Echocardiography A Case-Based Review Echocardiography A Case-Based Review Garvan C Kane, MD, PhD Co-Director, Echocardiography Laboratory Consultant , Division of Cardiovascular Diseases Assistant Professor of Medicine Mayo Clinic Rochester, Minnesota Jae K Oh, MD Cardiology Co-Director, Integrated Cardiac Imaging Consultant , Division of Cardiovascular Diseases Professor of Medicine Mayo Clinic Rochester, Minnesota Co-Director, Cardiac and Vascular Center Samsung Medical Center Seoul , South Korea I Wolters Kluwer Lippincott Williams & Wilkins Health Philadelphia • Baltimore • New York • London Buenos Aires • Hong Kong· Sydney • Tokyo Acquisitions Editor: Frances DeStefano Product Manager: Leanne Vandetty Production Manager: Alicia Jackson Senior Manufacturing Manager: Benjamin Rivera Marketing Manager: Kimberly Schonberger Design Coordinator: Holly Reid McLaughlin Production Service: S4Carlisle © 2013 Mayo Foundation for Medical Education and Research All rights reserved This book is protected by copyright No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without writ ten permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright Printed in China 978-1-4511-0961-0 1-4511-0961-X Library of Congress Cataloging-in-Publication Data Kane, Garvan C Echocardiography : a case-based review I authors, Garvan C Kane, Jae K Oh p ; cm Complement to: Echo manual I Jae K Oh, James B Seward, A Jamil Tajik 3rd ed c2006 Includes bibliographical references and index ISBN 978 - -45 1 -096 -0 (alk paper)-ISBN -45 1 -096 -X (alk paper) I Oh, Jae K II Oh, Jae K Echo manual III Title [DNLM: Heart Diseases-ultrasonography-Case Reports Heart Diseases-ultrasonography Examination Questions Echocardiography-methods-Case Reports Echocardiography methods-Examination Questions WG 2] 6 '207543-dc23 20 20 884 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of the information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to as certain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (30 ) 223-2320 International customers should call (30 ) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: at LWWcom Lippincott Williams & Wilkins cus tomer service representatives are available from 8:30 am to pm, EST 10 In memory of Mark J Callahan, MD Pref ace Echocardiography has become an essential diagnostic tool across the spectrum of cardiovascular disease In the era of rapid technology development and the increasing use of other imaging modalities, echocar diography remains the single most useful imaging technique which couples comprehensive hemody namic data with information on cardiac structure and systolic and diastolic function Strain-based imaging now provides sensitive incremental quantitation of myocardial function with 3-dimensional echocardiog raphy allowing real-time views of detailed true cardiac anatomy We have been very gratified by the success of The Echo Manual, currently in its 3rd edition, which has aided the education of physicians and sonographers since its first publication in 994 As its name indi cates, the book is first and foremost a manual to pro vide instruction to the learner on the various aspects of echocardiography and their clinical applications, highlighting the strengths and limitations of the mo dality and providing the reader the necessary steps to accomplish a comprehensive, quantitative diagnostic examination Echocardiography is a dynamic modality and The Echo Manual has not had real-time moving images or actual clinical cases to utilize comprehensive echo cardiographic data including hemodynamic calcula tion In this new case-based echocardiography book, we hope to fill this void, highlighting the importance of interpreting echocardiographic images in the set ting of the clinical scenario This book is designed as a guide for learners in the use of echocardiography data in the evaluation of patients through review of 00 selected cases from the Mayo Clinic with a variety of clinical conditions, both commonly and uncommonly encountered We have placed a particular emphasis on the assessment of systolic and diastolic function and quantitative hemodynamics throughout This book needs to be used in tandem with review of the mov ing images, available through the on-line site We rec ommend each case be reviewed in isolation from start to finish following the order of the case questions In many cases, further echocardiographic images play an important role as the clinical cases develops, whether transesophageal, intracardiac or supplemental or sub sequent transthoracic imaging While we have selected cases that hopefully are useful to the learner, whether new or old to the practice of clinical echocardiogra phy, we have tried to keep the cases true to life Images at times are 'presentation quality' while at other times challenging and we have chosen to portray the cases in a predominantly random order The focus of this book is on the interpretation of the echocardiographic data to provide guidance in the management of the patient While acting as a stand-alone educational tool, this case-book also serves as a companion to The Echo Manual, 3rd Edition Here we provide an answer and explanation to each question asked and we also include the location of a more detailed discussion of the topic in The Echo Manual 3rd Edition We have had and continue to have the good for tune to learn and practice echocardiography with a wonderful team of physicians and sonographers We thank our colleagues for sharing their expertise and interesting cases with us We would like to thank our families, time from whom was taken to help com plete this proj ect Finally we thank our patients for their educational images and we hope that this book will provide the reader with the tools to better diag nose and manage their patients through high quality echocardiography Garvan C Kane ]aeK Oh vii 3 I E C H O C A R D I O G RA P H Y: A C A S E - B A S E D R E V I E W On the basis of the ava i l a b l e Doppler data , the pea k LVOT ve locity of m per secon d at a t i m e when the correspon d i n g peak MR ve locity was m per seco nd suggests the system i c b lood p ressu re is n ot h i g h I n the sett i n g of seve re LVOT obstructi on a n d severe acute M R, the LA p ressu re wo u l d be expected to be ve ry h i g h I n d eed, the meas u red S B P was mm H g i e a ca lcu lated LA p ressu re o f 6- = m m H g S i m i l a r t o t h e method i n t h e a n swer t o , LVS P = (Pea k M R vel)2 LVS P a lso = System i c S B P g d i ent (Pea k MR vel)2 + LA p ress u re = S B P + + + LA p ressu re LVOT pea k LVOT pea k g rad ient (Peak M R vel)2 LVOT pea k