Assessing EF by Echocardiography and MRI

Good Agreement Between Echocardiography And MRI For The...
(56 %) were smokers, 6 patients (24 %) were drug addicts, 14 patients (56 %) had positive family
history of coronary artery disease table 1 & Figure 1. Good agreement between Echocardiography
and MRI for the estimation of ejection fraction (EF) was noted. In this study, the mean EF by cMRI
was 43.92% and the mean EF by echocardiography was 39.87% with mean difference was 4.05%
table 2 & Figure 2. As regard the detection of segmental wall motion abnormality, echocardiography
showed that 149 segments were normo–kinetic while cMRI revealed that 140 segments were
normo–kinetic. Also, echocardiography showed that 206 segments showed hypo–kinesia while
cMRI showed that only 186 segments were hypo–kinetic. 67 segments were seen to be akinetic by
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Only 23 segments (34.3%) of them were akinetic by both echocardiography and cMRI while 12
segments (17.9%) appeared akinetic by echo but they were normo–kinetic by cMRI and 31
segments (46.3 %) showed akinesia by echo but they were hypo–kinetic by cMRI. Moreover, 1
segment (1.5 %) appeared akinetic by echo but it was found to be dys–kinetic by cMRI. For the
prediction of the contractile reserve in the studied 25 patients, assessment of segmental wall motion
abnormality (SWMA) identified with cMRI associated with scar tissue as diagnosed by LGE was
studied in the collectively three vascular territories (LAD, LCX & RCA). A total number of 75
territories (in the studied 25 patients; three vascular territories in each patient) were studied. It was
found that 58 territories of the 75 territories (77.3 %) showed abnormal regional function, whereas
40 of them (53.3 %) showed scar by LGE and 18 territories (24 %) showed no scar. Seventeen
segments (22.7 %) showed no SWMA with only three of them (4 %) showed scar by cMRI table 5.
The same was done for echocardiography and it was found that 56 territories of 75 territories (74.6
%) showed abnormal regional function, whereas 36 of them (48 %) showed scar by LGE and 20
territories (26.6 %) showed no scar. Nineteen segments (25.4 %) showed no SWMA with only five
of them (6.7 %) showed scar by cMRI table 6. cMRI provided the ability to differentiate cases with
acute myocardial infarction from
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Echocardiography Essay
A routine follow up echocardiogram for an LVAD patient can help find complications that may arise
from this heart failure therapy. LVAD dysfunction can originate from the inflow cannula. The
misalignment and increase pump flow can cause the walls of the LV to be sucked down towards the
cannula resulting in obstruction of inlet flow. We will see this first from the parasternal long axis
view. When applying Doppler to the inflow cannula, the characteristic of the flow pattern can
represent obstruction or thrombus within the cannula. Flow pattern showing slow, turbulent and/or
lack of flow indicates some type of obstruction. With an LVAD, the aortic valve should remain shut
or only open once every few beats. Increase your beats on the PLAX view and putting an M–mode
As a result of the improvement in medicine, more and more people are able to live with congestive
heart failure than ever before. With that being said, there are more patients who have lived longer
because of the opportunity to have an LVAD implantation. Seeing an LVAD patient in the
Echocardiography lab has become a common occurrence in the recent years. It is important for
sonographers to be knowledgeable and to continue their education, as echo plays an important role
in assessing the LVADs and native heart's function.
This report has allowed us to have an exceptional understanding of LVADs and the advanced
sonographic technique needed to fully evaluate its function. With this found knowledge, we can
confidently enter an LVAD exam knowing what is required of us. Before a patient receives an
LVAD, an important area to evaluate is the presence of aortic regurgitation and its severity. Post
LVAD implant, we know to evaluate the aortic valve in more ways then one to assess any aortic
valve opening. Also, the inflow and outflow cannulas need show flow as continuous and pulsatile to
show no signs of

Pulmonary Hypertension Case Study
Pulmonary Hypertension (PH) is a rare and potentially fatal complication of hematopoietic stem cell
transplantation (HSCT). PH arises from increased pulmonary vascular resistance leading to
increased right ventricular pressure, right heart failure, and death. PH is often difficult to diagnose as
symptoms can be nonspecific, including shortness of breath, fatigue, dizziness, weakness, and
hypoxemia, and may also result in death if left untreated.1, 2
Bronchiolitis obliterans (BO) is a significant cause of morbidity and mortality in post–lung
transplant and HSCT patients3. BO is a non–reversible obstructive lung disease in which
bronchioles are compressed and narrowed by fibrosis and/or inflammation. This compression leads
to persistent hypoxia. ... Show more content on Helpwriting.net ...
Four patients (1.4%) were diagnosed with BO (Table 1). The median patient age was
7.9 years (range, 0.6 to 17.4), and 2 of the patients (50%) diagnosed with BO were male. Three
received bone marrow grafts (75%), and the other graft was peripheral blood stem cells. BO was
diagnosed in the four patients at a median of 196 days (range
131–305 days) after HSCT. Three of the four patients (75%) were diagnosed with PH after the
diagnosis of BO at a median of 46 days (range 2–89 days). The three patients diagnosed with PH
and BO were administered myeloablative conditioning regimens, while the one patient without PH
was administered a reduced intensity conditioning regimen. All four patients had a history of graft–
versus–host disease (GVHD). (Table 1)
The diagnosis of BO was made in all 4 patients by high–resolution CT demonstrating air trapping.
Two patients received pulmonary function tests (PFT) showing decreased forced expiratory volume
in one second (FEV1). PFTs were not completed in the

Common Type Of Benign Primary Cardiac Tumor
TERMINOLOGY
CLINICAL CLARIFICATION
The most common type of benign primary cardiac tumor, which can cause valvular or inflow–
outflow tract obstruction and thromboembolism; symptoms appear when the tumor fragments and
causes systemic emboli or when it interferes with cardiac valvular function and causes pulmonary
congestion 1
Most atrial myxomas arise from the atrial septum, but some originate in the posterior wall, anterior
wall or the appendages 1
CLASSIFICATION
By location 3, 1, 2
○ Left atrial myxoma – 75–90% of myxomas are estimated to originate in the left atrium 1, 2, 3
○ Right atrial myxoma – tends to be more solid and immobile than left atrial myxoma, with a wider
attachment to the septum or atrial wall 1
Atrial myxomas can ... Show more content on Helpwriting.net ...
t–sided heart failure (also seen in advanced stages of heart failure related to left atrial myxoma) 1
– Fatigue is the most common systemic symptom 4
○ Symptoms related to embolization 1
– Vision loss is possible with involvement of retinal arteries
– Signs of transient ischemic attack, stroke or seizure, which may result from central nervous system
embolization
– Signs of pulmonary embolism and infarction in right–side embolization
○ Constitutional symptoms – observed in 30–50% of cases 5, 1
– Fever and weight loss are seen in about 30% of patients 5
– Arthralgias, malaise and cough are also common
– Severe dizziness or syncope occur in 20% of patients, usually due to obstruction of mitral valve in
patients with left atrial myxomas 1
– Hemoptysis due to pulmonary edema or infarction is seen in up to 15% of patients 1
– Angina pectoris is seen infrequently; when present, it may be due to coronary embolization
Physical examination
○ General physical exam can reveal 1
– Cyanosis
– Rash or petechiae
– Digital clubbing
– Raynaud's phenomenon
– Signs characteristic of Carney syndrome (spotty pigmentation of the skin, myxomas in breast,

skin, thyroid gland or neural tissue)
– Peripheral edema (can be a sign of right–sided heart failure)
– Abdominal distension due to ascites (rare; more common in slowly–growing right sided tumors)
○ Cardiovascular exam 5, 1
– Jugular venous pressure may be elevated; a prominent A–wave may be present
– An early diastolic sound, called a "tumor

