ECHOCARDIOGRAPHY

Visualizes heart in real time with ultrasound; Doppler recordings noninvasively assess hemodynamics and abnormal flow patterns (Table 114-1 and Fig. 114-1). Imaging may be compromised in pts with chronic obstructive lung disease, thick chest wall, or narrow intercostal spaces. Transesophageal echocardiography (TEE) is performed when higher resolution images of cardiac structures is required.

TABLE 114-1: Clinical Uses of Echocardiography

2-D Echo

Cardiac chambers: size, hypertrophy, wall motion abnormalities

Valves: morphology and motion

Pericardium: effusion, tamponade

Aorta: aneurysm, dissection

Assess intracardiac masses

Doppler Echocardiography

Valvular stenosis and regurgitation

Intracardiac shunts

Diastolic filling/dysfunction

Approximate intracardiac pressures

Transesophageal Echocardiography

Superior to 2-D echo to identify:

 Infective endocarditis

 Cardiac source of embolism

 Prosthetic valve dysfunction

 Aortic dissection

Stress Echocardiography

Assess myocardial ischemia and viability

FIGURE 114-1
hmom20_ch114_f001.png
Two-dimensional echocardiographic still-frame images of a normal heart. Upper: Parasternal long axis view during systole and diastole (left) and systole (right). During systole, there is thickening of the myocardium and reduction in the size of the left ventricle (LV). The valve leaflets are thin and open widely. Lower: Parasternal short axis view during diastole (left) and systole (right) demonstrating a decrease in the left ventricular cavity size during systole as well as an increase in wall thickness. Ao, aorta. (Reproduced from Myerburg RJ: Harrison’s Principles of Internal Medicine, 12th ed, 1991.)

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