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Echocardiography Echocardiography Document Transcript

  • Feigenbaum’sEchocardiographySeventh Edition William F. Armstrong, MD Professor of Medicine Director, Echocardiography Laboratory University of Michigan Health System Ann Arbor, Michigan Thomas Ryan, MD John G. & Jeanne Bonnet McCoy Chair in Cardiovascular Medicine Professor of Internal Medicine Division of Cardiovascular Medicine The Ohio State University Medical Center Director, The Ohio State University Heart Center Columbus, Ohio
  • Acquisitions Editor: Frances R. DeStefanoProduct Manager: Leanne McMillanProduction Manager: Alicia JacksonSenior Manufacturing Manager: Benjamin RiveraMarketing Manager: Kimberly SchonbergerDesign Coordinator: Doug SmockProduction Service: Aptara, Inc.© 2010 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business530 Walnut StreetPhiladelphia, PA 19106 USALWW.comAll rights reserved. This book is protected by copyright. No part of this book may be repro-duced in any form by any means, including photocopying, or utilized by any informationstorage and retrieval system without written permission from the copyright owner, exceptfor brief quotations embodied in critical articles and reviews. Materials appearing in thisbook prepared by individuals as part of their official duties as U.S. government employeesare not covered by the above-mentioned copyright.Printed in ChinaSixth Edition, 2005 © Lippincott Williams & WilkinsFifth Edition, 1995 © Williams & WilkinsFourth Edition, 1986 © Lea & FebigerThird Edition, 1981 © Lea & FebigerSecond Edition, 1976 © Lea & FebigerFirst Edition, 1972 © Lean & FebigerLibrary of Congress Cataloging-in-Publication DataArmstrong, William F. Feigenbaum’s echocardiography/William F. Armstrong, Thomas Ryan. — 7th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-7817-9557-9 1. Echocardiography. I. Ryan, Thomas, 1953– II. Feigenbaum, Harvey. III. Title.IV. Title: Echocardiography. [DNLM: 1. Echocardiography—methods. 2. Heart Diseases—diagnosis.WG 141.5.E2 A739f 2010] RC683.5.U5F44 2010 616.1 207543—dc22 2009034420Care has been taken to confirm the accuracy of the information presented and to de-scribe generally accepted practices. However, the authors, editors, and publisher arenot responsible for errors or omissions or for any consequences from application of theinformation in this book and make no warranty, expressed or implied, with respect tothe currency, completeness, or accuracy of the contents of the publication. Applicationof the information in a particular situation remains the professional responsibility of thepractitioner. The authors, editors, and publisher have exerted every effort to ensure that drugselection and dosage set forth in this text are in accordance with current recommendationsand practice at the time of publication. However, in view of ongoing research, changes ingovernment regulations, and the constant flow of information relating to drug therapy anddrug reactions, the reader is urged to check the package insert for each drug for any changein indications and dosage and for added warnings and precautions. This is particularlyimportant when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and DrugAdministration (FDA) clearance for limited use in restricted research settings. It is theresponsibility of the health care providers to ascertain the FDA status of each drug or deviceplanned for use in their clinical practice.To purchase additional copies of this book, call our customer service department at(800) 638-3030 or fax orders to (301) 223-2320. International customers should call(301) 223-2300.Visit Lippincott Williams & Wilkins on the Internet: at Lippincott Williams& Wilkins customer service representatives are available from 8:30 am to 6 pm, EST.10 9 8 7 6 5 4 3 2 1
  • To Harvey Feigenbaum, our friend, colleague, and mentor, without whom none of this would have been possible.
