The figure is taken from a recent Vet Clinics of North America review article by Lisciandro GR, ©2020 but is also explained well in our 2nd edition of Point-of-care Ultrasound Techniques for the Small Animal Practitioner,©2021.

The strategy is that if the sonographer feels there is evidence for left-sided congestive heart failure (L-CHF), then do Vet BLUE®.  If Vet BLUE® is dry there may be left-sided heart disease but there is no evidence for L-CHF.  Conversely, if Vet BLUE® shows wet lung in a pattern that supports left-sided CHF, then a work-up is urgently needed along with L-CHF therapy.

The strategy is that if the sonographer feels there is evidence for right-sided congestive heart failure (R-CHF), then characterize the caudal vena cava (CVC) and hepatic veins at the AFAST®-TFAST® Diaphragmatico-Hepatic (DH) view.  If the CVC has a bounce or is flat (small maximum height), then R-CHF is not present. There may be right-sided heart disease but there is no evidence for right-sided CHF.  Conversely, if the CVC is FAT (increased maximum height) especially with distended hepatic veins (Tree Trunk Sign), these findings supports (Chou et al. PLOS ONE 2021) right-sided CHF, and a work-up is urgently needed along with R-CHF therapy.

Also, the Global FAST® Fallback views (Lisciandro Focused Ultrasound Techniques for the Small Animal Practitioner, ©2014, 2021; Lisciandro J Vet Emerg Crit Care 2o11) provide important information when echocardiography including TFAST® echocardiography views are not possible because of patient status.  For example, dry lung all Vet BLUE® views rules out L-CHF and the echocardiography can wait until the patient is more stable/tolerant of echocardiography (and empiric loop diuretic therapy is not indicated); and a bounce or flat CVC rules out R-CHF and the echocardiography can wait until the patient is more stable/tolerant of echocardiography.

Our table for maximum heights at the AFAST®-TFAST® Diaphragmatico-Hepatic (DH) view that assists in interpreting CVC findings.  Check out the related Blog and our textbook 2nd edition for more detail.

 

 

 

Buy our Big Saving
Bundle

We are BUNDLING the AFAST®-TFAST®-Vet BLUE®-Global FAST® Online Course Fee for a signup of ALL 3 Courses for $895.

Sign up for our FASTVet Newsletter