Practical Manual of Echocardiography in the Urgent Setting

Edited by: Vladimir Fridman MD Department of Cardiology Long Island College Hospital New York, NY, USA Mario J. Garcia MD Professor, Department of Medicine (Cardiology); Professor, Department of Radiology; Chief, Division of Cardiology; Co-Director, Montefiore Einstein Center for Heart and Vascular Care. New York, NY, USA

Contributors, x

Preface, xiv

1 Ultrasound physics, 1
Vladimir Fridman

Ultrasound generation, 7

Image formation, 9

Doppler ultrasound, 15

Summary and key points, 22

References, 22

2 The transthoracic examination, 23
Vladimir Fridman and Dennis Finkielstein

Performing the echocardiogram, 33

Using the transducer, 35

Steps involved in a comprehensive transthoracic echocardiogram, 37

References, 40

3 Transesophageal echocardiography, 41
Salim Baghdadi and Balendu C. Vasavada

Preparation of the patient, 42

Acoustic windows and standard views, 45

Clean-up and maintenance, 54

References, 56

4 Ventricles, 57
Deepika Misra and Dayana Eslava

Left ventricle, 57

Right ventricle, 66

Atria, 72

Contrast echocardiography, 74

References, 77

5 Left-sided heart valves, 79
Muhammad M. Chaudhry, Ravi Diwan, Yili Huang, and Furqan H. Tejani

Aortic valve, 79

Mitral valve, 94

References, 111

6 Right-sided heart valves, 113
Michael J. Levine and Vladimir Fridman

Tricuspid valve, 113

Pulmonic valve, 122

Qp/Qs: Pulmonary to systemic flow ratio, 127

References, 127

7 Prosthetic heart valves, 129
Karthik Gujja and Vladimir Fridman

Echocardiographic approach to prosthetic heart valves, 132

Approach to suspected valve dysfunction, 134

References, 140

8 The great vessels, 141
Vladimir Fridman and Hejmadi Prabhu

Aorta, 141

Pulmonary artery, 147

D-septal shift, 151

References, 152

9 Evaluation of the pericardium, 153
Chirag R. Barbhaiya

Pericardial effusions, 153

Cardiac tamponade, 154

Echo-guided pericardiocentesis, 159

Constrictive pericarditis, 161

Differentiation of constrictive pericarditis and restrictive cardiomyopathy, 163

Effusive–constrictive pericarditis, 165

References, 165

10 Specialty echocardiographic examinations, 167
Cesare Saponieri

TTE in a VAD patient, 167

Intracardiac echocardiography, 169

TEE in the operating room, 171

Echocardiography to guide percutaneous closure devices placement, 172

References, 173

11 Common artifacts, 174
Padmakshi Singh, Moinakhtar Lala, and Sapan Talati

References, 182

12 Hypotension and shock, 183
Sheila Gupta Nadiminti

Determination of central venous pressure, stroke volume, cardiac output, and vascular resistance, 183

Hypovolemia, 184

Septic shock, 188

Cardiogenic shock due to left ventricular failure, 189

Cardiogenic shock due to right ventricular failure, 189

Cardiogenic shock due to acute valvular insufficiency or shunt, 190

Acute pulmonary hypertension/pulmonary embolism, 190

References, 193

13 Chest pain syndrome, 195
Sandeep Dhillon and Jagdeep Singh

Myocardial Infarction, 195

Aortic dissection, 198

Pulmonary embolus, 199

Other causes, 201

References, 202

14 Cardiac causes of syncope and acute neurological events, 204
Erika R. Gehrie

Hypovolemia, 205

Arrhythmias, 205

Aortic stenosis, 207

Cardiac tamponade, 207

Pacemaker malfunction, 207

Endocarditis, 207

Pulmonary embolism, 208

Stroke and transient ischemic attacks, 208

Cardiac masses, 212

References, 215

15 Acute dyspnea and heart failure, 216
Mariusz W. Wysoczanski

Echocardiogram in “heart failure”, 216

Intracardiac pressures, 217

Echocardiographic approach to dyspnea with hypoxemia, 222

Differential diagnosis for cardiac induced dyspnea, 223

Algorithm for treatment, 223

References, 225

16 Evaluation of a new heart murmur, 226
Vinay Manoranjan Pai

Acute valvular regurgitation, 226

Intracardiac shunts, 231

Pericardial effusion, 232

Post myocardial infarction, 232

References, 233

17 Infective endocarditis, 234
Luis Aybar

Diagnosis and diagnostic accuracy, 234

Guidelines for use of echocardiography to diagnose endocarditis, 236

Appearance on echocardiography, 236

Complications and risk stratification, 238

Prosthetic valve endocarditis, 239

Cardiac device-related infective endocarditis, 240

References, 241

18 Post-procedural complications, 244
Vladimir Fridman

Noncardiac procedures, 244

Cardiac procedures, 245

References, 247

19 “Quick echo in the emergency department”: What the EM physician needs to know and do, 248
Dimitry Bosoy and Alexander Tsukerman

Goal of FOCUS, 248

Clinical use of FOCUS, 250

References, 252

Index, 253