Edgar Argulian @argulian Twitter profile

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Edgar Argulian

@argulian

2 years

What is the pathology and the treatment? Hint: the ultrasound machine is not broken

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Edgar Argulian

@argulian

3 years

Uremic pericarditis with pericardial effusion and fibrinous strands, 2D TTE, short axis view

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Edgar Argulian

@argulian

3 years

A patient with dyspnea

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Edgar Argulian

@argulian

3 years

In advanced cardiac amyloidosis with reduced ejection fraction, only the apex is contracting! 'Apical sparing' seen without fancy tools @ManiVannanheart

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Edgar Argulian

@argulian

2 years

A typical example of pseudodyskinesis due to hiatal hernia on an off-axis basal short axis view.

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Edgar Argulian

@argulian

2 years

An example of marked ventricular dyssynchrony due to conduction abnormality with remarkable inefficiency.

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Edgar Argulian

@argulian

2 years

Truly quadricuspid

Dr Sabe De

@drsabede

3 years

Seeing Quad! A real rarity (<0.05%) - quadricuspid aortic valve #echofirst @amerjohri @HeartDocSharon @RodrigoBagur @VLSorrellImages

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Edgar Argulian

@argulian

4 years

How many effusion locations can you identify?

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Edgar Argulian

@argulian

1 year

A patient with dyspnea

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Edgar Argulian

@argulian

3 months

A patient with chest pain. What is the diagnosis?

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Edgar Argulian

@argulian

4 years

A large thrombus resting comfortably in the right atrial appendage. With all the hype about LAA, RAA is often ignored.

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Edgar Argulian

@argulian

2 years

Purulent pericarditis, short axis view below pap muscles. Note large effusion, partial adhesion and soft echo densities in the pericardial space

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Edgar Argulian

@argulian

2 years

First TEE image at 0 degrees, what is the finding?

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Edgar Argulian

@argulian

4 months

A patient with severe chest pain and hypotension. What is the diagnosis?

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Edgar Argulian

@argulian

1 year

A patient with dyspnea

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Edgar Argulian

@argulian

1 year

Why is this patient short of breath?

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Edgar Argulian

@argulian

1 year

Why is this patient short of breath?

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Edgar Argulian

@argulian

1 month

An elderly patient in ICU. What is the diagnosis?

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Edgar Argulian

@argulian

1 year

A patient with pericardial effusion, 4 chamber view

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Edgar Argulian

@argulian

2 months

A patient with several weeks of intermittent chest pain, 3D TTE. What is the diagnosis?

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Edgar Argulian

@argulian

6 months

A patient is admitted to ICU with respiratory failure. The parasternal long axis view is shown. What is the finding?

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Edgar Argulian

@argulian

1 year

Where is the mirror?

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Edgar Argulian

@argulian

3 years

End-stage TTR cardiac amyloidosis with biventricular failure, TTE, short axis view. Occasionally, one image is diagnostic!

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Edgar Argulian

@argulian

3 years

Patient with heart failure and LBBB. Note dyssynchrony and apical rocking

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Edgar Argulian

@argulian

2 years

Patient with dyspnea

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Edgar Argulian

@argulian

5 years

A large thrombus in the right atrium attached to a catheter, 3D TEE RA perspective. No hardware is benign!

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Edgar Argulian

@argulian

1 year

In patients with difficult parasternal windows, especially COPD, subcostal short axis is commonly a rescue. In this patient, note partial fusion of RCC and LCC, as well as good delineation of the pulmonic valve

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Edgar Argulian

@argulian

2 years

Outpatient with some exertional dyspnea for 5 weeks. Unspecified rheum disease. Asymptomatic at rest, BP 150/80, HR 93. IVC engorged.

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Edgar Argulian

@argulian

4 years

When RV is too large and tricuspid valve refuses to coapt, 3D TEE, dual perspective

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Edgar Argulian

@argulian

2 years

A patient with no coronary artery disease and prior ICD implant. What is the likely diagnosis?

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Edgar Argulian

@argulian

1 year

A patient with dyspnea. CW thru the mitral valve. What are the findings?

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Edgar Argulian

@argulian

1 year

In this patient with severe right ventricular dysfunction due to lung disease, TAPSE measure at 1.8 cm. The annular motion is driven by the pulling effect of small, hyperdynamic left ventricle.

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Edgar Argulian

@argulian

4 months

Answer: PDA. Recognition of PDA in adults is based on the short axis view with proper PA visualization (shown) and the suprasternal view. Both can be challenging in adults if proper acquisition is not performed.