g rad ient = S B P - LA p ressu re (8)2 - 4(5)2 = S B P - LA p ressu re - 00 = = S B P - LA p ressu re ANS WER 6: C Altho u g h a septa l red uction p ro ced u re either myecto my or se pta l a b l ation is a con s i d erati o n , this s h o u l d be rese rved for patients who fa i l medical thera py C u rrently the patient is o n two vasod i l ators These were stopped a n d i n t h e i r place a negative i n otro p i c a nti hyperte nsive (,8-blocker) sta rted With i n weeks, the pati ent's sym ptoms h a d e n t i re l y resolved Index Note: Page number followed by 'f' indicate figures A velocity, value for, 207, 209 Abasacal echocardiographic score, 267, 268 Abdominal and lower extremity swelling, 39- , 9/ Abdominal aorta, 9, 9/, 0-1 Doppler assessment of, pulsed wave Doppler signal, 9, 9/, Abdominal aortic velocity, 5, ACE See Angiotensin-converting enzyme (ACE) inhibition Acoustic shadowing artifact, 296 Acute aortic regurgitation, 38 Acute infarction left anterior descending coronary artery (LAD) , in distribution of, 3, Acute myocardial infarction, 232 Acute pleuritic chest pain and lightheadedness, 99- 02, 99- 00/, 1/ Acute pulmonary embolism, 46, 47 Acute severe dyspnea, 25/ diagnosis, 25, 27 diagnostic coronary angiography, 25, 27 emergent mitral valve repair, with long-term outcomes, 26, 27 intravenous phenylephrine and increasing intravascular volume, 26, 27 mitral valve, flail scallop of, 25, 27 surgical manipulation of heart, 26, 27 transesophageal echocardiography and, 25, 27 Acute severe retrosternal chest discomfort, 03-1 05, 03/ agitated saline contrast study, 04, cardiac index, 04, 05 management, 04, pathology, 04 Agitated saline, 05, 3, 238 administration of, 1 , 303, 305, 320, 322 contrast study, 04, 05 AIDS, 299 Akinesis, 5, 6, 254 ALCAPA See Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) Aliasing velocity, 78, 78/, 80 a-galactosidase A gene, 8 Amniotic fluid embolus, 1 Amyl nitrite, 56, 56-1 57/, 59 Anemia, iron-deficiency, 9, 220 Angina, severe, 1 9- 20 Angiotensin-converting enzyme (ACE) inhibition, 1 5, 1 Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) , 238 in infancy, 237, 238 Anterior ischemia, 44, 145, 45/ Anterior leaflet prolapse, with severe mitral valve regurgitation (MR), 40, Anterior mitral valve leaflet prolapse, with flail middle scallop, 39/, 40, Antibiotic prophylaxis, fo r dental procedures, 220 Antimicrobial therapy, reinstitution of, 98, 99 Antineutrophilic cytoplasmic antibodies, 49 Antithrombotic therapy, 73, 74 Aortic coarctation, 5, 6, 263, 265 Aortic dissection, 9, 1 Aortic stenosis, 89, 90 peak velocity of, 46, 48 Aortic systolic blood pressures, 2, Aortic valve (AV) effective regurgitant orifice (ERO) of, 227, 229 factors with, 9, findings, potential explanations for, 76, 77 mitral valves and, 222, 224 opening status, 50, 0/, pathology of, 227, 228, 227-228/ Aortic valve area (AVA) , 7, 8, 43, 45, 60, , 77 calculation of, 7, 8, 66-67/, 67, 69, 88, 90, 46-1 47, 46/, 148 maximal velocity from, 88, 90 mean reduction in, 89, 90 replacement of, 89, 90 Aortic valve cusp, , 1/, 33 Aortic valve diastolic pressure halftime, 43, 45 Aortic valve endocarditis, 60, Aortic valve pressure gradients, Doppler-derived and catheter derived, 7, Aortic valve prosthesis orifice area, calculation of, 324, 326 Aortic valve regurgitation, , 32, 203, 204 degree of, 228, 229 moderate-severe, 39, 40 severe, 222, 224, 262-263/, 262, 265, 270, 270/, 27 , 272 Aortic valve replacement, 60, after diagnostic coronary angiography, 68, 68/, 69, 69/ urgent, 60, Aortic valve sclerosis with trivial stenosis, 82, 82/, 83 Aortic valve stenosis, symptoms and signs of, 7, Aortic valve vegetation, 99 Apical flow, Apical hypertrophic cardiomyopathy, 1 0, 1 0-1 1/, 1 Apical impulse, laterally displaced, 29 1-293, 29 1/ Apical three- or five-chamber view inferobasal septum, 5, Apical variant of hypertrophic cardiomyopathy, 79, 80, Ascending thoracic aorta, 252-253, 252/, 254, 254-255/ Ascites, cause for, 52, 54 ASDs See Atrial septa! defects (ASDs) Aspirin, 275, 283, 284 antithrombotic therapy, 73, 17 Asthma, 48, 49 Atherosclerotic plaque in thoracic aorta, 2, Atrial fibrillation, 80, , 282, 284 See also Symptomatic paroxysmal atrial fibrillation Atrial flow reversal velocity, 75 Atrial flutter, 207, 209 exertional shortness of breath with, 6-3 8, 6-3 7/ 337 3 I I N D EX Atrial myxoma, , 92, 93, 92-1 93/ Atrial septal aneurysms, 3, 278, 279 Atrial septal defects (ASDs) , 28-29, 30, 292, 293 caval flow verses transseptal flow, 30 sinus venosus defects in, 30 Atropine administration of, 261 use in dobutamine stress echocardiography, 230, 232 ventricular dysrhythmia, 232 Atypical chest discomfort, 39- , 9/ See also Chest pain, atypical Austin Flint murmur, 87 AV See Aortic valve (AV) AVA See Aortic valve area (AVA) Back pain, fever and, 98-1 99, 99/ Balloon valvuloplasty, 224-225 Benign primary cardiac tumor, 294295, 295/, 296 Bernoulli equation, 4, 6, 4, ,8-adrenoceptor antagonism, 1 5, 1 ,8-blockers, 20, 59, 230, 232, 336 ,8-blocker therapy, 302, 304 ,8-lactam and aminoglycoside, combination antibiotic therapy with, 60, ,8-myosin heavy chain defects in gene encoding, 302, 304 Bicuspid aortic valve disease, 9, 1 , 292, 293 coarctation of aorta, 20, configuration of, endocarditis prophylaxis and, 9, Bilateral lower extremity edema, 78-80 Bioprosthesis, thrombotic obstruction of, 72-1 73, 72/, 74 Bioprosthetic thrombosis, prevention of, 283, 284 Biplane area-length method, 1 , 1 Blood cyst, , 1/, 62 BrockenbroughBraunwald-Morrow sign, Bromocriptine, 1 5, 1 Bronchogenic cysts, 292, 293 Brugada syndrome, 304 Cabergoline, 140 Carbonated beverage, 73, 74 Cardiac amyloidosis, 128 Cardiac arrest, 42-1 43, 143/ Cardiac defibrillator, implantation with, 5, Cardiac fibromas, 42, 143 Cardiac hemangiomas, 296 Cardiac hemodynamic catheterization with dobutamine infusion, 68, 69 Cardiac index, 04, 05 , 1 , 1 7, 320, 322 Cardiac murmur etiology of, 46, 47 during pregnancy, 46-47 Cardiac output (CO) , 46, 148, 83, 6, 329, 330 calculation of, 4, 6, 227, 228, 294, 294/, 296 Doppler-derived, 23, 23f, 24, , l f, 22, , 36, 50, , 208, 209, 246, 247, 27 , 272 limiting factor in, 50, stroke volume (SV) and, Cardiac sarcoidosis, 88 Cardiac tamponade hepatic veins of, 302/, 302, 304 rwo-dimensional (2D) echocardiographic finding for, 63, 64 Cardiac troponin T, 24, 26 genetic defects in, 302, 304 Cardiac vegetation, 89, 90 Cardiomyopathy, dilated, 244-247, 244-245/, 246/ Carney syndrome, 92, 94 Carotid disease, 82-1 83 Catecholamines, 200, 20 , 232 Catheter-derived aortic valve pressure gradients, 7, Catheterization, 06, 07 