  • ContentsPreface xivAcknowledgments xvChapter 1 History of Echocardiography 1 Harvey Feigenbaum, MD Development of Various Echocardiographic Technologies 2 Recording Echocardiograms 5 Cardiac Sonographers 5 Echocardiographic Education and Organizations 6 References 7Chapter 2 Physics and Instrumentation 9 Physical Principles 9 Interaction Between Ultrasound and Tissue 10 The Transducer 12 Manipulating the Ultrasound Beam 14 Resolution 16 Creating the Image 17 Transmitting Ultrasound Energy 19 Display Options 20 Tradeoffs in Image Creation 22 Signal Processing 22 Tissue Harmonic Imaging 23 Artifacts 25 Doppler Echocardiography 26 Principles of Doppler Ultrasound 26 Doppler Formats 29 Color Flow Imaging 32 Technical Limitations of Color Doppler Imaging 33 Doppler Artifacts 34 Tissue Doppler Imaging 35 Biologic Effects of Ultrasound 35 Suggested Readings 37Chapter 3 Specialized Echocardiographic Techniques and Methods 39 Imaging Devices and Methods 39 M-Mode Echocardiography 39 Two-dimensional Echocardiography 40 Color B-Mode Scanning 40 Doppler Interrogation 40 Color Flow Doppler Imaging 43 Color Doppler M-Mode Imaging 43 Doppler Tissue Imaging 45 Speckle Tracking 48iv
  • Contents v Tissue Characterization 50 Acquisition of Cardiac Ultrasound Information 51 Transthoracic Echocardiography 51 Hand-Carried Ultrasound 52 Dedicated Single-Line Interrogation Transducers 52 Transesophageal Echocardiography 53 Three-dimensional Echocardiography 55 Epicardial Imaging 61 Intracardiac Echocardiography 62 Intravascular Ultrasound 63 The Digital Echo Laboratory 63 Suggested Readings 66Chapter 4 Contrast Echocardiography 67 Source of Ultrasound Contrast 67 Contrast Agents 67 Safety 69 Clinical Use 69 Ultrasound Interaction with Contrast Agents 70 Detection Methods 71 Machine Settings 71 Intermittent Imaging 72 Low Mechanical Index Imaging 72 Other Mechanical Factors Affecting Contrast Detection 72 Doppler Imaging 73 Contrast Artifacts 73 Detection and Utilization of Intracavitary Contrast 76 Intramural Cavity Flow, Trabeculation, Incomplete Filling 77 Enhancement of Doppler Signals 78 Shunt Detection 81 Detection of Miscellaneous Conditions 84 Myocardial Perfusion Contrast Echocardiography 85 Suggested Readings 89Chapter 5 The Echocardiographic Examination 91 Selecting the Transducers 93 Patient Position 93 Placement of the Transducer 95 An Approach to the Transthoracic Examination 96 Parasternal Long-Axis Views 96 Parasternal Short-Axis Views 97 Apical Views 102 The Subcostal Examination 106 Suprasternal Views 107 Orientation of Two-Dimensional Images 108 Echocardiographic Measurements 111 Left Ventricular Wall Segments 112 M-Mode Examination 113 Transesophageal Echocardiography 114 Transesophageal Echocardiographic Views 115 Echocardiography as a Screening Test 120 Training in Echocardiography 120 Suggested Readings 120Chapter 6 Evaluation of Systolic Function of the Left Ventricle 123 General Principles 123 Linear Measurements 123 Indirect M-Mode Markers of Left Ventricular Function 125 Two-dimensional Measurements 126 Assessment of Left Ventricular Function with Three-dimensional Echocardiography 128 Determination of Left Ventricular Mass 131 Physiologic Versus Pathologic Hypertrophy 132
  • vi Contents Regional Left Ventricular Function 133 Quantitative Techniques 133 Nonischemic Wall Motion Abnormalities 135 Premature Ventricular Contractions 139 Paced Rhythms 139 Ventricular Preexcitation 139 Postoperative Cardiac Motion 140 Posterior Compression 141 Pericardial Constriction 142 Doppler Evaluation of Global Left Ventricular Function 142 Myocardial Performance Index 143 Other Techniques for Determination of Left Ventricular Systolic Function 144 Determination of Left Ventricular dP/dt 145 Newer and Advanced Methods for Evaluating Left Ventricular Function 146 