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Clinical skills Yr2 > Data interpretation: ECHO report (Heart failure, cardiomyopathies, congenital defects) > Flashcards

Data interpretation: ECHO report (Heart failure, cardiomyopathies, congenital defects) Flashcards

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1
Q

How do you explain to a patient what an echocardiogram is?

A

Non-invasive ultrasound scan of the heart to check its structures and nearby blood vessels

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2
Q

How do you explain to a patient the echo procedure?

A

At a hospital or clinic appointment, a cardiologist or ultrasound technician will do the echo

They will place ultrasound gel on chest then use probe to scan the heart, which creates moving images on the monitor

Cardiologist will go through results in a later appointment

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3
Q

Which 5 types of conditions is an echo used to diagnose?

A

Heart failure

Cardiomyopathies

Congenital heart defects

Infective endocarditis

Damage from MI

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4
Q

What are the 3 types of echocardiogram?

A

Transthoracic echocardiogram (TTE): Probe is placed onto chest, with patient lying on left side with arm behind head. Preferred for valve defects

Transesophageal echocardiogram (TOE): Probe inserted into food pipe, with patient under sedation. Preferred for imaging of descending aorta and left atrium

Stress echo: Assess how the heart functions while under stress, typically from exercise or dobutamine, to check if heart receives adequate blood supply when working harder. Preferred for coronary heart disease

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5
Q

Which heart structures are assessed in echo?

A

Chambers

Valves

Myocardial muscle thickness

Pericardium

Ascending and descending aorta

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6
Q

What are the 3 main readings to interpret on an echo report?

A

Left ventricular ejection fraction

Valvular function

Myocardial function

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7
Q

What is the left ventricle ejection fraction (LVEF)?

A

Percentage of blood pumped out of the left ventricle (main pumping chamber of the heart) with each beat

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8
Q

What is a normal LVEF?

A

50-70%

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9
Q

If a patient has a clinical diagnosis of heart failure, why should they have an echocardiogram?

A

Heart failure causes left ventricle wall muscle to become weakened, so heart fills with blood by can’t contract forcefully, so less blood is pumped out of the left ventricle with each beat

The severity of the affected LVEF can be measured with an echo

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10
Q

What are the 3 types of heart failure classifications based on LVEF?

A

Reduced LVEF of 40% or less: HFrEF (heart failure with reduced ejection fraction)

LVEF between 41–49%: HFmrEF (heart failure with mildly reduced ejection fraction)

LVEF of 50% or more: HF-PEF (heart failure with preserved ejection fraction)

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11
Q

How do you explain to a patient what heart failure is?

A

Long-term clinical condition that occurs when the heart can’t pump blood effectively, leading to a buildup of fluids and a reduction in oxygen and nutrients delivered to the body

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12
Q

How do you explain to a patient what can cause heart failure?

A

Important risk factors include:
Coronary artery disease: Fat deposits build up in small arteries that supply heart muscle

High blood pressure

Diabetes

Lifestyle choices: High alcohol intake, smoking, lack of physical activity

Family history of heart failure

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13
Q

What is the difference between right-sided heart failure and left-sided heart failure?

A

Left-sided heart failure weakens the left ventricle, which pumps blood to the body

Right-sided heart failure weakens the right ventricle, which pumps blood to the lungs

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14
Q

What are the symptoms of left-sided heart failure?

A

Pulmonary edema (dry cough, bibasal fine crackles), pink sputum, tachypnea)

Cyanosis

Restlessness

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15
Q

What are the symptoms of right-sided heart failure?

A

Peripheral edema (sacral, legs, ankles), ascites

Hepatosplenomegaly (bloating, early satiety, abdominal pain)

Weight gain

Increased peripheral venous pressure (elevated JVP)

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16
Q

Why do left and right sided heart failure each cause specific symptoms?

A

Left-sided heart failure: Blood flow backs up into pulmonary veins and into lungs, causing fluid build up in lungs

Right-sided heart failure: Blood flow backs up into vena cava and into peripheral tissues, causing fluid build up in extremities

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17
Q

Apart from echo, what other investigations should be done for suspected heart failure?

A

12-lead ECG

FBC: U&Es, eGFR, FBC, iron studies, thyroid function tests, LFTs, HbA1c

Urinalysis

Lung function tests & CXR

N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) level: 400 no/L or more suggests heart failure diagnosis

Imaging tests: Cardiac CT/MRI, nuclear imaging, invasive coronary angiography

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18
Q

What scoring tool is used to estimate symptom severity of heart failure?