Chamber compression, 263, 265 Chest pain, 297-299, 297-298/ atypical, 240-242, 240/, 242/ and ECG changes, 4-2 cardiac defibrillator, implantation with, 5, diastolic function, 5, Doppler derived stroke volume, 5, echocardiogram, 214-2 5, 214-2 5/ echocardiographic parameters, 5, 6, 5/ further testing, 5, myocardium proportion, 5, exertional, 44-145, 145/ retrosternal See Retrosternal chest pain severe See Severe chest pain sharp, 1- 94, 1-1 92/, 92-1 93/ Chest tightness and dyspnea, 1 0-1 , 1 0-1 2/, 1 3/ Chronic cardiomyopathy, 1 Chronic obstructive lung disease, 54 Chronic thromboembolic pulmonary hypertension, 1 , 329, 330 Churg-Strauss syndrome, 48, 49, 40 Class III exertional shortness of breath without angina, 94-97, 94-96/, 97/ Class III shortness of breath, 22 1-225, 22 1-222/, 225/ CO See Cardiac output (CO) Coarctation of aorta, , 203, 204 Colchicine and indomethacin, combination of, 287, 288 Cold left foot, 2-2 , 2/ Colon cancer, 325, 326 Color Doppler imaging, 86 Color map, zero baseline for, 266, 268 Computed tomography (CT) scan, 237, 238, 238/, 286-287, 287/, 288 of chest, , 1/, 83 Congenital absence of pericardium, 29 1/, 292, 293 Congenital aortic valve stenosis pathology, 76, 77 status post replacement, 75-1 78, 75-1 76/ Congenital pulmonary valve stenosis, 64, 65 Constriction, 52, 54 diagnosis, Doppler profiles with right heart failure, 52-53, 5 pericardial thickening in, 52, 55 Constrictive pericarditis, 54, 5 , 56-58, 56-57/ diagnosis, 57, finding in, 5-86, 86/, physical examination findings for, 86, 87 Continuous wave Doppler echocardiography, 56/, 57 Continuous wave Doppler interrogation, 83 across ventricular septal defect, 07, 32 Continuous wave Doppler signal, 14, 8, 48 evidence of, 86 right ventricular outflow tract, 86 Contractile reserve, definition of, 68, 70 Coronary aneurysm, complications of, 263, 265 Coronary angiography, 7, 8, 06, 07, , 22, 47, 148, 54, 5 , 65, 66 Coronary artery, 94, 97, 230, 232 grafting of, 78-80, 78-79/ left main, 89, 89/, 90 Coronary artery atherosclerosis, 1 9, 20 Coronary artery spasm, 200, 20 Coronary sinus, 34, 36 dilatation of, 54, 5 Coronary-ventricular fistula, Corticosteroid therapy, immunosuppression with, 99 Cor triatriatum, , 93 Cross-sectional area (CSA), 83 CSA See Cross-sectional area (CSA) CT scan See Computed tomography (CT) scan Cusps, right and left, 9, 9/, I N D EX I 3 DC cardioversion, 235, 235/, 236 DeBakey rype III aortic dissection, 98, 99 Descending thoracic aorta, 0, 0/, 1 , 1/, 2, Desmin gene mutations, 302, 304 Diabetes mellitus, progressive exertional shortness of breath with, 87-1 88, 88/ Diabetic nephropathy, 273-275, 273/, 274/ Diastolic and systolic murmurs, 262, 262-263/ Diastolic dysfunction grade of, 8-9, 8/, for heart failure, 84, 87 mitral inflow pattern, 260, 261 Diastolic filling, restrictive, 5, Diastolic flow reversal, 1/, 5 abdominal aortic velociry, consistent with constriction, 5 i n constrictive pericarditis, 5-86, 87 in descending aorta, 39, 40 in hepatic vein, 257, 258 severe aortic valve regurgitation, 272 Diastolic function, 73, 74 assessment of, 286, 288 chest pain and ECG changes, 5, grade, 200, 200/, 20 myocardial infarction, 23, 23/, 24 mildly abnormal, 65, 66 moderate to severely abnormal, 27, 29 myocardial relaxation and, 207, 209 normal, 308, 309 progressive NYHA class III dyspnea, 67, 69 severely abnormal, 1 , 1 Diastolic mitral valve regurgitation, 76, 76/, 77-1 78 Diastolic retrograde flow, 140 Diastolic reversal flow time velociry integral (TVI) , 5, Diffuse ST-segment depression, 200-20 , 200/ Dilated cardiomyopathy, 244-247, 244-245/, 246/ Dissection, concomitant risk of, Dobutamine, Dobutamine-atropine stress echocardiography, 259, 261 Dobutamine infusion cardiac hemodynamic catheterization with, 68, 69 indications for cessation of, 230, 232 Dobutamine stress echocardiography, 08-1 09, 09/, 230, 232, 273, 275 atropine use in, 230, 232 evidence, 230, 232 nonsustained ventricular tachycardia, 232 Doppler-derived aortic valve area, 43, 45, 66-67/, 67, 69 Doppler-derived aortic valve pressure gradients, 7, Doppler-derived cardiac output (CO) , 23, 23/, 24, , 1/, 22, , 36, 50, , 208, 209, 246, 247, 27 , 272 Doppler-derived left ventricular cardiac index, 1 5, 1 Doppler-derived left ventricular stroke volume (SV), 67, 69, 5, Doppler findings constellation of, 258 and echo two-dimensional, 82, 82/, 83, 82, 82/, 83 moderate-severe aortic valve regurgitation, 39, 140 pulmonary artery end-diastolic pressure, 57, Doppler flow, 79-1 80, 80/, Doppler profiles, with right heart failure constriction diagnosis, 52-53, 5 Doppler stress echocardiography, 57, 59 Dyskinesis, 254 Dyspnea, 50, 1- 22 See also Progressive dyspnea and asymmetrical ground-glass pulmonary infiltrates, 70-1 4, 70- 1/, 72/ transesophageal echocardiograrn, 72, 74 and chest tightness, 1 0-1 3, 1 0-1 2/, 1 3/ and fever with history of severe pancreatitis, 289, 289/, 290 intermittent with modest exertion, 230-232 with modest exertion diastolic function, 65 , 66 etiology for, 65 , 66 and orthopnea, 34-36, 34-35/ palpitations and, 207-209, 207/, 208/ and presyncope, 46- 48, 46/, 47/ progressive exertional shortness of breath after, 84-1 86, 84-1 5/ Dysrhythmia etiology of, 42, 43 treatment of, 42, 43, 143/ Dyssynchrony of myocardial relaxation, 79-1 80, 80/, Early diastolic medial annular peak tissue velociry (e') , 52, 54 Ebstein anomaly, , 62, 62/ Echo contrast administration, 298, 299 Echo two-dimensional findings moderate-severe aortic valve regurgitation, 39, 140 ECM catheter, 46 redrawing, 46, 47 EF See Ejection fraction (EF) Effective regurgitant orifice (ERO) , 32, 33, 76, 77, 78, 80, 50, , 52-1 54, 5, 68, 69, 86, 234, 236, 250, 25 , 265, 330 of aortic valve, 43, 45, 227, 229 calculation of, 40, , 274, 275, 277, 279, 282, 284 formula for, 78, 80 of mitral valve, 95 , 97 Eisenmenger syndrome, 9, 220 Ejection fraction (EF), Elevated right ventricular (RV) enddiastolic pressures, 85 , 85/, 86 Emergency cardiac surgery, 65 , 66 Emotional stress, 1 9, 20 End-diastolic velociry of pulmonary regurgitation (PR) , Endocarditis, 272, 275 Endocarditis prophylaxis, 9, 220 Endomyocardial biopsy, , 22 Endothelin receptor antagonists, 220 Enlarged coronary sinus, cause of, 54, 5 Enterococcus, 78 Epstein-Barr virus, 299 Ergotamine, for migraine headaches, 39, 140 ERO See Effective regurgitant orifice (ERO) Eustachian valve, 0, 1 Exercise stress echocardiography anterior ischemia and, 44, 145, 145/ severe ischemia on, 44, 145 Exertional chest pain, 44-145, 145/ Exertional dyspnea, 14, 14-1 5/ Doppler-derived left ventricular cardiac index, 1 5, 1 etiology for