Additional Information
Book Details
Abstract
This book is a step-by-step manual for the complete echo-novice. It should be the only book needed to become a proficient echocardiographer. The text focuses on the practicalities of performing an examination, and the interpretation of images. Avoiding unnecessary technicalities, it places particular emphasis on the diagnostic features of sample cases and covers the entire breadth of adult cardiology. The majority of the echo images are also available in a dynamic form on the Expert Consult platform. Also included is access to 100 case scenarios and images for self-assessment interpretation. The combination of the book and the website materials provides an unparalleled learning experience for people who do not routinely practise echocardiography.
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- The text covers the basic concepts of how ultrasound works and looks at practical aspects of how to perform an echo.
- It examines both normal function as well as the whole range of pathologies encountered in day-to-day clinical practice.
- There is particular emphasis on how to report your interpretation of the echo findings.
- The book is highly illustrated throughout with real examples many of which are available to view in dynamic form on the Expert Consult platform, thus offering a comprehensive library of echo movies.
- The text is fully up to date with the latest recommendations of the American Society of Echocardiography as well as equivalents from the British Society of Echocardiography
- 100 self-assessment cases on the Expert Consult platform test knowledge and interpretation skills and are aimed at BSE accreditation exam level
- The full text of the book is available on the Expert Consult platform
- There are new chapters on 3D echo and right ventricular pathologies.
- The text has been fully updated and there are more than 200 new images to illustrate state-of-the-art echo.
- The presentation of the echo images has been simplified with the addition of a fold-out flap on the book referencing the key areas of anatomical detail.
- The text now includes the latest recommendations of the American Society of Echocardiography as well as the equivalents from the British Society of Echocardiography
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Half-title-page | i | ||
| Dedication | ii | ||
| Essential Echocardiography | iii | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Preface | vii | ||
| Abbreviations | viii | ||
| Acknowledgements | x | ||
| Second edition | x | ||
| First edition | x | ||
| A Getting started | 1 | ||
| 1 What is echocardiography? | 1 | ||
| Chapter contents | 1 | ||
| Basic principles | 1 | ||
| Echocardiographic modes | 2 | ||
| Two-dimensional imaging | 2 | ||
| Three-dimensional imaging | 3 | ||
| M-mode imaging | 3 | ||
| Doppler ultrasound | 4 | ||
| Pulse wave Doppler | 7 | ||
| Continuous wave Doppler | 8 | ||
| Colour flow mapping | 8 | ||
| Doppler tissue imaging (DTI) | 9 | ||
| 2 Views of the heart | 11 | ||
| Chapter contents | 11 | ||
| The anatomy of the heart | 11 | ||
| Standard echocardiographic windows | 11 | ||
| Positioning yourself and holding the probe | 13 | ||
| Standard views | 14 | ||
| Parasternal long axis (PSLAX) view | 14 | ||
| Parasternal short axis (PSSAX) view | 15 | ||
| Apical views | 17 | ||
| Subcostal views | 17 | ||
| Suprasternal views | 19 | ||
| Right parasternal view | 20 | ||
| Putting it all together | 21 | ||
| 3 Optimising the picture | 23 | ||
| Chapter contents | 23 | ||
| Patient optimisation | 23 | ||
| Examination environment | 24 | ||
| Echo optimisation | 24 | ||
