Atrial fibrillation echocardiography or ultrasound: Difference between revisions
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{{Template:Atrial fibrillation}} | {{Template:Atrial fibrillation}} | ||
{{CMG}} | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} | ||
'''Associate Editor-In-Chief:''' {{CZ}} | |||
==[[Echocardiogram|Echocardiography]]== | ==[[Echocardiogram|Echocardiography]]== | ||
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===Transesophageal echocardiography (TEE)=== | ===Transesophageal echocardiography (TEE)=== | ||
A normal [[echocardiography]] (transthoracic or TTE) has a low sensitivity for identifying [[thrombus|thrombi]] (blood clots) in the heart. If this is suspected - e.g. when planning urgent electrical [[cardioversion]] - a [[Echocardiogram#Transesophageal echocardiogram|transesophageal echocardiogram]] (TEE) is preferred.<ref name="pmid16908781"/> | A normal [[echocardiography]] (transthoracic or TTE) has a low sensitivity for identifying [[thrombus|thrombi]] (blood clots) in the heart. If this is suspected - e.g. when planning urgent electrical [[cardioversion]] - a [[Echocardiogram#Transesophageal echocardiogram|transesophageal echocardiogram]] (TEE) is preferred.<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref> | ||
The TEE has much better visualization of the [[left auricular appendix|left atrial appendage]] than transthoracic echocardiography. This structure, located in the [[left atrium]], is the place where thrombus most commonly is formed in the setting of atrial fibrillation or flutter. TEE has a very high sensitivity for locating thrombus in this area and can also detect sluggish bloodflow in this area that is suggestive of thrombus formation. | The TEE has much better visualization of the [[left auricular appendix|left atrial appendage]] than transthoracic echocardiography. This structure, located in the [[left atrium]], is the place where thrombus most commonly is formed in the setting of atrial fibrillation or flutter. TEE has a very high sensitivity for locating thrombus in this area and can also detect sluggish bloodflow in this area that is suggestive of thrombus formation. | ||
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===Transthoracic echocardiography (TTE)=== | ===Transthoracic echocardiography (TTE)=== | ||
A transthoracic [[echocardiogram]] is generally performed in newly diagnosed [[AF]], as well as if there is a major change in the patient's clinical state. This ultrasound-based scan of the heart may help identify [[valvular heart disease]] (which may increase the risk of [[stroke]] manifold), left and right atrial size (which indicates likelihood that [[AF]] may become permanent), left ventricular size and function, peak right ventricular pressure ([[pulmonary hypertension]]), presence of left ventricular hypertrophy and pericardial disease.<ref name="pmid16908781"> | A transthoracic [[echocardiogram]] is generally performed in newly diagnosed [[AF]], as well as if there is a major change in the patient's clinical state. This ultrasound-based scan of the heart may help identify [[valvular heart disease]] (which may increase the risk of [[stroke]] manifold), left and right atrial size (which indicates likelihood that [[AF]] may become permanent), left ventricular size and function, peak right ventricular pressure ([[pulmonary hypertension]]), presence of left ventricular hypertrophy and pericardial disease.<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref> | ||
Significant enlargement of both the left and right atria is associated with long-standing [[atrial fibrillation]] and, if noted at the initial presentation of [[atrial fibrillation]], suggests that the [[atrial fibrillation]] is likely of a longer duration than the individual's symptoms. | Significant enlargement of both the left and right atria is associated with long-standing [[atrial fibrillation]] and, if noted at the initial presentation of [[atrial fibrillation]], suggests that the [[atrial fibrillation]] is likely of a longer duration than the individual's symptoms. | ||
==Guideline Resources== | |||
*[http://content.onlinejacc.org/cgi/reprint/48/3/e1.pdf The ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref> | |||
*[http://circ.ahajournals.org/content/123/10/e269.full.pdf 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Electrophysiology]] | [[Category:Electrophysiology]] | ||
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[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 14:15, 29 October 2011
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Atrial Fibrillation Microchapters | |
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Special Groups | |
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Diagnosis | |
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Treatment | |
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Cardioversion | |
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Anticoagulation | |
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Atrial fibrillation echocardiography or ultrasound On the Web | |
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Atrial fibrillation echocardiography or ultrasound in the news | |
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Directions to Hospitals Treating Atrial fibrillation echocardiography or ultrasound | |
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Risk calculators and risk factors for Atrial fibrillation echocardiography or ultrasound | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Echocardiography
Overview
Performing an echocardiogram is essential to identify;
- Valvular heart disease
- Left and right atrial size
- LV size and function
- Peak RV pressure (pulmonary hypertension)
- LV hypertrophy
- LA thrombus (low sensitivity)
- Pericardial disease
Transesophageal echocardiography (TEE)
A normal echocardiography (transthoracic or TTE) has a low sensitivity for identifying thrombi (blood clots) in the heart. If this is suspected - e.g. when planning urgent electrical cardioversion - a transesophageal echocardiogram (TEE) is preferred.[1]
The TEE has much better visualization of the left atrial appendage than transthoracic echocardiography. This structure, located in the left atrium, is the place where thrombus most commonly is formed in the setting of atrial fibrillation or flutter. TEE has a very high sensitivity for locating thrombus in this area and can also detect sluggish bloodflow in this area that is suggestive of thrombus formation.
If no thrombus is seen on TEE, the incidence of stroke immediately after cardioversion is performed is very low.
Transthoracic echocardiography (TTE)
A transthoracic echocardiogram is generally performed in newly diagnosed AF, as well as if there is a major change in the patient's clinical state. This ultrasound-based scan of the heart may help identify valvular heart disease (which may increase the risk of stroke manifold), left and right atrial size (which indicates likelihood that AF may become permanent), left ventricular size and function, peak right ventricular pressure (pulmonary hypertension), presence of left ventricular hypertrophy and pericardial disease.[1]
Significant enlargement of both the left and right atria is associated with long-standing atrial fibrillation and, if noted at the initial presentation of atrial fibrillation, suggests that the atrial fibrillation is likely of a longer duration than the individual's symptoms.
Guideline Resources
- 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation [2]
References
- ↑ 1.0 1.1 1.2 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
- ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897