A F Mnemonic Observation Paper
Study objective: To evaluate the role and usefulness of a focused transthoracic echocardiography
with A–F mnemonic performed by emergency physicians in the diagnosis of patients with acute
chest pain.
Design: This prospective observational study was conducted on 100 patients with chest pain
presenting to the emergency department (ED) of Alexandria Main University Hospital (AMUH).
The following data were analyzed: demographics, medical history, clinical condition, ECG, levels of
cardiac biomarkers, and transthoracic echocardiography (TTE). TTE was performed by the
emergency resident. TTE images were interpreted and reported with mnemonic A–F. All studies
were recorded and reviewed by the cardiologist.
Results: 100 consecutive patients were

Doppler Echocardiography
In addition life threating shortness of breath,shock and finally death are the possible complications
of cor pulmonale.
INVESTIGATIONS –
X ray of the chest Enlargment of right ventricle and right atrium can be seen.Posteroanterior ches x
ray shows increase of the transverse diameter of the heard shadow to the right and lateral chest x ray
shows filling of the retrosternal air space due to right ventricular enlargement.Prominent pulmonary
arteries also may be here.9 In 95% of patients with COPD and pulmonary hypertention the diameter
of the descending branch of right pulmonary artery is greater than 20mm in width.Oligaemic lung
fields are caused by peripheral vessels attenuation.
Electrocardiogram(ECG)
Right ventricular hypertrophy,right axis ... Show more content on Helpwriting.net ...
This procedure is used only when the necessary information can not be obtained with Doppler
echocardiography. This one can also be used to determine the potential reversibility of pulmonary
arterial hypertention with vasodilators,such as sustained release calcium channel blockers.10
Ventilation & perfusion scan of the lungs It may be indicated to diagnose pulmonary
thromboembolism as the underlying etiology of cor pulmonale.
Lung biopsy This one is rarely done. Pathologic assessment of pulmonary artery hepertention
requires lung biopsy. Historically pathologic examination has been used intra–operatively to look
for evidence of irreversible pulmonary artery pathology.
Aterial blood gas analysis It provides important information about the level of oxygenation and type
of acid–base disorder.
Brain Natriuretic Peptide(BNP) Only elevated BNP level is not adequate to establish the presence of
cor pulmonale,but it helps to diagnose cor pulmonale in conjunction with other noninvasive tests
and in appropriate clinical

The Effect Of Ultrasound On The Body
When asked what is ultrasound many people may give answers such as, "Oh that's when they scan
women who are pregnant to see the baby", but little do people know that ultrasound is much more
then that. Not only do people misunderstand the job description but also the salary that comes along
with the career. Both job description and salary are based on the specialty you choose to pursue.
Ultrasound is a very diverse field with many different specialties to choose from within the field and
each specialty has a specific salary along with it depending on the state you live in.
Specialties
As you enter the field of ultrasound you will be involved in one, two, or more specialties.
(Technology, 2016) Ultrasound focuses on many different parts of the body and many organs as
well. The many different specialties keeps this career interesting, challenging, and as a sonographer
you will never have a dull moment. (Technology, 2016) As a sonographer you may choose from
being a general tech, obstetrics and gynecology tech, echocardiography tech, vascular tech, or a
pediatric echo tech. As a sonographer you are able to specialize in all of the different specialties you
are not limited to just choosing one specialty making ultrasound a diverse career. As a general tech
you will evaluate the abdominal organs which include liver, kidneys, gallbladder, spleen, pancreas,
bladder, and blood vessel within the abdomen. Also, as a general tech you may do vascular and
evaluate the arteries and veins

Detection of Heart Defects with Fetal Echocardiography
Fetal echocardiography is indicated in high risk pregnancies where the chances of fetus having a
congenital heart disease (CHD) are likely to be high – for exapmle, in a fetus with extracardiac
anomalies picked up on obstetric ultrasound, those with a history of CHD in family, maternal
diabetes and maternal connective tissue disorder (Srinivasan,2000). Congenital heart defects are
abnormalities in the heart's structure that are present at birth. They are the most common congenital
malformations with a reported incidence of 8 to 10 per 1000 live births, and about a third of these
CHDs are severe (fatal or requiring an intervention in the first year of life) (Dolk and Loane, 2009;
Hoffman and Kaplan, 2002; Vaartjes et al., 2007) . CHDs happen because of incomplete or
abnormal development of the fetus' heart during the very early weeks of pregnancy.
CHDs responsible for significant mortality and morbidity in the neonatal period and infancy, with an
overall mortality rate (perinatal and termination of pregnancy (TOP) rate) in Europe of 0.7/1000
births (Dolk and Loane, 2009). The majority of CHDs can be diagnosed prenatally by fetal
echocardiography. After adequate selection and referrals to specialised units a prenatal detection rate
of 85–95% is possible in experienced hands (Meyer–Wittkopf et al., 2001; Tegnander and Eik–Nes,
2006; Berkley et al., 2009; Nelle et al., 2009). Furthermore, additional cardiac and noncardiac
problems, such as fetal tumors and cardiomyopathies,

Why I Want To Become An Echocardiography
When I entered college I was uncertain of what my career would be. I chose to get my degree in
Biology because I knew that it can open my path to many different fields in healthcare. Following
the completion of my Bachelor in Biology from the University of Texas at San Antonio, I worked at
a medical office and during those times I came across the field of Ultrasound. I was amazed and
fascinated by the technology and the sight of a human heart. Echocardiography was created a unique
opportunity for me to combine my interest in medicine and technology with concern for others.
I studied cardiovascular science for two years, and spent many hours of externships at major
hospitals. I was very happy with my chose of career. As an echo tech, I also

Common Prenatal Congenital Heart Disease Essay
Tetrology of Fallot(TOF) is the most common prenatal congenital cyanotic heart disease accounts
for about 1/3600 live births and about 7% to 10% of of all congenital heart disease and is the most
common cause of cyanosis in the neonatal period1 , 2. Typical Tetralogy of Fallot (TOF) may be
missed in Four chamber view. An abnormal Four chamber view is rarely seen in typical TOF cases .
In the typical form of TOF the fetal echocardiography is often characterized by a normal four–
chamber view, a subaortic Ventricular septal defect (VSD), Dilated over riding of aorta seen in a
LVOT view, Pulmonary stenosis and an increased Aorta/Pulmonary artery ratio, minimal antegrade
flow in the main pulmonary artery and the aortic flow originated from right and left ventricle. All
pregnant women with low risk factors , suspected fetal cardiac anomalies and with increased risk
factors should be analyzed by extended fetal echo during the level 2 scan (18 – 22 weeks scan ). It is
also important to identify the side of the aortic arch, which is quite easier in the prenatal period in
three vessel view . This will be useful if surgery is planned postnatally. Extracardiac abnormalities,
such as midline defects, central nervous system and renal abnormalities may be found in fetuses
with TOF. These extracardiac defects are associated with chromosomal abnormalities. When TOF is
diagnosed, serial follow up scans at 5 – 6 weeks intervals are adviced to know about the growth of
the