clinical and echocardiographic findings, 1 5, 17 left atrial (LA) volume index, 1 5, 17 left ventricular ejection fraction (LVEF) , calculation of, 1 , 1 management, 1 5, 1 progressive, 248-25 , 248/, 249/, 250/ repeat transthoracic echocardiography, 1 6, 1 6/, 1 with systemic hypertension, 332, 332-334/ clinical findings, 334, 334/, 335-336 340 I I N D EX Exertional dyspnea (continued) diagnosing, 334, 335 echocardiography evidence, 332334, 332-333/ left atrial (LA) pressure, 334, 335 management strategy, 334, 336 pulmonary vein profile, 332/, 334, 335 Exertional fatigue, 1- 22, 1/, 270-272 Exertional shortness of breath, 42-45, 42-43/, 78-80, 79-1 , 79-1 80/, 234-236, 234-235/, -284, 28 1/, 282/, 283/ See also Progressive exertional shortness of breath and chest pain, 327-33 , 327-328/, 33 1/ with episode of atrial flutter, 6-3 8, 6-3 7/ with history of lymphoma, 256-258, 256-257/ and lower extremity edema, 28-30, 28/ atrial septal defects (ASDs) and, 28-29, 30 evidence, 28, 28/, 30 mean pulmonary artery pressure (MPAP) , 28, 30 with no medical history, 33, 33-1 3'if 5-1 36, 5/ after transesophageal echocardiography, 35 , 36 slowly progressive, 266-269, 266-267/ Eisenmenger syndrome and, 9, 220 endocarditis prophylaxis, 9, 220 examination, unexpected finding on, 8, 8/, 220 pulmonary artery (PA) end diastolic pressure, estimation of, 8, 220 right ventricular longitudinal contractility, 8/, 9, 220 right ventricular systolic pressure, estimation of, 9, 220 risk of, 9, 220 with systolic blood pressure, 8-220, 8/ Fabry disease, 88 Fainting episode, soft systolic murmur after, 300-305, 300-302/, 304/ Fatigue, 67-1 69 Fat, pericardial, 37, 37/, 38 Femoral pulses, Fenfluramine and dexfenfluramine, 140 "Fen-Phen," 140 Fever, 67-1 69 and back pain, 98-1 99, 99/ on examination, 98-1 99 treatment undergone, and dyspnea, with history o f severe pancreatitis, 289, 289/, 290 Fibrinolytic therapy, in pulmonary embolism, 1 Flow rate, 83 Foramen ovale patent, 2, Functional class III exertional dyspnea, 202/ associated lesions, 203, 204 diagnosis, 202, 204 instantaneous maximum gradient, 202, 204 management, 203, 204 Functional class III shortness of breath, 282, 282-283/ Functional ventricular chamber, 1 Hammock valve See Mitral valve (MV) arcade Harsh pansystolic murmur, 307, 309 Harsh systolic murmurs, 9-6 , 59/, 60/, 63-65, 63-64/, 334, 334/, 335 acute management, 64, 65 echocardiogram of, 9-60/ echocardiographic images, 60, management, , obtaining transesophageal echocardiography, 60, HCM See Hypertrophic cardiomyopathy (HCM) Headache, 9, 220 Heart failure, 84-87, 84-86/, 80, 181 etiology for, 84, 87 Heart Mate II, Heart murmur, 6- , 6- 7/ Hematuria with large renal mass, 88-90, 88/ etiology for, 89, 89/, 90 Hemochromatosis, 22 testing for, , 22 Hemodynamic cardiac catheterization, transesophageal echocardiogram of, Hepatic carcinoid metastases with patent foramen ovale, 39, 40- Hepatic vein of cardiac tamponade, 302-303, 303/, 304-305 diastolic flow reversal in, 257, 258 dilation of, 63, 64 Doppler pattern, 37, 37/, 38, 8/, 329, 330 Doppler with respirometer, 56/, 57, flow patterns, explanation for, 249, 249/, 250/, 25 Hepatopulmonary syndrome, 322 Hereditary hemorrhagic telangiectasia, 50-5 1/, 52, 54 HIV infection, 22 "Hockey-stick'' appearance, 5, 268, 284, Holodiastolic flow reversals, in descending thoracic aorta, 263, 265 Hydrochlorothiazide, 332 Hyperlipidemia, 44, 82-1 83 Hypertension, 82-1 83 treatment for, 37, 38 Hypertensive heart disease, 334, 335 Hypertrophic cardiomyopathy (HCM) , 3, 56, 59, 79, , 304 complications associated with, 80, with gene defect, 304 sudden cardiac death risk stratification, Hypertrophic obstructive cardiomyopathy, 4- Hypokinesis, 254 Hypotension, 09 with exercise, for severe coronary disease, 44, 45 treatment strategies for, 1 9, 120 Idiopathic dilated cardiomyopathy, 22 Immunosuppression, 1 Indeterminate left ventricular filling, 286, 288 Indomethacin and colchicine, combination of, 287, 288 Infective endocarditis, 76, 77, 9, 220, 325, 326 embolic complication of, 89, 90, 274, 275 predisposes to, 89, 90 Inferior and lateral ischemia, 08, 09, 09/ Inferobasal septum, 5, Inflow cannula systolic velocity profile, 50, 50/, Inhaled prostacyclin analogs, 220 Instantaneous maximum gradient, 202, 204 Interventricular dependence, 85, 5/, 87 Intra-aortic balloon pump, 27, 77 and surgical consultation, 06, 07 Intra-atrial septum, Intracardiac right-left shunt, 04, 05 Intracardiac thrombus, 24, 26 Intraoperative transesophageal echocardiography, 77-1 78 I N D EX I Intrapulmonary shunt, 320, 322 echocardiographic evidence of, 52, 54 in patients with cirrhosis, 32 , 322 Intravenous fluid and inotrope administration, 04, 05 Intravenous phenylephrine, 1 2, 1 3, 1 3/ and increasing intravascular volume, 26, 27 Intravenous thrombolytic therapy, 283, 284 Iron-deficiency anemia, 9, 220 Iron studies, , 22 Ischemia, 263, 265 without echocardiographic evidence of, 273, 275 Ischemic cardiomyopathy, 237, 238 Isosorbide mononitrite, 208, 209 Kussmaul sign, 330 LAA See Left atrial appendage ( LAA) Lambl excrescences, 242 Lateral wall ischemia, 230, 232 Left anterior descending coronary artery acute infarction in, 4-2 5, 4-2 5/, wall motion abnormalities in, 44, 45 Left atrial ablation procedure, , 83 Left atrial appendage ( LAA) , 253, 253/, 255, 288 flow velocities, 235, 236 Left atrial hypertension, 28, 29 Left atrial index, 286, 288 Left atrial pressure, 334, 335 normal, , 1/, 83 Left atrial radiofrequency ablation, 286, 286/, 288 Left atrial systolic strain assessment, 288 Left atrial thrombus, 267 Left atrial volume, 4, calculation of, 286, 288 index, 1 5, 1 Left atrioventricular (AV) groove, round structure in, 34, 36 Left coronary cusp, , 33 Left heart failure, recurrent episodes of, 276-280, 276/, 277/, 279/ Left inferior pulmonary vein, 35, 36 Left main coronary artery, 89, 89/, 90 Left pleural effusion, 276, 279 Left ventricular (LV) aneurysm, 23, 24 Left ventricular assist device, 50, Left ventricular cardiac index, Doppler-derived, 1 5, 1 Left ventricular cardiomyopathy, 57, 58 Left ventricular diastolic filling pressure, 67, 68 on mitral inflow, 63, 64 Left ventricular diastolic function, 1-92, 1-92/, 93, 257, 258 Left ventricular dilation, 145, 308, 309 Left ventricular dimensions, measurement of, 7, 7f, Left ventricular ejection fraction (LVEF) , 4, 6, 0, 24, 46, 47, 63, 64, 95, 97, 208, 209, 5, 6, 245, 247, 282, 284 calculation of, 1 5, 1 7, 24 , 242, 252, 252/, 254 estimation of, 0, 1 at rest, 273, 273/, 275 two-dimensional, M-mode, 275 Left ventricular end-diastolic dimensions (LVEDD) , 254 Left