ABSTRACT
These tables give a guide on what to assess in various common indications for echocardiography not yet covered:
Murmur (Table 18.1)
Heart failure (Table 18.2)
Stroke, TIA and peripheral embolism (Table 18.3)
Cardiac arrhythmia (Table 18.4)
Hypertension (Table 18.5)
Cocaine (Table 18.6)
HIV (Table 18.7)
Neuromuscular diseases (Table 18.8)
Inflammatory diseases (Table 18.9)
Hypereosinophilia (Table 18.10)
Drugs causing valvopathy (cabergoline, pergolide, benfluorex) (Table 18.11)
Radiation (Table 18.12) mainly after treatment for non-Hodgkin’s lymphoma or left-sided breast cancer more than 20 years ago
Chagas disease (Table 18.13), which is beginning to be seen outside South America as a result of migration
Checklist in ‘murmur’Valve thickening or regurgitation
Subaortic septal bulge
ASD: clue is dilated active RV
VSD:
parasternal long- and short-axis views with colour box on the membranous septum detect most
colour box over the muscular septum in parasternal long and short and apical 4-chamber view
apical septal defects may be missed (put CW probe over the site of the maximum murmur)
Coarctation (suprasternal view)
Continuous wave in pulmonary artery
PDA (parasternal short and suprasternal views)
<target id="page_200" target-type="page">200</target>Checklist in suspected ‘heart failure’LV cavity size and wall thickness and systolic and diastolic function
RV morphology, size and function
Indexed LA volume (as a sign of chronically high LV filling pressures)
IVC size and response to respiration
Valve appearance and function
Checklist in stroke, TIA or peripheral embolism<sup> <xref ref-type="bibr" rid="ref18_1">1</xref> </sup>LV global hypokinesis, aneurysm or large regional wall motion abnormality
Signs of hypertension (as the underlying cause of generalised vascular disease): LV hypertrophy, diastolic dysfunction, dilated LA, aortic sclerosis, aortic dilatation
Dilated LA
Evidence of aortic dissection: dilated aorta, dissection flap
Mitral valve disease: stenosis > regurgitation
ASD or patent foramen ovale (bubble study according to clinical indications usually in patients aged <50 years)
Masses: LA myxoma or thrombus, LV thrombus, valve vegetation or fibroelastoma
Atrial fibrillation (should already have been detected on the 12-lead ECG)
Checklist after ventricular tachycardiaLV size and systolic function
LV hypertrophy?
RV dysplasia (see pages 41–44)
Valve disease
Checklist in atrial fibrillationLeft and right atrial size
LV size and function
Mitral valve appearance and function
LA thrombus?
RV size and function
PA pressures
<target id="page_201" target-type="page">201</target>Checklist in hypertensionLV hypertrophy (subaortic septal bulge may be an early sign)
LV cavity size and systolic function
Systolic anterior motion of the anterior mitral leaflet (rare)
LV diastolic function
LA size
Aortic dimensions
Coarctation
Unfolding of the arch
Aortic valve thickening
Checklist in cocaine<sup> <xref ref-type="bibr" rid="ref18_2">2</xref> </sup>Acute
Wall motion abnormality (myocardial infarction)
Generalised LV hypokinesis (myocarditis)
Aortic dissection
Long-term use
Dilated LV
LV hypertrophy
Evidence of endocarditis
Checklist in HIV<sup> <xref ref-type="bibr" rid="ref18_3">3</xref> </sup>Dilated left ventricle
Pulmonary hypertension
Pericardial effusion
Evidence of endocarditis (increased susceptibility to infection)
Pericardial thickening (e.g. Kaposi sarcoma, non-Hodgkin’s lymphoma)
<target id="page_202" target-type="page">202</target>Echocardiographic abnormalities in neuromuscular disorders<sup> <xref ref-type="bibr" rid="ref18_4">4</xref>,<xref ref-type="bibr" rid="ref18_5">5</xref> </sup>Duchenne’s muscular dystrophy
LV systolic dysfunction (starts inferoposteriorly) Pulmonary hypertension and RV dysfunction (secondary to respiratory failure)
Becker
LV dilatation (starts inferoposteriorly)
Fascioscapulohumeral
Usually no involvement
Myotonic dystrophy
Cardiomyopathy uncommon (may be subclinical minor dysfunction on echo)
Emery–Dreifuss