Stress Echocardiography
Coronary artery disease (CAD) is the leading cause of morbidity and one of the top killers among
adults in industrialized countries. It accounts for approximately 600,000 deaths in the United States
every year. 1,2 CAD can present itself in different ways, from chest pain during exercise ("angina")
to the most dreaded complication of heart disease, acute heart attack and sudden death.3 Identifying
patients with CAD in daily clinical practice represents a challenging task. Accurate diagnosis and
sufficient assessment of both symptomatic and asymptomatic patients with suspected CAD may
show an essential impact on mortality rates and thus, it is of substantial interest.1 One method used
to identify patients with myocardial ischemia due to CAD and those at high risk of future heart
attacks is cardiac stress testing. ... Show more content on Helpwriting.net ...
4 In stress echocardiography (SE), cardiologists use ultrasound imaging for this purpose. Due to its
accessibility and cost efficiency, SE represents a common type of noninvasive diagnostic tool for the
detection of myocardial ischaemia.3 SE is widely used, has a moderate to high degree of sensitivity
and moderate to high specificity in correctly identifying CAD, but it is cumbersome and adds
substantial costs to the patient's care. It is also fraught with false positive and false negative results
that typically require even more testing.3

Atrial Septal Defect Case Study
Atrial septal defect(ASD) is a common congenital heart disease with a female–to–male ratio of
approximately 2:1.The most common type of Atrial Septal Defect is a secundum defect which is
characterized by a defect in the inter atrial septum which allows pulmonary venous return from the
left atrium to pass directly to the right atrium. Normally the patients with Atrial Septal Defect
remain asymptomatic up to third or fourth decade of life and in the middle age some clinical
symptoms can be observed. A "shunt" is the presence of a net flow of blood through the defect,
either from left to right or right to left. The amount of shunting actually determines the
hemodynamic significance of the ASD. A "right–to–left–shunt" typically presents the more ... Show
more content on Helpwriting.net ...
Doppler imaging and echo–PIV cannot measure the velocity in a direction perpendicular to the
beam, but Vector Flow Mapping (VFM) allows the calculation of velocities perpendicular to the
direction of the beam without angle dependency with the use of the continuity equation and speckle
tracking echocardiography[14]. This energy loss is assumed to become a new indicator of cardiac
function[15]. So, it is considered an effective index to monitor the blood flow efficiency within the
heart chambers under various pathological conditions. Blood is viscous in nature and generates
frictional heat due to viscosity at the site where turbulent flows occur[16]. In case of Atrial Septal
Defect blood flows through the hole across the atrial chambers and creates a turbulence in the atrial
as well as ventricle chambers during early diastole, ventricular systole and atrial contraction,which
probably ensue an increased intra–cardiac Energy Loss.
Therefore, the aim of this study was to use the new technique of Vector Flow Mapping (VFM) to
measure the reference values of intra–cardiac energy loss in ASD patients pre and post occlusion

PDA Device Closure Case Study
Every isolated PDA needs closure beyond 3 months of age except for silent ducts, Eisenmenger
ducts and ducts in premature infants. Percutaneously closure of PDA with device is an established
modality of treatment worldwide and is regarded as safe and effective. Important information to
have a successful duct occlude include age and weight of the patient, size and the experience of the
center and operator. The PDA device closure is considered in infant with age beyond 6 months and
weight of more than 6 kgs. If PDA is directly responsible for CHF, felling to increase duct closure is
indicated as soon as possible. Early closure of PDA improve cardio–respiratory status and as a
importance long–term follow–up Pre–procedure assessments ... Show more content on
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Male to female ratio of 0.8:1 mean height was 69cm and mean weight was 8kgs. Out of 55 cases, 3
cases were considered unfitting for device closure, as duct was either large or tiny to be closed. Out
of remaining 52 cases, procedure was successful in 50 (96.1%) patients. Mean procedural time was
30 minutes. Percutaneous device closure of PDA is considered safe and preferred mode of treatment
for both children and adults. Among 50 successful cases, occluder device were used in 49, while coil
was used only in one case. (M.ULLAH , 2012) From 2006 to 2009, 518 consecutive premature
infants were admitted in single university Neonatal intensive care unit (ICU). PDA patency was
present in 109 (21%) patients With a mean gestational age of 29.1 weeks. Because of the failure of
the medical treatment, 19 patients (17%) underwent PDA surgical closure. Only one infant weighed
>1000 g. All infants were intubated in the ICU and mechanically ventilated. The result showed no
Premature infant died as a direct result of anesthesia or operative procedure. (R.MARGARYAN,
2009) Conclusion; For me I think the best approach of treatment is to wait for 7 days to allow
normal

Morphological Assessment Of Late Gadolinium Viactional...
traced manually from the short axis images cine images during peak systole and end diastole giving
global functional parameters (EF). The impact of IHD on regional function was assessed
qualitatively using SA cine images (described as normal, hypokinetic, akinetic, or dyskinetic) using
the 17–segment model.
Morphological assessment:
The end diastolic wall thickness was assessed to detect cases with reduced end diastolic wall
thickness in chronic state. Also, the functional 2 chamber and 4 chamber cine images were assessed
for other associated abnormalities such as valvular lesion or intra–cavitary thrombus.
The presence of edema to determine acute cases was assessed in the morphological short axis black
blood T2WIs qualitatively as an ... Show more content on Helpwriting.net ...
For people who had the characteristic (segmental wall motion abnormality), the number of people
who tested positive and the number of people who tested negative were recorded. The same was
done for people who didn't have the characteristic. People with the characteristic and tested positive
(enhanced scared myocardium on LGE in cMRI) are the true positives (TP). People with the
characteristic (SWMA) and tested negative (No enhanced scared myocardium on LGE in cMRI) are
the false negatives (FN). People without the characteristic (No SWMA) and tested positive are the
false positives (FP). People without the characteristic and tested negative are the true negatives
(TN).
To calculate the sensitivity, TP was divided by (TP+FN).
To calculate the specificity, TN was divided by (FP+TN).
To calculate the positive predictive value (PPV), TP was divided by (TP+FP).
To calculate the negative predictive value (NPV), TN was divided by (TN+FN).
Accuracy, or efficiency, is the percentage of test results correctly identified by the test, i.e. (true
positives + true negatives) / total test results = (TP+TN) / (TP+TN+FP+FN).
3. RESULTS:
Among the twenty five (25) patients included in our study, males represented 88 % & females
represented 12 %. (22 males, 3 females), the age ranged between (28–68 years); with mean age:
48.68 years; standard deviation: 11.29.
According to the predisposing factors for developing coronary artery disease, hypertension was the

The Importance Of Echocardiography For Clinical Practice...
Module: Clinical Instrumentation
Module Code: 5BM020
Echocardiography
Word count: 1973
21/1/2015
Raj Chavda
1112009
Introduction
In this essay I will be discussing the importance of echocardiography in clinical practice as they are
used for screening, diagnosis, guiding treatment, assessing recovery and monitoring care. I will be
discussing the principles in which make echocardiography possible, the importance of selecting the
correct electromedical technique, the advantages and disadvantages and the clinical constraints
which may occur within different patient groups.
Echocardiography is routinely used in the diagnosis, management, and follow–up of patients with
any suspected or known heart disease. It is ... Show more content on Helpwriting.net ...
Sound consists of oscillating waves of compression and decompression of a transmitting medium
i.e. air or water, traveling at a fixed velocity (Støylen, 2015). The frequency of sound waves refers to
the number oscillations per second, with one cycle per second is considered a unit of 1 hertz
(Henderson, 2014). Sound waves oscillating above 20,000 Hz are categorised as ultrasound waves.
As sound waves are a transverse wave forms this means the only variant is its frequency and
wavelength despite the location in the spectrum. The wavelength is defined as the distance travelled
by sound in one cycle, or the distance between two identical points in the wave cycle i.e. the
distance from each oscillation (Cura Rodríguez, Seguí and Nicolau, 2012). In regards to wave forms
the wavelength shows very little significance as it is inversely proportional to frequency.
In reference to the structure a waveform, the significance of the wavelength is one of the main
factors affecting the resolution of an ultrasound image, this is because smaller wavelengths (higher
frequency) are absorbed more by soft tissue. This variable absorption rate with structures of
different impedances allows distinctive structures to be clearly represented. In echocardiography, the

wavelengths are often manipulated in order to view deeper structures within the patient but
compromising with resolution. In principle of

