Essential Echocardiography A Practical Handbook With DVD

473 Pages·2007·40.5 MB·English

by  Solomon, Scott D.

E E
SSENTIAL CHOCARDIOGRAPHY
C C
ONTEMPORARY ARDIOLOGY
CHRISTOPHER P. CANNON, MD
SERIES EDITOR
ANNEMARIE M. ARMANI, MD
EXECUTIVE EDITOR
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E E
SSENTIAL CHOCARDIOGRAPHY
A Practical Handbook With DVD
Edited by
S D. S ,
COTT OLOMON MD
Noninvasive Cardiac Laboratory, Brigham and Women’s Hospital
Harvard Medical School, Boston, MA
With
B B ,
ERNARD ULWER MD
Medical Illustrator and Associate Editor
for Illustrations and Videos
Brigham and Women's Hospital, Harvard Medical School, Boston, MA
Foreword by
P L ,
ETER IBBY MD
Chief, Cardiovascular Medicine, Brigham and Women’s Hospital
Mallinckrodt Professor of Medicine
Harvard Medical School, Boston, MA
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Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1
eISBN 1-59259-977-X
Library of Congress Cataloging-in-Publication Data
Essential echocardiography : a practical handbook with DVD / edited
by Scott D. Solomon ; associate editor for illustrations and videos,
Bernard Bulwer.
p. ; cm. -- (Contemporary cardiology)
Includes bibliographical references and index.
ISBN-13: 978-1-58829-322-0 (alk. paper)
ISBN-10: 1-58829-322-X (alk. paper)
1. Echocardiography. 2. Heart--Diseases--Diagnosis. I. Solomon,
Scott D. II. Bulwer, Bernard E. III. Series: Contemporary cardiology
(Totowa, N.J. : Unnumbered)
[DNLM: 1. Echocardiography--methods. WG 141.5.E2 E78 2006]
RC683.5.U5E87 2006
616.1'207543--dc22 2005037877
To the memory of my father,
Edwin Frederick Solomon

