture is worth a thousand words:
In answer to Question 16 from the second paper of 2020, the single best view to assess the pericardial tamponade is through a subxiphoid view. At least that's what it sounds like the examiners wanted ("which view", they asked, implying one view). Most echosavvy people will agree that to fully appreciate the effusion and its haemodynamic effects you would need to image it in at least a couple of different planes. Loculated effusions could have disproportionate regional effects, and limited views can give rise to the misidentification of all kinds of sonolucent friendlies (eg. ascites, pericardial cysts). If there is an effusion, it is also very easy to overestimate its size. D'Cruz & Constantine (1993) detail these pitfalls in their paper, for the interested reader with infinite time.
The subxiphoid view, however, has a couple of benefits:
Echocardiographic features of cardiac tamponade are listed elsewhere.
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Zafiropoulos, Andreas, et al. "Critical Care Echo Rounds: Echo in cardiac arrest." Echo Research and Practice 1.2 (2014): D15-D21.
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