A

New York Heart Association (NYHA) tool

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19
Q

What are the 3 criteria of Class 1 heart failure, according to NYHA tool?

A

No limitation to physical activity

No fatigue, palpitations, breathlessness

Comfortable at rest

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20
Q

What are the 3 criteria of Class 2 heart failure, according to NYHA tool?

A

Slight limitation to physical activity, symptoms occur with ordinary exertion

Occasional fatigue, palpitations, breathlessness

Comfortable at rest

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21
Q

What are the 3 criteria of Class 3 heart failure, according to NYHA tool?

A

Severe limitation to physical activity, symptoms occur with little exertion

Frequent fatigue, palpitations, breathlessness

Comfortable at rest

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22
Q

What are the 3 criteria of Class 4 heart failure, according to NYHA tool?

A

Can’t do physical activity without symptoms occurring

Constant fatigue, palpitations, breathlessness

Uncomfortable at rest

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23
Q

What are the 4 main drugs prescribed to treat HFrEF?

A

Beta-blocker

Mineralocorticoid receptor antagonist

SGLT2 inhibitor

Loop diuretic

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24
Q

How do you explain to a patient what a beta blocker is, and give examples?

A

A drug that blocks the hormone adrenaline. Beta blockers cause the heart to beat more slowly and with less force. This lowers blood pressure