F
OREWORD
Echocardiography occupies a pivotal position in specialty of cardiovascular medicine and the field
contemporary cardiovascular medicine. The results of noninvasive imaging. We have entered an era
of the echocardiographic examination have almost in which laptop devices can provide strikingly useful
assumed a position alongside the vital signs and the echocardiographic images at the bedside. The advent of
electrocardiogram in the evaluation of the patient with these small ultrasound machines obviates the need
or suspected of having cardiovascular disease. The for wheeling a bulky instrument. This advance has also
ubiquity and utility of this examination have even given facilitated the broad dissemination of echo-cardiography.
rise, among some medical trainees, to a mentality that Can the introduction of palm-sized micro-ultrasound
seeks the results of the echocardiographic evaluation devices with penlight-sized transducers lag far behind the
before seeing the patient! laptop ultrasound instruments? The increasing facility of
Given its prominence in current practice, it is hard acquisition of echocardiograms raises the important
to conceive that the utility of echocardiography as other question of the qualifications of the acquirer and interpreter.
than an experimental curiosity really dates back only Who should properly perform and interpret echocardio-
a few decades. Springing from the roots of sonar developed graphic examinations? Should the handheld echocar-
for marine surveillance, medical ultrasound assumed real diograph become an extension of the physician’s physical
utility in cardiology with the development of the M mode. examination, taking its place beside the stetho-scope and
The echocardiograms recorded using M mode required sphygmomanometer? How much training and oversight
substantial special training for decipherment. The would optimize the benefit to patients of such broad
introduction of two-dimensional echocardiography dissemination of echocardiography? Should the use of
rendered the arcana of wavy lines in the M mode virtually miniature echocardiography be restricted to cardiologists,
obsolete. The appreciation of cardiac anatomy using this to internists, or be disseminated to emergency physicians,
modality was nearly intuitive. The interpretation of anesthesiologists, surgeons, etc.? These impor-tant issues
echocardiograms became accessible to a much broader require resolution with the patient’s interests paramount
population of practitioners. and academic and medical “turf” considerations subsidiary.
Echocardiography results from a fusion of physics, The ease of modern echocardiography presents
engineering, anatomy, and physiology. The more recent another challenge. The availability and accurate infor-
introduction of Doppler techniques to the echocardiogram, mation available from the echocardiogram has fostered
the advent of transesophageal echocardiography, and the an ingrained reliance on this noninvasive imaging
use of echo contrast illustrate the union of these disciplines modality, quite possibly to the detriment of skills in
in the service of cardiovascular diagnosis. bedside physical diagnosis. Does echocardiography
Essential Echocardiography: A Practical Handbook represent a threat to the traditional toolkit of the
With DVD, lavishly illustrated and carefully selected, is cardiovascular practitioner, careful observation with
a primer that illustrates the seamless coalescence of the physician’s own senses, independent of micro-
physics, instrumentation, hemodynamics, anatomy, and processors and electronic displays? Has the physical
patho-physiology. Accurate but approachable, extensive exam become antiquated, and have those who resist the
but not exhaustive, this manual provides a practical reliance upon the echocardiogram instead of the physical
but scholarly overview of the contemporary state examination become Luddites resisting inevitable and
of echocardiography. It should be useful to trainees, desirable progress? Will cardiovascular medicine
sonographers, and cardiologists who practice echo- lose its soul by forsaking the primacy of the physical
cardiography as a daily pursuit. examination, or will we enhance our ability to help
The very quotidian acceptance of echocardiography, patients through examination that, in the right hands,
however, raises several concerns for the future of the promises prompt and accurate evaluations?
vii
viii Foreword
The elements of echocardiography presented in this complete and careful physical examination by the aware
volume indirectly help us with both of those issues. First, practitioner with state-of-the-art information available
whatever their specialty, training, or background, those from the latest technological advances in noninvasive
who wish to add acquisition and/or interpretation of diagnosis.
echocardiograms to their skill set can benefit remarkably Peter Libby, MD
from this clear and readable text. Second, by integrating Chief, Cardiovascular Medicine
echocardiography into the physiological tradition of Brigham and Women’s Hospital
cardiovascular medicine, Solomon and colleagues provide Mallinckrodt Professor of Medicine
a firm foundation for those who wish to supplement the Harvard Medical School, Boston, MA
P
REFACE
In 2006, echocardiography remains the most commonly both is required of the echocardiographer. A substantial
used cardiac imaging technique. Despite the existence of amount of this text is dedicated to the underlying physical
other methods to image the heart, such as nuclear imaging, and physiological principles. Yet echocardiography
angiography, cardiac magnetic resonance, and cardiac is primarily a visual discipline. The principles discussed
computed tomography, echocardiography continues to be in the text will be reinforced by the abundant echo-
the “bread and butter” imaging modality of cardiologists cardiographic images and dedicated illustrations demon-
worldwide. Echocardiography has become so central to strating relevant cardiac anatomy and physiology. Our
our care of patients precisely because it is almost universally experience teaching echocardiography to fellows suggests
available, can be performed in the outpatient setting or the that it can be difficult to learn a dynamic imaging modality
intensive care unit, provides usable clinical information on such as echocardiography from static images. Thus, in
the vast majority of patients, is relatively inexpensive, and addition to the large number of embedded images in the
has significant clinical and prognostic value. text, this book is uniquely accompanied by a DVD
The goal of Essential Echocardiography: A Practical containing moving images illustrating virtually all of
Handbook With DVD is to teach echocardiography the major points in the chapters. The DVD will provide a
to anyone learning the discipline. Although most previous unique learning tool for the introductory student, who is
echocardiography books have been designed either encouraged to view the DVD while reading the text,
for physicians—generally cardiologists—or cardiac and a comprehensive visual encyclopedia for the more
sonographers, the basic principles of echocardiography are experienced learner.
the same regardless of the learner. In the general practice Even as we embrace other emerging cardiac imaging
of echocardiography, these distinctions blur. Indeed, technologies, advances in ultrasound technology in
sonographers are often the first to make an important diag- general and cardiac ultrasound in particular are leading
nosis; conversely, in many institutions, physicians, not to continued improvements in image quality and new
sonographers, perform echocardiographic scans. Written techniques and applications of cardiac ultrasound.
by a variety of experts with a commitment to the education These advances will ensure that echocardiography will
and training of sonographers, students, and cardiology fel- continue to remain the leading cardiac imaging modality
lows, all the chapters in Essential Echocardiography: for some time to come. Essential Echocardiography:
A Practical Handbook With DVD are designed to be basic A Practical Handbook With DVD will provide the
enough for the introductory student, but offer enough sub- physiological, anatomical, and diagnostic grounding all
stance to serve as a reference for the more advanced students of cardiac ultrasound need and provide a sound
practitioner. basis for a more general understanding of cardiac
Echocardiography is the perfect marriage between imaging.
anatomy and physiology, and an essential understanding of
Scott D. Solomon, MD
ix