ventricular end-diastolic pressure (LVEDP) , 43, 45 Left ventricular end-systolic dimensions (LVESD), 254 Left ventricular filling pressures assessment of, 286, 288 increase of, 34-35, 34-35/, 36 normal, 50, patient's dyspnea cause and, 95-96, 97, 97/ severely elevated, 23, Left ventricular fractional shortening (FS), calculation of, 67-1 68, 67/, 69 Left ventricular function, 48, 49 wall motion abnormalities and, 48, 49 Left ventricular hypertrophy, 88, 203, 204 Left ventricular opacification, 44, 145 Left ventricular outflow tract (LVOT) to AoV TVI ratio (LVOT:AoV TVI) , 7, cardiac output of, 227, 228 diameter, 294, 296 gradient, 13, 3/, 14 obstruction, 14, 5, 89, 90 signal, time velocity integral (TVI) o f, 46, 47, 88, 90 Left ventricular stroke volume (SV), 82, 82/, 83 Left ventricular systolic function, 69, 208, 208/, 209 Left ventricular systolic pressure, Left ventricular wall segment, 2, 2/, Leiomyosarcoma, 298, 299 Libman-Sacks endocarditis, 97 Lightheadedness and severe fatigue, 06-1 07, 06/, 07/ Lipomatous tissue, Lisinopril, 332 Lithium, 40 Liver function test abnormalities, 50-5 5, 50-5 1/, 52-53/ Longitudinal right ventricular contractility, 5, Loud systolic murmur, 30-1 32, 30/, 1/, 8, 220 Lower extremity edema, 234-236, 234-235/, 270-272 progressive exertional fatigue and, 1- 62, 1/, 62/ Lupus anticoagulant, 96, 97 LVEDD See Left ventricular end diastolic dimensions (LVEDD) LVEF See Left ventricular ejection fraction (LVEF) Lymphoma, exertional shortness of breath with, 256-258, 256-257/ Malaise, 67-1 69 Malignant tumors, 298, 299 Maximal instantaneous intracavitatory gradient, calculation of, 12, Maximum instantaneous gradient, 202, 204 Maximum instantaneous systolic gradient across pulmonary valve, 64, 65 Mean pulmonary artery pressure (mPAP), 28, 30, 72, 74 Mechanical index, 08, 09, 44, 145 Medial mitral annulus, tissue Doppler velocity of, 75, 75/, 77 Medications, for palpitations and dyspnea, 208, 209 Membranous ventricular septal defect (VSD), , 1/, 32, 306, 309 Mesothelioma, 299 Metastatic carcinoma, 205, 205/, 206 Methicillin-sensi tive Staphylococcus aureus, 89, 90 Metoprolol succinate, 56 Microvascular dysfunction, 200, 20 Mid inferior wall left ventricular wall segment, 2, 2/, Midsystole, 32, 33 Migraine headaches, ergotamine for, 39, 40 Mild aortic regurgitation, 43, 45 Mild-moderate stenosis, 15 342 I I N D EX Mitral and aortic valves, pathology affecting, 222, 224 Mitral and tricuspid valve replacements, 54, 5 Mitral annular early diastolic velocities (e') , 52, 54 Mitral annulus diameter, 2, Mitral annulus dilation, with secondary regurgitation, 235, 236 Mitral annulus early diastolic velocity, in constriction, 86, 87 Mitral annulus velocity, 57, 57/, 58 Mitral balloon valvuloplasty, outcome of, 267, 268, 269t Mitral bioprosthesis, pressure halftime of, 72, 74, 248, 248/, 25 Mitral effective regurgitant orifice (ERO) area, 234, 234/, 236 Mitral inflow, 56/, 57, 58, 75, 75/, 77 A wave duration for, 75, 76/, 77 color M-mode of, 97 deceleration time (OT) of, 84-85, 87 pattern of, 8/, 0, 74, 259, 259/, 261 respiratory variation in, pattern of, 1/, 52, 54, 63, 64 restrictive, 97 stroke volume, calculation of, 247 Mitral lateral annulus e' velocity, 67, 69 Mitral prosthesis effect orifice area, calculation of, 324, 326 flow velocities for, 72, 17 surgical re-replacement of, 250, 25 ventricular aspect of, 325, 326 Mitral regurgitant volume, 33, 247 Mitral regurgitation, severity of, 34, , 76, 77 Mitral stenosis assessing degree of, 266, 268 pulsed wave Doppler and, 39/, 40, severe, 267, 269 Mitral tissue prosthesis, 282, 284 Mitral valve (MV) 30 image of, 266, 268 anterior leaflet prolapse with severe mitral valve regurgitation (MR) , 40, effective regurgitant orifice (ERO) area of, 95, 97 Mitral valve arcade, 2, Mitral valve area (MVA) , 266-267, 266-267/, 268, 269 by continuity equation on, 223, 224 by pressure half-time (PHT) method, 223, 224 Mitral valve disease, mechanism of, 282, 284 Mitral valve endocarditis, 96, 97 Mitral valve leaflets flail scallop of, 25, 27 scallops of, 24 , 242, 242f Mitral valve pathology, 76, 77 diagnosis of, , 33 Mitral valve periprosthetic regurgitation, location of, 264, 265 Mitral valve pressure halftime (PHT) , 267, 268 Mitral valve prolapse, , 33, 236 Mitral valve prosthesis, 324, 324-325/, 326 Doppler interrogation of, 282, 283/, 284 Mitral valve prosthesis area, 79, 79/, 80, 92, 94 Mitral valve prosthetic gradient, 72-1 73, 72/, 74, 277, 279 Mitral valve prosthetic regurgitation, 248, 25 Mitral valve regurgitant fraction, calculation of, 246, 247 Mitral valve regurgitation (MR) , 89, 90, 237, 238 degree of, severe, 96, 97, 249, 25 mechanism of, 234, 234-235/, 236 moderate-severe, 32, 33 quantification of, 2, regurgitant volume of, 96, 97 severe, 34, 36, 262, 265, 4, 325, 326 volume, 67-1 68, 67-1 68/, 69, 3, 3/, 4-3 Mitral valve stenosis, severe, 223, 224 Mitral valve surgery, referral for, 40, Mitral valve tenting area, 34, 36 M-mode echocardiogram, 85, 85/, 87 M-mode echocardiography, of left atrial myxoma, 1- 92, 92/, 93 M-mode recordings showing pulmonary hypertension, , 36 M-mode tracing, of hypertrophic cardiomyopathy, 57-1 8, 57/, 59 Mobile structure in right atrium, 0, 1 Monomorphic ventricular tachycardia, after cardiac arrest, 42-1 43, 43f Montelukast, 40 Motor function transient loss of, in right upper extremity, 0-2 1 , 21 lf Murmur, 270-272, 306-309, 306-307f asmptomatic, 226-229, 226-227/, 228-228f intervention, 308, 309 in adulthood, 237, 238 computed tomography scan, 237, 238, 238f in infancy, 237, 238 management, 237, 238 on routine physical examination, 237-238, 238! physical examination findings in, 307, 309 with regular exercise, 226-229, 226-227/, 227-228f with systemic hypertension, 205-206 etiology of, 205, 205/, 206 Muscular ventricular septal defect, 30, 32 Myocardial echo contrast intravenous infusion, 246, 247 Myocardial infarction, 80, complications, 23, 24 diastolic function grade, 23, 23/, 24 Doppler-derived cardiac output (CO) , 23, 23/, 24 extent of, 5, management, 23, 24 prognostic factors, 23, 24 Myocardial ischemia, 97 dobutamine stress echocardiography, 08, 09 Myocardial relaxation, 54, 207, 209 dyssynchrony of, 79-1 80, 80/, Myocardial thickness, 5, Myocardium, stunned, Myxomas, 93, 206, 242 Carney syndrome with, 92, 94 symptoms of, 92, 94 Myxomatous mitral valve disease with flail segment, 25, 27 Nafcillin, 90 Near-field clutter artifact, 295, 295/, 296, 296f Nephropathy, diabetic, 273-275, 273/, 274f Noise artifact, 295, 295/, 296, 296f Noncoronary cusp to right atrium, 79, 79/, 80 Normal images and values, 1-6, 1-'if