Atenolol, bisoprolol, propanolol

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25
What are the 5 main side effects of beta blockers?
Cold fingers or toes Difficulty sleeping or nightmares Sexual dysfunction Drowsiness and fatigue Dizziness
26
How do you explain to a patient what a mineralocorticoid receptor antagonist is, and give examples?
A drug that blocks that effect of aldosterone, a hormone that increases sodium retention and water retention, which cause fluid build up in heart failure Spironolactone, eplerenone
27
What are the 5 main side effects of MRA drugs?
Gynecomastia: Unexpected breast tissue growth in males Irregular menstrual cycles or spotting Breast area tenderness Dizziness Headache
28
How do you explain to a patient what SGLT2I drug is, and give examples?
Type 2 diabetes drug that is also used for heart failure A drug that increases the amount of sugar (glucose) excreted in urine, which also helps to remove extra fluid. Also improves heart's workload Dapagliflozin, empagliflozin
29
What are the 5 main side effects of SGLT2I drugs?
Thrush Back pain Peeing more frequently Dizziness Mild skin rash
30
How do you explain to a patient what a loop diuretic is, and give examples?
A drug that help the kidneys pass out more fluid, which reduces swelling in heart failure Furosemide, bumetanide
31
What are the main side effects of loop diuretics? OH DANG
Ototoxicity: Develop hearing or balancing problems from medication Hypokalemia: Muscle cramping, constipation Dehydration Allergic reaction Nephritis Gout
32
How does an echo assess valvular fraction?
Checks for mild/moderate/severe valve stenosis or regurgitation
33
How do you explain to a patient what aortic stenosis is?
The aorta is the biggest blood vessel in the body, and it comes directly off the heart's main pumping chamber (left ventricle). Blood has to pass through the aortic valve to enter the aorta. Aortic stenosis is when the aortic valve becomes narrowed. This reduces blood flow to the rest of the body, and causes turbulent flow in the heart as blood is struggling to get past the narrowing
34
What are the main echo findings in aortic stenosis?
Thickened aortic valve leaflets Small aortic valve area Left ventricular hypertrophy (severe aortic stenosis): Reduced LV chamber size and more stiffness, so it is unable to eject blood and Left Ventricular End-Diastolic Pressure LVEDP increases due to increased volume of blood in left ventricle
35
How do you explain to a patient what can cause aortic stenosis?
Born with bicuspid valve instead of tricuspid valve Age-related calcification and stiffening Infections: IE, rheumatic fever Autoimmune conditions: Lupus, RA Inherited conditions: Paget's disease, hypercholesterolemia Genetic conditions: Marfans
36
How do you explain the risk factors for heart valve disease? DIABETES
D: Diabetes I: Inactivity A: Age over 65, male B: Blood pressure high T: Tobacco smoking E: Elevated cholesterol S: Stress
37
How do you explain to a patient what aortic regurgitation is?
The aorta is the biggest blood vessel in the body, and it comes directly off the heart's main pumping chamber (left ventricle). Blood has to pass through the aortic valve to enter the aorta. Aortic regurgitation is when the aortic valve doesn't close properly. This causes backflow of blood into the heart again, and less is pumped out to the rest of the body
38
What are the main echo findings in aortic regurgitation?
Backwards flow (regurgitant jet) from aorta into left ventricle Left ventricular hypertrophy: Volume overload in left ventricle during diastole, due to regurgitation of blood from aorta as well as blood ejected from left atrium
39
How do you explain to a patient what can cause aortic regurgitation? CREAM
C: Congenital heart defects eg. bicuspid aortic valve R: Rheumatic damage eg. Rheumatic fever, SLE, RA, Takayasu arteritis, Crohn’s, AxSpa E: Endocarditis A: Aortic dissection or aortic root dilation (functional/secondary regurgitation which causes stretched valve ring, so cusps don’t meet and valve can’t close) M: Marfan’s syndrome
40
How do you explain to a patient what mitral stenosis is?
Mitral valve is the opening that separates 2 of the heart chambers on the left side: The left atrium and left ventricle. The main function of the mitral valve is to open to let blood flow from left atrium into left ventricle, and to prevent backflow Mitral stenosis is when the mitral valve becomes narrowed
41
What are the main echo findings in mitral stenosis?
Mitral valve area is smaller than normal Left atrial hypertrophy Leaflet thickening, commissural fusion, thickening and shortening of chordae tendinae
42
How do you explain to a patient the causes of mitral stenosis? CREDIT
C: Congenital heart defects R: Rheumatic damage eg. Rheumatic fever, SLE, RA, Takayasu arteritis, Crohn’s, AxSpa E: Endocarditis D: Degenerative calcification I: Inflammation (carcinoid syndrome) T: Therapy (radiation)
43
What is mitral regurgitation?
The mitral valve is the opening between the 2 heart chambers on the left side, the left atrium and the left ventricle. The mitral valve normally opens and closes to let blood flow from the left ventricle to the left atrium, and closes to prevent back flow. Mitral regurgitation is when the mitral valve doesn't close properly, so blood leaks back into left atrium, and less is pumped around the rest of the body
44
What are the main echo findings of mitral regurgitation?
Backwards flow (regurgitant jet) from left ventricle into left atrium Left atrial hypertrophy: Volume overload in left atrium during diastole, due to regurgitation of blood from left ventricle
45
How do you explain to a patient the causes of mitral regurgitation?
Congenital defects Ischaemic mitral regurgitation: heart attack can injure the heart muscle, including the papillary muscles and chordae tendineae (tendon-like cords) that support the mitral valve Rheumatic fever Autoimmune and collagen vascular diseases
46
Which congenital heart defects can be identified on echo?
Valve stenosis/regurgitation Atrial septal defect (patent foramen ovale) Ventricular septal defect Tetralogy of Fallot Aortic coarctation Transposition of the great arteries
47
How do you explain to a patient what atrial septal defect is?
Opening in the wall that separates the 2 upper chambers of the heart (atria) The patient was born with this
48
How do you explain to a patient what patent foramen ovale is?
Small flap-like opening between the 2 upper heart chambers (atria) that usually closes after birth, but can remain open in some individuals
49
How do you explain to a patient what ventricular septal defect is?
