A 45 year old woman with chronic alcoholic liver disease presents to the ED with exertional dyspnoea and is noted to have a SpO2 of 90% at rest despite having a normal chest examination and CXR.  She has numerous spider naevi on her chest.

She describes dyspnoea that is improved when she lays down in bed.

An echocardiogram is performed to look for evidence of heart failure, pericardial effusion or pulmonary hypertension. This clip was taken during the echocardiogram:


Which view of the heart is this?  How is it acquired?

What is the abnormal finding on this clip?

In order to identify the possible cause of these bubbles an echo “bubble study” was performed.  Agitated blood, saline and air are rapidly injected into a proximal vein as the heart is viewed in the apical 4 chamber window.


What does the video clip show?

So what is happening to this patient?

What is the diagnosis?



GP working in Broome in the NW of Western Australia. I work as a hospital DMO (District Medical Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care | @broomedocs | BroomeDocs |

Dr James Rippey LITFL Ultrasound SonoCPD

An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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