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Heart Failure: Difference between revisions
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===== Echocardiography ===== | ===== Echocardiography ===== | ||
{| class="wikitable" border="1" style="float: right" width="600" | |||
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| colspan="3" style="border-bottom: 0; background-color: white" | '''Table 3. Common echocardiographic abnormalities in heart failure''' | |||
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| colspan="3" style="border-bottom: 0; border-top: 0; background-color: white" | | |||
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| width="200" style="border-bottom: 0; background-color: #CCCCFF; border-right: 0" | '''Measurement''' | |||
| width="200" style="border-bottom: 0; background-color: #CCCCFF; border-right: 0; border-left: 0;" | '''Abnormality''' | |||
| width="200" style="border-bottom: 0; background-color: #CCCCFF; border-left: 0" | '''Clinical implications''' | |||
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| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0" | LVEF | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0; border-left: 0" | Reduced (<45 – 50%) | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-left: 0;" | Systolic dysfunction | |||
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| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-right: 0;" | LV ejection fraction | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-right: 0; border-left: 0;" | Akinesis, hypokinesis, dyskinesis | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-left: 0;" | Myocardial infarction/ischaemia, cardiomyopathy, myocarditis | |||
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| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0;" | End-diastolic diameter | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0; border-left: 0;" | Increased (>55 – 60 mm) | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-left: 0" | Volume overload | |||
HF likely | |||
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| width="200" style="border-bottom: 0 border-top: 0; background-color: #CCCCFF; border-right: 0" | End-systolic diameter | |||
| width="200" style="border-bottom: 0 border-top: 0; background-color: #CCCCFF; border-left: 0; border-right: 0" | Increased (>45 mm) | |||
| width="200" style="border-bottom: 0 border-top: 0; background-color: #CCCCFF; border-left: 0" | Volume overload | |||
HF likely | |||
|- | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0" | Fractional shortening | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0; border-left: 0" | Reduced (<25%) | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-left: 0" | Systolic dysfunction | |||
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| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-right: 0" | Left atrial size | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-right: 0; border-left: 0" | Increased (>40 mm) | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-left: 0" | Increased filling pressures, mitral valve dysfunction, atrial fibrillation | |||
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| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0" | Left ventricular thickness | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0; border-left: 0" | Hypertrophy (>11 – 12 mm) | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-left: 0" | Hypertention, aortic stenosis, hypertrophic cardiomyopathy | |||
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| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-right: 0" | Valvular structure and function | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-right: 0; border-left: 0" | Valvular stenosis or regurgitation (especially aortic stenosis and mitral insufficiency) | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-left: 0" | May be primary cause of HF or complicating factor | |||
Asses haemodynamic consequences | |||
Consider surgery | |||
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| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0" | Mitral diastolic flow profile | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0; border-left: 0" | Abnormalities of the early and late diastolic filling patterns | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-left: 0" | Indicates diastolic dysfunction and suggests mechanism | |||
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| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-right: 0" | Tricuspid regurgitation peak velocity | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-right: 0; border-left: 0" | Increased (>3 m/s) | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-left: 0" | Increased right ventricular systolic pressure | |||
Suspect pulmonary hypertention | |||
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| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0" | Pericardium | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-right: 0; border-left: 0" | Effusion, haemopericardium, thickening | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: white; border-left: 0" | Consider tamponade, uraemia, malignancy, systemic disease, acute or chronic pericarditis, contrictive pericarditis | |||
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| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-right: 0" | Aortic outflow velocity time integral | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-right: 0; border-left: 0" | Reduced (<15 cm) | |||
| width="200" style="border-bottom: 0; border-top: 0; background-color: #CCCCFF; border-left: 0" | Reduced low stroke volume | |||
|- | |||
| width="200" style="border-top: 0; background-color: white; border-right: 0" | Inferior vena caval | |||
| width="200" style="border-top: 0; background-color: white; border-right: 0; border-left: 0" | Dilated retrograde flow | |||
| width="200" style="border-top: 0; background-color: white; border-left: 0" | Increased right atrial pressures, right ventricular dysfunction, hepatic congestion | |||
|} | |||
Echocardiography is the cornerstone in diagnosing HF, and should routinely be performed, because ventricular function can be evaluated accurately with this technique. It can provide objective evidence of a structural or functional abnormality of the heart at rest besides signs and symptoms typical of heart failure. Important parameters that can be assessed include but are not limited to wall motion, valve function, and left ventricular ejection fraction and diastolic function. Diastolic dysfunction might be an important finding in symptomatic patients with a preserved ejection fraction. Please refer to Table 3 for common echocardiographic findings in HF. Transoesophageal echocardiography is indicated in patients with an inadequate thansthoracic echo window, suspected endocarditis, complicated valvular disease or to exclude a LV thrombus. If echocardiography provides inadequate information or in patients with suspected coronary artery disease, additional imaging includes CT scanning, cardiac magnetic resonance imaging or radionuclide imaging. | Echocardiography is the cornerstone in diagnosing HF, and should routinely be performed, because ventricular function can be evaluated accurately with this technique. It can provide objective evidence of a structural or functional abnormality of the heart at rest besides signs and symptoms typical of heart failure. Important parameters that can be assessed include but are not limited to wall motion, valve function, and left ventricular ejection fraction and diastolic function. Diastolic dysfunction might be an important finding in symptomatic patients with a preserved ejection fraction. Please refer to Table 3 for common echocardiographic findings in HF. Transoesophageal echocardiography is indicated in patients with an inadequate thansthoracic echo window, suspected endocarditis, complicated valvular disease or to exclude a LV thrombus. If echocardiography provides inadequate information or in patients with suspected coronary artery disease, additional imaging includes CT scanning, cardiac magnetic resonance imaging or radionuclide imaging. | ||