| Two-dimensional imaging | 24 | ||
| Probe choice | 24 | ||
| Sector depth | 24 | ||
| Sector width | 24 | ||
| Gain | 24 | ||
| Focusing | 25 | ||
| Harmonics | 26 | ||
| Colour flow mapping Doppler | 27 | ||
| Sector size | 27 | ||
| Colour gain | 28 | ||
| Aliasing velocity | 28 | ||
| Spectral Doppler | 28 | ||
| Type of Doppler | 28 | ||
| Position of sample volume/cursor | 29 | ||
| Scale/baseline | 29 | ||
| Sweep speed | 30 | ||
| B The cardiac chambers | 31 | ||
| 4 The left ventricle | 31 | ||
| Chapter contents | 31 | ||
| The anatomy of the left ventricle | 31 | ||
| Echocardiographic appearance | 31 | ||
| Left ventricular structure | 32 | ||
| Left ventricular mass | 33 | ||
| M-mode methods | 33 | ||
| Left ventricular wall thickness | 33 | ||
| Cubed formula | 34 | ||
| Two-dimensional methods | 34 | ||
| Area–length formula | 34 | ||
| Truncated ellipsoid | 35 | ||
| Left ventricular hypertrophy | 35 | ||
| Left ventricular systolic function | 36 | ||
| What is the best measure of left ventricular function? | 37 | ||
| Subjective assessment | 37 | ||
| Semiquantitative assessment | 38 | ||
| Quantitative assessment | 41 | ||
| Fractional shortening | 41 | ||
| Ejection fraction | 41 | ||
| 5 Diastolic function and dyssynchrony | 44 | ||
| Chapter contents | 44 | ||
| Left ventricular diastolic function | 44 | ||
| Diastolic dysfunction | 44 | ||
| Conditions associated with diastolic dysfunction | 45 | ||
| Pulse wave Doppler assessment of diastolic function | 45 | ||
| Doppler tissue imaging (DTI) | 47 | ||
| Pulmonary vein flow | 48 | ||
| Classifying diastolic function | 49 | ||
| Ventricular synchrony | 49 | ||
| Echocardiographic assessment of ventricular dyssynchrony | 51 | ||
| Interventricular dyssynchrony | 52 | ||
| Pre-ejection times | 52 | ||
| Intraventricular dyssynchrony | 52 | ||
| M-mode | 52 | ||
| Tissue Doppler imaging | 53 | ||
| Speckle tracking | 55 | ||
| Real-time three-dimensional echo | 55 | ||
| 6 The right ventricle | 57 | ||
| Chapter contents | 57 | ||
| The anatomy of the right ventricle | 57 | ||
| Echocardiographic appearance | 57 | ||
| Assessing the right ventricle | 58 | ||
| Structural assessment | 58 | ||
| Assessment of systolic function | 58 | ||
| Subjective assessment | 59 | ||
| Quantitative assessment | 59 | ||
| Assessment of diastolic function | 61 | ||
| 7 The atria | 63 | ||
| Chapter contents | 63 | ||
| Anatomy of the atria | 63 | ||
| Echocardiographic appearance | 63 | ||
| Assessment of atrial structure | 64 | ||
| Normal variants | 65 | ||
| Lipomatous hypertrophy of the interatrial septum | 65 | ||
| Chiari network | 65 | ||
| Eustachian valve | 65 | ||
| Atrial diseases | 66 | ||
| Atrial enlargement | 66 | ||
| Spontaneous contrast and thrombus | 67 | ||
| Atrial masses | 68 | ||
| Atrial septal defects | 68 | ||
| Cor triatriatum | 68 | ||
| 8 Myocardial infarction | 70 | ||
| Chapter contents | 70 | ||
| Introduction | 70 | ||
| Acute complications | 70 | ||
| Left ventricular dysfunction | 70 | ||
| Right ventricular dysfunction | 72 | ||
| Myocardial rupture | 72 | ||
| Ventricular free wall rupture | 72 | ||
| Ventricular septal rupture | 73 | ||
| Papillary muscle rupture: acute mitral regurgitation | 73 | ||
| Mural thrombus | 75 | ||
| Pericarditis | 75 | ||
| Chronic complications | 76 | ||
| Left ventricular remodelling | 76 | ||
| Chronic mitral regurgitation | 77 | ||
| 9 The cardiomyopathies | 80 | ||
| Chapter contents | 80 | ||
| Hypertrophic cardiomyopathy | 80 | ||
| Anderson–Fabry disease | 85 | ||
| Athlete’s heart | 85 | ||
| Dilated cardiomyopathy | 85 | ||
| Assessment of the underlying cause | 86 | ||