Strain and Strain Rate Imaging 148 Ventricular torsion 155 Conclusion 155 Suggested Readings 156Chapter 7 Evaluation of Left Ventricular Diastolic Function 159 Normal Diastolic Function 159 Stages of Diastolic Dysfunction 160 Normal Diastolic Function 160 Impaired Relaxation, Grade I 161 Pseudonormalization, Grade II 162 Restrictive Filling (Reversible), Grade III 162 Restrictive Filling (Irreversible), Grade IV 163 Echo-Doppler Parameters of Diastolic Function 163 Isovolumic Relaxation Time 163 Mitral Inflow 164 Color M-mode Flow Propagation Velocity (Vp) 165 Tissue Doppler Mitral Annular Velocity 166 Pulmonary Venous Flow Patterns 167 Left Atrial Volume 169 The Valsalva Maneuver 171 Other Markers of Diastolic Dysfunction 171 A Comprehensive Approach to Diastolic Dysfunction 172 Estimating Left Ventricular Filling Pressures 175 Stress Testing to Assess Diastolic Function 175 The Differential Diagnosis of Heart Failure with Normal Ejection Fraction 180 Evaluation of Diastolic Dysfunction in Specific Patient Groups 180 Sinus Tachycardia 180 Atrial Fibrillation 181 Mitral Valve Disease 181 Hypertrophic Cardiomyopathy 181 Prognosis in Patients with Diastolic Dysfunction 181 Suggested Readings 182Chapter 8 Left and Right Atrium, and Right Ventricle 185 Left Atrium 185 Left Atrial Dimensions and Volume 185 Left Atrial Function 188 Atrial Septum 190 Pulmonary Veins 193 Right Atrium 196 Right Atrial Thrombi 199 Right Atrial Blood Flow 200 Right Ventricle 203 Right Ventricular Dimensions and Volumes 204 Right Ventricular Overload 209 Right Ventricular Dysplasia 213 Suggested Readings 214
  • Contents viiChapter 9 Hemodynamics 217 Use of M-Mode and Two-Dimensional Echocardiography 217 Quantifying Blood Flow 218 Clinical Application of Blood Flow Measurement 221 Measuring Pressure Gradients 223 Applications of the Bernoulli Equation 228 Determining Pressure Half-Time 233 The Continuity Equation 236 Proximal Isovelocity Surface Area 237 Myocardial Performance Index 239 Suggested Readings 240Chapter 10 Pericardial Diseases 241 Clinical Overview 241 Echocardiographic Evaluation of the Pericardium 241 Detection and Quantitation of Pericardial Fluid 242 Direct Visualization of the Pericardium 246 Differentiation of Pericardial from Pleural Effusion 248 Cardiac Tamponade 248 Echocardiographic Findings in Cardiac Tamponade 249 Doppler Findings in Tamponade 251 Pericardial Constriction 254 Echocardiographic Diagnosis 254 Doppler Echocardiographic Findings in Constriction 256 Effusive Constrictive Pericarditis 257 Constrictive Pericarditis Versus Restrictive Cardiomyopathy 258 Miscellaneous Pericardial Disorders and Observations 259 Postoperative Effusions 259 Echocardiography-Guided Pericardiocentesis 260 Congenital Absence of the Pericardium 261 Pericardial Cysts 261 Suggested Readings 262Chapter 11 Aortic Valve Disease 263 Aortic Stenosis 263 Doppler Assessment of Aortic Stenosis 266 Other Approaches to Quantifying Stenosis 275 Defining the Severity of Aortic Stenosis 275 Dobutamine Echocardiography in the Evaluation of Aortic Stenosis 276 Natural History of Aortic Stenosis 276 Clinical Decision Making 278 Aortic Regurgitation 280 Appropriateness Criteria 280 M-Mode and Two-dimensional Imaging 280 Establishing a Diagnosis of Aortic Regurgitation 283 Evaluating the Severity of Aortic Regurgitation 286 Acute versus Chronic Aortic Regurgitation 291 Assessing the Left Ventricle 291 Miscellaneous Abnormalities of the Aortic Valve 293 Suggested Readings 293Chapter 12 Mitral Valve Disease 295 Anatomy of the Mitral Valve 295 Physiology of Mitral Valve Disease 297 Mitral Stenosis 297 Two-Dimensional Echocardiography in Rheumatic Mitral Stenosis 298 Congenital Mitral Stenosis 301 M-Mode Echocardiography 301 Transesophageal Echocardiography 302 Role of Three-Dimensional Echocardiography 303 Anatomic Determination of Severity 303 Doppler Echocardiographic Determination of Severity 304
