超声心动在日常心脏病学实践中的应用.ppt

STAT Echocardiography Leng Jiang, MD, FACC, FAHA, FASE Director, Noninvasive Cardiology, BMC Professor of Medicine, Tufts University ~ Oct. 2008 ~ Guidelines for STAT Echo To request a “STAT Echo” by webpage The on-call cardiology fellow, who has the Cardiology/ Echo knowledge and skills, is to: request a brief explanation of indication perform the STAT Echo if indicated give a preliminary report immediately Indications for STAT Echo Acute hemodynamically unstable syndrome of possible cardiac origin Donor heart evaluation  High clinical suspicion of cardiac tamponade Suspected mechanical complications of AMI: Free wall rupture Ventricular septal defect Papillary muscle rupture Dynamic LVOT obstruction RV MI  Acute valvular insufficiency (endocarditis) Other unexplained hemodynamic unstability Acute LV / RV dysfunction pump failure pulmonary embolism Hypovolemia Aortic dissection (TEE or CT scan preferred) Inadequate Preload The best measure of left ventricular preload is the LVEDV Surrogate markers: LAP PCWP Echo: Small chamber, Hyperdynamic Takotsubo Cardiomyopathy Chest pain with reversible systolic LV apical ballooning Mean age in 60’s, more in women (85%) EKG: anterolateral or anterior STE Minimal rise of serum cardiac markers Echo: hyperkinesis of the basal segments with severe hypokinesis of the other segments Cath: Normal Cors RA / RV Collapse Sen Spe RAC 88% 55% RVC 48% 95% IVC plethora 97% 66% * May not be seen: in the presence of elevated RVP: - with volume expansion - with RVH (PHTN, PS) when the pericardial effusion is loculated, such as after surgery Doppler In tamponade, respiration provokes exaggerated and reciprocal changes in the stroke volume of the RV and LV. Doppler demonstrates a decrease in mitral flow velocity and a prolongation of the isovolumic relaxation time with inspiration while the tricuspid flow velocity increases; with expiration the opposite occurs This pattern is seen at all sampling