Cardiomyopathy moderately common
Limb girdle dystrophy
Cardiomyopathy moderately common
Friedreich’s ataxia
LV hypertrophy
Mitochondrial myopathies
MELAS
Moderate risk of HCM
MERRF
Moderate risk of dilated cardiomyopathy or asymmetric septal hypertrophy
Kearns–Sayre
Low risk of dilated myopathy. May be mitral and tricuspid prolapse
<target id="page_203" target-type="page">203</target>Checklist in systemic inflammatory diseases<sup> <xref ref-type="bibr" rid="ref18_6">6</xref>,<xref ref-type="bibr" rid="ref18_7">7</xref> </sup>Systemic lupus erythematosus (SLE)
LV dysfunction secondary to myocarditis
Generalised valve thickening and vegetations (mitral and aortic most commonly affected) with regurgitation (stenosis very rare)
Pulmonary hypertension
Pericardial effusion (tamponade uncommon)
Primary antiphospholipid syndrome
Generalised valve thickening and vegetations (mitral and aortic most commonly affected) with regurgitation (stenosis very rare)
Right-sided thrombus
Pulmonary hypertension
LV dysfunction (secondary to systemic hypertension or coronary disease)
Rheumatoid arthritis
Nodules typically at base of leaflets
Valve thickening commonly focal and mild but may be diffuse
Ankylosing spondylitis
Aortic root dilatation with thickening and fibrosis of the base of the aortic cusps and anterior mitral leaflet
Wegener’s
Aortic valve vegetations with regurgitation
Pericarditis
LV systolic dysfunction
Aortic aneurysms
Churg–Strauss
Myocarditis common
Pericardial effusion
Systemic sclerosis (scleroderma)
Myocardial fibrosis leading to diastolic > systolic LV failure
Pulmonary hypertension and RV failure (secondary to lung fibrosis)
Pericardial effusion (c40%)
Aortic or mitral valve thickening (c10%)
Polymyositis/dermatomyositis
LV diastolic dysfunction (c40%)
Pulmonary hypertension (interstitial lung disease)
Mixed connective tissue disease
Pulmonary hypertension
Sjogren syndrome
Cardiac involvement uncommon
Pulmonary hypertension (secondary to lung involvement)
Behçet’s disease
Myocarditis
RA and RV thrombus
Pulmonary artery aneurysms
Cogan’s disease
Aortic dilatation and aortic regurgitation
Sarcoidosis
Dilated myopathy or regional scarring
Localised nodules
Takayasu’s arteritis
Aortic dilatation with secondary aortic regurgitation
Pulmonary artery dilatation
Pulmonary stenosis
Fistulae between pulmonary artery and coronary or bronchial arteries or aorta
Subclinical myocardial involvement
Giant cell arteritis
Thoracic aortic aneurysm
Polyarteritis nodosa
Dilated cardiomyopathy
Microscopic polyangiitis
Heart failure
Pericarditis
Kawasaki
Myocardial infarction
Myocarditis and pericarditis acutely
<target id="page_204" target-type="page">204</target>Checklist in hypereosinophilia, Loeffler’s endocarditis, endomyocardial fibrosisHyperdense endocardium
LV and RV apical thrombus (Figure 4.2, page 38)
Fibrous attachment of tricuspid and mitral valves
Checklist in drug treatment with cabergoline, pergolide, benfluorexMay affect mitral, aortic or tricuspid valves
Thickening, restriction and regurgitation
First sign may be increased tenting height of the mitral valve
The thickening affects the whole the leaflet
Almost never seen with low dose cabergoline used in microprolactinoma
Checklist in radiation<sup> <xref ref-type="bibr" rid="ref18_9">9</xref> </sup>Valve disease
Thickening of the aortic and mitral valves
Regurgitation more common than stenosis
Incidence 6% 20 years after irradiation
LV dysfunction
Diffuse myocardial fibrosis
Initially systolic dysfunction, later restrictive myopathy
Coronary disease
Regional wall motion abnormalities
Pericardial constriction
Incidence 4–20% depending on dose and concomitant use of chemotherapy
Checklist in Chagas disease<sup> <xref ref-type="bibr" rid="ref18_10">10</xref> </sup>Regional wall motion abnormalities especially posteroinferior (20% asymptomatic but up to 30% with symptoms)
Apical aneurysm (8% in asymptomatic patients but up to 60% in those with breathlessness)
Generalised LV dilatation and hypokinesis in advanced disease
