Disorders

Disease-specific echocardiography for 36 conditions: what to acquire and measure, diagnostic and severity criteria, thresholds that change management and pitfalls.

• Hypertrophic cardiomyopathy — Wall thickness, obstruction at rest and on provocation, the mitral apparatus, and the SCD risk inputs.
• Dilated cardiomyopathy — Volumes and EF, secondary MR, filling pressure, the RV, thrombus — and the numbers that trigger devices.
• Cardiac amyloidosis — Red flags on echo, the ESC score, apical sparing — and the two blood tests that must come next.
• Arrhythmogenic cardiomyopathy — Task Force RV criteria measured correctly, regional wall motion, and when to send for CMR.
• Takotsubo syndrome — Circumferential wall-motion pattern beyond one coronary territory — and the complications that kill.
• Ischaemic heart disease & post-MI — Regional wall motion by territory, viability, the mechanical complications of infarction, and LV thrombus.
• HF with preserved ejection fraction — Proving raised filling pressure — at rest, with scores, or during exercise — and finding the specific cause.
• Cardio-oncology — Baseline and serial LVEF and GLS by the same method, CTRCD grading, and the other toxicities echo must find.
• Pericardial effusion — Is it pericardial, how big, where, what is it made of — and is it compressing anything?
• Cardiac tamponade — A clinical diagnosis that echo supports: collapse, interdependence, plethora — and where to put the needle.
• Constrictive pericarditis — Septal shift, preserved medial e′, expiratory hepatic reversal — and how to separate it from restriction.
• Acute pulmonary embolism — RV dysfunction for risk stratification — and in shock, the bedside echo that justifies reperfusion.
• Pulmonary hypertension — Echocardiographic probability, the left-heart clues to group 2, and RV–PA coupling for prognosis.
• Aortic stenosis — Concordant or discordant grading, flow and calcium, cardiac damage — and when an asymptomatic patient needs a valve.
• Aortic regurgitation — Integrated grading, LV size and function for timing, the aorta — and recognising acute severe AR.
• Mitral regurgitation — Mechanism first (primary, ventricular or atrial secondary), integrated severity, then LV and LA triggers.
• Mitral stenosis — Planimetry and PHT, the rate-dependent gradient, Wilkins anatomy for balloon valvotomy, and LA thrombus.
• Tricuspid regurgitation — Five grades (up to torrential), mechanism including leads, RV and PA — and who benefits from intervention.
• Acute aortic syndrome — Flap, true and false lumen, and the complications that make type A a surgical emergency — plus the artefacts that fool you.
• Atrial septal defect & PFO — Type, size and rims, RV volume load, Qp:Qs and PVR — and the saline study done properly.
• Infective endocarditis — Vegetations, destruction and perivalvular extension — TTE first, TOE almost always, and repeat when suspicion persists.
• Cardiac masses & sources of embolism — Thrombus, tumour, vegetation or normal variant — location, attachment, mobility, perfusion and context.
• Shock & critical care echo — Phenotype the shock, measure flow, test fluid responsiveness and tolerance, and find the obstructive causes.
• Athlete's heart vs cardiomyopathy — Physiological remodelling is balanced and functional; the grey zone is solved by the pattern, not one number.
• Left ventricular non-compaction & hypertrabeculation — Two-layered myocardium, deep recesses filled with colour — and the much commoner benign hypertrabeculation it must not be confused with.
• Hypertensive heart disease & LV hypertrophy — LV mass and geometry, diastolic function and the left atrium — and the hypertrophy that is not hypertension.
• Regional wall motion & stress echo — Seventeen segments, three coronary territories, thickening not motion — and a quiz to train your eye.
• Prosthetic heart valves — Mechanical or biological, stenotic or regurgitant, patient–prosthesis mismatch or thrombosis — read against the valve's own baseline.
• Pulmonary valve disease — Pulmonary regurgitation and stenosis — the forgotten valve after tetralogy repair, in pulmonary hypertension and in carcinoid.
• Ventricular septal defect — Where is the hole, how big is the shunt, what does the pulmonary circulation look like — and is the aortic valve in danger?
• Adult congenital heart disease — Tetralogy, transposition, Fontan, Ebstein, AV canal, ductus and a persistent left SVC — segmental anatomy first, then the haemodynamics.
• Aortic aneurysm, coarctation & atheroma — Measure the root and ascending aorta the same way every time, find coarctation by Doppler, and grade the atheroma that embolises.
• Atrial fibrillation, flutter & the LA appendage — The atrium that drives the stroke risk: appendage thrombus and smoke, atrial size and function, and the ventricle that tachycardia can damage.
• Pacemakers, LVADs & intracardiac devices — Leads, assist devices, Impella and closure devices — position, function, complications and the artefacts they create.
• Normal anatomy, views & variants — The normal heart in every window, TTE and TOE — and the variants (Chiari network, crista, false tendons, moderator band) that are not disease.
• Artefacts, mimics & look-alikes — Reverberation, side lobes, attenuation and near-field clutter — and the normal structures that masquerade as thrombus, tumour or dissection.