| Left ventricular non-compaction (LVNC) | 87 | ||
| Takotsubo cardiomyopathy | 87 | ||
| Assessment of left ventricular function | 89 | ||
| Restrictive cardiomyopathy | 89 | ||
| Endomyocardial fibrosis | 90 | ||
| 10 Right ventricular pathologies | 93 | ||
| Chapter contents | 93 | ||
| Right ventricular myocardial infarction | 93 | ||
| Arrhythmogenic right ventricular dysplasia (ARVD) | 93 | ||
| Cor pulmonale | 94 | ||
| Acute cor pulmonale: acute pulmonary embolism | 95 | ||
| Chronic cor pulmonale | 97 | ||
| C The valves | 98 | ||
| 11 Principles of valve disease | 98 | ||
| Chapter contents | 98 | ||
| Introduction | 98 | ||
| Estimating pressure gradients: the Bernoulli equation | 98 | ||
| Peak instantaneous and mean gradients | 99 | ||
| Measuring volumes and flow | 101 | ||
| Clinical applications: continuity and discontinuity | 103 | ||
| Estimation of valve area: the continuity equation | 103 | ||
| Regurgitant fraction: discontinuity | 103 | ||
| Potential limitations | 105 | ||
| Effective regurgitant orifice area: PISA | 105 | ||
| PISA in practice: an example | 107 | ||
| Potential limitations | 108 | ||
| 12 The aortic valve | 109 | ||
| Chapter contents | 109 | ||
| The normal aortic valve | 109 | ||
| Echocardiographic appearance | 109 | ||
| Doppler examination | 109 | ||
| Aortic valve sclerosis | 109 | ||
| Aortic valve stenosis | 111 | ||
| Echocardiographic appearance | 111 | ||
| Assessment of aortic stenosis | 111 | ||
| Aortic valve gradient | 112 | ||
| Simplified Bernoulli equation | 112 | ||
| Pitfalls | 113 | ||
| Estimation of aortic valve area | 114 | ||
| The continuity equation | 114 | ||
| Pitfalls | 115 | ||
| Aortic valve planimetry | 115 | ||
| Assessment of the left ventricle | 116 | ||
| Surgery for aortic stenosis | 116 | ||
| Aortic valve regurgitation | 116 | ||
| Detection of aortic regurgitation | 117 | ||
| Assessment of chronic aortic regurgitation severity | 117 | ||
| Specific measures | 117 | ||
| Vena contracta | 117 | ||
| Jet width in the LVOT | 118 | ||
| Supportive measures | 119 | ||
| Jet area/length | 119 | ||
| Pressure half-time and rate of deceleration | 119 | ||
| Descending aortic diastolic flow reversal | 120 | ||
| Quantitative echocardiographic techniques | 120 | ||
| Effective regurgitant orifice area (EROA) | 121 | ||
| Assessment of the left ventricle in chronic aortic regurgitation | 121 | ||
| Assessment of acute aortic regurgitation | 121 | ||
| Causes of aortic regurgitation | 121 | ||
| Surgery for aortic regurgitation | 121 | ||
| Congenital abnormalities | 122 | ||
| Bicuspid aortic valve | 122 | ||
| Quadricuspid aortic valve | 124 | ||
| Subvalvular aortic stenosis | 125 | ||
| Supravalvular aortic stenosis | 125 | ||
| 13 The mitral valve | 127 | ||
| The normal mitral valve | 127 | ||
| Echocardiographic appearance | 127 | ||
| Doppler examination | 129 | ||
| Diseases of the mitral valve | 130 | ||
| Mitral annular calcification | 130 | ||
| Rheumatic mitral valve disease (RMVD) | 131 | ||
| Mitral valve prolapse | 132 | ||
| Assessing severity of mitral regurgitation | 134 | ||
| Detection | 134 | ||
| How severe is the mitral regurgitation? | 135 | ||
| Specific measures | 135 | ||
| Structural signs | 135 | ||
| Vena contracta width | 137 | ||
| PISA lite | 137 | ||
| Pulmonary vein flow | 138 | ||
| Supportive measurements | 138 | ||
| Structural signs | 138 | ||
| Continuous wave Doppler of mitral regurgitant jet | 139 | ||
| Pulse wave Doppler | 140 | ||
| Other measures | 141 | ||
| Jet area/length | 141 | ||
| Quantitative estimates of mitral regurgitant severity | 141 | ||
| Regurgitant volume and regurgitant fraction | 141 | ||
