Tag Archives: echocardiography

Introduction The tricuspid valve (TV) is involved in 90% of patients with right-sided endocarditis and is most common in people with intravenous drug use (IVDU). Septic pulmonary emboli occur in >50% of patients with TV involvement and manifests with various respiratory symptoms.1 Case report A 38-year-old man presented with a prodrome of flu-like illness along with night sweats, pleuritic chest pain and cough for two weeks unresponsive to the usual first- and second-line oral antibiotics (amoxicillin 1 g 8 hourly for five days, and doxycycline 100 mg 12 hourly for five days, respectively). There was no history of illicit IVDU or any condi

Introduction The World Health Organisation (WHO) defines obesity as “abnormal or excessive fat accumulation that may impair health” and classifies obesity based on body mass index (BMI), with those with a BMI of 25–30 kg/m2 termed as overweight and those with BMI over 30 kg/m2 defined as obese.1,2 Obesity has reached pandemic levels in the last 50 years.3 One and a half billion people over the age of 20 in the world are thought to be overweight or obese.4 Obesity is associated with low-grade chronic inflammation leading to insulin resistance, which may progress to diabetes mellitus.5 Moreover, fatty liver disease, systemic hypertension

Introduction Timely corrective surgery for severe mitral regurgitation (MR) reduces the risk of limiting symptoms and irreversible left ventricular dysfunction.1,2 Left untreated, severe MR carries a poor prognosis. In asymptomatic patients, the estimated five-year rates of death from any cause, death from cardiac causes and adverse cardiac events (death, heart failure or new atrial fibrillation), are 22%, 14% and 33%, respectively.2 The prognosis for symptomatic patients is significantly worse, and further adversely affected by older age and comorbidities, including atrial fibrillation, pulmonary hypertension, left atrial dilatation, and re

Introduction In recent years heart failure with preserved ejection fraction (HFpEF) has become a research priority, since despite having a preserved ejection fraction (EF), it is still associated with mortality and survival rates similar to heart failure with a reduced ejection fraction (HFrEF).1 Historically, the interest in HFpEF stems from the collaboration of two areas of research. Studies found that diastolic left ventricular (LV) dysfunction contributed to myocardial hypertrophy.2,3 Shortly after, HFpEF was found to be an adjunct in heart failure (HF) trials, examining the usefulness of angiotensin-converting enzyme (ACE) inhibitors in

The problems First: we are leaking highly skilled workforce Dr Claire Colebourn, President of the British Society of Echocardiography The experienced Band 7 echocardiographer is the lynch-pin of every UK NHS echo service, acting as trainers, on-the-ground supervisors and quality assurers. Our data show that, far from recruitment being our major issue, there is a steady drip of senior workforce leaking from the profession. Departments with a high proportion of newly qualified echocardiographers risk a gradual decline in quality without adequate senior presence, the ‘rookie factor’ is simply too high. Second: echocardiography is an advanced

Table 1. Clinical features and complications First author Symptoms / complications Pur Jn Spl SCH Os Valve Culprit pathogen Cecarelli1 Meningitis, SMA, SE Y N N N N Mitral Staph. aureus Deonarine2 Cirrhosis, CHF, spondylitis Y N N N N Quadrivalve Strep. mutans El Chami3 CHF, respiratory failure Y N N N N Aortic Enterococcus faecalis Yokota4 Mesenteric abscess Y N N N N Mitral MSSA Miridjanian5 Fever, myalgia, headache Y N Y Y N Aortic Moraxella kingae Mahmoud6 Cirrhosis, CHF, ICE Y N N N N Mitral Pasteurella multocida Tiliakes7 Polyarthralgia, ANCA+ve, splenomegaly Y N N N N Aortic Strep. viridans Messiaen8 CHF, Gln, ANC

Dr Garbi (President, British Heart Valve Society, and Consultant Cardiologist) Capacity increase is imminently needed to meet the current demand. An immediate increase in workforce to increase capacity is not realistic, because of the national shortage of cardiac physiologists and the time needed to appropriately train them in echocardiography. Thus, the BHVS proposed an increase in capacity by reducing the time used for echocardiography when a comprehensive study is not needed. The complete description of the proposal is available on the BHVS website (https://bhvs.org/bhvs-management-of-echocardiography-requests/). The BHVS proposes the use

Discussion Biomarkers have not been used routinely in clinical AS management, but recent advances look set to change this. The PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) study identified that a higher ratio of apolipoprotein B/apolipoprotein A‐I was associated with a 3.4-fold increase in haemodynamic progression in the younger (<70 years) AS cohort. The balance of atherogenic and anti-atherogenic lipid factors appears to play a crucial role in pathogenesis in younger patients,4 presenting a screening target. Regardless of symptom status, biomarkers have application in risk stratification. Systematic review

Introduction Takotsubo cardiomyopathy (TTCM) is an often reversible injury of the myocardium caused by catecholamine excess, usually after a stressor.1 The first case series were described by Tsuchihashi et al. three decades ago, and it was named due to the resemblance of the left ventricle (LV) in ventriculography to a Japanese pot used to catch octopuses. It usually affects post-menopausal women and has a typical form involving the mid and apical segments of the LV (apical ballooning), and atypical forms (mid, basal and focal TTCM).2 Mid-ventricular TTCM is a rare variant that affects the mid-segments of the LV, and accounts for 14.6% of pa

Presentation A 52-year-old woman with a background of alpha-1-antitrypsin deficiency and severe emphysema underwent transthoracic echocardiography (TTE) that demonstrated an apparent right atrial mass adhering to the inter-atrial septum. She was referred for transoesophageal echo (TOE) to investigate further. Additionally, she had been noted to desaturate on exercise, raising the possibility of intra-cardiac shunting. She was thus also referred for saline-bubble contrast TTE. Figure 1. Transthoracic echocardiography immediately following transoesophogeal echocardiogram. Apical four-chamber view at end-diastole demonstrating normal left ventri