Echocardiography A Practical Guide to Reporting - part 9

14 GENERAL SPECIFIC CLINICAL REQUESTS The request form may not specify what to look for on the echocardio-gram, and this chapter provides lists for a focused study or part of a standard study. Emergency echocardiography This may be requested for the following: · cardiac arrest (Table 14.1) · collapse with suspected pulmonary embolism (Table 14.2) · hypotension after an invasive cardiac procedure (including central line insertion): look for the following: Table 14.1 Focused list for echocardiography after cardiac arrest · LV function: – Global dysfunction – Regional wall motion abnormality – Hypertrophy · Acute complications of infarction: – Flail mitral valve – Ventricular septal rupture – Free wall rupture · RV dilatation (see Table 14.2) · Pericardial tamponade · Severe aortic stenosis · Obstructed prosthetic valve · Aortic dissection rupturing into pleural space or abdominal cavity 120 Echocardiography:APractical Guide for Reporting Table 14.2 Echocardiographic signs of massive pulmonary embolism1 · RV dilatation and free wall hypokinesis · Tricuspid regurgitation Vmax usually <4.0 m/s · Short time to PA Vmax <60 ms · IVC dilated and unreactive · Occasionally thrombus in the PA or right heart – pericardial effusion – signs of tamponade (may be present even if the effusion is small) – other causes of hypotension (Table 14.3). Urgent echocardiography This may be requested for the following: · trauma (Table 14.4) · hypotension (Table 14.3) · hypotension after cardiac surgery (Table 14.5) · hypoxaemia: – causes of hypotension (Table 14.3) – contrast study for right-to-left shunting at atrial level. Table 14.3 Focused list in hypotension Signs of underfilling · Flat IVC · Small and active RV and LV · Low E and A wave on transmitral pulsed Doppler Cardiogenic causes · LV global or regional dysfunction · RV dysfunction (see also Table 14.2) · Pericardial tamponade · Severe valve lesions Sepsis · LV dilated and hypokinetic · RV dilated and hypokinetic General 121 Table 14.4 Focused list for echocardiography after blunt or penetrating trauma Blunt · Pericardial effusion · Contusion – RV dilatation and hypokinesis – Localised LV thickening and wall motion abnormality, especially anteroapically · Ventricular septal rupture · Regional wall motion abnormality (dissected coronary artery) · Valve rupture causing acute mitral or tricuspid regurgitation, occasionally aortic regurgitation · Aortic dilatation and dissection flap or intramural haematoma (TOE) · Aortic transection (TOE) Penetrating · RV wall hypokinesis · VSD · Pericardial effusion or haematoma (which may be localised) · Pleural fluid · Mitral regurgitation from valve laceration or damage to papillary muscle or chordae · Aortic regurgitation from laceration of aortic valve Table 14.5 Focused list for echocardiography in hypotension after cardiac surgery · LV global and regional systolic function · Hypertrophic cardiomyopathy-like physiology after aortic valve replacement for aortic stenosis with small LV cavity and LV outflow acceleration · RV size and systolic function · Prosthetic valve regurgitation or obstruction · Native valve function · Pericardial tamponade · Localised haematoma over atria (TOE) · Signs of underfilling (Table 14.3) 122 Echocardiography:APractical Guide for Reporting Table 14.6 Ventricular tachycardia · LV systolic and diastolic function · Localised abnormalities (e.g. metastases) · LV hypertrophy? · RV dysplasia (see page 35) Table 14.7 Atrial fibrillation · LA and RA size · LA thrombus? · LV size and function · Mitral valve appearance and function · RV size and function · PA pressures · Mitral valve appearance and function Table 14.8 Heart failure · LV cavity size and wall thickness · LV systolic and diastolic function · RV function and PA pressure · IVC size and response to respiration · Valve appearance and function Table 14.9 Stroke, TIA, or peripheral embolism · LV size and systolic function · Signs of hypertension – LV hypertrophy – LV diastolic dysfunction – Dilated LA – Dilated aorta · Mitral valve disease · PFO · Intracardiac masses ... - tailieumienphi.vn