Normal left ventricular (LV) myocardial relaxation property, 4, Normal mitral prosthetic function, 277, 279 NT-pro-BNP, 24, 26 NYHA functional class III, 2- , 2- 3f Omeprazole, 40 Osler-Weber-Rendu syndrome, 94 See also Hereditary hemorrhagic telangiectasia Oxygen saturation samples, 06, 07 I N D EX I 343 Palpitations and dyspnea, 207-209, 207/, 208/ A velocity, value for, 207, 209 diastolic function, 207 E/e' ratio, 207, 209 left ventricular systolic function, 208, 208/ medications, 208, 209 Pancreatitis, severe, 289, 289/ Pansystolic murmur, harsh, 307, 309 Papillary fibroelastoma (PFE) , 89, 89/, 90, 206, 240, 242 Papillary muscle rupture, 76, 77, 23 , 232 Paraganglioma, 265 Parasternal long-axis imaging, 74, 37, 37/, 38, 56, 59 Patent ductus arteriosus (PDA), 63/, 64, 65, 39, 40, Patent foramen ovale (PFO) , , , 28, 29, 2, with bidirectional flow, 87, 88, 88/ and higher risk of stroke, 2, 3, 278, 279 with left-right shunt, 98, 99, 99/ PDE5 inhibitors, 220 Peak left ventricular systolic pressure, 1 9, 20 Peak transaortic pressure gradient, 7, Peak tricuspid regurgitant (TR)/ right ventricular outflow tract time velocity integral (RVOT TVl) , in patients with cirrhosis, 32 , 322 Peak velocity of aortic stenosis, 46, 148 from continuous wave Doppler interrogation, 07 mitral early filling, 69 across pulmonary valve, 65 versus time velocity integral, across ventricular septal defect, 32 Pergolide, 140 Pericardial cyst, 263-264, 265 Pericardial effusion, 64 Pericardial fat, 37, 37/, Pericardial fluid, laboratory findings on, 303, 305 Pericardial thickening, in constriction, 52, 5 Pericardial tumors, 298, 299 Pericarditis, constrictive, 56-5 8, 56-57/ Pericardium, congenital absence of, 29 1/, 292, 293 Peripartum cardiomyopathy, 1 Peripheral edema, 52, 52-1 54/, 54-1 5 Peripheral neuropathy, 48-49 Periprosthetic leak, location of, 277, 279 Perivalvular leak, percutaneous repair of, 278, 280, 279/ Phenylephrine, 37, 38 infusion of, 1 Pheochromocytoma, 1 9, 20, 20 , 206 Pleural effusion, 265 Portopulmonary hypertension, 322 Posterior mitral leaflet perforation, 274, 275 Posterior mitral valve leaflet echocardiographic evidence of vegetation on, 274, 275 Post mitral and aortic valve replacements with tissue prostheses with exertional dyspnea, 323-326, 323-325/ Postmyocardial infarction rupture, of ventricular septum, 06, 07 Postviral myocarditis, 22 Precordial T wave inversion, 300-302, 304 Pregnancy, cardiac murmur during, 46-47 Pressure half-time method, 94 Presyncope and dyspnea, 46-148, 46/, 47/ Primary amyloidosis, 87, 88 versus senile cardiac amyloidosis, 28, 29 Primary biliary cirrhosis, 9-322, 9-320/ Primary pulmonary hypertension, 47 Primary ventricular tachydysrhythmia, , 62 Progressive dyspnea, 48-49, 75-77, 75-76/ etiology for, 76, 77 treatment of, 76, 77 Progressive exertional dyspnea, 27-1 29, 27-128/, 29/, 39-1 , 39/, 52, 52-1 54/, 54-1 5, 248-25 , 248/, 249/, 250/ Progressive exertional fatigue and lower extremity edema examination, , 62 pathology, , 62, 62/ secondary finding, , 1/, 62 Progressive exertional shortness of breath, 2-1 5, 2- 3/ with diabetes and systemic hypertension, 87-1 88, 88/ and lower extremity edema, 63-1 64 clinical findings in, 63, 64 after onset of dyspnea, 84-1 86, 84-1 85/ three month history of, 23-1 26, 23/, 24/ Progressive fatigue and marked lower extremity edema, 37- , 37/, 8/ Progressive NYHA class III dyspnea, 66-70, 66-67/, 68/, 69/ Progressive NYHA class II-III exertional dyspnea and palpitations, 56-1 59, 56-1 57/, 59/ Prostaglandin infusion, 64, 65 Prosthetic function orifice area, 74, 77 Proximal isovelocity surface area (PISA) method, , 78, 78-79/, 80 aliasing velocity, 40 ERO calculation, 40, optimal timing fo r measurement of, 32, 33 radius of, 68, 69, 95 , 97 regurgitant volume calculation, 40, Pseudonormalized diastolic dysfunction, diagnosis of, 95, 97 Pulmonary arterial flow, 48, 48/, 49 Pulmonary arterial pressures, 329, 330-33 Pulmonary artery (PA) capacitance, 73, 74, 329, 33 Pulmonary artery catheter, 25, 27 Pulmonary artery diastolic pressure (PADP) , 246, 247, 309, 330-33 estimation of, 8, 8/, 0, 73, 74 Pulmonary artery end-diastolic pressure (PAEDP) , 57, 58, 294, 294/, 296 estimation of, 8, 220 Pulmonary artery pressures, , 36 hemodynamic measures of, 63, 64 Pulmonary artery systolic pressure (PASP) , 56/, 57, 58, 246, 247, 330-33 estimation of, 8, 8/, 0, 73, 74 Pulmonary balloon valvuloplasty, 64, 65 Pulmonary disease, 65, 66 Pulmonary embolism, transthoracic echocardiography of, 00, 1 Pulmonary hypertension, , 32, , 36, 309, 320, 322, 329, 330 Pulmonary regurgitation (PR) velocity, 56/, 57, Pulmonary valve, maximum instantaneous systolic gradient across, 64, 65 Pulmonary valve regurgitation, severe, 85 , 86 Pulmonary valve stenosis, 205, 206 signs of severe, 64, 65 44 I I N D E X Pulmonary vascular (PY) capacitance, 33 Pulmonary vasodilators, 9, 220 Pulmonary vein Doppler interrogation of, 8/, Doppler recording, , pattern, 29 1-292, 29 1/, 293 profile, 332/, 334, 335 Pulmonary vein flow, 256/, 258 pulsed wave Doppler assessment £ 39/, 40, 41 Pulmonary vein pulsed wave Doppler interrogation, 2, 2/, Pulmonary vein stenosis Doppler findings with, 82, 82/, 83 symptoms of, 83 Pulmonary venous drainage, 7, Pulsed wave Doppler signal from abdominal aorta, 9, 9/, assessment o f pulmonary vein flow, 39/, 40, Pulsus alternans, 87 Quinones method, Radiation-induced cardiac disease, 258 Reduced second heart sound, 87 Regional wall motion assessment, 56/, 57, 57/, 59 Regurgitant flow, 45, , 5 , 25 , 265 Regurgitant fraction, 33 Regurgitant jets, combined radius 0£ 249, 250/, 25 Regurgitant volume, , 1/, 33, 40, , 76, 76/, 77, 86, 236, 265, 330 of mitral valve regurgitation (MR) , 96, 97 Retrosternal chest pain, 08-1 09, 09/ Reverberation artifact, 296, 296/ "Reverse-dagger" shape, of tricuspid regurgitation (TR) velocity, 39, 9/, Rheumatic disease, 222, 224, 282, 284 aortic and mitral valve replacements for, 276 valvular findings, etiology for, 266, 268 Rheumatic mitral stenosis, 266, 268 Rheumatic mitral valve disease, 282, 284 Rhinosinusitis, 48-49 Right atrial (RA) pressure, based o n hepatic vein velocity, 257, 257/, 258 estimation of, 249, 249/, 25 Right atrium, mobile structure in, 0, 1 Right coronary artery (RCA), 34, 36 Right coronary sinus, 27 , 272 Right heart failure, 54, 5 , 56-58, 56-57/ Right index of myocardial performance (RIMP) , 73, 74 Right ventricle in cardiac output, 50, Right ventricular (RV) diastolic collapse, 63, 64 Right ventricular dysfunction, severe, 249, 25 Right ventricular end-diastolic pressures, 85 , 85/, 86 Right ventricular