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Echocardiography

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Abstract

Echocardiography is probably the single most useful tool available for assessment of cardiac disease, with the possible exception of physical examination. Echocardiography is safe and versatile, giving information about both cardiac structure and function. Nevertheless, echocardiography findings should always be interpreted in the context of other clinical findings and all echocardiography results should be integrated to produce a plausible ‘story’. In other words, physical examination findings, chamber enlargement and Doppler echocardiography findings should all be consistent with one another. The echocardiographer needs to be more than just a good ultrasonographer. In addition to possessing the technical skills to record standard imaging planes in a variety of patients, the echocardiographer should have a good understanding of cardiac pathophysiology and of the haemodynamic effect of different diseases and lesions. Although a standardized protocol should form the basis of every echocardiography study, some ability to ‘think on one’s feet’ enables additional questions to be answered during the course of the examination. The following topics are addressed: Types of echocardiography; Technique; Chamber measurements; Systolic function; Valve function; and Interpretation.

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Figures

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11.1 Types of echocardiography.
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11.2 PW spectral Doppler recording of aortic blood flow. Velocity (m/s) is displayed along the y axis and time is displayed along the x axis. An ECG is shown for reference.
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11.3 PW spectral Doppler recording of mitral valve inflow (above the baseline during diastole) with an aliased signal during systole caused by high velocity mitral regurgitation.
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11.4 Normal approximate pressures (mmHg) in the cardiac chambers and great vessels. Right-sided heart chambers are blue, left-sided heart chambers are red. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission
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11.5 Standard right-sided echocardiographic views. Ao = Aorta; AoV = Aortic valve; LA = Left atrium; LV = Left ventricle; LVOT = Left ventricular outflow tract; MV = Mitral valve; PA = Pulmonary artery; RA = Right atrium; RV = Right ventricle; RVOT = Right ventricular outflow tract.
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11.6 Standard left-sided echocardiographic views. Ao = Aorta; LA = Left atrium; LAur = Left auricular appendage; LV = Left ventricle; LVOT = Left ventricular outflow tract; RA = Right atrium; RAur = Right auricular appendage; RV = Right ventricle. PA = Pulmonary artery; RVOT = Right ventricular outflow tract.
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11.7 Normal PW spectral Doppler echocardiographic views.
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11.8 Measurement of LA dimensions. Ao = Aorta; LA = Left atrium; LV = Left ventricle.
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11.9 Measurement of LV dimensions. LV = Left ventricle; LVDd = Left ventricular diameter in diastole; LVDs = Left ventricular diameter in systole.
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11.11 Measurement of left ventricular wall thickness. IVSd = Interventricular septal thickness in diastole; LV = Left ventricle; LVFWd = Left ventricular free wall thickness in diastole.
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11.12 2D right parasternal short-axis view at the level of the papillary muscle in a cat. The interventricular septal thickness is shown by the green arrow. The white arrow indicates a false tendon, which can easily be mistaken for the endocardial surface of the LV (falsely increasing wall thickness).
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11.13 Measurement of left ventricular systolic function. LV = Left ventricle; LVDd = Left ventricular diameter in diastole; LVDs = Left ventricular diameter in systole.
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11.15 Left apical four chamber view (zoomed) showing a jet of mitral regurgitation at the closed mitral valve. The colour aliases from blue to yellow at the proximal flow convergence region (white arrow). The ‘neck’ of the jet (vena contracta, black arrow) corresponds with the regurgitant orifice diameter.
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11.17 Differential diagnosis for abnormalities of chamber dimensions and valves. LA = Left atrium; LV = Left ventricle; RA = Right atrium; RV = Right ventricle.

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