Echocardiography Analysis
The echocardiography is currently the most commonly used imaging technique to diagnose various
cardiovascular diseases especially Takotsubo syndrome. The reasons behind its popularity includes:
its low risk non–invasive nature, simplicity, low cost, and easy equipment transportation.
Additionally, there have been noticeable improvements in the imaging quality after the development
of technological progress of transthoracic transducers and transesophageal echocardiography.
Furthermore, early diagnosis is possible because this imaging technique is able to show clearly the
reverse wall motion involvement abnormalities. The main features of echocardiography imaging
that enable it to be used as the best technique for early analysis or diagnosis ... Show more content
on Helpwriting.net ...
Additionally the ST–segment elevation is regularly noted only briefly and then T–wave inversion
replaces it; this results in increasing the persistence and depth to many days, weeks, and to some
extent months. All these processes follow each other systematically and this to some extent has
resulted in becoming a rule to be followed. All these arguments try to explain in depth whether ST–
segment is as a result of

Amyloidosis Research Paper
Amyloidosis is a disease characterized by the extracellular deposition of insoluble fibrillar proteins
in the tissues and organs including the heart [1,2]. There are 3 major subtypes of cardiac amyloid:
light chain amyloidosis, hereditary transthyretin amyloidosis and wild–type transthyretin
amyloidosis, also called senile systemic amyloidosis (SSA). SSA is almost exclusively a disease of
the elderly caused by the deposition of wild–type transthyretin fibrils predominantly in the
myocardium leading to progressive heart failure, arrhythmia and conduction blocks [3]. Post
mortem studies have shown that the finding of amyloid depositis (wild–type transthyretin) is not
uncommon [4], however the actual prevalence is not known.
The natural history of SSA is not well documented, most likely due to the fact that it's rarely
diagnosed before death [5]. Typically it presents with symptoms and signs of biventricular cardiac
failure ... Show more content on Helpwriting.net ...
This, however, is difficult in the patient population affected, as an endomyocardial biopsy is an
invasive procedure that patients are not keen to undergo. Cardiac MRI is a useful investigation when
cardiac amyloid is suspected but it is unable to differentiate between different amyloid types [13].
Tc–DPD scintigraphy is a recent addition to the workup of the condition and has been shown to be a
specific imaging tool for transthyretin cardiac amyloid [12].
The prognosis of patients with SSA is much better than other subtypes of cardiac amyloid [5,9]; a
previous study found that for patients with SSA and heart failure the median survival was 5 years [9]
compared with 6 months after the onset of heart failure for AL amyloidosis [14]. Currently no
specific disease modifying therapies are available, although promising new agents are being
investigated in a number of clinical

Animal Model Pharmacology
The use of experimental animal models is imperative to advance our understandings of the disease
pathophysiology and pharmacology. Small animal models are often used as experimental animal
models for studying these human diseases including cardiovascular diseases. However, these animal
models possess various problems to make the direct translational approach difficult. These factors
include the small body size and their different cardiovascular physiology and kinetic. Large animal
models including dogs, cats and pigs are also used for studying various diseases, but they still
possess inherited physiological, biochemical and genetic differences from humans. Non–human
primate model of cardiovascular diseases has great advantages for the translational ... Show more
content on Helpwriting.net ...
It has been used for assessing cardiac conditions of animals for cardiovascular and other research.
For cardiovascular research, it is essential to fully assess the cardiac conditions using
echocardiographic examination. For non–cardiovascualr research, it is still imperative to assess their
cardiac condition using echocardiography before enrolling these animals because their
cardiovascular condition can affect other organ systems and pharmacological assessment. A few
previous studies reported echocardiographic parameters of adult and geriatric rhesus macaques.
However, the reference intervals established in these study does not have sufficient power due to
small sample sizes. The availability of reference intervals for echocardiographic parameters in a
large population of adult rhesus macaques is fundamental to assess their cardiovascular conditions
and abnormalities. Decisions in regard with medical, interventional and surgical treatment are often
dependent on echocardiographic finding. Therefore, knowing the normal reference values is of
upomost importance to know the presence and severity of cardiovascular abnormalities. In addition,
it is important to know if the reference values for rhesus macaques are comparable to those in
humans in respect of translational

My Philosophy Of The Medical Field
My road to medicine started when I had an excellent score in the Jordanian General Secondary
Education Certificate Examination. Following two months of thorough thinking, I chose the to go to
the medical field because of belief that happiness is best achieved by relieving the suffering of
others, and physicians have a primary role in making others live better and healthier. During my 6
years of medical school, I achieved a tremendous knowledge in different specialties and felt the joy
of exploring the secrets of life through human bodies.
After my graduation I completed a year of internship in Zarqa Governmental Hospital in Zarqa,
Jordan. Thereafter, I participated in a pediatric residency program in Jordan University Hospital for
four years. I passed the Jordanian as well as the Arab Boards in General Pediatrics from the first
time. At that point, I felt that I have to learn more about the latest maneuvers in diagnosing and
treating children with cardiac disorders and to reach the top levels in pediatric cardiology through
sub–specialty. I was so excited when I had the opportunity to start my pediatric cardiology training
at Rush University Medical Center for nearly two years. During that period, I realized the need re–
explore the pediatric field in a different approach and to have a new insight through training in the
US. Moreover, the American Board of Pediatrics (ABP) required repeating my pediatric residency in
an accredited program before I can sit for the

Dyspnea Case Study
Protocol
Patients were randomized in block size of four as follows:
►TG: 16 patients received 1 gm of taurine capsule (Now Foods, USA) twice daily in addition to
maximum tolerated doses of guideline directed medical therapy [ACE–I or ARBs, BBs, Loop
Diuretics and MRAs] for two months.
►CG: 18 patients received only maximum tolerated doses of guideline directed medical therapy for
two months.
At baseline patients underwent full clinical and laboratory assessment. A thorough patient history
was taken. Assessment of functional capacity and degree of Dyspnea was done according to "NYHA
class". The Quality of life was evaluated by using the Minnesota Living with Heart Failure
Questionnaire (MLHFQ). A 2 ml blood sample was obtained for ... Show more content on
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Categorical data were summarized as percentages (%) or number (n). Comparison between groups
was done using the unpaired t–test or Mann–Whitney test as appropriate. Comparison within each
group (baseline versus after two months) was done using the Wilcoxon signed rank test. Chi–Square
test or Fisher's exact test were used for categorical variables. Percent change was calculated as
follows:
[(current value – baseline value )/(baseline value)]x 100
Statistical significance was considered for p–value < 0.05.
Results:
From September 2014 to October 2015, a total of 94 patients admitted to CR unit were assessed for
eligibility. 60 Patients fulfilled the criteria and 42 patients accepted to participate in the study with
only 34 patients who continued to the end of the study.
At Baseline the two groups were comparable in all variables except for LVESV, patients in the CG
had significantly higher LVESV values (p = 0.03), (table 1). Both groups were comparable for the
medications administered except that the CG had higher number of patients receiving nitrates (p =
0.01), (table 2).
NT–proBNP
There was a significant decline in NT–proBNP levels after two months in both the TG (from 216.4
[89.4 – 363.2] to 120.1 [36.7 – 307.7], p=0.009) and CG (from 352.7 [130.9 – 601.9] to 208.82
[112.1 – 374.4], p=0.002). However, when comparing the percent change of NT–proBNP between
the two groups, there was no significant

