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Clinical Echocardiography

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  1. Introduction to echocardiography and ultrasound imaging
    12 Chapters
  2. Principles of hemodynamics
    5 Chapters
  3. The echocardiographic examination
    3 Chapters
  4. Left ventricular systolic function and contractility
    11 Chapters
  5. Left ventricular diastolic function
    3 Chapters
  6. Cardiomyopathies
    6 Chapters
  7. Valvular heart disease
    8 Chapters
  8. Miscellaneous conditions
    5 Chapters
  9. Pericardial disease
    2 Chapters
Section 3, Chapter 1
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Principles and Preparations for Echocardiographic Examinations

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The echocardiographic examination

The use of echocardiography has increased dramatically during the past few decades. Advances in echocardiography have been propelled by breakthroughs in engineering, software development, and progress in our understanding of the pathophysiology of cardiac disease. Ultrasound systems have become cheaper, more portable, more powerful, equipped with an increasing number of methods to interrogate organ structure and function. Ultrasound imaging, including echocardiography, has become a standard tool for clinicians worldwide (Narula et al). This chapter discusses the principles of the standard echocardiographic examination.

Currently, three-dimensional (3D) echocardiography is the most revolutionary method, but it is not yet included in the standard protocol. The majority of examinations included in the standard protocol are performed using two-dimensional (2D) imaging. Some measurements are still done using M-mode echocardiography.

A formal consensus regarding the components of the standard study has not been established, although the American Society of Echocardiography (ASE), the European Association of Cardiovascular Imaging (EACVI) and the British Society of Echocardiography (BSE) have issued guidelines with very similar recommendations. Thus, an informal consensus regarding the standard survey exists, and it is presented in this section.

It is important to follow the recommendations. It increases the quality of the examination, and allows for standardized comparisons of serial examinations. If pathology is discovered during the standard examination, other examinations (which are not included in the standard examination), may be warranted. For most pathological conditions, there are specific guidelines (see links below).

This chapter presents recommendations for conducting a standard transthoracic echocardiographic (TTE) examination and it is in line with guidelines issued by ASE, EACVI and BSE.

External resources
Guidelines from ASE (American Society of Echocardiography)
Guidelines from ESC (European Society for Cardiology)

Preparations for the examination

Patients referred for echocardiography should receive information regarding the conduction of the examination. Some patient engagement is required to obtain all views and the best possible image quality. A standard study takes approximately 30-60 minutes.

Each examination must be stored in a database, where the patient’s personal identification number or equivalent is used for secure identification. If the examination is performed urgently, the examination can be performed before personal identification data is assigned to the study.

Electrocardiogram (ECG)

The ECG is recorded during the entire examination. A 12-lead ECG is not required; limb lead II is sufficient and it provides adequate opportunities for rhythm diagnostics, as well as detection of T-waves and R-waves. It is essential that T-waves and R-waves are clearly visible, since these waves trigger the acquisition of video clips. Difficulties identifying R-waves and T-waves may result in incorrect recordings.

Patient data

Gender, age, weight and height are required to evaluate the examination. Most echocardiographic parameters vary with age, gender and body size (see Normal values for echocardiography). Moreover, the ultrasound system performs several calculates based on these parameters (e.g adjusting various dimensions/volumes to body surface area).

Heart rate and blood pressure

Heart rate and blood pressure have implications for Doppler studies and evaluation of hemodynamic parameters. Hence, heart rate and blood pressure must also be noted.

In summary, the following variables should be included in the survey: personal identification, age, sex, weight, height, ECG, blood pressure, heart rate, ECG.


Narula et al: Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation. JAMA Cardiology.


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