EEEEEccccchhhhhooooo MMMMMaaaaadddddeeeee EEEEEaaaaasssssyyyyy®®®®® EEEEEccccchhhhhooooo MMMMMaaaaadddddeeeee EEEEEaaaaasssssyyyyy®®®®® Third Edition Atul Luthra MBBS MD DNB Diplomate National Board of Medicine Physician and Cardiologist New Delhi, India www.atulluthra.in [email protected] ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • Panama City • London • Dhaka • Kathmandu ® Jaypee Brothers Medical Publishers (P) Ltd. Headquarter Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd., Jaypee-Highlights Medical Publishers Inc. 83 Victoria Street London City of Knowledge, Bld. 237, Clayton SW1H 0HW (UK) Panama City, Panama Phone: +44-2031708910 Phone: +507-301-0496 Fax: +02-03-0086180 Fax: +507-301-0499 Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd Jaypee Brothers Medical Publishers (P) Ltd 17/1-B Babar Road, Block-B Shorakhute Shaymali, Mohammadpur Kathmandu, Nepal Dhaka-1207, Bangladesh Phone: +00977-9841528578 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2012, Jaypee Brothers Medical Publishers All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher. Inquiries for bulk sales may be solicited at: [email protected] This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Echo Made Easy® First Edition : 2005 Second Edition : 2007 Third Edition : 2012 ISBN 978-81-8448-939-2 Printed at To My Parents Ms Prem Luthra and Mr Prem Luthra Who guide and bless me from heaven PPPPPrrrrreeeeefffffaaaaaccccceeeee tttttooooo ttttthhhhheeeee TTTTThhhhhiiiiirrrrrddddd EEEEEdddddiiiiitttttiiiiiooooonnnnn Ever since the second edition of Echo Made Easy was published five years back, there have been tremendous advancements in the field of echocardiography. To name a few, three- dimensional technique, tissue-Doppler study and myocardial- contrast imaging have gained considerable popularity. Nevertheless, there remains an unmet need for a simplistic book on basic echocardiography for the uninitiated reader. It gives me immense pleasure to present to cardiology students, resident doctors, nurses and technicians working in cardiology units, this vastly improved third edition of Echo Made Easy. The initial chapters will help the readers to understand the principles of conventional echo and color-Doppler imaging, the various echo-windows and the normal views of cardiac structures. The abnormalities observed in different forms of heart disease including congenital, valvular, coronary, hypertensive, myocardial, endocardial and pericardial diseases have been discussed under separate sections. Due emphasis has been laid on diagnostic pitfalls, differential diagnosis, causative factors and clinical significance. Those who have read the previous editions of Echo Made Easy will definitely notice a remarkable improvement in the layout of the book. Readers will appreciate a bewildering array of striking figures and impressive tables. For this, I am extremely grateful to Dr Rakesh Gupta, an expert in echocardiography of international repute. He has been very kind and generous in providing me with real-time images from his vast and valuable viii Echo Made Easy collection. I am also very thankful to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who infuse life into subsequent editions of all my books, by virtue of their typesetting and artwork expertise. Do keep pouring with your comments and criticism. Bouquets and brickbats are both welcome. Bon voyage through Echo Made Easy, third edition. Atul Luthra PPPPPrrrrreeeeefffffaaaaaccccceeeee tttttooooo ttttthhhhheeeee FFFFFiiiiirrrrrsssssttttt EEEEEdddddiiiiitttttiiiiiooooonnnnn Ultrasound has revolutionized clinical practice by providing the fifth dimension to physical examination after inspection, palpation, percussion and auscultation. Echocardiography is the application of ultrasound for examining the heart. It is a practi- cally useful, widely available, cost-effective and noninvasive diagnostic tool. Usage of echo is rapidly expanding with more and more clinicians requesting for and interpreting it to solve vexing clinical dilemmas. While I was preparing the manuscript of this book, many a time two questions crossed my mind. First, is such a book really required? And second, am I the right person to write it? At the end of the day, I, somehow, managed to convince myself that a precise and practical account of echocardiography is indeed required and that an academic Physician like myself can do justice to this highly technical subject. The book begins with the basic principles of ultrasound and Doppler and the clinical applications of various echo-modalities including 2-D echo, M-mode scan, Doppler echo and color- flow mapping. This is followed by an account of different echo- windows and normal echo-views along with normal values and dimensions. The echo features of various forms of heart disease such as congenital, valvular, coronary and hypertensive disorders are individually discussed. Due emphasis has been laid on pitfalls in diagnosis, differentiation between seemingly similar findings, their causation and clinical relevance. Under- standably, figures and diagrams can never create the impact of dynamic echo display on the video-screen. Nevertheless, they have been especially created to leave a long-lasting visual x Echo Made Easy impression on the mind. In keeping with the spirit of simplicity, difficult topics like complex congenital cardiac disease, prosthetic heart valves and transesophageal echocardiography have been purposely excluded. The book is particularly meant for students of cardiology as well as keen established clinicians wanting to know more about echo. If I can coax some Physicians like myself to integrate echocardiography into their day-to-day clinical practice, I will feel genuinely elated for a mission successfully accomplished. Atul Luthra AAAAAccccckkkkknnnnnooooowwwwwllllleeeeedddddgggggmmmmmeeeeennnnntttttsssss I am extremely grateful to: • My school teachers who helped me to acquire good command over English language. • My professors at medical college who taught me the science and art of clinical medicine. • My heart patients whose echo-reports stimulated my gray matter and made me wiser. • Authors of books on echocardiography to which I referred liberally, while preparing the manuscript. • Dr Rakesh Gupta who has been kind and supportive in providing me with excellent images. • My readers whose generous appreciation, candid comments and constructive criticism constantly stimulate me. • M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who repose their unflinching faith in me and provide encouragement along with expert editorial assistance.