Cardiac Magnetic Resonance Imaging
Cardiac Magnetic Resonance Imaging Functional cardiac magnetic resonance imaging (MRI) is a
diagnostic imaging modality that uses magnetic resonance imaging to assess cardiac function (5).
Cine studies can reconstruct images across several phases of the cardiac cycle. This method of MRI
can measure left ventricular volume, ejection fraction, myocardial contraction, and strain rate (10).
MRI has the ability to provide information on left ventricular function as well as regional profusion
simultaneously (11). The new MRI techniques can also evaluate angiogenesis and myocardial
viability. This has proven to be a valuable tool in diagnosing many heart conditions such as
myocarditis, amyloidosis, and restrictive cardiomyopathy. Technology ... Show more content on
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MRI does not expose the patient to radiopharmaceuticals, which gives cardiac MRI an advantage
over nuclear medicine (13). MRI also has better resolution than nuclear medicine. The excellent
contrast resolution of MRI produces a well–defined endocardial border (7). MRI does not have the
problem of limited acoustic windows that sometimes inhibits echocardiographic imaging. Although
MRI is a reliable modality for cardiac imaging, there are some limitations to consider with this
modality. MRI is contraindicated for patients implanted devices such as pacemakers or
defibrillators. As with MUGA and SPECT studies, cardiac MRI is not as accurate in patients with
cardiac arrhythmias. When calculating ejection fraction with MRI, it is necessary for the patient
hold their breath. This means poor image quality for studies done on patients who cannot hold their
breath. In addition to this, any variation in the level of inspiration will affect the accuracy of ejection
fraction calculations

Rheumatic Aortic Technique Lab Report
Abstract Objectives: the current work evaluates the course of untreated moderate rheumatic aortic
incompetence following mitral valve surgery over a period of one year. Background: most of the
previous studies agreed that the moderate rheumatic aortic regurgitation is a benign disease that has
a slow progression over a very long period of time. There is no major consensus on how to deal with
concomitant moderate rheumatic aortic regurgitation during mitral valve surgery. Methods: we
prospectively enrolled 30 patients who had moderate rheumatic aortic regurgitation associated with
pure rheumatic mitral stenosis in 15 patients ( group S) and 15 patients with pure rheumatic mitral
incompetence ( group R). Quantification of the degree of the aortic incompetence done by
echocardiography using the percentage of the width of the regurgitant get to the width of the left
ventricular outflow tract ( LVOT). All patients had mitral valve surgery through a median
sternotomy with cardiopulmonary bypass. The follow–up of the patients done over one year period
by both clinical and echocardiography to estimate the progression of the degree of aortic
incompetence postoperatively. ... Show more content on Helpwriting.net ...
There were no early or late postoperative deaths and we achieved 100% follow–up for included
patients. No patient had aortic valve replacement after one year. Preoperatively the mean ejection
fraction in group S was 62.33±4.39% while in group R was 59.53±6.10%, the width of the
regurgitant jet in group S was 34.67±2.72 % and in the group, R was 35.73±1.87 % ( p–value non–
significant). Postoperatively after 1 year follow up the width of the regurgitant jet in group S
increased significantly to 37.27±4.67% ( p > 0.5) while in group S almost remained unchanged
34.73±4.13% ( p <

MVR Case Study
The issue of MV repair in RHD is dealt with as a class IIa recommendation. Mitral valve repair may
be considered in patients with rheumatic mitral valve disease when surgical treatment is indicated if
a durable and successful repair is likely or when the reliability of long–term anticoagulation
management is questionable. Mitral valve surgery may be considered in symptomatic patients with
chronic severe primary MR and LVEF less than or equal to 30% (stage D).However, MVR should
not be performed for the treatment of isolated severe primary MR limited to less than one half of the
posterior leaflet unless mitral valve repair has been attempted and was unsuccessful(class III).
The Australian RHD guidelines ... Show more content on Helpwriting.net ...
Subclinical carditis i.e. valve regurgitation detected with echocardiography but not associated with a
murmur typical of mitral or aortic regurgitation, is included as a major manifestation of ARF. Valve
regurgitation will improve in 25–50% within one year of the acute episode if secondary prophylaxis
is well delivered.It also endorses the 2012 World Heart Federation guidelines for echocardiographic
diagnosis of chronic RHD. As there is no differentiation of the colour–Doppler findings of acute
carditis and that of chronic rheumatic valve regurgitation the same criteria are recommended for
defining the acute phase and the chronic phase.The minimal echo criteria for diagnosis of
pathological MR are delineated. The jet should be seen in atleast 2 views with jet length more than 2
cm in atleast one view.The peak velocity should be >3m/s and it should be pansystolic in atleast one
envelope. A regurgitant jet length should be measured from the vena contracta to the last pixel of
regurgitantcolour (blue or red).These criteria assume importance in the light of the finding that the
proportion of children with physiological valve regurgitation in a New Zealand population was
15%and this proportion increases in later decades. As per the New Zealand guidelines,if the
aetiology of aortic or mitral

Case Analysis: Disruptive Technology a Heartbeat Away:...
Case Evaluation
Ecton is going to position the company to be acquired but the board of directors and clinical
advisors has some concerns about the ramifications of that plan. This paper evaluates Cannon's
Phase III Plan on March 1998. Cannon proposed a path for the next year containing five major
points (Edward, 1999, 8 and 9). The bottom line of this proposal is positioning Ecton to be acquired
by the end of the 1998. One of the crucial concerns of this acquisition is the possible effects on
"Ecton's product development process". Another concern Cannon holds is the ability of Ecton to
penetrate a very harsh market fills with big, established, and advanced manufacturers. Also, Cannon
is not sure on how to approach specific market ... Show more content on Helpwriting.net ...
Although Ecton Inc. could obtain 0.5 million in the first year, 1996, and another 1.5 million the year
after, the necessary funds for Ecton Inc. in 1998 have not met yet. That is because VC firms are not
attracted to the medical imaging industry even though industry's experts are expecting a high growth
rate (mainly because ultrasound instruments provide less expensive diagnosis tool than MRA
machines and other imaging diagnostic tools). This situation puts more pressure on the company's
growth plan. The acquisition is one of the best ways to survive in this market, especially with a
start–up company like Ecton Inc. Moreover, in case if the seven trail tests succeeded in spring 1998,
the lack of required funds is expected to cause a delay of delivery for the next year orders. Cannon
proposes a contingency plane that contains establishing independent marketing and production
units; however, there is still a high risk regarding the time frame of the production process.
Acquisition will provide a good penetration for Ecton Inc. by expanding its market to enter the most
difficult ones, hospitals. That is because hospitals are heading to consolidation. Since Ecton team
has only one product, this will not satisfy hospitals which prefer to have all of their equipment from
one vendor.
Acquisition: Cons
Ecton team has potential alternative markets, such as the privet practice, primary care physician
angles, and international market. Being acquired will decrease Ecton