  • viii Contents Exercise Gradients 307 Secondary Features of Mitral Stenosis 307 Atrial Fibrillation 309 Secondary Pulmonary Hypertension 310 Decision Making Regarding Intervention 310 Mitral Regurgitation 310 Doppler Evaluation of Mitral Regurgitation 311 Flail Leaflets 313 Functional Mitral Regurgitation 318 Determination of Mitral Regurgitation Severity 320 Other Considerations in Assessing Mitral Regurgitation 324 Mitral Valve Prolapse 326 Miscellaneous Mitral Valve Abnormalities 330 Calcification of the Mitral Annulus 331 Tumors of the Mitral Valve 331 Aneurysms of the Mitral Valve 332 Endocarditis and Valve Perforation 334 Anular Dehiscence 334 Radiation Damage 334 Carcinoid and Diet Drug Valvulopathy 334 Suggested Readings 335Chapter 13 Tricuspid and Pulmonary Valves 337 Clinical Overview 337 Pulmonary Valve 337 Pulmonary Valve Stenosis 341 Pulmonary Valve Regurgitation 342 Miscellaneous Abnormalities of the Pulmonary Valve 343 Evaluation of the Right Ventricular Outflow Tract 344 Tricuspid Valve 345 Doppler Evaluation of the Tricuspid Valve 346 Tricuspid Stenosis 348 Tricuspid Regurgitation 348 Pacemaker and Catheter-Induced Tricuspid Regurgitation 349 Ischemic Heart Disease 350 Quantitation of Tricuspid Regurgitation 351 Determination of Right Ventricular Systolic Pressure 353 Other Specific Conditions Resulting in Tricuspid and Pulmonary Valve Disease 355 Carcinoid Heart Disease 355 Endocardial Fibroelastosis 357 Ebstein Anomaly 357 Tricuspid Valve Resection 357 Cardiac Biopsy 359 Tumors and Other Masses 359 Suggested Readings 359Chapter 14 Infective Endocarditis 361 Clinical Perspective 361 Echocardiographic Characteristics of Vegetation 361 Diagnostic Accuracy of Echocardiography 366 Evolution of the Diagnostic Criteria 367 Complications of Endocarditis 368 Prognosis and Predicting Risk 374 Prosthetic Valve Endocarditis 375 Infected Intracardiac Devices 377 Right-Sided Endocarditis 378 Approach to the Patient with Endocarditis 379 Suggested Readings 383Chapter 15 Prosthetic Valves 385 Types of Prosthetic Valves 385 Normal Prosthetic Valve Function 386
  • Contents ix Application of Echocardiography to Patients with Prosthetic Valves 392 General Approach to Prosthetic Valves 394 Prosthetic Aortic Valves 397 Prosthetic Mitral Valves 402 Specific Causes of Dysfunction 402 Obstruction 402 Infective Endocarditis 409 Mechanical Failure 415 Right-Sided Prosthetic Valves 415 Valved Conduits 419 Mitral Valve Repair 419 Suggested Readings 424Chapter 16 Echocardiography and Coronary Artery Disease 427 Clinical Overview 427 Pathophysiology of Coronary Syndromes 427 Detection and Quantitation of Wall Motion Abnormalities 431 Role of the Three-dimensional Echocardiography 436 Doppler Tissue Imaging and Speckle Tracking 437 Other Methods for Evaluating Ischemic Myocardium 438 Echocardiographic Evaluation of Clinical Syndromes 438 Angina Pectoris 438 Acute Myocardial Infarction 438 Natural History of Wall Motion Abnormalities 444 Prognostic Implications 446 Doppler Evaluation of Systolic and Diastolic Function in Acute Myocardial Infarction 446 Complications of Acute Myocardial Infarction 448 Pericardial Effusion 448 Infarct Expansion/Acute Remodeling 450 Free-Wall Rupture 450 Ventricular Thrombus 451 Right Ventricular Infarction 451 Acute Mitral Regurgitation 453 Ventricular Septal Rupture 455 Cardiogenic Shock 457 Chronic Coronary Artery Disease 457 Left Ventricular Aneurysm 457 Left Ventricular Pseudoaneurysm 460 Chronic Remodeling 462 Mural Thrombus 462 Mitral Regurgitation 464 Chronic Ischemic Dysfunction 465 Direct Coronary Visualization 468 Kawasaki Disease 470 Direct Visualization of Atherosclerosis 470 Suggested Readings 471Chapter 17 Stress Echocardiography 473 Physiologic Basis 473 Methodology 475 Treadmill 475 Bicycle Ergometry 476 Dobutamine Stress Echocardiography 477 Dipyridamole and Adenosine 478 Three-dimensional Stress Echocardiography 478 Choosing among the Different Stress Modalities 479 Interpretation of Stress Echocardiography 479 Categorization of Wall Motion 482 Wall Motion Response to Stress 484 Localization of Coronary Artery Lesions 484 Correlation with Symptoms and Electrocardiographic Changes 485
