Echocardiogram in Congestive Heart Failure

1. See Also
   1. Echocardiogram
   2. Bedside Lung Ultrasound in Emergency (Blue Protocol)
   3. Rapid Ultrasound in Shock (RUSH Exam)
   4. Inferior Vena Cava Ultrasound for Volume Status
   5. Congestive Heart Failure
   6. Systolic Dysfunction
   7. Diastolic Dysfunction
   8. Parasternal Long-Axis Echocardiogram View ( PLAX View)
   9. Parasternal Short-Axis Echocardiogram View (PSAX View)
   10. Subcostal Echocardiogram View (Subxiphoid Echocardiogram View)
   11. Apical Four Chamber Echocardiogram View
   12. Suprasternal Echocardiogram View
   13. Echocardiogram in Congestive Heart Failure
   14. Inferior Vena Cava Ultrasound for Volume Status
   15. Emergency Pericardiocentesis
   16. Pericardial Effusion
   17. Stress Echocardiogram
   18. Transesophageal Echocardiogram
   19. FAST Exam
2. Indication
   1. Every patient with Congestive Heart Failure!
   2. Distinguishes
      1. Systolic Dysfunction
      2. Diastolic Dysfunction
   3. Identify underlying valve disease
   4. Identify underlying ischemic heart damage
   5. Quantify Congestive Heart Failure severity
3. Assessment
   1. Chamber size (diastolic and end-systolic dimensions)
      1. Left Ventricular Hypertrophy
      2. Left Atrial Enlargement
   2. Ejection Fraction (EF)
      1. Systolic Dysfunction: EF < 45%
      2. Diastolic Dysfunction (isolated): EF > 50%
      3. Echocardiogram accuracy is +/- 5% at best
   3. Heart Valve Function and dysfunction
   4. Wall thickness and wall motion abnormalities
   5. Parasternal long axis view
      1. Mitral valve leaflet at maximal opening >13 mm distance from septum suggests Ejection Fraction <30%
      2. Ejection fraction can be estimated visually (tilt probe to include cardiac apex)
   6. Parasternal short axis view below mitral valve
      1. Ejection fraction can be estimated visually
4. Findings: Diastolic Dysfunction
   1. Ejection Fraction >50% (see above)
   2. Abnormal pulmonary venous flow pattern
   3. Measurement of Tau (LV pressure decay)
      1. Assesses left ventricular stiffness
      2. Prolonged isovolemic relaxation time
      3. Prolonged deceleration time
   4. E-A Wave Ratio (Trans-mitral valve Blood Flow)
      1. Components
         1. E-Wave (LV filling) Peak Flow velocity
         2. A-Wave (atrial contraction) Peak Flow velocity
      2. Interpretation
         1. Normal: 1.5
         2. Early Diastolic Dysfunction: <1.0
         3. Late Diastolic Dysfunction: >2.0
5. Approach: Obesity
   1. Body habitus too large for adequate exam
      1. Nuclear Ventriculogram (MUGA Scan)
6. Resources
   1. Echocardiographer.org
      1. http://echocardiographer.org/index.html