echocardiography
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Introduction
Use of high-frequency ultrasound (2-10 MHz) in the investigation of the heart & great vessels. Sound waves are generated from a piezoelectric crystal.
Indications
- evaluation of suspected valvular heart disease
- systolic murmurs >= grade 3/6
- late or holosystolic murmurs
- diastolic murmurs
- continuous murmurs
- murmur with accompanying symptoms[3]
- evaluation of heart failure*
- chamber size, wall thickness & regional wall motion abnormalities
- LV systolic dysfunction vs LV diastolic dysfunction[3]
* in the absence of a murmur,with an ECG indicating left ventricular hypertrophy, echocardiography will not contribute to evaluation of persistent hypertension[9]
Contraindications
- asymptomatic patients with innocent murmurs[3]
- routine assessment of mild aortic stenosis more frequently than every 3-5 years in the absence of symptomatic evidence of progression[3]
- repeat assessment of asymptomatic mild mitral regurgitation with normal LV size & LV function[3]
- routine surveillance of chronic heart failure in the absence of change in clinical status or a planned intervention[3]
- limited visualization of the aortic arch[3]
Methods
- M-mode:
- single cursor beam
- single dimensional information
- identification of characteristic borders
- endocardium
- epicardium
- aortic root (< 40 mm)
- atria, left atrium (< 40 mm)
- valve leaflets
- heart motion
- Two-dimensional:
- provides beat to beat tomogram of heart
- left ventricular volume: end-diastolic & end-systolic
- stroke volume
- ejection fraction
- muscle mass
- regional wall motion abnormalities can be assessed
- morphology of cardiac valves
- pliability
- degree of calcification
- morphologic abnormalities
- assessment of intracardiac & pericardial structures
- may be used in conjunction with exercise or dobutamine stress
- assess regional wall motion at rest & during stress for the assessment of coronary artery disease
- requires highly skilled interpretation
- mobile equipment
- Doppler:
- allows direct measurement of blood flow velocities
- across valves
- along conduits
- left ventricular outflow tract
- vessels
- stroke volume
- cardiac output
- valve gradients
- severity of regurgitant lesions
- semiquantitation of intracardiac & extracardiac shunts
Interpretation
- detects & records intracardiac structures & their motion
- measures cardiac chamber size, shape, & wall thickness
- measurements are used in the diagnosis of cardiovascular lesions
Interferences
- accoustic windows may be limiting in:
- obese patients
- patients with COPD or restrictive lung disease
- operator-dependent
- pericardial thickening generally requires CT or MRI for confirmation
- inaccurate for measuring pulmonary artery pressure in patients with suspected pulmonary hypertension[4]
Notes
More general terms
More specific terms
- fetal echocardiography
- pocket mobile echocardiography; mobile-device echocardiography
- stress echocardiography
- transesophageal echocardiography (TEE)
- transthoracic echocardiogram (TTE)
- ultrasound atrial septum; ultrasound of atrial septal defect
- ultrasound atrial volume; left/right atrial volume
- ultrasound endocardium; ultrasound of endocardial area
- ultrasound epicardium; ultrasound of epicardial area
References
- ↑ Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999.
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 57-58
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Medical Knowledge Self Assessment Program (MKSAP) 11,15,16.17,18,19. American College of Physicians, Philadelphia 1998,2009,2012,2015,2018,2022.
- ↑ 4.0 4.1 Rich JD et al. Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: Implications for clinical practice. Chest 2011 May; 139:988 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20864617
- ↑ Douglas PS, Garcia MJ, Haines DE et al ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol. 2011 Mar 1;57(9):1126-66. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21349406
- ↑ 6.0 6.1 Douglas PS, Khandheria B, Stainback RF et al ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 appropriateness criteria for stress echocardiography: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine. J Am Coll Cardiol. 2008 Mar 18;51(11):1127-47 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18342240
- ↑ Mulvagh SL, Rakowski H, Vannan MA et al American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography. J Am Soc Echocardiogr. 2008 Nov;21(11):1179-201; PMID: https://www.ncbi.nlm.nih.gov/pubmed/18992671
- ↑ Premkumar P. Utility of Echocardiogram in the Evaluation of Heart Murmurs. Med Clin North Am. 2016 Sep;100(5):991-1001. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27542419
- ↑ 9.0 9.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022