By Christophe Klimczak MD PhD, Petros Nihoyannopoulos MD FRCP FACC FESC
This publication bargains either skilled cardiologists and trainees alike the chance to spot and deal with the most typical pitfalls encountered with echocardiology in regimen medical perform. The publication covers a chain of demanding situations starting from technical problems to issues of echocardiographic interpretation with each one part proposing a sequence of simulations to check the reader's knowing of the matter. The textual content is written in a hugely useful and didactic type in order to aid the busy general practitioner by way of proposing the knowledge in a succinct, 'essentials simply' demeanour. The heavy use of fine quality illustrations serves to make sure that the ideas defined are supported via real-life examples and hence with no trouble acceptable to the medical setting.Edited through a global expert.Abundant use of full-colour permits actual illustration of pictures to manage to pay for exact dialogue of the recommendations involved.Didactic strategy guarantees supply of key info in doable parts therefore saving time for the busy cardiologist.Includes the main common pitfalls linked to various thoughts therefore making sure applicability to quite a few scientific settings and kit availability.
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Additional info for 100 Challenges in Echocardiography
5 m/s) the use of the simplified equation leads to an overestimation of the gradient. The ‘complete’ Bernoulli formula 4(V22 – V12) should be used in this case. Neglect of the phenomenon of restoration of pressure in the case of aortic stenosis In general, this phenomenon is due to the difference in gradient between the vena contracta (Doppler), on the one hand, and the prestenotic zone and poststenotic zone (catheterization) on the other. It equates to a retransformation, downstream of the vena contracta (zone of lowest pressure and highest velocity), of the kinetic energy into potential energy (remounting of pressure).
A fault in the distribution of the echocardiographic gel on the patient’s skin, leading to a poor air–skin interface. In summary, even if the echocardiographic examination is not of good technical quality in such situations, the information obtained can be used to resolve some simple problems. This is where the operator’s experience and skill come into play. 6 Cardiac valves VALVULAR STENOSES Echocardiographic diagnosis of valvular stenoses, such as mitral stenosis (MS) or aortic stenosis (AS), is based on the study of: • • • the morphology and motion of the stenotic valve the degree of valvular stenosis the haemodynamic consequences of the valvular stenosis.
Hatle’s method must, therefore, not be used in the 48 hours following the dilatation procedure. Pitfalls when studying the degree of valvular stenosis In practice Planimetry is the preferred method in cases where there is satisfactory imaging, and Hatle’s method is preferred in cases of a severely calcified mitral orifice, subvalvular stenosis or poor quality imaging. When there is a discrepancy between the results obtained using mitral planimetry and Hatle’s method, it is necessary to resort to a third method (continuity equation).