Principal basics of the echocardiogram diastolic dysfunction and left ventricular hypertrophy

Editor's Notes

• #10: (CINDYs NOTE) --- there are 3 dimensional echo's but we rarely see them - I have never seen one --- the ultrasonographer simply uses a switch to change the transducers to go from M mode to the 2 D mode. Sound waves go out from the transducer to detect mass/ or an object and then the waves object they return back to the transducer and the sound waves are then converted into an image via the US machine and into a picture on the monitor – kind of like a depth or fish finder for those of you who fish
• #11: CINDY’S NOTE---This view is where the aortic root LA measurement is completed . Visually the technician can see the MV function as it opens and closes , assess for MV prolapse or abnormalities of the chordae ;can look at the walls and for any abnormal structures . In general they are constantly reviewing and assessing the LV function and structures throughout the test and as they go form one view to another view
• #12: CINDYS NOTE: -once again the technician just switches a button on the machine to change mode form US to Doppler mode The Doppler function sees color flow and can use audible signals as well images to provide a path of the blood flow through the heart. It also can be used to measure the velocity of the blood flow.
• #13: Note this is a normal E/A ratio . E is > A . Ill talk about E A ratios more in depth - shortly PW doppler ALSO allow us to listen to specific portion of the blood as it moves through the heart which is addedd benefit to the cardioglgist AND can addl info about how the heart muscle squeezes and relaxes by AUDIO … I don’t have sound bite of that ……
• #16: Can any one guess what this might be ? Remember LV is on right and its upside down Answer - VSD and trace AI or some impedence going out the AV ?
• #17: L Diastole / how do I know --- MV open R Systole / MV closed= + mild Regurg the mosaic pattern on the L is because of the ^^ filling there is high velocity and this is nl the blue or red more solid colors = less velocity
• #18: Cindy’s note---- the technician may mention on their report how difficult the test was to perform , indications for the test and so forth They will provide an assessment for the cardiologist to interpret however the final interpretation is up to the cardiologist // this is why we may see one part of the test that may note one finding and another part of the test in the final interpretation field with somewhat different notes –its important to take it all into consideration and read the dimensions not just the interpretation …because clinical assessment may be a bit different than what we would assess in the life insurance arena
• #19: Cindys note – its not prognosticating its using critical thinking and applying it to our purpose which is different of course than what the persons MD may be assessing for
• #20: CINDYS NOTE ---- SUBJECTive – LETS SAY A CARDIOLIGST CALLES LA OF 4.5 MILD LAE-- , BUT BY OUR CRIERIA a la OF 4.5 is not MILD . Re bod habitus and other phys deformiatis -- realy skinny boney folks , obese folks hard to scan ; T Those with kyphosis or COPD can be difficult to get good “ windows” too CINDYS NOTE – time specific example of that would be changes in a person’s fluid level and or whether or not they have been treated for htn or not adequately so one yr they may have sig lvh but it can improve the next yr so that’s why using the echo findings as a compliment to the current clinical status has a lot of value
• #23: MAC -- In the elderly 10% men and nearly 16% of woman have MAC) Diastolic dys in elderly is very common and alsmost expected because of the generla loss of complaince all over there bodies We get old and brittle Thrombus can develop due to an akinetic LV after MI because the blood is allowed to stagnate because the wall doesn’t move normally / other things that cause thrombus are issues such as hypercoag states )
• #24: CINDYS NOTE --often see this post op CABG – typically goes away on its own , sometimes have to have a percardiocentesis ; can be seen with inflammatory diseases as well as infectious diseases ; cancer also can cause an effusion
• #25: Cindys note -- So in other words when a person at age 40 has mild LA enlargement – that is NOT common finding and we would look at more harshly and likely rate the 40 yr old but not likely rate a 70 yr old with the same finding
• #26: Cindys note -- So in other words when a person at age 40 has mild LA enlargement – that is NOT common finding and we would look at more harshly and likely rate the 40 yr old but not likely rate a 70 yr old with the same finding
• #27: Cindy to qualify the LVID 6 CM EX -- the heart suppose to be the size of your fist . So for example take the size of “SHAQS “fist .. You would expect it to be bigger than Betty Whites fist If his LA / LV were a bit bigger or just a tad out of the NORMAL on echo we may not be to awfully concerned if the rest of the echo and his clincial pic was NL But we would be concerned about Betty if the chamber sizes were enlarged or if her LA was showing some mod enlargement – NOTE **** RE LVID – SWISS IS A BIT MORE FORGIVING ON LV SIZE THAN LAE - spoke to Dr Clark about this and the 6.0cm speaks to MEN and the 6.0 begin what he said was mildly abnormal > he further noted that measurements should take into acct build / body size but typically don’t
• #30: as much as 50 % CHF admissions is on account of Diastolic Dys gorwoing problem a lot of it due to obesity / Htn and our aging populatoinl and all that entails ( long time htn , longstanding valve dis , noncompliance we spoke about earlier )
• #31: Eventually, if severe enough blood then backs up into the left atrium and, backward into the lungs.  In very severe cases it can back up and can cause pulmonary edema / and right sided heart failure The heart simply wont and cant accommodate the stretch because its so STIFF so it can fill up normally and things back up
• #32: (CINDYS NOTE --- a lot of times SS diast dys very vague . Typically we see evidence of it in minor forms such as … example the Pt complains slight SOB / no longer to climb stairs like they used to in the absence of any pulm abnormalities
• #33: CIndys note See Swiss for how to handle ^ BNP But as a reminder just look at a BNP as another tool to asssess how this persons diastolic and systolic fucntoin is doing overall
• #37: Cindys note -- Loss of passive filling passive filing is represents as the E WAVE and so with loss of that the E wave is smaller And that could be because the LV is noncompliant /or restricted due to various disease processes and as a result the atria has to “stuff “ the blood in there against walls that wont expand and that is represented as increased velocity === increased A wave . SIDE NOTE -- general observ – also not the general enlargement of all of the chambers / LVH seen here -- which is typical in more advanced diastolic dysfuntion
• #38: Cindys note grade I ----- we typcially rate the abvn echo findings and htn or whatever and that s our typcial case more often than not grade II ---- more problems ; the heart has kicked up compensatory mechanisims and I think what we want to look at is what type of SS is the person having , what is the Bp control and follow up etc and rate according to that grade III IV --- I would say your going to be looking at a sig rating and possible DCL
• #39: Cindys note grade I ----- we typcially rate the abvn echo findings and htn or whatever and that s our typcial case more often than not grade II ---- more problems ; the heart has kicked up compensatory mechanisims and I think what we want to look at is what type of SS is the person having , what is the Bp control and follow up etc and rate according to that grade III IV --- I would say your going to be looking at a sig rating and possible DCL
• #44: They treated him with diurectics and released him . Since then his BP has been under better control His Dr added a daily diuretic and Ca channel blocker plus lost a few #’s . Has no more sob , pedal edema resolved . Given this was 6 months how would we rate ? ANSWER --- T4 range . I think you have to be able to recognize that he had mild SS CHF that was likely associated with diastolic dys .