ECHOCARDIOGRAPHY

Deductions for Clinical Practice

Dott. Mirco Baccino – Cardiologia Ospedale Santa Corona
GUIDELINES
 
For no acute patients.
Clinical evidence or general consensus. 

Appropriates indications.
Class I clinical evidence – general consensus
Class II frequent use without clinical evidence
Class III inappropriate  indications
 ECHO TEST

-  Preceded by clinical estimation
- EKG
- Specific issue
- Targets

   
 ECHO TEST

• Patients without well-known

cardiopathy:                                   
The target is to show a cardiopathy in 
hight rish subject

   
 ECHO TEST IN PATIENTS WITHOUT 
WELL-KNOWN CARDIOPATHY
•  NO SYMPTOMATIC PEOPLE 
• class I         familial genetic disease (HCM, Marfan)
                         antiblastic therapy – cardiotoxic agent/drug  
                         organ donor                 
                         
 
•   class II     athlete
                       heart involving disease
                       left bundle branch block

   
 ECHO TEST IN PATIENTA WITHOUT 
WELL-KNOW CARDIOPATHY

   chest pain, dyspnea, edema, murmurs, 
palpitations  
 
- class I in hight suspect

- class III in low suspect

   
 ECHO TEST IN PATIENTS WITH WELL-
KNOW CARDIOPATHY

 DIAGNOSIS  
 CHECK-UP

   
 ECHO TEST IN PATIENTS WITH WELL-
KNOW CARDIOPATHY
 VALVULAR HEART DISEASES    
- class I    diagnosis
                 to check
                                                 6 months/ 1 year
                                                in prosthesis  (3 mounths after the surgery)   
                                                   
                                                in valvular ptostehesis dysfunction            
 
-  Class II  to check valvular disorder and proSthesis  without ventricular 
disorder  ( 1-2 year)

   
 ECHO TEST IN PATIENTS WITH WELL-
KNOW CARDIOPATHY

Coronary artery disease 

• class I  always in diagnosis and 3 months after 
AMI, PCI, CABG
• class I cheking left ventricle disorder evry 6 
months/1 year in clinical change

• class II  C.D.D. without left ventricle disorder

   
 ECHO TEST IN PATIENTS WITH WELL-
KNOW CARDIOPATHY
CARDIOMYOPATHIES
     class I  always in diagnosis
              in checking every 6 months/1 year
                                                                                      
                           class II  diseases involving heart
                                                                                      
                                                           class III  
diseases rarely involving heart

   
 ECHO TEST IN PATIENTS WITH WELL-
KNOW CARDIOPATHY

Pericardial diseases  

• class I  always in diagnosis
                  every year in checking                     
                                                                     

• class II in checking                                 
   
 ECHO TEST IN PATIENTS WITH WELL-
KNOW CARDIOPATHY

Systemic hypertension

• Class I           in checking severe HTA with   
          symptoms
                                           

• Class III         in borderline HTA

   
EXTRA CARDIAC DISEASES

PULMONARY DISEASES   

• class I             pulmonary hypertension

• class II             PTE/COBP
                                                  

   
EXTRA CARDIAC DISEASES

Neurological ischemia    

• class I  with embolism
                 <45 y.o., 
                 >45 y.o. without carotid pathology

   
EXTRA CARDIAC DISEASES

SYNCOPE

• class I     HOCM
                   AORTIC STENOSIS 

   
EXTRACARDIAC DISEASES

AORTA DISEASES

• class I    aortic dyssection
                 Marfan Syndrome
• class II   aortic expansion

   
 ECHO TEST
• PARAMETERS:

• - EJECTION FRACTION
• - contractility
• - ventricle diameters
• - Flows Doppler   - regurgitations
                                          - gradients

   
 ECHO TEST
TEE

• Prosthesys
• Clots
• Endocarditis

   
 ECHO TEST
• TDI
• Stress-Echo (dobutaminE-dipiridamolo)

=> Searching Ischemia

   
 ECHO TEST
• CAD
• Cardiomyopathies (dilated, hypertrophic)
• Hypertensive C.
• Congenital C.
• Valvular C.
• Pericardial effusion

   
 CAD
• Cardiac diameters(TD e TS)
• Wall movement
• Ejection fraction (>45%)
• => diagnosis and prognosis

   
 CARDIOMYOPATHIES
• Cardiac diameters (TD e TS)
• Wall thickness 
• Wall movement
• Ejection fraction
• Flow Doppler (rigurgitation and gradients)

   
 HYPERTENSIVE 
CARDIOMYOPATY
• Cardiac diameters
• Wall thickness
• Wall movement
• Ejection fraction
• Flow Doppler (Trans-mitral flow)

   
 CONGENITAL 
CARIOMYOPATHIES
• Cardiac diameters
• Valvular morphology, chambers)
• Flow Doppler (rigurgitation, gradient, 
shunt)

   
 VALVULAR 
CARDIOMYOPATHIES
• Aortic stenosis
• Mitral stenosis
• Aortic regurgitation
• Mitral regurgitation
• => diagnosis, prognosis, cardiosurgery 
timing.

   
 AORTICA STENOSIS
• Cardiac diameters
• Wall thickness
• Ejection fraction
• Flow Doppler (gradient)

   
 MITRAL STENOSIS

• Valvular area (anatomic and functional)
• Left atrium diameters
• Pulmonary pressure

   
 AORTIC REGURGITATION

• Left ventricle diameters (TD e TS)
• Ejection fraction
• Flow Doppler 

   
 MITRAL REGURGITATION

• Left ventricle diameters (TD e TS)
• Left atrium diameters
• Ejection fraction
• Flow Doppler 
• Pulmonary pressure

   
 PERICARDIAL EFFUSION
• Quantity
• Nature
• Location

=> Prognosis, pericardiocentesis