  • x Contents Detection of Coronary Artery Disease 486 Role of Myocardial Perfusion Imaging 488 Comparison with Nuclear Techniques 491 Applications of Stress Echocardiography 492 Prognostic Value of Stress Echocardiography 492 Stress Echocardiography After Myocardial Infarction 495 Stress Echocardiography After Revascularization 496 Preoperative Risk Assessment 498 Stress Echocardiography in Women 499 Assessment of Myocardial Viability 501 Stress Echocardiography in Valvular Heart Disease 502 Diastolic Stress Echocardiography 503 Suggested Readings 505Chapter 18 Dilated Cardiomyopathies 507 Clinical and Echocardiographic Overview 507 Dilated Cardiomyopathy 507 Doppler Evaluation of Systolic and Diastolic Function 512 Assessment of Diastolic Function 514 Myocardial Performance Index 516 Secondary Findings in Dilated Cardiomyopathy 517 Etiology of Dilated Cardiomyopathy 518 Determination of Prognosis in Dilated Cardiomyopathy 521 The Role of Echocardiography in Basic and Advanced Therapy 523 Biventricular Pacing for Congestive Heart Failure 523 Cardiac Transplantation and Other Advanced Support 527 Ventricular Assist Devices 530 Myocarditis 534 Peripartum Cardiomyopathy 536 Chagas Myocarditis 536 Suggested Readings 537Chapter 19 Hypertrophic and Other Cardiomyopathies 539 Overview 539 Hypertrophic Cardiomyopathy 539 Echocardiographic Evaluation of Hypertrophic Cardiomyopathy 539 Assessment of the Left Ventricular Outflow Tract in Obstructive Cardiomyopathy 541 Mitral Regurgitation in Hypertrophic Cardiomyopathy 546 Variants of Hypertrophic Cardiomyopathy 547 Mid-Cavitary Obstruction 548 Screening of Family Members 549 Conditions Mimicking Hypertrophic Cardiomyopathy 550 End-Stage Hypertrophic Cardiomyopathy 553 Hypertrophic Cardiomyopathy Therapy 554 Infiltrative and Restrictive Cardiomyopathy 554 Echocardiographic Evaluation of Restrictive Cardiomyopathy 555 Cardiac Amyloid 556 Restrictive Cardiomyopathy 556 Constrictive Versus Restrictive Heart Disease 556 Endocardial Fibroelastosis and Hypereosinophilic Syndrome 559 Suggested Readings 560Chapter 20 Congenital Heart Diseases 561 The Echocardiographic Examination: A Segmental Approach to Anatomy 562 Cardiac Situs 562 Ventricular Morphology 563 Great Artery Connections 564 Abnormalities of Right Ventricular Inflow 565 Abnormalities of Left Ventricular Inflow 566 Pulmonary Veins 566 Left Atrium 567 Mitral Valve 570
  • Contents xi Abnormalities of Right Ventricular Outflow 571 Right Ventricle 571 Pulmonary Valve 573 Pulmonary Artery 573 Abnormalities of Left Ventricular Outflow 575 Subvalvular Obstruction 576 Valvular Aortic Stenosis 578 Supravalvular Aortic Stenosis 580 Coarctation of the Aorta 581 Abnormalities of Cardiac Septation 584 Atrial Septal Defect 584 Ventricular Septal Defect 590 Endocardial Cushion Defect 600 Abnormal Vascular Connections and Structures 600 Patent Ductus Arteriosus 600 Abnormal Systemic Venous Connections 602 Abnormal Pulmonary Venous Connections 603 Abnormalities of the Coronary Circulation 608 Conotruncal Abnormalities 612 Tetralogy of Fallot 612 Transposition of the Great Arteries 615 Double-Outlet Right Ventricle 621 Persistent Truncus Arteriosus and Aortopulmonary Window 623 Abnormalities of Ventricular Development 623 Single Ventricle 624 Tricuspid Atresia 626 Echocardiographic Evaluation During and After