Transthoracic Echocardiography

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Cardiac symptoms
    • Cardiac murmur (grade 3 or louder systolic murmur, any diastolic murmur, or any murmur with associated cardiac symptoms)
    • Dyspnea or suspected heart failure symptoms
    • Chest pain
    • Palpitations or cardiac arrhythmia
  • Known cardiac disease
    • Valve stenosis or regurgitation
    • Prosthetic valves
    • Endocarditis
    • Coronary artery disease
    • Cardiomyopathy
    • Pericardial disease
    • Aortic disease
    • Hypertensive heart disease
    • Congenital heart disease
    • Cardiac masses or systemic embolic event
    • Pulmonary heart disease
  • Screening or monitoring
    • Family history of inherited cardiac condition
    • Athletes with concerns on physical exam or ECG
    • Pre-operative evaluation for noncardiac surgery
    • Monitoring after cardiac procedures or surgery
CONTRAINDICATIONS
  • There are no contraindications to transthoracic echocardiography (TTE).
EQUIPMENT
  • Echocardiography (echo) system with transducer: The transducer type and frequency should be appropriate for the patient being examined.
  • Ultrasound gel
  • ECG electrodes
ANATOMY
  • Echo can evaluate each of the cardiac chambers, each of the valves, the great vessels, inferior vena cava, superior vena cava, and the aortic arch including the proximal portion of the head and arm vessels. Small portions of the abdominal aorta are also visualized.
  • Four standard transducer positions on the patient’s chest wall are used to produce the images
  • The patient is generally positioned in the left lateral decubitus position and in the supine position during the examination to capture all standard views.
  • A set of “core elements” should be included in every TTE examination; additional data recording may be included as clinically indicated, as detailed in the Textbook of Clinical Echocardiography.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Cleanse the ultrasound gel from the patient’s skin and remove all ECG electrodes.
  • No other specific post-procedure care is needed.
COMPLICATIONS
  • There are no known complications of TTE.
RESULT ANALYSIS
  • Echocardiographic images and Doppler data are recorded in digital cine-loop format for later review.
  • The images are reviewed by the cardiologist, and a report is generated.
  • The following key elements are included in every report:
    • Clinical data: the reason for the study, pertinent history, and physical examination findings, cardiac medications, and blood pressure.
    • Measurements: left ventricular chamber size and wall thickness at end-diastole and end-systole, two-dimensional or three-dimensional measurement of left ventricular LV end-diastole and end-systole volumes and ejection fraction, aortic root end-diastole dimension, left atrial end-systole dimension or volume, Doppler antegrade velocities (LV outflow tract, aorta, LV inflow early and atrial filling), tricuspid regurgitant velocity and an estimate of right atrial pressure). Additional measurements are made depending on the specific abnormal findings.
    • Echo findings: estimated pulmonary pressure and anatomy and function of the following:
      • Left ventricle
      • Right ventricle
      • Left atrium
      • Right atrium and atrial septum
      • Aortic valve
      • Mitral valve
      • Tricuspid valve
      • Pulmonic valve
      • Pericardium
  • Conclusions
    • The conclusions indicate the major diagnosis, associated findings, and pertinent negative findings (depending on the indication for the study).
    • When clinically appropriate, specific recommendations are made.
    • Serious unexpected findings are communicated promptly to the referring physician.
    • When data are not definitive, the findings are described along with a differential diagnosis to explain the findings.
    • Additional diagnostic approaches are recommended as appropriate.
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