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Edgar Argulian

@argulian

3 years

Typical flow separation in the abdominal aorta in a patient with aortic dissection

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Edgar Argulian

@argulian

3 years

Secondary mitral regurgitation, 3D TEE with high tissue transparency. Note jet asymmetry slightly favoring the medial aspect of the valve

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Edgar Argulian

@argulian

9 months

A patient with renal disease. Modified subcostal view is shown.

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Edgar Argulian

@argulian

3 years

Small jets of residual MR after a single clip implantation in a patient with secondary mitral regurgitation, 3D TEE, high tissue transparency

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Edgar Argulian

@argulian

4 years

Check out this challenging TEE probe advancement in a patient with mediastinal shift pre-mitral clip reported by Ishizu et al. For full case please go to: @JGrapsa @JACCJournals

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Edgar Argulian

@argulian

24 days

Normal aortic valve, 3D TEE rendering with low tissue transparency. Note no dropout and crisp coaptation line

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Edgar Argulian

@argulian

2 years

An outpatient with non-cardiac symptoms. What is wrong with the tricuspid valve?

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Edgar Argulian

@argulian

2 years

Interatrial septal aneurysm with PFO. Note that the PFO opening is commonly best evaluated on TEE at the short axis view, 40-50 degrees

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Edgar Argulian

@argulian

2 years

Septal motion typical for right ventricular volume overload (caused by lead related TR) in the basal short axis view: note systolic rounding and diastolic flattening of the interventricular septum

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Edgar Argulian

@argulian

2 years

Patient with chronic dyspnea. Which scallop is affected?

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Edgar Argulian

@argulian

1 year

What is wrong with the wall motion in this attempted 2-chamber view?

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Edgar Argulian

@argulian

2 years

A patient with chest discomfort

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Edgar Argulian

@argulian

26 days

3D TEE tips: aortic valve It is difficult to avoid dropout since aortic leaflets are thin, and beam alignment is not perpendicular 1) Clean up 2D image and acquire the dataset using the short axis 2) Narrow the acquired volume, switch to spatial resolution from balanced 3)…

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Edgar Argulian

@argulian

1 year

A large coaptation gap in a patient with secondary MR, 3D TEE, LV perspective. LV perspective is essential in assessing valve coaptation, jet exit and valve tenting in secondary MR patients

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Edgar Argulian

@argulian

2 years

A middle-age patient with dyspnea. How can history help in diagnosis?

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Edgar Argulian

@argulian

10 months

A young, active adult with a loud murmur. Modified PLAX shown. What do you expect on CW Doppler thru the lesion?

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Edgar Argulian

@argulian

4 years

'Twin' thrombi in the left atrium as seen from the roof of the left atrium in a patient with a hypercoagulable state, 3D TEE

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Edgar Argulian

@argulian

1 year

Typical doming of the bicuspid aortic valve in a patient with biventricular failure. This finding should raise strong suspicion of a bicuspid valve, even if the short axis views are inconclusive

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Edgar Argulian

@argulian

2 years

Mitral annular calcification with mobile components in an elderly non-infected patient with a stroke, 3D TEE, left atrial perspective

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Edgar Argulian

@argulian

3 years

Upper esophageal view of the pulmonic valve on 2D TEE, fascinating but may be technically challenging

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Edgar Argulian

@argulian

3 months

A patient with dyspnea. Suprasternal view is obtained. 1/2

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Edgar Argulian

@argulian

4 years

Subaortic membrane causing severe calcification and immobility of the non-coronary aortic cusp due to chronic turbulence

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Edgar Argulian

@argulian

4 years

A 'black hole' of secundum ASD, 3D TEE, RA perspective

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Edgar Argulian

@argulian

2 years

A patient with leg swelling. When color Doppler is obvious enough....

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Edgar Argulian

@argulian

5 years

For all believers in isolated LVNC: a 'spiderweb' sign

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Edgar Argulian

@argulian

11 months

What is the most likely cause of this finding?

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Edgar Argulian

@argulian

3 years

Normal bileaflet mechanical mitral valve, 3D TEE, LA perspective

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Edgar Argulian

@argulian

7 months

A patient with aortic regurgitation, 2D TTE, zoomed long axis view. What is the causal mechanism?

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Edgar Argulian

@argulian

6 months

A patient with recent onset fever and shortness of breath. A suprasternal CW Doppler recording is shown. What explains the notching of the forward flow marked by arrows?

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Edgar Argulian

@argulian

8 months

Systolic anterior motion of an elongated, redundant anterior mitral leaflet, with septal contact, as seen on 3D TEE. Note high temporal resolution.

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Edgar Argulian

@argulian

3 years

Double trouble: severe AI and severe MR jets from an overhead left atrial perspective, 3D TEE, high tissue transparency

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Edgar Argulian

@argulian

11 months

A patient with remote cancer history. 2D TTE, frame rate >100 fps. What is the finding?