Surgery 628 Systemic Artery to Pulmonary Artery Shunts 628 The Fontan Procedure 629 Right Ventricle to Pulmonary Artery Conduits 630 Suggested Readings 632Chapter 21 Diseases of the Aorta 633 Normal Aortic Anatomy 633 Echocardiographic Evaluation 634 Aortic Dilation and Aneurysm 637 Marfan Syndrome 640 Sinus of Valsalva Aneurysm 643 Aortic Dissection 645 Echocardiographic Diagnosis 646 Intramural Hematoma 653 Complications and Natural History of Aortic Dissection 655 Aortic Atheroma 657 Miscellaneous Conditions 661 Coarctation of the Aorta 661 Aortic Pseudoaneurysm 661 Aortic Trauma 661 Infections of the Aorta 662 Aortic Thrombus 663 Takayasu Arteritis 664 Suggested Readings 665Chapter 22 ICU and Operative/Perioperative Applications 667 Evaluation of Patients in the Medical Intensive Care Unit 667 Hypotension and Shock 667 Evaluation of Hypoxia 671 Echocardiography in the Emergency Department 671 Echocardiography Following Cardiac Arrest 673 Pre-, Intra-, and Postoperative Echocardiography 673 Role of Echocardiography in Mitral Valve Surgery 676
  • xii Contents Tricuspid Valve Repair 687 Role of Echocardiography in Aortic Valve Procedures 687 Miscellaneous Applications 692 Other Intraoperative Complications of Cardiac Surgery 693 Intraoperative Monitoring for Noncardiac Procedures 696 Delayed Cardiac Surgery Complications 696 Monitoring of Nonoperative and Interventional Procedures 698 Interventional Cardiac Procedures 700 Other Applications in the Catheterization Laboratory 708 Suggested Readings 708Chapter 23 Masses, Tumors, and Source of Embolus 711 Normal Variants and Artifacts: Sources of False-Positive Findings 711 Role of Echocardiography 712 Cardiac Tumors 712 Primary Tumors 712 Metastatic Tumors to the Heart 717 Intracardiac Thrombi 720 Left Ventricular Thrombi 720 Left Atrial Thrombi 726 Right Atrial Thrombi 731 Spontaneous Echo Contrast 731 Role of Echocardiography in Systemic Embolus 732 Pseudotumors and Other Cardiac Masses 736 Suggested Readings 739Chapter 24 Echocardiography in Systemic Disease and Clinical Problem Solving 741 Echocardiography and Systemic Disease 741 Hypertension 741 Diabetes Mellitus 743 Thyroid Disease 743 Chronic Renal Insufficiency 744 Connective Tissue/Autoimmune Disease 746 Systemic Lupus Erythematosus 746 Antiphospholipid Antibody Syndrome 747 Scleroderma/Raynaud Phenomenon 747 Marfan Syndrome 748 Chronic Liver Disease and Cirrhosis 750 Chronic Obstructive Pulmonary Disease 752 Pulmonary Hypertension 753 Miscellaneous Diseases 757 Sarcoidosis 757 Hemochromatosis 758 Muscular Dystrophy/Glycogen Storage Disease 758 Hypereosinophilia 758 Carcinoid Syndrome 759 Sickle Cell Anemia 759 Human Immunodeficiency Virus 759 Diet-Drug Valvulopathy 760 Obesity 760 Clinical Presentations and Problem Solving 760 Congestive Heart Failure 760 Evaluation of Dyspnea 761 Acute Pulmonary Embolus 762 Echocardiographic Findings 762 Atrial Fibrillation 763 Neurogenic Myocardial Stunning 766 Syncope 767 Evaluation of Cardiac Arrhythmias 767 Evaluation of Patients Before and During Chemotherapy 768 Radiation-Induced Cardiac Disease 768 Screening for Athletic Competition and the Athlete’s Heart 769
  • Contents xiii The Heart in Pregnancy 770 Effects of Advanced Age 772 Suggested Readings 773INDEX 775DVD CONTENTS Lectures Acute Myocardial Infarction Aortic Syndromes Atrial Fibrillation Mitral Regurgitation Video Atlas