Heart Attacks: Echocardiography
What is a heart attack?
A heart attack is a sudden and sometimes fatal occurrence of coronary thrombosis, resulting in the
death of part of a heart muscle. It can also be called myocardial infarction, acute coronary
syndrome, or coronary thrombosis. There are greater than three million cases just in the United
States per annum.
There are three most popular methods to diagnose a heart attack.
Blood tests
During blood tests, blood is checked for abnormal amounts of proteins such as cardiac troponin.
They may also check for creatine kinase, myoglobin, and creatine kinase MB.
Echocardiography
Echocardiography is an imaging test that can be used during and after a heart attack to learn how the
heart is pumping, to see if any areas are pumping ... Show more content on Helpwriting.net ...
See our topics in the 'Your food' category to learn about the foods your body needs and what your
heart prefers.
 Make a doctor's appointment for four to six weeks after you leave the hospital following a heart
attack. Your doctor will want to check the progress of your recovery. Your doctor may ask you to
undergo diagnostic tests such as an exercise stress test at regular intervals. These tests can help your
doctor diagnose the presence or progression of blockages in your coronary arteries and plan
treatment
 Experts say it is vital that a recovering heart attack patient try to stay active. Exercise is a crucial
part of recovery, as it strengthens the heart muscles, and significantly lowers the risk of another
heart attack. Most patients will be given some kind of exercise program while they are still in
hospital. It is important that any exercise program is devised by an exercise specialist who is part of
the patient's health professional team. Most initial exercise programs will be about 12 weeks long.
You need to exercise your heart by making it work harder for at least 30 minutes a

Echocardiography And Cardioversion Procedure: A Case Study
Last Thursday was an exciting and enthusiastic day getting to observed a patient who is having a
transesophageal echocardiography (TEE) and cardioversion procedure done due to atrial fibrillation
which is a quivering or irregular heartbeat. The TEE was performed before the cardioversion to look
for clot in the heart, which could make it dangerous to proceed with the shock. The Tee is an
ultrasound test done from the esophagus to allow a close inspection of the heart to make sure there is
no clot. Before the procedure, all the equipment's were set–up by the nurse techs. After everything
was set–up, the anesthesiologists and medical doctors entered the room and proceeded with the
procedure. The anesthesiologist and doctors explained to the patient

Marfan Syndrome Case Study
After clinical diagnosis of Marfan syndrome is established, transthoraic echocardiography is used to
routinely monitor and assess the proximal aorta in order to decrease the risk of aortic dissection.
Serial measurements of the proximal aorta, the greatest dimension at the aortic root, sinotubular
junction, and ascending aorta are taken at yearly assessments by echocardiography to establish the
appropriate time for surgical intervention (Judge & Dietz, 2005). Surgical repair of the aortic root is
strongly recommended when the maximum aortic diameter exceeds 5 to 6 cm (Keane & Pyeritz,
2008). To determine the "normal" diameter of the aorta, body size and age is frequently used in
scaling normal aortic root dimensions and measurements are indexed ... Show more content on
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Research has shown that aortic dilatation typically occurs at about 0.2 cm/ year in patients with
Marfan syndrome (Kornbluth, Schnittger, Eyngorina, Gasner, & Liang, 1999). The medical
treatment currently regarded as the standard of care for patients with Marfan syndrome is β–
adrenergic receptor blockade in order to delay or prevent aortic aneurysm and dissection (Keane&
Pyeritz, 2008). This method of treatment was first suggested in 1971, with the presumption that β–
blocker therapy can decrease hemodynamic stressors, both negative inotropic and chronotropic, to
the proximal aorta and therefore slow the progression of aortic dilation (Judge& Dietz, 2005). There
was a randomized trial published in the 1990s assessing the effect of β blockers in Marfan syndrome
and the results showed that the treatment group had a significantly lower rate of aortic growth than
the control group (Keane & Pyeritz, 2008). Until more effective treatment directed at the fibrillin
gene defect associated with Marfan syndrome can be developed, β–blocker therapy currently
remains the standard of

Right Ventricular Analysis
Right ventricular fractional area change (RVFAC) is the percentage change in RV area between end–
diastole and end–systole. It is obtained from a four–chamber view where the RV end–diastolic
(RVEDA) and end–systolic areas (RVESA) are measured, and the RVFAC is calculated as follows:
RVFAC (%) = (RVEDA – RVESA)/RVEDA (Figure 6B). It has a good correlation with MRI–
derived RVEF and was shown to have prognostic significance in patients with myocardial infarction
and pulmonary hypertension (Anavekar et al., 2008). Figure (6): Methods of determining indices of
right ventricular systolic function. (A) Determining right ventricular outflow tract shortening
fraction (RVOT–SF) as a ratio between the difference in end–diastolic (RVOTD) and end–systolic ...
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The ejection time can be determined from the parasternal short–axis view at the pulmonary valve,
while isovolumic intervals are derived based on the tricuspid flow. It was shown to correlate with
radionuclide–derived right ventricle ejection fraction (RVEF) (Karnati et al., 2008). Normal values
for MPI are 0.28+0.04, and it usually rises in diseases associated with RV dysfunction (Tei et al.,
1996). Another parameter of contractility is RV dP/dt which is measured using the velocity profile
of the tricuspid regurgitant jet using continuous wave Doppler of the tricuspid regurgitation (TR) jet;
dP/dT is the time interval for the TR velocity to rise from 1 to 2 m/s. Although relatively easy to
measure, RV dP/dT can be dependent on loading conditions and may be less accurate in the setting
of severe TR. Because of lack of normative data, this measure is not recommended for routine use
and should only be used in patients who have suspected RV dysfunction (Rudski et al.,

Clinical Note On Clinical Disorders
Clinical vignette
A fifty–two–year–old white male visited his physician because he started experiencing shortness of
breath on walking short distances at ground level. He had smoked half a packet of cigarettes daily
for 40 years. Physical examination revealed a loud fourth heart sound and a blood pressure of
147/95 mmHg. Chest examination and chest X–ray were unremarkable, and ECG showed left atrial
abnormality. The patient had normal serum electrolytes, blood sugar, and kidney function tests. A
stress echocardiogram was ordered to exclude potential coronary artery disease (CAD). His resting
echocardiography showed an ejection fraction (EF) of 60%, normal septal and posterior wall
thickness, and mild diastolic dysfunction [septal early diastolic mitral annular velocity (e') of 7 cm/s,
early diastolic (E–wave) to late diastolic (A–wave) transmitral Doppler flow velocity ratio (E/A) of
1.4, E–wave deceleration time of 210 milliseconds, and E/e' ratio of 9]. There were no resting
segmental wall motion abnormalities suggestive of ischemia. The patient exercised on a treadmill
using Bruce protocol for 4 minutes and 43 seconds, and achieved 6.6 metabolic equivalent of task
(MET) and maximum heart rate of 148 beats/minute (88% of his maximum age predicted heart
rate). At peak exercise, the patient developed severe dyspnea and his blood pressure was 213/90
mmHg. Post exercise echocardiography was acquired within 1 minute of exercise termination with
Doppler recordings obtained at

Colorimetric Analysis Essay
Methods of Assessment of LV Mass and Geometry Estimation of LV mass in epidemiological
studies, the diagnostic classification of LV hypertrophy, and studies of the effects of therapeutic
intervention must depend on reliable and comparable measurement techniques. For long time, the
gold standard for estimation of the cardiac mass was autopsy. Over the last decades, and due to the
advances in the different imaging modalities and the new evolving technologies, many techniques
were developed to estimate the LV mass. Notably, each technique has its pros and cons, and its own
rate of accuracy in prediction of the LV mass compared to the gold standard. Different cut off values
were developed for each technique. Reporting of the method used to evaluate LV mass is crucial to
specify what cut off values were used, and to expect the change in sensitivity and specificity, and the
cut off values if a change in the method used to detect LV mass occurred during follow up periods.
In general, LV mass determination by ... Show more content on Helpwriting.net ...
It is widely available, inexpensive, easily analyzable, lack the use of radiation and contrast agents,
and does not cause

