Formal echocardiography

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Diagnostic Pearls

  • Normal directional flow in CW and PW in apical, parasternal short:
    • Below the line for pulmonic and aortic valves (systole)
    • Above the line in tricuspid and mitral valves (diastole)
  • Parasternal long
    • Assess for mitral valve prolapse, systolic anterior motion
    • Differentiate pleural effusion from pericardial effusion
      • Pericardial effusion is anterior to descending aorta
      • Pleural effusion posterior to descending aorta

Pericardial effusion vs. pleural effusion

  • Parasternal short
  • Apical
    • Best obtained in left lateral decubitus with L arm above head to open up ribs
    • LVEF by Simpson, LV volume change
    • LVEF by Teichholz method, using M-mode (estimation of LV volume by diameter measured just beyond mitral tips in diastole)
    • EF visual assessment:
      • >65% = hyperdynamic
      • 55-65% = normal
      • 45-54% = mildly depressed
      • 30-44% = moderately depressed
      • <30% = severely depressed
  • Two chamber view
  • Three chamber view
  • Subxiphoid view
  • Suprasternal view

E/A Ratio

  • Measure of diastolic dysfunction
  • PW doppler across MV in apical view
    EAnormal.jpg
  • The following rules will apply to most pts[1](Video)
  1. Rule 1: Normal diastolic function if echo normal, age<45 yrs, E>A
  2. Rule 2: Impaired relaxation if A>E, with E/A<1
  3. Rule 3: Pseudonormal if echo abnormal (LVH), age>65, E>A, E/A>1
  4. Rule 4: Restrictive filling if E/A>2
Grading diastolic dysfunction.JPG

See Also

External Links

References

  1. 123sonography. Nov 20, 2010. https://www.youtube.com/watch?v=qdLkbcFe_DI.