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Edgar Argulian

@argulian

4 months

A patient with dyspnea. Spectral Doppler recording thru LVOT. What are the abnormalities? Difficult but solvable

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Edgar Argulian

@argulian

1 year

An example of poor tricuspid leaflet coaptation due to tethering leading to secondary TR

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Edgar Argulian

@argulian

11 months

A large atrial septal aneurysm, 3D TEE, LA perspective

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Edgar Argulian

@argulian

2 months

A patient with renal disease, no evidence of infection 1/2

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Edgar Argulian

@argulian

1 year

Patient in ICU, what is the unifying diagnosis based on color M-mode in parasternal long axis view?

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Edgar Argulian

@argulian

3 years

A young asymptomatic patient with a murmur as a child. Color Doppler unremarkable. What is the diagnosis?

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Edgar Argulian

@argulian

3 years

Marked tethering of the posterior mitral leaflet with anterior leaflet override in a patient with non-ischemic dilated cardiomyopathy, the beauty of MPR

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Edgar Argulian

@argulian

4 years

Mitral valve aneurysm (A2) post endocarditis with a discrete perforation, 3D TEE, dual volume layout (LA and LV)

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Edgar Argulian

@argulian

2 years

Patient with dyspnea

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Edgar Argulian

@argulian

7 months

A patient with heart failure 1/3

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Edgar Argulian

@argulian

2 years

Extensive mitral annular calcification engulfing the posterior leaflet and medical commissure, 3D TEE, left atrial perspective

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Edgar Argulian

@argulian

3 years

Patient with marked cardiomegaly and severe mitral regurgitation. What is the mechanism of MR?

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Edgar Argulian

@argulian

2 years

A patient with dyspnea

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Edgar Argulian

@argulian

2 months

What is going on in the aorta in this TEE view?

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Edgar Argulian

@argulian

3 years

Stress cardiomyopathy with a single beat triplane acquisition. Note the temporal resolution!

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Edgar Argulian

@argulian

4 years

Interatrial septal aneurysm, 3D TEE, RA perspective

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Edgar Argulian

@argulian

4 years

From good, old pre-COVID days: classic Barlow's mitral valve disease with multi-scallop prolapse

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Edgar Argulian

@argulian

2 years

In patients with eccentric mitral regurgitation, high tissue transparency highlights the jet contour and direction. 3D TEE, flail medial scallop

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Edgar Argulian

@argulian

4 years

Successful surgical closure of LAA in a patient with MV replacement. Left pulmonary veins are seen on top

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Edgar Argulian

@argulian

1 year

Subcostal view in a patient with dyspnea

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Edgar Argulian

@argulian

4 years

A non-infected patient with bioprosthetic MV and paroxysmal AF treated with apixaban.

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Edgar Argulian

@argulian

4 years

Rheumatic severe mitral stenosis, 3D TEE, LV perspective. Note valve thickening and commissural fusion

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Edgar Argulian

@argulian

1 year

An example of floppy, redundant mitral chords prolapsing into LVOT (without clinical significance) in an elderly patient

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Edgar Argulian

@argulian

2 months

A patient with dyspnea 1/3

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Edgar Argulian

@argulian

3 years

How would you interpret this hepatic vein waveform?

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Edgar Argulian

@argulian

7 months

A single strip of CW thru the aortic valve in a patient with aortic stenosis, low LVEF and irregular rhythm that nicely demonstrates significant flow dependency of transaortic gradients. In this single strip, the observed spectrum includes phantom systole, low velocity, moderate…

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Edgar Argulian

@argulian

5 days

An apical thrombus in a patient with revascularized anterior MI on day 7 confirmed with contrast echo. Not seen on day 1. 1/2

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Edgar Argulian

@argulian

3 years

Left atrial appendage thrombus, realistic 'overhead' projection made possible by 3D TEE

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Edgar Argulian

@argulian

1 year

A patient with known precap pulmonary hypertension and LVEF of 55%. What is the finding?

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Edgar Argulian

@argulian

3 years

Rheumatic aortic stenosis, 3D TEE, aortic perspective. In addition to cusp thickening, note bulky commissural thickening and fusion

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Edgar Argulian

@argulian

1 year

An asymptomatic patient after recent aortic surgery. TAPSE 1.4 cm.

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Edgar Argulian

@argulian

2 years

Answer: patient with acute pulmonary embolism receiving catheter-directed ultrasound-assisted thrombolysis. Note fan-shaped interference artifact created by the device

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Edgar Argulian

@argulian

9 months

A young adult patient with a murmur. History of heart surgery as a child. What is the likely etiology of this condition?