0:00

Okay, let's go to this case.

0:01

So this is a, um, we're gonna have a little bit of fun here.

0:05

So this is a 37-year-old man who has cordal swelling.

0:10

Uh, he was done portably in the ICU

0:12

and the sonographer called me

0:14

and say, I don't understand

0:15

what is going on everywhere I look in the testicle,

0:18

I think the testicle has good flow,

0:20

but eyes just see, I can't find agel flow.

0:23

I just find this kind of flow. Okay?

0:26

So this is when, uh, you, you wear your detective head,

0:30

I think, where your, is a little bit like detective

0:33

and say, okay, this patient was on a coronary unit, right?

0:37

So why does a flow look like that?

0:39

And I would've told you that if you had looked at any

0:42

of his artery, the flow would've looked like that.

0:44

And the reason is that the patient has an LVAD, right?

0:48

And so the sonographer didn't think about it.

0:51

And I've seen this in the carotid,

0:53

I've seen in the femoral artery.

0:54

So unless you, you, you know, you know about it,

0:58

you're gonna be flustered and why can't I find out Jill?

1:00

So, but it's simply

1:01

because a patient has left ventricular assist device.

1:06

Okay? Just another example.

1:08

In the iliac, uh, uh, in all the vessel, this was all, uh,

1:13

left iliac artery, the right, uh, SFA femoral artery.

1:18

And that's a typical appearance of, uh, high flow,

1:22

low sistant wave form with minimal systolic positivity

1:25

or absent systolic positivity

1:27

because there is a left, uh, ventricle assist device.

1:32

This is an other, um, consequence of, you know,

1:36

what the patient passed.

1:38

So this was a femoral artery,

1:40

but we probably do, um, more commonly common, um, you know,

1:46

carotid artery evaluation in patient

1:48

who are in the coronary care unit

1:50

because maybe they go to surgery

1:51

and they wanna make sure that they carotid artery

1:53

or patent, they don't have any risk for stroke.

1:56

In this particular case, we were looking at the,

1:58

at the lower extremity artery,

2:00

but you see this typical dual dual peak flow.

2:04

And these are usually patients who are in a, again,

2:07

in the cardiac unit and they have intraaortic balloon pump.

2:12

And so with intra uh, um, aortic balloon pump,

2:16

you have two systolic pigs, right?

2:17

Because you want to make sure that the,

2:19

the vessels are well perfused.

2:21

So you have the unassisted systole

2:24

and you have diastolic augmentation

2:26

where the balloon expands so

2:27

that there is more fluent patient usually

2:29

where have severe heart failure to continue

2:31

to prouse the brainin in particular.

2:34

And then while the balloon deflates, you have a little bit

2:37

of flow at or below baseline.