| PISA | 141 | ||
| Acute mitral regurgitation | 141 | ||
| What is the cause? | 141 | ||
| Surgery for mitral regurgitation | 143 | ||
| Mitral stenosis | 143 | ||
| Assessing the severity of mitral stenosis | 144 | ||
| Planimetry | 144 | ||
| Pressure half-time method | 145 | ||
| Mean pressure gradient | 145 | ||
| Complications of mitral stenosis | 146 | ||
| Surgery for mitral stenosis | 146 | ||
| 14 The right heart valves | 148 | ||
| Chapter contents | 148 | ||
| The normal tricuspid and pulmonary valves | 148 | ||
| Echocardiographic appearance | 148 | ||
| Doppler examination | 150 | ||
| Tricuspid regurgitation | 151 | ||
| Assessing severity | 151 | ||
| Two-dimensional imaging | 151 | ||
| CFM Doppler | 151 | ||
| Spectral Doppler | 152 | ||
| Secondary features | 153 | ||
| What is the cause? | 154 | ||
| Tricuspid stenosis | 154 | ||
| Pulmonary stenosis | 155 | ||
| Assessment of pulmonary stenosis | 155 | ||
| Valve gradient | 155 | ||
| Continuity equation | 156 | ||
| Pulmonary regurgitation | 156 | ||
| Assessment of pulmonary regurgitation | 156 | ||
| Valve appearance | 157 | ||
| CFM Doppler | 157 | ||
| CW Doppler | 157 | ||
| Quantitative techniques | 157 | ||
| Secondary effects | 158 | ||
| Diseases of the right heart valves | 158 | ||
| Tricuspid valve prolapse | 158 | ||
| Carcinoid syndrome | 158 | ||
| Ebstein’s anomaly | 159 | ||
| Assessment of right heart pressures | 159 | ||
| Right atrial pressure | 160 | ||
| Right ventricular systolic pressure | 161 | ||
| Pulmonary artery systolic pressure | 161 | ||
| Pulmonary artery diastolic pressure | 162 | ||
| 15 Infective endocarditis | 166 | ||
| Chapter contents | 166 | ||
| Diagnosis | 166 | ||
| Complications | 168 | ||
| Abscess formation | 168 | ||
| Valve destruction | 168 | ||
| Seeding | 169 | ||
| Embolic complications | 169 | ||
| Prosthetic valve dehiscence | 169 | ||
| Detection of a predisposing condition | 170 | ||
| 16 Prosthetic valves | 173 | ||
| Chapter contents | 173 | ||
| Types of prosthetic valve | 173 | ||
| Mechanical valves | 173 | ||
| Bioprosthetic valves | 173 | ||
| Normal function | 175 | ||
| Appearance | 175 | ||
| Function | 176 | ||
| Abnormal prosthetic valve function | 176 | ||
| Paravalvular regurgitation | 176 | ||
| Dehiscence | 177 | ||
| Pannus | 178 | ||
| Thrombus | 178 | ||
| Endocarditis | 178 | ||
| Percutaneous valve treatments | 178 | ||
| D Inside and outside the heart | 180 | ||
| 17 Pericardial disease | 180 | ||
| Chapter contents | 180 | ||
| Introduction | 180 | ||
| Echocardiographic appearance | 180 | ||
| Pericarditis, pericardial effusion and tamponade | 180 | ||
| Differential diagnosis | 182 | ||
| Assessment of pericardial effusions | 183 | ||
| Depth | 183 | ||
| Localisation | 183 | ||
| Tamponade | 184 | ||
| Echocardiographic features of cardiac tamponade | 185 | ||
| Constrictive pericarditis | 186 | ||
| Physiology of pericardial constriction | 187 | ||
| Two-dimensional and M-mode findings | 187 | ||
| Doppler findings | 187 | ||
| Effusive–constrictive pericarditis | 189 | ||
| Pericardial constriction versus restrictive cardiomyopathy | 189 | ||
| Pericardial tumours | 190 | ||
| 18 Cardiac masses | 192 | ||
| Chapter contents | 192 | ||
| Introduction | 192 | ||
| Primary neoplasms | 192 | ||
| Benign | 192 | ||
| Atrial myxoma | 192 | ||
| Cardiac rhabdomyoma | 193 | ||
| Malignant | 194 | ||
| Secondary neoplasms | 194 | ||
| Thrombus | 194 | ||
| Valvular masses | 196 | ||
| Infective endocarditis | 196 | ||
| Papillary fibroelastoma | 196 | ||
| Intravascular devices | 197 | ||
| Normal variants and artefact | 197 | ||
| 19 The aorta | 200 | ||
