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The case study in this issue (see pages 46–7) demonstrates a potential use of CT scanning in the diagnosis of a patient with endocarditis. Electrocardiogram (ECG)-gated multi-detector cardiac computed tomography (MDCT) scanning has been proposed by many to have potential in the evaluation of endocarditis by demonstration of vegetations, complications (coronary artery occlusion, fistulae) and peripheral embolism.3 The major limitations of the technique include availability, spatial resolution, failure to demonstrate leaflet perforations and lack of haemodynamic information (table 1). Further, CT findings have not been correlated with clinica

Introduction Heart failure is one of the most common conditions in industrialised society. Today, in the UK, around 900,000 people have heart failure with a further similar number who have yet to develop symptoms.1 Heart failure is predominantly a disease of the elderly, and the increasing age of the population, combined with improvements in the treatment of ischaemic heart disease (IHD), account for the increasing prevalence. Heart failure has a poor prognosis: just under 40% of patients diagnosed with heart failure die within a year, depending on initial severity, although, thereafter, mortality is less than 10% per year. This suggests that

Introduction Rheumatic fever is the leading cause of acquired heart disease in children and young adults in the world.1,2 The relationship between rheumatic fever and streptococcal infection has been well documented.3,4 Stenosis of the mitral valve, either alone or in combination with other valvular diseases, is caused almost exclusively by rheumatic fever.3 Involvement of the mitral valve represents the most common of all sites affected by the rheumatic process.5 However, as many as half of the population with mitral stenosis give no history of rheumatic fever.5 On the other hand, the majority of patients with mitral stenosis remain asympto

Figure 1. Electrocardiogram (ECG) showing new-onset atrial fibrillation Figure 3. Cardiac magnetic resonance image (MRI) consistent with a lymphoma tumour Figure 2. Echocardiography showing large intra-atrial mass One year previously he had been treated with six cycles of chemotherapy for aplastic large cell lymphoma. He had a pyrexia (38.5oC), elevated C-reactive protein (14.6 mg/L) and low haemoglobin (10.8 g/dL). As part of a screen for infection, echocardiography was performed to exclude endocarditis (figure 2), but revealed a large intra-atrial mass. Cardiac magnetic resonance imaging (MRI) (figure 3) appearance was consistent with a lym

Discussion Figure 1. Trans-oesophageal echocardiograph showing a large multi-lobed echogenic mass attached to interatrial septum and protruding into all four cardiac chambers via patent foramen ovale The transit of a thrombus across a patent foramen ovale has been serendipitously documented on imaging studies in extremely rare instances.1-4 Nearly 40 cases of thrombus in transit diagnosed ante mortem using various imaging studies have been described in the literature and only one case documenting the serial passage of a thrombus across a patent foramen ovale in real time.1,3 Figure 2. Trans-oesophageal echocardiograph image showing the long v

Echocardiography: Oxford specialist handbook in cardiology Authors: Leeson P, Mitchell ARJ, Becher H Publisher: Oxford University Press, Oxford, 2007 ISBN: 978-0-19-921575-1 Price: £34.95 Echocardiography: a practical guide for reporting Authors: Rimington H, John Chambers Publisher: Taylor & Francis, London, 2007 ISBN: 9781841846347 Price: £55 The initial chapter provides helpful information on the physics of ultrasound, as well as incorporating practical details on recent techniques such as Doppler tissue imaging, strain and strain rate, and real-time three-dimensional image acquisition that have become an invaluable aspect to the p

Introduction Heart failure (HF) is common and is associated with a high morbidity and mortality. Forty per cent of patients with symptomatic left ventricular systolic dysfunction (LVSD) die within a year of diagnosis and 10% per annum thereafter, giving a five-year mortality rate of up to 70%.1 Estimates of the prevalence of symptomatic HF in the general European population range from 0.4–2%,2-4 with half of these patients suffering from LVSD and half from left ventricular diastolic dysfunction (LVDD).3,5 HF consumes nearly 2% of National Health Service (NHS) resources (a figure which will inevitably increase with the advent of relatively e

This focus on echocardiography is to be welcomed. But who is to perform these additional echocardiograms and what sort of studies will be performed? The standard adult transthoracic echocardiogram (TTE) has stood the test of time. When performed by appropriately trained individuals, e.g. those holding BSE Accreditation,1 it can reliably describe and quantitate left ventricular systolic and diastolic function, structure and function of all four valves, basic prosthetic valve function, common congenital abnormalities and cardiomyopathies, and the presence and significance of pericardial fluid. Importantly, it can provide an answer to the two mo

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