  • PrefaceEchocardiography has evolved into a mature technology that is gram should be performed. In particular, we have included,an essential and fully integrated component of the practice of whenever possible, the newly developed Appropriateness Crite-cardiology. It plays an instrumental role in management of virtu- ria for the utilization of echocardiography. These rigorously de-ally all forms of heart disease. Modern ultrasound platforms and veloped guidelines provide recommendations regarding whennewer imaging methods, such as real-time three-dimensional it is appropriate and when it is not appropriate to order anechocardiography, Doppler tissue imaging, and speckle track-, have opened new windows to improve accuracy and ex- The seventh edition includes new chapters on diastolic func-pand applications. tion and hypertrophic and restrictive cardiomyopathy. There is As with previous editions, the seventh edition of Feigen- also a revised chapter on the use of echocardiography for clini-baum’s Echocardiography is focused heavily on proven uses of cal problem solving. The illustrations and examples have beenechocardiography and is intended primarily for those engaged extensively updated and a DVD is again included to providein the practice of clinical echocardiography. When appropriate, video loops of most of the figures. We have also included on thewe have included a discussion of the newest techniques and ap- DVD a series of “mini lectures” on important topics, such asplications but only after the promise of clinical utility has been mitral regurgitation and atrial fibrillation. These are intendeddemonstrated. We have tried to emphasize how these newer to supplement the didactic information in the text and providemethods supplement and improve upon traditional approaches examples and clinical context.and how they compare to competing modalities. However, we Finally, this seventh edition represents an important depar-have avoided, to the degree possible, platform-specific refer- ture from the previous six. It is the first in which Dr. Feigen-ences, instead focusing on the generic and clinically relevant baum has not been primarily involved as an author or coauthor.application of technology. Harvey published the first edition in 1972. It was 239 pages in We have tried to approach the many issues of echocardio- length and focused exclusively on the M-mode technique. Thatgraphic diagnosis from the perspective of the clinician, rather and subsequent editions have educated a generation of physi-than that of the imager. We believe that it is most helpful to cover cians and sonographers. Harvey has decided to retire from text-what is new in the field of echocardiography by presenting the book writing to focus on his other passions, many of which in-information in clinical context. This is in part because we, as volve echocardiography. Despite this, it should be obvious toechocardiographers, are also clinicians and consultants. We not anyone who reads this text that his shadow looms large and hisonly provide a report, we frequently supplement that with clin- influence is evident throughout.ical advice, intended to place the echo findings in context. In addition, because of the intense pressure on utilizationrates of imaging, we have tried to provide evidence-based guid- William F. Armstrongance on usage, including when and how often an echocardio- Thomas Ryanxiv
  • AcknowledgmentsWe could never have completed this project without the assis- and the University of Michigan for their support, suggestions,tance and support of several individuals. In particular, Jamie and contributions.Tracy, Michele Hill, Meredith Cole, and Stephanie Boeckmann We are grateful to our editors at Lippincott Williams &helped with manuscript preparation and the creation of figures. Wilkins for their expertise, guidance, and patience. Finally, weMaria Choi, Min Pu, Mani Vannan, Stephen Cook, and Stephen acknowledge the tolerance and support of our wives, Cindy andSawada provided several of the outstanding illustrations and Dea, without whom this textbook could never have been com-cases. We also thank our colleagues, the echocardiographers, pleted.sonographers, and fellows, both at The Ohio State University xv