Pocket Guide to Echocardiography

Andro G. Kacharava, Alexander T. Gedevanishvili, Guram G. Imnadze, Dimitri M. Tsverava, Craig M. Brodsky, Andro G. Kacharava, Alexander T. Gedevanishvili, Guram G. Imnadze, Dimitri M. Tsverava, Craig M. Brodsky

• Publisher: Wiley-Blackwell
• Year: 2012
• ISBN:
  9781118480038
• Edition: 1
• Topic: Medicine
• Subtopic: Cardiology

With its easy accessibility, low cost, and ability to deliver, essential bedside information about the cardiac structure and function, echocardiography has become one of the most relied-upon diagnostic tools in clinical medicine. As a result, more clinicians than ever before must be able to accurately interpret echocardiographic information in order to administer appropriate treatment.

Based on the authors' experience teaching echocardiography in busy clinical settings, this new pocketbook provides reliable guidance on everyday clinical cardiac ultrasound and the interpretation of echocardiographic images. It has been designed to help readers develop a stepwise approach to the interpretation of a standard transthoracic echocardiographic study and teach how to methodically gather and assemble the most important information from each of the standard echocardiographic views in order to generate a complete final report of the study performed.

What's included:

•A summary of TTE examination protocol and a comprehensive listing of useful formulas and normal values

•Atrial and ventricular dimensions, LV and RV systolic function, LV diastolic patterns

•Echocardiographic findings in the most commonly encountered cardiac diseases and disorders, including various cardiomyopathies, cardiac tamponade, constrictive pericarditis, valvular heart disease, pulmonary hypertension, infective endocarditis, and congenital heart disease

•Companion website with video clips and over 70 self-assessment questions

Packed with essential information and designed for quick look-up, this pocketbook will be of great assistance for anyone who works in busy clinical settings and who needs a ready and reliable guide to interpreting echocardiographic information to help deliver optimal patient care.

Chapter 1

Comprehensive Transthoracic Echocardiographic Examination Protocol

Parasternal Long-axis view (Fig. 1)

1. 2D image (4 beats) (measure LVOT diameter).

2. Color Doppler through MV and AoV (4 beats).

3. M-mode through Aortic root (measure root and LA diameter, and aortic cusp separation).

4. Color Doppler M-mode through the aortic root (4 beats).

5. M-mode through MV (± Valsalva test to check for MV prolapse and SAM; measure “E” to “S” separation distance).

6. Color Doppler M-mode through MV (4 beats).

7. M-mode through mid LV (4 beats) (measure septal and inferolateral wall thickness LVEDD and LVESD).

Figure 1 (A and B) Parasternal long-axis view.

RA/RV view

From parasternal LAX view tilt transducer to point it to right hip:

1. 2D image (4 beats);

2. Color Doppler through TV (4 beats);

3. CW Doppler through TV to measure max TR velocity if TR jet present.

Parasternal Short-axis view (Fig. 2 and Fig. 3)

1. 2D through AoV (4 beats) (to assess structure and mobility; use zoom).

2. Color Doppler through AoV (4 beats).

3. 2D through PV (4beats).

4. Color Doppler through PV (4 beats).

5. PW Doppler at the tips of PV to measure PAT (4 beats).

6. CW Doppler through PV to measure PR velocity if present, and maximum outflow velocity through PV.

7. 2D through TV (4 beats).

8. Color Doppler through TV (4 beats).

9. PW Doppler at the tips of TV leaflets to assess inflow pattern (4 beats).

10. If inflow jet max velocity is >1.5 m/sec, trace the diastolic flow to measure mean transvalvular gradient.

11. CW Doppler through TV to measure max TR velocity if TR jet present.

12. Serial 2D short axis images through the LV from base toward apex.

Figure 2 (A and B) Parasternal short-axis view.

Figure 3 (A and B) Parasternal short-axis view.

Apical 4-chambers view (Fig. 4)

1. 2D image (4 beats).

2. Color Doppler through the MV (4 beats).

3. Color Doppler M-mode through the MV at the end expiration (4 beats).

4. PW Doppler at the tips of MV leaflets to assess inflow pattern and velocity (4 beats); if pseudonormal or restrictive inflow pattern observed, decrease the preload and reassess the inflow pattern; in impaired relaxation act opposite.

5. PW Doppler at the right/left upper PV to assess inflow pattern (4 beats).

6. PW tissue Doppler at the basal and mid septal and lateral walls (4 beats).

7. If inflow jet max velocity is > 1.9 m/sec, trace the diastolic flow to measure mean transvalvular gradient, then measure PHT of the jet in CW mode.

8. CW Doppler through MV to measure max MR velocity if MR jet present. (Obtain simultaneous SBP measurement to calculate mean LAP.)

9. PW tissue Doppler at basal lateral walls of the RV to assess TEI index and systolic velocity.

10. M-mode through the RV basal lateral wall to measure TAPSE.

Figure 4 (A and B) Apical 4-chambers view.

Apical 5-chambers view

From apical 4-chambers view tilt transducer slightly anteriorly; examiner's hand moves downward toward the patient's bed:

1. 2D image (4 beats).

2. Color Doppler through AoV and MV (4 beats).

3. PW Doppler through LVOT and trace the flow (4 beats).

4. CW Doppler through AoV and if outflow max velocity is >1.9 m/sec, trace...