1echo 2009

ECHOCARDIOGRAPHY Deductions for Clinical Practice Dott. Mirco Baccino – Cardiologia Ospedale Santa Corona

GUIDELINES   For no acute patients. Clinical evidence or general consensus. 

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Appropriates indications

Class I clinical evidence – general consensus Class II frequent use without clinical evidence Class III inappropriate  indications

ECHO TEST -  Preceded by clinical estimation - EKG - Specific issue - Targets

 

 

ECHO TEST • Patients without well-known cardiopathy:                                    The target is to show a cardiopathy in  hight rish subject

 

 

ECHO TEST IN PATIENTS WITHOUT  WELL-KNOWN CARDIOPATHY •  NO SYMPTOMATIC PEOPLE  • class I         familial genetic disease (HCM, Marfan)                          antiblastic therapy – cardiotoxic agent/drug                            organ donor                                              •   class II     athlete                        heart involving disease                        left bundle branch block  

 

ECHO TEST IN PATIENTA WITHOUT  WELL-KNOW CARDIOPATHY    chest pain, dyspnea, edema, murmurs,  palpitations     - class I in hight suspect - class III in low suspect

 

 

ECHO TEST IN PATIENTS WITH WELLKNOW CARDIOPATHY  DIAGNOSIS    CHECK-UP

 

 

ECHO TEST IN PATIENTS WITH WELLKNOW CARDIOPATHY  VALVULAR HEART DISEASES     - class I    diagnosis                  to check                                                  6 months/ 1 year                                                 in prosthesis  (3 mounths after the surgery)                                                                                                        in valvular ptostehesis dysfunction               -  Class II  to check valvular disorder and proSthesis  without ventricular  disorder  ( 1-2 year)

 

 

ECHO TEST IN PATIENTS WITH WELLKNOW CARDIOPATHY Coronary artery disease  • class I  always in diagnosis and 3 months after  AMI, PCI, CABG • class I cheking left ventricle disorder evry 6  months/1 year in clinical change • class II  C.D.D. without left ventricle disorder  

 

ECHO TEST IN PATIENTS WITH WELLKNOW CARDIOPATHY CARDIOMYOPATHIES      class I  always in diagnosis               in checking every 6 months/1 year                                                                                                                   class II  diseases involving heart                                                                                                                                                   class III   diseases rarely involving heart  

 

ECHO TEST IN PATIENTS WITH WELLKNOW CARDIOPATHY

Pericardial diseases   • class I  always in diagnosis                   every year in checking                                                                                            • class II in checking                                   

 

ECHO TEST IN PATIENTS WITH WELLKNOW CARDIOPATHY

Systemic hypertension • Class I           in checking severe HTA with              symptoms                                             • Class III         in borderline HTA  

 

EXTRA CARDIAC DISEASES PULMONARY DISEASES    • class I             pulmonary hypertension • class II             PTE/COBP                                                     

 

EXTRA CARDIAC DISEASES Neurological ischemia     • class I  with embolism                  <45 y.o.,                   >45 y.o. without carotid pathology

 

 

EXTRA CARDIAC DISEASES

SYNCOPE • class I     HOCM                    AORTIC STENOSIS 

 

 

EXTRACARDIAC DISEASES AORTA DISEASES • class I    aortic dyssection                  Marfan Syndrome • class II   aortic expansion

 

 

ECHO TEST • PARAMETERS: • - EJECTION FRACTION • - contractility • - ventricle diameters • - Flows Doppler   - regurgitations                                           - gradients  

 

ECHO TEST TEE • Prosthesys • Clots • Endocarditis

 

 

ECHO TEST • TDI • Stress-Echo (dobutaminE-dipiridamolo) => Searching Ischemia

 

 

ECHO TEST • • • • • •

 

CAD Cardiomyopathies (dilated, hypertrophic) Hypertensive C. Congenital C. Valvular C. Pericardial effusion  

CAD • • • •

 

Cardiac diameters(TD e TS) Wall movement Ejection fraction (>45%) => diagnosis and prognosis

 

CARDIOMYOPATHIES • • • • •

Cardiac diameters (TD e TS) Wall thickness  Wall movement Ejection fraction Flow Doppler (rigurgitation and gradients)

 

 

HYPERTENSIVE  CARDIOMYOPATY • • • • •

 

Cardiac diameters Wall thickness Wall movement Ejection fraction Flow Doppler (Trans-mitral flow)

 

CONGENITAL  CARIOMYOPATHIES • Cardiac diameters • Valvular morphology, chambers) • Flow Doppler (rigurgitation, gradient,  shunt)

 

 

VALVULAR  CARDIOMYOPATHIES • • • • •

 

Aortic stenosis Mitral stenosis Aortic regurgitation Mitral regurgitation => diagnosis, prognosis, cardiosurgery  timing.

 

AORTICA STENOSIS • • • •

 

Cardiac diameters Wall thickness Ejection fraction Flow Doppler (gradient)

 

MITRAL STENOSIS

• Valvular area (anatomic and functional) • Left atrium diameters • Pulmonary pressure

 

 

AORTIC REGURGITATION

• Left ventricle diameters (TD e TS) • Ejection fraction • Flow Doppler 

 

 

MITRAL REGURGITATION • • • • •

 

Left ventricle diameters (TD e TS) Left atrium diameters Ejection fraction Flow Doppler  Pulmonary pressure

 

PERICARDIAL EFFUSION • Quantity • Nature • Location => Prognosis, pericardiocentesis