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Role of Echocardiography in Cardiology Consultation

  • Philip G. Haines
  • Nidhi Mehta
  • James N. KirkpatrickEmail author
Chapter

Abstract

Echocardiography can be used to evaluate almost any cardiovascular disease process and provide structural/anatomical, functional, and hemodynamic information in real time at the patient’s bedside. It can be used in both stable and critically ill patients. This chapter discusses important elements and uses of transthoracic, transesophageal, and stress echocardiography that are important to consultative cardiology, including appropriate ordering, echocardiographic techniques, and standard and emerging clinical uses.

Keywords

Echocardiography Transesophageal echocardiography Stress echocardiography Doppler echocardiography Contrast echocardiography Appropriateness 

Notes

Acknowledgements

The authors would like to thank Carol Dennis for her assistance with formatting of the manuscript.

Supplementary material

Video 14.1

Mitral valve in 3D (see Fig. 14.1). Three-dimensional transesophageal echocardiographic images of the mitral valve from the “surgeon’s view”—the left atrial perspective. The anterior leaflet is on top and the posterior leaflet is on the bottom. This technique provides a unique perspective from which to evaluate all scallops of the mitral valve leaflets—from left (lateral) to right (medial) aspects of the posterior leaflet, P1, P2, and P3, and the corresponding scallops of the anterior leaflet, A1, A2, and A3. In this patient there is also a medial commissural leaflet (CL) which is located at the intersection of the anterior and posterior leaflets. The video demonstrates prolapse of the P2 segment (middle portion of the posterior leaflet) and P3 (medial or rightward portion of the posterior leaflet) (AVI 42191 kb)

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Video 14.2a Stress-induced cardiomyopathy (see Fig. 14.2). Apical four-chamber view demonstrates akinesis of the mid chamber to the apex, consistent with either multivessel coronary ischemia or stress-induced cardiomyopathy (Takotsubo). (AVI 7035 kb)
Video 14.2b

Stress-induced cardiomyopathy (see Fig. 14.2). Several weeks later, repeat echocardiography demonstrates complete resolution of the wall motion abnormalities, consistent with a diagnosis of stress-induced cardiomyopathy (AVI 11966 kb)

Video 14.3a

Echodensity filling the left ventricle (see Fig. 14.3). The left ventricle is filled from the mid wall to the apex with a large echodensity. The differential diagnosis included thrombus and endocardial fibroelastosis. (AVI 3603 kb)

Video 14.3b

Echodensity filling the left ventricle (see Fig. 14.3). Color Doppler demonstrated flow within the echodensity (small arrows) and highlighted deep crypts (large arrow). These morphological findings are consistent with non-compaction cardiomyopathy (AVI 1911 kb)

Video 14.4

Apical mass (see Fig. 14.5). Zoomed view of the apex in the apical two-chamber view, demonstrating a large mass (arrow). It is well circumscribed with smooth borders and has an echotexture similar to that of the adjacent myocardium. As seen in the video, there is anterior apical and inferior hypokinesis. These findings suggest the mass is a thrombus (AVI 60472 kb)

Video 14.5a

Right atrial mass (see Fig. 14.6). Apical four-chamber view demonstrating a large, well-circumscribed mass in the right atrium prolapsing across the tricuspid valve (AVI 137817 kb)

Video 14.5b

Right atrial mass (see Fig. 14.6). Subcostal imaging demonstrated origin of the mass in the inferior vena cava (arrow). Pathology was consistent with carcinoid tumor (AVI 137817 kb)

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Video 14.6 Stress echocardiogram demonstrating ischemia (see Fig. 14.7). Comparison rest (upper left), stress (upper right), and recovery (lower left) two-chamber views during exercise stress echocardiography. The stress images demonstrate reduced ejection fraction with a mid to distal inferior wall motion abnormality, consistent with a significant right coronary artery stenosis. Recovery images demonstrate resolution of the wall motion abnormality (AVI 3319 kb)
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Video 14.7 Left ventricular assist device imaging (see Fig. 14.8). Parasternal long-axis view of a patient with a left ventricular assist device (LVAD) set at 9,400 rpm. The video demonstrates that the left ventricular (LV) ejection fraction is severely decreased (~10 %) and that there is no aortic valve opening. The inflow cannula of the LVAD is seen near the LV apex (arrow). It is normally positioned and is unlikely to be subject to any suction events, in which portions of the ventricle or the mitral apparatus are drawn into the opening of the cannula, obstructing flow. The septum is neutral between the LV and right ventricle (RV), indicating adequate LV decompression from LVAD function and suggesting that there is no RV volume or pressure overload (AVI 33967 kb)
Video 14.8

Endocarditis (see Fig. 14.9). Parasternal long-axis zoomed view of the mitral valve demonstrating a very large, multilobulated and highly mobile echodensity on both sides and both leaflets of the mitral valve, consistent with endocarditis lesion (AVI 80160 kb)

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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Philip G. Haines
    • 1
  • Nidhi Mehta
    • 1
  • James N. Kirkpatrick
    • 1
    Email author
  1. 1.Department of CardiologyHospital of the University of PennsylvaniaPhiladelphiaUSA

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