| Chapter contents | 200 | ||
| Introduction | 200 | ||
| Basic anatomy | 200 | ||
| Echocardiographic appearance | 200 | ||
| Standard measurements | 202 | ||
| Diseases of the aorta | 202 | ||
| Aortic atheroma | 202 | ||
| Thoracic aortic aneurysm | 203 | ||
| Echocardiographic appearance | 204 | ||
| Aortic dissection | 204 | ||
| Echocardiographic appearance | 205 | ||
| Sinus of Valsalva aneurysm | 206 | ||
| Congenital aortic disease | 206 | ||
| Aortic coarctation | 206 | ||
| Patent ductus arteriosus | 207 | ||
| 20 Congenital septal abnormalities | 209 | ||
| Chapter contents | 209 | ||
| Atrial septal defects | 209 | ||
| Embryology | 209 | ||
| Patent foramen ovale (PFO) and atrial septal aneurysm (ASA) | 209 | ||
| Bubble contrast studies | 210 | ||
| Clinical syndromes associated with PFO | 212 | ||
| Cryptogenic stroke | 212 | ||
| Platypnoea orthodeoxia | 212 | ||
| Secundum atrial septal defect | 212 | ||
| Primum ASD | 213 | ||
| Other ASDs | 213 | ||
| Ventricular septal defects | 214 | ||
| Conoventricular VSD (outlet VSD) | 214 | ||
| Perimembranous VSD | 214 | ||
| Subpulmonic VSD | 215 | ||
| Misaligned VSD | 215 | ||
| Muscular VSD | 215 | ||
| Inlet VSD | 216 | ||
| Quantitative assessment of intracardiac shunts | 217 | ||
| Percutaneous device closure | 218 | ||
| 21 3D echocardiography | 221 | ||
| Chapter contents | 221 | ||
| Introduction | 221 | ||
| Principles of 3D echo | 221 | ||
| Imaging protocol | 224 | ||
| Transthoracic 3D echocardiography | 224 | ||
| Transoesophageal echocardiography (TOE) | 225 | ||
| Clinical applications | 226 | ||
| Assessment of left ventricular function | 226 | ||
| Assessment of valvular heart disease | 227 | ||
| Guiding interventions | 228 | ||
| Summary | 228 | ||
| Limitations | 229 | ||
| Future directions | 229 | ||
| E Approach to examining and reporting | 230 | ||
| 22 The comprehensive examination | 230 | ||
| Chapter contents | 230 | ||
| Integrating information | 230 | ||
| The echo examination | 230 | ||
| 23 The focused examination | 237 | ||
| Chapter contents | 237 | ||
| Introduction | 237 | ||
| Cardiac arrest (pulseless electrical activity) | 238 | ||
| Acute chest pain | 238 | ||
| Acute breathlessness | 238 | ||
| Hypotension | 239 | ||
| Ventricular arrhythmia | 239 | ||
| Systemic embolism | 240 | ||
| Blunt trauma | 240 | ||
| 24 Reporting an echo study | 241 | ||
| F Appendices | 243 | ||
| Appendix 1 Normal values | 243 | ||
| Appendix 2 Useful formulae | 248 | ||
| Basic physics | 248 | ||
| Properties of ultrasound | 248 | ||
| Doppler formula | 248 | ||
| Nyquist limit | 248 | ||
| Left ventricular function | 248 | ||
| Fractional shortening | 248 | ||
| Ejection fraction | 249 | ||
| Simpson’s biplane formula | 249 | ||
| Left ventricular hypertrophy | 249 | ||
| Cubed formula | 249 | ||
| Area–length formula | 249 | ||
| Truncated ellipsoid | 249 | ||
| Quantitative Doppler echocardiography | 250 | ||
| Stroke volume (SV) | 250 | ||
| Cardiac output | 250 | ||
| Regurgitant volume | 250 | ||
| Regurgitant fraction | 250 | ||
| Shunt ratio | 250 | ||
| Valvular disease | 250 | ||
| Continuity equation | 250 | ||
| Proximal isovelocity surface area (PISA) | 251 | ||
| PISA lite (mitral regurgitation only) | 251 | ||
| Regurgitant volume | 251 | ||
| Index | 253 | ||
| A | 253 | ||
| B | 254 | ||
| C | 254 | ||
| D | 254 | ||
| E | 254 | ||
| F | 255 | ||
| G | 255 | ||
| H | 255 | ||
| I | 255 | ||
| J | 255 | ||
| L | 255 | ||
| M | 256 | ||
| N | 257 | ||
| O | 257 | ||
| P | 257 | ||
| Q | 258 | ||
| R | 258 | ||
| S | 258 | ||
| T | 259 | ||
| U | 259 | ||
| V | 259 | ||
| W | 260 | ||
| Figure labels | e1 |