Diastolic Heart Failure Research Paper
DIASTLOIC HEART FAILURE
Introduction: Heart failure can also occur as a result of myocardial infraction that leaves the
ventricles unable to function properly. Diastolic heart is mainly common in elderly people with age
of 65 or older.
There are two types of heart failure: systolic heart failure and diastolic heart failure. In systolic heart
failure, left ventricle have difficulty contracting and ejecting blood into the circulation, which causes
reduced left ventricular fraction. On the other hand, diastolic heart failure has a slow and delayed
relaxation and chamber rigidity increase, which then causes inadequate filling of blood and slows
down the ability to eject blood efficiently. Calcium is not ... Show more content on Helpwriting.net
...
This method demonstrates impaired relaxation and filling because it delivers straight measurement
of ventricular diastolic pressure. But, the balance of benefit, harm and cost can debate against its use
to diagnose diastolic dysfunction. The other technique which can be used to diagnose diastolic heart
failure is Doppler echocardiography. Doppler echocardiography is used to assess cardiac diastolic
function, which can confirm the diagnosis of diastolic heart failure. For example, according to the
online article, "Diastolic heart failure: challenges of diagnosis and treatment" states
"echocardiographic measurement of tau, the time constant of left ventricular pressure decay during
isovolunteric relaxation, can be performed to assess left ventricular stiffness." Doppler
echocardiography plays an important role to evaluate the characteristic of diastolic Trans–mitral–
value– blood flow. Doppler echocardiography helps to measure the peak velocities of blood flow
during early diastolic filling (E wave) and atrial contraction (A wave) and then ratio is calculated.
When the heart is working normal, the early filling E–wave velocity is greater than the A–wave
velocity and E to A wave ratio is 1.5. But, in diastolic dysfunction, this correlation reverses, because
stiffness increases and the relaxation of heart occur slowly and E to A wave ratio decreases to 1.0.
Also, as the diastolic

Essay On Becoming A Sonographer
Sonography is a largely growing profession in the public health world. A sonographer will use
ultrasound technology to construct sonograms of each body part in question. This is an important
tool in helping physicians diagnose patients. Becoming a sonographer includes strenuous education
like most health field professions.
Sonography is non–invasive. A sonographer uses equipment that directs high–frequency sound
waves to body organs and tissue to generate medical diagnostic images. It does not use radiation and
is expected to grow in a professional manor and as a tool used by physicians. This is also a way for
many individuals to use non–invasive technology to help assist in diagnostics.
The professional responsibilities of a DMS include but are not limited to: obtaining and recording an
accurate patient history, performing diagnostic procedures and obtaining diagnostic images,
analyzing technical ... Show more content on Helpwriting.net ...
These programs must meet requirements through CAAHEP or Commission on Accreditation for
Allied Health Education Programs. In the state of Alabama there are a few programs in Mobile and
only one in north Alabama at Wallace State Community College. This is the standard route for a
sonographer. After entering the technical school or college an associate's two–year degree or a
certificate will be obtained to be able to take the next step. Once graduating with either a degree or
certificate a sonographer will have to take state exams to obtain their licensures. The professional
certification exams are offered through ARDMS. This is the American Registry for Diagnostic
Medical Sonography. While not all states require certifications it remains that if a professional hold
a certification they will more likely get the job. Many employers prefer sonographers with
certifications due to Medicare and some insurances reimbursements issues if they are not

The Role of Echocardiography in Diagnosing & Treating...
"Ebstein's anomaly is a rare cardiac anomaly that occurs in approximately one in 20,000 live births
and accounts for less than 1% of all congenital heart disease (Ebstein's anomaly in adults)". The goal
of this paper is to examine Ebstein's Anomaly – to understand what it is, how it affects the heart,
possible presenting symptoms, and other possible complications associated with this anomaly.
Diagnosis of this anomaly is key in treating patients, thus echocardiographic as well as other test
modalities are vital in assessing what the treatment options are available, as well as discerning what
the prognosis may be. Advancing test modalities have helped distinguish Ebstein's Anomaly with
other differential diagnoses. Developments with ... Show more content on Helpwriting.net ...
Background In 1866 Wilham Ebstein first described the cardiac defects associated with Ebsteins's
Anomaly. Ebstein was a doctor born in Prussia in 1836 who received his medical degree from Berlin
in 1859. A 19–year–old patient who presented with shortness of breath and palpitations was not able
to withstand his insufficient tricuspid valve. Wilham's autopsy of the young man indicated "an
enlarged and fenestrated anterior tricuspid leaflet; the posterior and septal leaflets were hypoplastic,
thickened and adherent to the right ventricle, an enlarged right atrium, and a patent foramen ovale"
(Swiss Medical Weekly, 2005). Although Ebstein portrayed the first case it was not until 1927 that
Alfred Arnstein suggested the name Ebstein's Anomaly for these defects. Ten years later in 1937
Yates and Sharpiro confirmed a case of Ebstein's Anomaly with radiographic and
electrocardiographic data (Riaz, 2013). In the past this anomaly was typically diagnosed during an
autopsy, now echocardiography is the standard for diagnosis. Once patients could be diagnosed with
Ebstein's while they were still alive, a group of symptoms was eventually composed.
Symptoms
Although minor cases of Ebstein's Anomaly may not present with any obvious symptoms in youth,
once in adulthood the symptoms usually

Broken Heart Syndrome Essay
Broken Heart Syndrome or Takotsubo Cardiomyopathy is a unique disease of the cardiovascular
system. It is a reversible form of Cardiomyopathy. This disease got its name from the look of the left
ventricular wall following changes when the disease takes place. The changes of the wall are called
apical akinesis and basal hyperkansis. It is reported that the left ventricle resembles a round
bottomed, narrow–necked Japanese pot that was used to catch octopi. Tako– meaning octopus and
tsubo– meaning trap. This disease is generally caused by emotional stress or physical stress. Broken
Heart Syndrome is noted to be more prevalent in women who are sixty years of age or older. Most
often it presents following the loss of a spouse or loved one, but this disease has been known to
occur after vigorous exercise, accidents or excessive alcohol intake.
Characteristics of Broke Heart Syndrome include transient left ventricular wall motion
abnormalities, reversible ST segment abnormalities and cardiac enzyme elevation. The cardiac
enzymes are only mildly elevated in most cases. These enzymes include Troponin levels, with a
normal value of less than 0.02 and Myoglobin ... Show more content on Helpwriting.net ...
The patient had no medical history or family history of any coronary risk factors or coronary artery
disease. There was no evidence of alcohol or drug use. An assessment of the patient was preformed
on arrival and she was noted to be tachycardic and tachypneic. The young lady was crying and
reported she had a fight with her boyfriend two hours prior to the chest pain starting. Vital signs
were stable with a blood pressure of 135/75 mmHg and heart rate of 92 beats per minute. An
electrocardiogram was obtained revealing ST elevation and depression. The physician ordered for
300mg of aspirin and 5,000 U of Heparin to be given and admitted the patient to the coronary
intensive care unit

