Echocardiography Workshop

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Echocardiography Workshop
Paul Lindower, MD, FASE Associate Professor of Clinical Medicine University of Iowa Hospitals Friday October 6, 2006

Echocardiography for the Primary Care Practitioner
• Educational Objectives:
– Understand the Bernoulli and Continuity equations and how they may be used to assess valvular disease – Recognize echo techniques to assess the severity of mitral regurgitation and their limitations – Describe what factors determine whether a pericardial effusion promotes tamponade and echo features that would support this – Appreciate the utility of echo in diagnosing and following patients with cardiomyopathies – Understand the role of exercise echo in predicting cardiac risk – Relate which echo technique is most appropriate in evaluating patients for various cardioembolic sources – Appreciate the different diastolic dysfunction patterns and their implied prognoses

• • • • Pre Test Review of Normal Echo Views Cases with Didactic Material Post Test

Pre Test
• 1) An elderly patient presents with worsening dyspnea over the last few months and is found to have aortic stenosis on an echo. The peak gradient through the aortic valve is 30 mm Hg. This finding represents what degree of aortic stenosis? – – – – A) Mild B) Moderate C) Severe D) Unknown

Pre Test
• 2) A young woman with a history of a heart murmur and a mid systolic click has an echo study performed to assess for mitral valve prolapse. What echo view is most appropriate to make this diagnosis? – – – – A) Parasternal long axis B) Parasternal short axis C) Apical four chamber D) Apical two chamber

Pre Test
• 3) A breast cancer patient has significant shortness of breath symptoms and echo reveals a moderate sized pericardial effusion. Which of the following echo features does not support tamponade physiology? – – – – A) Right atrial systolic collapse B) Right ventricular diastolic collapse C) Inferior vena cava collapse D) Marked respiratory variation of tricuspid valve inflow

Pre Test
• 4) The following echo features are noted in a patient with shortness of breath and dyspnea. Biatrial enlargement; normal left ventricular size, function, and wall thickness; mitral valve inflow Doppler with a tall E wave. Which type of cardiomyopathy do these findings support? – – – – A) Dilated cardiomyopathy B) Restrictive cardiomyopathy C) Arrhythmogenic right ventricular dysplasia D) Isolated left ventricular noncompaction

Pre Test
• 5) A patient undergoes an exercise echo to evaluate chest pain symptoms. The patient walks 9 minutes achieving > 85% PMHR. No chest pain or ischemic ECG changes are seen. The echo portion reveals normal hyperkinesis of the myocardium. This patient has what percent cardiac event rate for the coming year? – – – – A) 10% B) 5% C) 3% D) < 1%

Pre Test
• 6) Transesophageal echo has a greater sensitivity than transthoracic echo for detecting all of the following cardioembolic sources except which? – – – – A) Left atrial appendage thrombus B) Left ventricular thrombus C) Patent foramen ovale D) Aortic atherosclerotic debris

Pre Test
• 7) A patient with severe heart failure has a restrictive Doppler mitral inflow pattern on echo. After treatment with diuretics, the echo is repeated and shows Doppler mitral inflow velocity findings with E/A < 1 and a DT > 220 ms. These findings suggest a prognosis for this patient that is which of the following? – – – – A) Improved B) Unchanged C) Worsened D) Undetermined

Normal Study

Normal Echo Views
• Parasternal
• Long, short axis, and right ventricular inflow

• Apical
• 4, (5), 2 chamber, and long axis

• Subcostal
• 4 chamber and short axis

• Other
• Suprasternal

Parasternal Long Axis View

Parasternal Short Axis Views

Apical Views

Subcostal View

Case Series 1
• A 62 year old man was found to have a grade III/VI crescendo-decrescendo murmur at the base of the heart which radiates to his carotid arteries. His...
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