Congestive heart failure echocardiography

Congestive Heart Failure Microchapters
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Pathophysiology Systolic Dysfunction Diastolic Dysfunction HFpEF HFrEF
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Medical Therapy:
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Acute Pharmacotherapy
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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
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Surgical Therapy: Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) Implantation of Intracardiac Defibrillator Ultrafiltration Cardiac Surgery Left Ventricular Assist Devices (LVADs) Cardiac Transplantation
ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
Implementation of Practice Guidelines
Congestive heart failure end-of-life considerations
Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Echocardiography is commonly used to diagnose and monitor the progress of heart failure. This modality uses ultrasound to determine the stroke volume (SV, the amount of blood in the heart that exits the ventricles with each beat), the end-diastolic volume (EDV, the total amount of blood at the end of diastole), and the SV divided by the EDV, a value known as the ejection fraction (EF). In pediatrics, the shortening fraction is the preferred measure of systolic function.

Abnormalities Detected / Evaluated on Echocardiography in Congestive Heart Failure

Echocardiography can be used in the following ways:

• To evaluate left ventricular function and ejection fraction to distinguish systolic dysfunction with a low ejection fraction (<40%) from diastolic dysfunction with a preserved ejection fraction.
• To assess for the presence of regional wall motion abnormalities that would suggest an ischemic basis for the heart failure
• Detection and quantification of mitral regurgitation
• Detection and quantification oof aortic stenosis
• Measurement of pulmonary artery pressure
• Pericardial diseases such as cardiac tamponade can be rapidly diagnosed by echocardiography.
• Echocardiography may also aid in deciding what treatments will help the patient, such as medication, insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy.

2009 ACC/AHA Focused Update on Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult- Recommendations for Echocardiography in Patients Presenting With Heart Failure (DO NOT EDIT)

Class I

"1. Two-dimensional echocardiography with Doppler should be performed during initial evaluation of patients presenting with heart failure to assess left ventricular ejection fraction, left ventricular size, wall thickness, and valve function. Radionuclide ventriculography can be performed to assess left ventricular ejection fraction and volumes. (Level of Evidence: C) "

ACC/AHA Guidelines- Serial Clinical Assessment Recommendation

Class IIa

"1. Repeat measurement of ejection fraction and the severity of structural remodeling can provide useful information in patients with heart failure who have had a change in clinical status or who have experienced or recovered from a clinical event or received treatment that might have had a significant effect on cardiac function. (Level of Evidence: C) "

Vote on and Suggest Revisions to the Current Guidelines

• The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

• The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

• 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation

References

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