Hole between the 2 lower heart chambers (ventricles) that pump blood
50
How do you explain to a patient what tetralogy of fallot is?
Combination of 4 heart issues that are present at birth: pulmonary stenosis – a narrowing at, under or above the valve between the right pumping chamber (right ventricle) and the large blood vessel that carries blood to the lungs to pick up oxygen (pulmonary artery) ventricular septal defect – a hole between the right and left pumping chambers (ventricles) over-riding aorta – the entrance to the large blood vessel that takes blood away from the heart to the rest of the body (aorta) is next to the ventricular septal defect, allowing oxygen-poor blood to flow through it thick right ventricle – the heart has to work harder to pump blood through the narrowed pulmonary artery, causing the muscle to thicken
51
How do you explain to a patient what aortic coarctation is?
Part of your aorta is narrower than it should be. The narrowing stops your blood from flowing as easily as it should.
52
How do you explain to a patient what transposition of the great arteries is?
Two main arteries leaving the heart, the aorta and the pulmonary artery, are switched in position This means that blood flows to the lungs and picks up oxygen but is then pumped back to the lungs instead of travelling around the body. Blood flowing round the body is unable to reach the lungs to pick up oxygen and continues circulating
53
How are congenital heart defects usually treated?
Urgent surgical repair
54
What are the 3 types of aortic coarctation?
Preductal: Narrowing is proximal to the ductus arteriosus Ductal: narrowing occurs at the insertion of the ductus arteriosus Postductal: narrowing is distal to the insertion of the ductus arteriosus
55
How do you explain to a patient the common symptoms of aortic coarctation
high blood pressure in arms, lower blood pressure in legs and ankles shortness of breath tiredness in legs leg cramps or cold feet Rib notching: Enlarged left ventricle presses against ribs
56
Apart from echo, what other tests are done to diagnose aortic coarctation?
CT or MRI angiogram of aortic flow CXR ECG
57
How is aortic coarctation fixed?
Angioplasty with balloon dilatation and stenting Surgical repair: End-end, subclavian flap repair, patch repair
58
How do you explain to a patient who is likely to get congenital heart disease?
Babies with family history Pregnancy complications due to maternal diabetes, rubella infection, smoking or drinking alcohol Babies with genetic conditions eg. Down syndrome
59
How do you explain to a patient what cardiomyopathy is?
A group of heart muscle diseases, where the walls of the heart chambers have become stretched, thickened or stiff
60
How do you explain to a patient what the most common types of cardiomyopathies are?
Dilated cardiomyopathy Restrictive cardiomyopathy Hypertrophic cardiomyopathy Arrhythmogenic cardiomyopathy Takotsubo cardiomyopathy
61
What are the common symptoms of cardiomyopathies?
Breathlessness Tiredness Palpitations due to arrhythmias Swelling in ankles or ascites (secondary heart failure) Dizziness or fainting Chest pain
62
What is dilated cardiomyopathy, and what is the main echo finding?
Muscle walls of the heart become stretched and thin, so they cannot squeeze (contract) properly to pump blood around the body Enlarged ventricular chamber size with decreased ventricle wall thickness, decreased LVEF
63
What is hypertrophic cardiomyopathy, and what is the main echo finding?
Heart muscle cells enlarge and the walls of the heart chambers thicken. The heart chambers are reduced in size so they cannot hold much blood, and the walls cannot relax properly and may stiffen. Decreased ventricular chamber size with increased ventricular wall thickness, normal or increased LVEF Obstructive HCM: Septum thickens and blocks blood flow from left ventricle to aorta (left ventricular outflow tract obstruction) Non-obstructive HCM: Septum thickens but doesn’t block blood flow
64
What is restrictive cardiomyopathy, and what is the main echo finding?
Walls of the main heart chambers become stiff and rigid and cannot relax properly after contracting. This means the heart cannot fill up properly with blood Biatrial enlargement and restrictive filling patterns
65
What is arrhythmogenic cardiomyopathy?
Proteins that usually hold the heart muscle cells together are abnormal. Muscle cells can die and the dead muscle tissue is replaced with fatty and fibrous scar tissue. The walls of the main heart chambers become thin and stretched and cannot pump blood around the body properly
66
What is takotsubo/stress-induced cardiomyopathy?
Heart muscle becomes suddenly weakened or "stunned", causing the left ventricle (one of the heart's main chambers) to change shape. Usually after stress, bereavement, major surgery
67
How do you explain to a patient what cardiomyopathy screening is?
Patients can undergo tests to identify any inherited conditions that could result in cardiomyopathy Includes genetic testing and exploring family history, MRI scan, 24 hrs ECG tape, myocardial biopsy, exercise tests This is important because some types of cardiomyopathies eg. arrhythmogenic, restrictive are more common in younger adults under 30-40 and can lead to sudden death
68
What are the 4 mainstays of treatment for cardiomyopathies?
Medications for heart failure, high blood pressure, anticoagulation Cardiac myosin inhibitors eg. mavacamten: Reduce excessive muscle contraction Alcohol septal ablation: Ethanol injected into artery that supplies diseased heart muscle, so that ethanol causes cardiac cells to die and tissue shrinks to normal size Surgical interventions: Devices: Pacemaker, ICD, CRT Heart transplant: Treats end-stage HCM Septal myectomy: Open-heart surgery to remove thickened septum that bulges into left ventricle
69
Which congenital heart defects are cyanotic, and why?
Transposition of the great arteries, tetralogy of fallot Because they cause right-to-left shunts, which causes deoxygenated blood to be pumped around body Symptoms: Tiredness when feeding, poor weight gain, Blue baby syndrome: Skin is pale grey or blue colour due to hypoxic cyanosis, as deoxygenated blood enters left side of heart
70
Which congenital heart defects are acyanotic, and why?
ASD, VSD, PFO Because they cause left-to-right shunts, which means oxygenated blood is still pumped around body even though there is less Symptoms: Heart failure, swelling in legs and ascites, rapid breathing

Clinical skills Yr2 (38 decks)

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