Echocardiography: color flow Doppler imaging
Small "flame" of color signal may be seen in middle region of atrial septum
Contrast echocardiography (Bubble Study)
Bolus of agitated saline injected to antecubital vein
Microbubbles appear in right atrium
Study positive for<unk>  if microbubbles appear in left atrium within 3 cardiac cycles of their appearance in right atrium
Valsalva increases right atrial pressure and facilitates right-to-left shunting if present
2D TEE with contrast provides superior visualization and is preferred
Obtain 2E TEE with constrast if suspicion is high and TTE is negative
Small "flame" of color signal may be seen in middle region of atrial septum
Bolus of agitated saline injected to antecubital vein
Microbubbles appear in right atrium
Study positive for<unk>  if microbubbles appear in left atrium within 3 cardiac cycles of their appearance in right atrium
Valsalva increases right atrial pressure and facilitates right-to-left shunting if present
Study positive for<unk>  if microbubbles appear in left atrium within 3 cardiac cycles of their appearance in right atrium
Obtain 2E TEE with constrast if suspicion is high and TTE is negative
Patent foramen ovale
Intrapericardial foreign body
Left ventricular aneurysm
Systemic venous embolism
Left ventricular pseudoaneurysm
Right heart and pulmonary artery embolism
Anomalous coronary arteries
Pulmonary vein embolism