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Mona Rayan

on 15 February 2015

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Transcript of Copy of MAKING SENSE OF ECHO

Dyspnea is a clinical manifestation of various cardiac and non-cardiac disorders. A referral for this diagnosis requires complete evaluation of the following:
Systolic and diastolic function
Valvular anatomy and function
Exclusion of an intracardiac shunt
Evaluation for dynamic LVOT obstruction
Evidence of pericardial disease

Grade 1 = impaired relaxation pattern with normal filling pressure E/e<8
1a = impaired relaxation pattern with increased filling pressure E/e=8-15
Grade 2 = pseudo normalized pattern
Grade 3 = reversible restrictive pattern
Grade 4 = irreversible restrictive pattern E/e>15

Patients who are referred for echocardiography frequently have hypertension. Hypertrophy of the LV is a characteristic response to systemic hypertension, and LV mass is an independent prognostic indicator .
Two-dimensional and M-mode echocardiography can measure LV wall thickness and estimate LV mass, both of which are indices of LV hypertrophy .
Although various bedside maneuvers are helpful in determining the cause of murmur with auscultation, it is often necessary to confirm the clinical suspicion or to characterize the morphologic and hemodynamic abnormalities responsible for the murmur.
valve area assessment.
Echocardiography is helpful in determining the cause of atrial fibrillation and in identifying the subset of patients at high risk for thromboembolism , recurrence . TEE provides superb visualization of the LA and LA appendage , and if no thrombus is seen, cardioversion can be performed with minimal embolic risk in patients with AF.
Atrial fibrillation is usually related to a cardiac functional or structural abnormality such as diastolic dysfunction, mitral valve disease, cardiomyopathy, or atrial septal defect. Because atrial fibrillation may be the first manifestation of these treatable or repairable conditions, echocardiography is one of the more commonly used initial diagnostic tests in patients with atrial fibrillation
Echocardiography is helpful in evaluating chest pain, especially when it is not accompanied by a diagnostic ECG change. In a major proportion of patients with acute myocardial infarction, the initial ECG is nondiagnostic.
The diagnostic value is greatest if the study is performed during the episode of chest pain. If the pain is due to ischemia, regional wall motion abnormalities are usually present, sometimes even before typical ECG changes occur.
The presence of regional wall motion abnormalities is not specific for acute ischemia, but their absence during chest pain strongly suggests a nonischemic cause.
A numeric scoring system has been adopted based on the contractility of the individual segments. In this scoring system, higher scores indicate more severe wall motion abnormality (1, normal; 2, hypokinesis; 3, akinesis; 4, dyskinesis; 5 aneurysmal). A wall motion score index (WMSI) is derived by dividing the sum of the wall motion scores by the number of visualized segments:
TTE should be used to do the following:
Evaluate the anatomic substrate of thrombi formation, such as aneurysm, dyskinetic segments, LA enlargement, hidden Mitral valve disease,and atrial septal aneurysm
Search for vegetation
Search for cardiac tumor(myxomas).
TEE may be also applied for LAA thrombi , Aortic palques.
Infrequent, but important, causes of hypertension are coarctation of the aorta . The descending thoracic aorta should be interrogated from the suprasternal notch with CW Doppler Echocardiography.
The LVOT stroke volume can be obtained also from the product of the LVOT area and LVOT TVI (time velocity integral.
Cardiac output (CO) is calculated as stroke volume (SV) multiplied by heart rate (HR) and cardiac index (CI) by dividing CO by body surface area (BSA)
Stress Echo
Stress echocardiography is performed with exercise, the administration of a pharmacologic agent, mental stress, or transesophageal atrial pacing . The exercise protocol includes a treadmill exercise test, with immediate postexercise. Echocardiographic images or upright or supine bicycle echocardiographic images obtained at peak exercise.
in the clinical setting
-why do we need it?


90% of echo requests are for LV function assessment
Qualitative and quantitative
Remainder for valvular and structural problems


-why do we need it?


90% of echo requests are for LV function assessment
(Qualitative and quantitative) in hypertensives or ischemic patients.
Remainder for valvular and structural problems
In the emergency situations(chest pain , hypotension)



Thank u
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