Most echocardiography laboratories have adopted the 2016 diastolic guidelines. With the release of the 2025 update, an important question arises: What are the key conceptual differences between the 2016 and 2025 approaches to diagnosing diastolic dysfunction? academic.oup.com/ehjcimaging… @JGrapsa

#ASEchoJC The Pickelhaube sign: Lateral annular S′ ≥16 cm/s associated with ventricular arrhythmias in MVP ⚡️ #EPeeps 👉jacc.org/doi/epdf/10.1016/j.…

#POCUS #echofirst #Nephpearls RVOT pulse-wave Doppler can provide useful clues about pulmonary vascular resistance. In normal individuals (A), the waveform has a smooth, dome-shaped appearance, with peak velocity occurring in mid-systole, reflecting a compliant, low-resistance pulmonary circulation. As RV afterload increases, the waveform gradually becomes more triangular. The RVOT acceleration time shortens, and the peak velocity shifts earlier into systole (B). With further increases in pulmonary vascular impedance and reduced arterial compliance, a characteristic mid-systolic notch may appear (C), creating the classic "W sign." In advanced pulmonary hypertension with RV failure, the Doppler envelope becomes smaller and more abbreviated, with a very short and steep AccT (D). This reflects rapid equilibration of RVOT and proximal pulmonary artery pressures due to severe afterload elevation. Like most POCUS findings, RVOT Doppler should be interpreted in the context of the overall echocardiographic picture rather than in isolation.

#CardioNuggets™ The Pickelhaube sign is a sharp, spiked high-velocity systolic tissue Doppler signal of the lateral mitral annulus seen in arrhythmic mitral valve prolapse. It’s named after the old German “Pickelhaube” helmet because the Doppler waveform resembles the helmet’s pointed spike. Why it happens: Prolapsing mitral leaflets cause abrupt systolic tugging of the papillary muscles/mitral annulus → creating a tall systolic velocity spike on TDI. Why it matters: Suggests arrhythmic MVP Associated with ventricular arrhythmias/SCD risk Often seen with bileaflet MVP and mitral annular disjunction (MAD) Image from @drahmedmohsen85 #CardioNuggets #MedEd #EchoFirst

Same patient, a few minutes apart

@Ecgloverr @BerkBmf @akuseierikachan @FrdBjk112 @lila_enis @MertAvsever @marioalrb84_a @nihar_nayak2 @Nikhil_Kr16 @ThaierT13525 @MiguelP23970914 @sohrab1104 @ghwamasoob @Drakhil_cardio @Amhar_47 @AMigelheva @josecruz2102 @praneet_manekar @momochaname @YilmazEile63275

What do you think about this anomaly ⁉️⁉️⁉️

Everything you need to know about acute pericarditis

🚨 HOT OFF THE PRESS! 🚨 New guidance from the American Society of Echocardiography @ASE360 for Cardiac Ultrasound Artifacts 🫀📡 ➡️bit.ly/4tKDSvf 👉 A must-read for everyone in #EchoFirst! 🔍 What is an artifact? ➡️ An imaging feature that does NOT reflect true anatomy/pathology ➡️ Common, expected, and rooted in ultrasound physics ⚙️ 💡 Why this matters ⚠️ Artifacts can mimic disease → misdiagnosis → inappropriate management ⚠️ Present across ALL modalities: • 2D 🖥️ • Spectral Doppler 📈 • Color Doppler • 3D echo 🧊 📘 What this guideline delivers ✅ Standardized, structured approach to artifacts ✅ Clear explanation of: • Appearance 👁️ • Mechanism ⚙️ • Clinical impact 🏥 • Real-world cases 🧾 • Mitigation strategies 🛠️ 🧠 Also covers 🔹 “Artifact-like” phenomena 🔹 Interference from external devices & equipment 📡 🎯 Key takeaway 👉 Artifacts are inevitable—but misinterpretation is not 👉 Mastering them = safer, smarter echo practice 👩‍⚕️👨‍⚕️ Who should read this? ➡️ Sonographers ➡️ Cardiologists ➡️ Trainees ➡️ Anyone interpreting cardiac ultrasound 📢 Elevate your imaging game. Recognize. Understand. Mitigate. #CardioX #Cardiotwitter @JournalASEcho #ACCFIT

Dagger-shaped LVOT Doppler - classic in HOCM, but increasingly relevant in #CriticalCare #Nephrology #POCUS • What you see Late-peaking, “dagger” CW Doppler profile Slow rise → abrupt mid–late systolic peak • Why it matters Distinguishes dynamic LVOT obstruction from fixed AS (which peaks early) • Mechanism Systolic anterior motion (SAM) of mitral valve → leaflet pulled into LVOT during ejection → obstruction worsens as systole progresses • Hemodynamics Gradient = 4 × V² ≥30 mmHg → significant obstruction Not just HCM — big ICU problem Dynamic LVOTO can occur without structural HCM Seen in septic shock, stress cardiomyopathy, hypovolemia 🚨 Can present as refractory hypotension …and paradoxically worsens with inotropic vasoactive agents. Triggers • Hypovolemia • Inotropes (dobutamine 👎) • Low afterload (sepsis) • Tachycardia, hypercontractility • High sympathetic tone Substrate • LVH (common in #ESRD) • Small LV cavity • Sigmoid septum • Elderly, often female #POCUS clues (don’t miss this) • Hyperdynamic, small LV • SAM of mitral valve (use M-mode in PLAX) • LVOT flow acceleration • Dagger-shaped CW Doppler (key finding) Management flips the script (“LVOTO bundle”) ❌ Stop harm • Inotropes • Diuretics ✅ Do the opposite • Fluids → increase preload • Afterload → switch norepinephrine to phenylephrine/vasopressin • Beta-blockade → reduce contractility • ↓ PEEP if too high Bottom line Not all hypotension needs more inotropy. If you see a dagger, think LVOTO and reverse your reflexes.