Essay On Myocardial Viability
wall thickening and wall motion throughout the cardiac cycle and so, LV volumes and EF obtained
by cMRI are highly accurate, reproducible and well validated (14) (15). In the current study, good
agreement between Echocardiography and MRI for the estimation of ejection fraction (EF) was
noted. The mean EF by cMRI was 43.92% and the mean EF by echocardiography was 39.87% with
mean difference was 4.05%. These findings agreed with Hoffmann et al, 2005 (16) who stated that
the mean differences between EF defined by echocardiography images and EF by cMRI were below
5%. Gardner et al 2009 (17) found that LVEF correlated moderately well between MRI and
echocardiography. However, echo underestimated LVEF compared to cMRI by 4 % points. This also
Hedgire et al, 2017 (21) found that the superiority of LGE in assessing myocardial viability in acute
or chronic myocardial infarction has been well established with sensitivity as high as 99 or 94%,
respectively. The extent of LGE of the transmural thickness to predict functional recovery post
revascularization is widely validated and has become a standard clinical practice. LGE images can
also identify thrombi in the LV, which can cause catastrophic outcomes as a result of systemic
embolization. It can also identify MVO as a persistent hypo–intense (dark) area, surrounded by
abnormal late gadolinium on delayed images. In the current study, 2 segments showed 1–25%
transmural extent of the myocardial wall infarction, 34 segments showed 26–50% transmural extent
of infarction, 8 segments showed 51–70% transmural extent of infarction and 120 segments showed
71–100% transmural extent of infarction while 261 segments showed no enhancing scar tissue
however, no follow up studies were performed for those patients to evaluate functional improvement
after revascularization. Casolo et al, 2006 (22) evaluated the diagnostic capabilities of the different
imaging modalities in detecting CAD. LGE showed the best diagnostic

Congenital Heart Disease's Incidence
Congenital heart disease's incidence depends on how the population is studied. With better diagnosis
through the introduction of echocardiography the incidence figures of congenital heart diseases has
raised from the range of 5–8 per 1000 live births to 8–12 per 1000 live births (Hoffman JIE, 2013).
All the countries have similar incidence of congenital heart disease. Some minor differences in types
of congenital heart disease by country are there. China and Japan for example have a higher
incidence of sub–pulmonic ventricular septal defects, while coarctation of the aorta and aortic
stenosis may be slightly less common in Asian countries. Total incidence of congenital heart disease
remained same and does not affect by these variations (Hoffman JIE, 2013).
In most of the countries in African continent and other developing nations, a small portion of the
population can afford the diagnosis and treatment cost of congenital heart diseases. In rural
population situation become worse where accessibility to basic healthcare is already a serious
concern. Although the rural areas in developing countries are rich in natural resources, yet these
regions are poorest in financial resources ( Tantchou, 2011)
Congenital cardiovascular defects are structural problems that cause abnormal formation of the heart
or major blood vessels. ICD–9 has listed twenty five congenital heart defects codes, of which twenty
one designate specified anatomic or hemodynamic lesions. These defects

Echocardiography Personal Statement Examples
My decision to pursue echocardiography as a professional study was influenced by several life
experiences. The arrival of my decision began with the many volunteering opportunities I
participated in throughout my life, which nurtured my desire to serve the community and to pursue a
career in the medical field. From elementary school through high school I have been involved in
various service projects that ranged from distributing clothes to the homeless to building a
community recreational center. My experience volunteering at Spectrum Health this past year
solidified my passion to pursue a health profession. I enjoyed working in the hospital environment
and developing my interpersonal skills while establishing a rapport with the patients as I discharged
them from the hospital. During my volunteering experiences I was deeply affected by the people I
have encountered and found satisfaction in helping those in need. I decided to pursue a career in the
medical field so that I ... Show more content on Helpwriting.net ...
In an English course I was instructed to conduct research on a profession of my choice. I was
already interested in the imaging sciences due to my mother's occupation as a computed tomography
technologist. I discovered echocardiography as I was reading about the different non invasive
procedures of diagnostic medical sonography. Helping patients with cardiovascular disease
resonated with me due to my family's connection to cardiovascular disease, so I decided to conduct
research on echocardiography. The research project challenged me to delve deeper into the
profession by job shadowing, conducting interviews with established sonographers, and reading
journal articles pertaining to its importance to medical diagnostics, which helped formed my
expectations of the profession. I finally decided to pursue echocardiography for the profession's
constant intellectual challenges and its role in preventative

Echocardiography: Observing A Patient's Heart
Echocardiography (echo) is a common procedure used by medical practioners to observe a patient's
heart. Also known by the term heart ultrasound, it is a medical procedure that takes a dynamic image
of the heart with sound waves. This test makes use of certain physical principles to create pictures of
your heart's movement, while providing unique information as compared to what a standard ECG
might produce; however, like most other medical procedures, there are risks associated with some
forms of this test.
Echocardiography makes use of the properties of sound waves to identify tissues based on their
densities. It differentiates tissue due to the fact that the speed of sound waves is dependent on the
elastic properties and density of the medium it is travelling in, also known as the acoustic density of
the tissue. The test uses ultrasound which have frequencies >20 KHz. Sound waves are generated by
electrically stimulated piezoelectric crystal medium which then travels through an interface between
tissues such as myocardium and blood. A ... Show more content on Helpwriting.net ...
It also has the ability to show weakness in a wall or section of heart muscle and the functionality of
heart valves and chambers. An ECG simply shows the electrical activity associated with the heart as
it beats. An echo may be able to detect clots in the heart, pericardial fluid build–up or problems with
the aorta.
With foetal and transthoracic echocardiography there are no risks associated, and are safe for all
persons from infants to adults. Only transoesophageal echo (TEE) involve risk to the patient. Risks
associated include adverse reactions to the medicine used to relax patient (nausea, difficulty
breathing, etc.), sore throat post–op and in rare instances minor oesophageal injury from the tube
used. Stress echocardiography also has risks, but these are related to the exercise and medicine
required to raise the patient's heart rate and not the echo

Ecton Inc Case Summary
Ecton, Inc., a startup company, has brought a new invention into the ultrasound equipment industry.
This invention exists in the form of a compact, easy to use, non–conventional and newly developed
Doppler echocardiography technology. The company is now poised to move from the product
developmental phase of its invention to bringing it to launch in the market. Towards a successful and
profitable launch however, the company needs to make a choice on whether to activate its marketing
and production efforts towards an existence as an independent company or whether to use the
success of the invention to pursue a deal to be acquired by a large firm. In making a choice, the
company needs to critically evaluate whether they possess the resources ... Show more content on
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The Company's strategy lies in making this lowly priced product attractive to an alternative market
(a narrowed segment of users) outside the traditional cardiology settings namely in such areas as
ICUs, Surgery departments and physician's offices. The advantage of tackling such a narrow
segment is that Ecton Inc, is able to immune itself from the cult followership enjoyed by the
established makers of Echo Machines from the Echo Techs Also, as against the widely used
"Mammoth" state of the art Echo machines widely sold by established manufacturers Ecton's new
Doppler echocardiography instrument delivered a compact easy to use product which has some of
the important features of a standard echo machine at a fraction of the standard price. To attain such
low price, Ecton also employed some cost effective approach (e.g. making the machine compact) in
ensuring its delivery to the market at such low price as there are no indication in the case that the
products were delivered to the market at a discount. By drastically reducing the price of the product
to a price point of $38,000, a fraction of the standard price of echo machines, and by targeting a
potentially huge target base of alternative consumer other than the 35% already captured by the
cardiology industry (narrowed focus strategy), the

Assessing EF by Echocardiography and MRI

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