end-systolic pressure, hemodynamic measures 0£ 63, 64 Right ventricular enlargement, 328, 330 cause for, , 36 Right ventricular fractional area, 329, 33 Right ventricular free wall, 294-295, 294-295/, 296 Right ventricular function, parameters 0£ 54, 5 Right ventricular index of myocardial performance, 00, 1 , if Right ventricular index of myocardial performance (RIMP) , , 36, 54, 5 Right ventricular longitudinal contractility, 8/, 9, 220 Right ventricular longitudinal systolic function, 257, 257/, 258 explanation of, 05 measures 0£ 135, 36, 329, 33 Right ventricular outflow tract (RVOT) obstruction, 48, 48/, 49, 58, , 32 Right ventricular size contractility of, 7, moderate to severe enlargement in, 6-3 7, 6-3 7/, Right ventricular systolic function, normal, 72, 17 Right ventricular systolic pressure (RVSP) , 58, 06, 07, 07/, 30, 32, 32 , 322 calculation 0£ 4, 6, 247, 308, 309 estimation 0£ 0, 9, 220 Right ventricular volume overload, 85 , 86 RIMP See Right index of myocardial performance Roth spots, 90 Rupture, 263, 265 Ruptured sinus, ofValsalva aneurysm, 270, 270-271/, 272 Scallops, of mitral valve, 25, 27 Scimitar syndrome, Sclerodactyly and esophageal dilatation, 63, 64 Scleroderma, 22 Sclerosis, systemic, 71-74, 1-73/ SCN5A sodium channel gene, defects in, 302, 304 Second heart sound and opening snap, interval between, 266, 268 Secundum atrial septal defect, , 36 Senile cardiac amyloidosis versus primary (AL) amyloidosis, 28, 29 Septal hypertrophic cardiomyopathy, 1 0, 1 0/, 1 Septal hypertrophy, with risk of sudden cardiac death, 302, 304 Septal myectomy, Septal rupture, 07 Serotonin 2B receptors, 40 Serum free light chains, 24, 26 immunoassay for, 23-1 24, Serum uric acid, 24, 26 Serum white blood cell count test, 68, 69 Severe angina, 1 9- 20 Severe chest pain, 37-38 clinical evaluation for, 37, 38 management, 37, 38 for hypotension, 37, 38 risk factors for, 37, 38 Severe chronic obstructive pulmonary disease, 259-26 , 259/ use of echo contrast, 260 Severe ischemic cardiomyopathy and functional class IV left heart failure, 49-1 , 149- 0/, if Severe mitral valve regurgitation, 1 1-1 2, 1 1- 1 2/, 1 Severe pancreatitis history, fever and dyspnea with, 289, 289/, 290 Severe tricuspid valve regurgitation, 65, 66 Shah, Pravin, 8, 59 Sharp chest pain, 1- 94, 1-1 92/, 92-1 93/ auscultatory finding, 92, 93 management, 92, 94 Shone syndrome, 94 Sinus ofValsalva aneurysm, 27 , 272 Soft systolic murmur after fainting episode, 300-305, 300-302/, 304/ Sphericity index, 246, 247 Stable functional Class II exertional dyspnea, 252-254, 252-25 5/ Staphylococcus aureus, 273, 275 I N D EX I Staphylococcus bovis, 275 ST elevation myocardial infarction, 23, 24 Steroid therapy, 99 Streptococcus bovis, 325, 326 Streptococcus viridans, Stress echocardiogram, 57, 57/, Stress echocardiography dobutamine, peak doses of, 08-1 09, 09/ Stress-induced cardiomyopathy, 1 9, 20, 200, 20 pathogenesis for, 200, 20 Stroke, higher risk of and patent foramen ovale (PFO) , 2, 3, 278, 280 Stroke volume (SV) , 6, 24, 67, 69, 05, 1 7, 36, , 209, 247, 272, 329, 330 Doppler derived, 5, Subaortic valve membranes, 204 surgical resection of, 203, 204 Subarachnoid hemorrhage, 1 9, 20 Sudden cardiac death (SCD) , 2, 14, 80, risk of, 302, 304 Sudden cardiac death risk stratification, in hypertrophic cardiomyopathy, Sunitinib therapy, 206 Superior vena cava, 1/, 54 Supraventricular rhythm abnormalities, 62 Surgical myectomy, , 3/, Surgical septal myectomy, 57, 59, 59/ Suture material, 278, 279 Symptomatic paroxysmal atrial fibrillation, 1-83, 1-82/ history of, 285-288, 285-286/ Syncopal episode, 7-1 , 7-9/ Syncope, 9, 220 cardiovascular causes for, 9, 1 Syphilis, 272 Systemic anticoagulation, , 22, 96, 97 Systemic blood pressure, 1 9, 20 Systemic hypertension, 9-2 , 9/, 1/ exertional dyspnea with, 332-336, 332-334/ murmur with, 205-206, 205/ progressive exertional shortness of breath with, 87-1 88, 88/ Systemic sclerosis, -74, 1-73/ Systolic and diastolic murmurs, 262, 262-263/ Systolic anterior motion of anterior mitral valve leaflet, 7-1 8, 57/, 59 Systolic blood pressure, exertional shortness o f breath with, 8-220, 8/ Systolic ejection murmur, 6- 8, 6/, 7/ with amyl nitrite inhalation, 56, 56-1 57/, 59 Systolic flow reversals, 53/, 55, 138 in hepatic veins, 58, 54, 5 pulmonary vein, 4, 326 Systolic longitudinal strain patterns, 24, , 2'if Systolic murmur, 1-33, 1-32/, 42-45, 42-43/, 78-80, 234-236, 234-235/, 0-3 5, 0-3 2/, 3/, 322 asymptomatic, 39-4 , 39-40/ explanation for, 23 , 232 harsh, 334, 334/, 335 loud, 8, 220 Tamponade, characteristics of, 148 Tei index See Right index of myocardial performance (RIMP) Tetralogy of Fallot, Thoracic aorta, ultrasound examination of, Thoracic radiation, 257, 258 Thromboendarterectomy, 329, 33 , 33 1/ Thrombolytic therapy, 65 , 66 Thrombotic obstruction, of bioprosthesis, 72-1 73, 72/, 74 Thrombus, 76, 77, 289, 290 incidence of, 289, 290 Transesophageal echocardiogram (TEE), 148, 89, 90, 289, 289/, 290 dyspnea and, 72, 17 progressive exertional dyspnea, 249, 25 recurrent episodes of left heart failure, 277, 279 Transesophageal echocardiography, , 1/, 83 and acute severe dyspnea, 25, 27 anterior mitral valve leaflet prolapse with flail middle scallop, 39/, 40, class III shortness of breath, 223, 224-225 congenital aortic valve stenosis, 76, 77 Doppler findings, 82, 82/, 83 Transient loss of motor function descending thoracic aorta, structure, 0, 0/, 1 , 1/ estimating left ventricular ejection fraction, 0, 1 management, 0, 1 mobile structure in right atrium, 0, 1 in right upper extremity, 0-2 1 , 1/ Transient loss of vision, 89-1 90 with modest exertional shortness of breath, 95-1 97, 195/ treatment of, 96, 97 Transmitral flow, time velocity integral (TVI) of, 2, Transmitral prosthetic valve diastolic mean gradient, 276/, 276-277, 279 Transthoracic echocardiographic images apical hypertrophic cardiomyopathy and, 1 0, 1 0-1 1/, 1 Transthoracic echocardiography, 9, 1 , 63, 63-64f, 64 performed after valve surgery, 60, fo r severe angina, 1 9- 20 soft systolic murmur after fainting episode, 302, 305 on sonography student, 1-93, 1-92/ Treadmill exercise stress test, Treadmill stress echocardiogram, 57 Tricupsid annular dilatation, 325, 326 Tricuspid annular plane systolic excursion (TAPSE) , 04, 05, 74, 258, 295, 296 and RV TOI, 6-3 7/, 7, Tricuspid annular tissue peak velocity, 295, 296 Tricuspid annulus dilation, 329, 330 Tricuspid effective regurgitant orifice (ERO) area, 52-1 54, 52-1 54/, 5 Tricuspid regurgitant jet, shape of, 39, Tricuspid regurgitation (TR) severe, 57, velocity o f, 6, , volume, , 78-79/, 79, 80, 85 , 86 Tricuspid valve, 37, 38, 8/ Tricuspid valve regurgitation, 25 mechanism of, 325, 326, 329, 330 severe, 54, 5 , 85, 86, 234-235, 236, 277, 279, 329, 330 Tumor plop, 92, 93 Tumor resection, 42, 43, 143/ Turner syndrome, 37, 38, 94 T-wave inversion, 67, in precordial leads, 302, 304 346 I I N D EX Twelve-lead ECG, 47, 47/, 48, 56 with hypertrophic cardiomyopathy (HCM) , 79, septal hypertrophic cardiomyopathy and, 1 0, 1 0/, 1 Two-dimensional (2D) echocardiographic finding, 94, 97, 24, aortic valve (AoV) in, 82, 82/, 83 for cardiac tamponade, 63, 64 T wave inversions in precordial leads, 302, 304 Two pillow orthopnea, - 22 Ultrasound examination, of thoracic aorta, Ultrasound frequency, 08, 09 Valsalva aneurysm, ruptured sinus of, 270, 270/, 27 , 271/, 272 Valsalva maneuver, 5, 6, 206 Valvular findings, etiology for, 266, 268 Valvular vegetation, Vascular radiology, 0, 1 , 1/ Vasodilator agents, 302, 304 Vasodilator therapy, 77 Vasopressor agents, 38 Vegetation aortic valve, 99 cardiac, 89, 90 valvular, Vena caval filter, placement of, 329, 33 Vena contracta, 40 Venous cast, 00, 1 Ventricular dysrhythmias, 237, 238 Ventricular perspective, 266, 268 Ventricular septal defect complications of, , 32 muscular type, 30, 32 Ventricular septal rupture, 07 Ventricular tachycardia with rapid palpitations, 294-296, 294-295/, 296/ Vision, transient loss of, 89-1 90 with modest exertional shortness of breath, 95-1 97, 95/ Visual disturbances, 9, 220 Wall motion abnormalities in distribution of left anterior descending coronary artery, 44, 45 left ventricular (LV) function and, 48, 49 Warfarin, 283, 284 anticoagulation of, 2, 3, 329, 33 anti thrombotic therapy, 73, 74 Weight gain, 52, 52-1 54/, 54-1 5 Weight loss, 48-49 Wolff-Parkinson-White syndrome, 62 Zero baseline, for color map, 266, 268 [...]... Subject CASE8 7 Cardiac Masses and Aortic Diseases Exertional Shortness of Breath in CASE 11 Severe Chest Pain 37 CASE 21 Systemic Sclerosis 71 CASE2 6 Hematuria with Large Renal Mass 281 CASE8 9 Fever and Dyspnea with History of Severe Pancreatitis 289 CASE9 1 88 Ventricular Tachycardia with Rapid Palpitations CASE4 1 294 CASE9 2 Progressive Fatigue and Marked Lower Extremity Edema a 68-Year-Old Woman 137...Contents CASE1 CASE1 6 Liver Function Test Abnormalities, Normal Images and Values Ascites, and Dyspnea CASE2 Syncopal Episode 7 12 16 19 23 Acute Severe Dyspnea 25 28 Coronary Artery Grafting 31 CASE1 0 Increasing Dyspnea and Orthopnea CASE1 2 Systolic Murmur, Asymptomatic Transthoracic Echocardiography on a Exertional Shortness of Breath Sonography Student 42 CASE1 4 Cardiac Murmur during Pregnancy 91 CASE2 8... CASE2 8 Class I l l Exertional Shortness of Breath without 46 Angina 94 CASE2 9 CASE1 5 Acute Pleuritic Chest Pain and Progressive Dyspnea with Asthma, Rhinosinusitis, Weight Loss, and Peripheral Neuropathy 88 CASE2 7 CASE1 3 and Systolic Murmur 84 CASE2 6 Hematuria with Large Renal Mass 39 81 CASE2 5 Heart Failure 37 78 CASE2 4 Symptomatic Paroxysmal Atrial Fibrillation 34 CASE1 1 Severe Chest Pain Exertional Shortness... Chest Pain in a 52-Year-Old Woman 297 CASE4 3 Cardiomyopathies Monomorphic Ventricular Tachycardia after Cardiac Arrest 142 CASE5 9 Transient Loss of Vision 189 CASE6 0 Sharp Chest Pain 191 CASE6 2 Fever and Back Pain 210 12 114 Three Month History of 123 CASE3 8 127 CASE4 6 234 Severe lschemic Cardiomyopathy and Functional Class IV Left CASE7 6 240 CASE7 9 252 CASE8 2 Systolic and Diastolic Murmurs Exertional... Ventricular Tachycardia with Rapid 237 Palpitations 294 CASE9 2 CASE7 6 240 CASE7 7 Chest Pain in a 52-Year-Old Woman 297 CASE9 3 244 Soft Systolic Murmur after Fainting Episode CASE7 8 300 CASE9 4 Three Months of Progressive 248 CASE7 9 Murmur in a 38-Year-Old Patient 306 CASE9 5 Exertional Dyspnea following Bypass Grafting 289 CASE9 0 Systolic Murmur and Lower Exertional Dyspnea CASE8 9 Severe Pancreatitis Exertional... Infiltrates 323 CASE1 9 CASE3 3 and Peripheral Edema Valve Replacements Liver Function Test Abnormalities, Ascites, Extremity Edema, and Systolic Murmur after Dyspnea and Chest Tightness CASE9 8 CASE1 6 Exertional Shortness of Breath, Bilateral Lower Coronary Artery Grafting 276 Exertional Dyspnea following Mitral and Aortic 59 CASE2 0 Progressive Dyspnea CASE8 6 Heart Failure 56 CASE1 8 Progressive NYHA Class... Shortness of Breath Edema of Breath and Lower Extremity CASE3 6 Orthopnea CASE4 9 CASE5 0 CASE3 5 Severe Angina CASE4 8 Progressive Exertional Fatigue and Lower Extremity 110 CASE3 4 Exertional Dyspnea 152 Progressive NY HA Class 11-111 Exertional Dyspnea and 156 Palpitations CASE3 2 Retrosternal Chest Pain Progressive Exertional Dyspnea, Weight Gain, and Peripheral Edema 149 Fever and Back Pain 198 C O N T... Fevers, Malaise, and Fatigue CASE1 5 CASE5 8 Progressive Dyspnea with Asthma, Progressive Exertional Shortness of Rhinosinusitis, Weight Loss, and Breath with Diabetes and Systemic Peripheral Neuropathy 48 CASE2 4 187 CASE8 0 Exertional Shortness of Breath with Symptomatic Paroxysmal Atrial Fibrillation Hypertension 167 81 History of Lymphoma 256 Echocardiography A Case- Based Review CAS E 1 Normal I mages a n... Exertional Shortness of Breath, Dilated Cardiomyopathy 285 Fever and Dyspnea with History of CASE7 4 Atypical Chest Pain 281 CASE8 8 Atrial Fibrillation Intermittent Dyspnea with Modest Examination Exertional Shortness of Breath in a 68-Year-Old Woman CASE 73 Extremity Edema 276 CASE8 7 CASE7 2 Exertion 27 3 CASE8 6 Exertional Shortness of Breath with Systolic Blood Asymptomatic Murmur 270 CASE8 5 CASE7 0 Class... Hypertension CASE2 Heart Failure 149 CASE4 8 Progressive NY HA Class 11-111 Exertional Dyspnea and Palpitations 156 CASE 55 262 Exertional Shortness of Breath 179 xi i i X I V I C ONT E NTS BY S U B J E C T CASE6 6 Palpitations and Dyspnea CASE9 6 207 CASE7 7 Dilated Cardiomyopathy 244 319 CASE9 9 Soft Systolic Murmur after 300 Exertional Shortness of Breath and Chest Pain in a 30-Year-Old Woman CASE1 00 Exertional ... Echocardiography A Case-Based Review Echocardiography A Case-Based Review Garvan C Kane, MD, PhD Co-Director, Echocardiography Laboratory Consultant , Division of Cardiovascular Diseases Assistant... above-mentioned copyright Printed in China 97 8-1 -4 51 1-0 96 1-0 1-4 51 1-0 961-X Library of Congress Cataloging-in-Publication Data Kane, Garvan C Echocardiography : a case-based review I authors, Garvan... paper)-ISBN -4 5 1 -0 96 -X (alk paper) I Oh, Jae K II Oh, Jae K Echo manual III Title [DNLM: Heart Diseases-ultrasonography-Case Reports Heart Diseases-ultrasonography Examination Questions Echocardiography- methods-Case