Tag Archives: echocardiography

National Audit: variation and inequality persist Opening the meeting, Dr Suzanna Hardman (Consultant Cardiologist, Whittington Hospital, London) presented the latest data from the NICOR National Heart Failure Audit.1 Admissions have returned to pre-pandemic levels, but substantial regional variation remains. Ethnicity recording continues to be poor, limiting the ability to address disparities. Access to echocardiography — central to diagnosis and phenotyping — also varies significantly. Half of hospital admissions are now for patients without heart failure with reduced ejection fraction (HFrEF), reflecting the growing burden of heart fai

Sally Roberts Introduction In 2023, a nurse-led heart murmur clinic was established at Sheffield Children’s Hospital. The initiative was introduced with three key objectives: to reduce the paediatric consultant outpatient waiting list, to expand the scope of practice for clinical nurse specialists (CNS), and to deliver cost savings to the National Health Service (NHS) trust. This case study evaluates the impact of the clinic on waiting times and explores its cost-effectiveness over the first year of implementation. Background In paediatrics, heart murmurs are frequently detected incidentally by general practitioners (GPs) during examination

Professor Colebourn “I ain’t afraid of no ghosts” Work-flow in outpatient echocardiography departments lends itself to the process of performing and reporting in tandem. By the time the patient has left the department, the report is written, images archived and, if needed, an on-hand senior opinion sought. The audit cycle is clear and tight. In the world of acute care echocardiography, that focus changes from a cycle of ‘perform-upload-report’, to ‘perform-decide-act’. “Don’t cross the streams!” Governance must sometimes come second to patient care. Some echo findings are so time-critical that it is life-saving not to carr

Introduction Heart failure (HF) remains a leading cause of hospital admissions and healthcare expenditure worldwide, and is associated with substantial morbidity and mortality.1 HF is commonly classified into three subtypes based on left ventricular ejection fraction (LVEF)1 as heart failure with preserved ejection fraction (HFpEF), LVEF ≥50%; mildly reduced ejection fraction (HFmrEF), LVEF 41–49%; or with a reduced ejection fraction (HFrEF), LVEF ≤40%. Patients with HF are at risk of decompensation due to the inability of the heart to sustain a functional cardiac output. Compensatory mechanisms, such as neurohormonal activation and sa

Introduction Cardiotoxicity, primarily in the form of left ventricular (LV) dysfunction, is a feared side-effect of selected drugs that are widely used in oncology.1,2 To reduce its occurrence, practice guidelines consistently recommend assessing LV systolic function, primarily by echocardiography, before and during exposure to cardiotoxic medications.3 However, apart from left ventricular ejection fraction (LVEF), contemporary echocardiography reports include dozens of numerical data points, as well as detailed information about haemodynamics, all the cardiac chambers and the heart valves; and some of this information may be clinically relev

Introduction Fabry disease is a rare X-chromosome-linked disorder that results from alpha-galactosidase A enzyme deficiency. It is broadly divided into classical (earlier onset, low enzyme activity) and non-classical (milder, later-onset and some residual activity). It is underdiagnosed despite the availability of diagnostic tests, such as blood (plasma or leucocyte alpha-galactosidase A enzyme) and genetic testing. Due to its heterogeneous nature as a multi-system disorder, Fabry disease (FD) is rarely considered. Patients often present with non-specific symptoms, such as fatigue and gastrointestinal symptoms akin to irritable bowel, taking

Introduction In the financial year 2022–23 there were 185 heart transplants performed in the National Health Service (NHS) of the UK.1 These were performed across six adult centres: Queen Elizabeth Birmingham, Golden Jubilee Glasgow, Harefield London, Wythenshawe Manchester, Royal Papworth Cambridge, Freeman Newcastle upon Tyne; and two paediatric centres: Great Ormond Street London and Freeman Newcastle. Each hospital has an allocation zone, which encompasses 336 referring hospitals across the UK.2 The heart donations are classified as either donation after brainstem death (DBD) or donation after circulatory death (DCD). The donation proc

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