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Camelia Demetrescu
Sandeep S Hothi
John Chambers LRC Press
Echocardiography
Key Features
● Expanded first chapter on levels of echocardiography
● New sections on COVID-19, cardio-oncology, multivalve disease, and
specialist valve clinics
● Incorporation of new international guidelines, grading criteria, and normal
data
● Guide to how cardiac CT and magnetic resonance can complement
echocardiography
● Reformatted text and extra diagrams and tables to improve understanding
Echocardiography
A Practical Guide for Reporting
and Interpretation
Fourth Edition
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DOI: 10.1201/9781003242789
Typeset in Universe
by Apex CoVantage, LLC
Contents
Prefaceix
Acknowledgementsxi
Authorsxiii
Disclaimerxv
Icons and QR Codes xvi
List of Abbreviations xvii
7 Cardiomyopathies 61
The Dilated LV 61
The Hypertrophied LV 65
Restrictive Cardiomyopathy 72
Non-Compaction74
Arrhythmogenic Right Ventricle Cardiomyopathy/Dysplasia
(ARVC/ARVD)75
Cardio-Oncology: Evaluation of Patients on Chemotherapy 77
13 Endocarditis 149
vi
Contents
18 Masses 201
Mass Attached to a Valve 201
Left or Right Atrial Mass 202
Left or Right Ventricular Mass 205
Pericardial Mass 208
Extrinsic Mass 208
Mass in the Great Vessels 210
19 Echocardiography in Acute
and Critical Care Medicine 213
The Critically Ill Patient 213
The Acutely Ill Patient 213
Further Indications for Echocardiography
on Critical Care Units 216
Echocardiography in COVID-19 218
Appendices229
Index245
vii
Preface
Expansion of Echocardiography
Since the third edition, echocardiography has expanded further into acute,
intensive care, and emergency medicine. COVID-19 has necessitated limiting
exposure of both patient and operator to infection and also caused a huge
increase in waiting lists. This has sharpened the debate over the balance
between abbreviated scans and comprehensive studies and highlighted the
importance of collaboration between clinicians and echocardiographers. It
is clear that the nature of the cardiac scan should be tailored to the clinical
question, and this has led to the development of a range from basic, through
focused, to standard and comprehensive echocardiograms. We discuss this in
an expanded first chapter.
ix
Preface
New Sections
We also include new sections on COVID-19, cardio-oncology, multivalve
disease, and specialist valve clinics. We incorporated new international
guidelines, grading criteria, and normal data. Since the third edition, there has
been further development of cardiac CT and magnetic resonance, and we
explain where these techniques are complementary to echocardiography and
should be incorporated in a multimodality approach to normal clinical practice.
General Changes
The text has been reformatted to be more easily accessible, and numerous
diagrams have been added or updated. Images and clips have been placed in a
web-based archive.
This book will be relevant to all echocardiographers, including cardiac
physiologists, clinical scientists, cardiologists, and clinicians in acute, critical
care, general, and emergency medicine. It will also be useful to hospital and
community physicians needing to interpret reports.
x
Acknowledgements
We should like to thank the people who took part in our online straw polls:
Brian Campbell, Laura Dobson, Madalina Garbi, Jane Graham, Antoinette
Kenny, Navroz Masani, Jim Newton, Petros Nihoyannopoulos, Keith Pearce,
Bushra Rana, Dominik Schlosshan, Roxy Senior, Benoy Shah, and Rick Steeds.
We are also grateful to colleagues who read through chapters and offered
helpful advice: Claire Colebourne, Jane Draper, Yaso Emmanuel, Madalina
Garbi, Jane Graham, Jeffrey Khoo, Simon MacDonald, Peter Saville, and David
Sprigings. Any remaining mistakes are ours and not theirs. We should also like
to thank Phillip Bentley, graphic designer, for updating the diagrams.
xi
Authors
xv
Icons and QR Codes
A number of new icons and QR codes have been used in this edition of the
book to increase its usefulness to practitioners.
Throughout the book, the CHECKLIST icon is used to signal checklist boxes
summarising the main information on topics discussed.
The THINK icon marks a point of controversy or where consensus has not
been reached.
xvi
Abbreviations
xviii
Defining the Study
1
Deciding the Level of Echocardiogram
Required
● Cardiac ultrasound has now expanded in:
● Setting—from the echocardiography laboratory to include cardiac and
general wards; GP surgery and community echo clinics; the interventional
laboratory, theatre, and intensive therapy unit; the emergency room and
emergency settings, e.g. the road side or battlefield.
● Application—from cardiology to acute, emergency, and intensive care
medicine; to exclude significant structural disease in the community or
the outpatient clinic.
● Hardware—from high-end system through mid-range portable machines
to handheld devices.
● Training—from the use of cardiac ultrasound as an aid to resuscitation
(by first responders) to basic studies (by the accredited physician
in charge of the case or by accredited and highly experienced
echocardiographers), to focused echocardiograms e.g. for community
screening projects (often by nurses), to standard echocardiograms
(by accredited echocardiographers), and to comprehensive studies
(accredited and highly experienced echocardiographers).
● Cardiac ultrasound (e.g. FATE or FEEL protocols), usually including chest
and abdominal imaging, is separate from echocardiography and part of
emergency management.
● There are four levels of transthoracic echocardiography (TTE) (Table 1.1).
● Deciding the level of scan requires collaboration between clinician and
echocardiographer (Figure 1.1) via:
● A system of formal triage, including cases which do not need an
echocardiogram at all (e.g. repeat studies with no clinical change).
● Discussion about individual cases (e.g. in valve or heart failure specialist
clinics).
● The decision on the level of scan will be based on:
● The likelihood of disease. A basic TTE is sufficient to confirm the
clinical impression of normality in low-risk cases, for example, flow
murmurs or perceived palpitation in a young person1, 2. By comparison,
1
DOI: 10.1201/9781003242789-1
Defining the Study
Table 1.1 Aims of the four levels of echocardiogram (TTE) (Figure 1.1)
Title: Sequel
Language: English
ILLUSTRATED BY BERWIN
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