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Feigenbaum’s Echocardiography EIGHTH EDITION William F. Armstrong, MD Franklin Johnston Collegiate Professor of Medicine Division of Cardiovascular Medicine Frankel Cardiovascular Center University of Michigan Ann Arbor, Michigan Thomas Ryan, MD John G. and Jeanne Bonnet McCoy Chair in Cardiovascular Medicine Director, Ohio State Heart and Vascular Center The Ohio State University Wexner Medical Center Columbus, Ohio Senior Acquisitions Editor: Sharon Zinner Development Editor: Ashley Fischer Editorial Coordinator: John Larkin Marketing Manager: Rachel Mante Leung Production Project Manager: Kim Cox Design Coordinator: Stephen Druding Manufacturing Coordinator: Beth Welsh Prepress Vendor: Aptara, Inc. Eighth edition Copyright © 2019 Wolters Kluwer. Seventh Edition, 2010 © Lippincott Williams & Wilkins Sixth Edition, 2005 ©Lippincott Williams & Wilkins Fifth Edition, 1995 © Williams & Wilkins Fourth Edition, 1986 © Lea & Febiger Third Edition, 1981 © Lea & Febiger Second Edition, 1976 © Lea & Febiger First Edition, 1972 © Lean & Febiger All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at shop.lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Names: Armstrong, William F., author. | Ryan, Thomas, 1953- author. Title: Feigenbaum’s echocardiography / William F. Armstrong, Thomas Ryan. Other titles: Echocardiography Description: Eighth edition. | Philadelphia : Wolters Kluwer, [2019] | Includes bibliographical references and index. Identifiers: LCCN 2018033966 | eISBN 9781496394408 Subjects: | MESH: Echocardiography–methods | Heart Diseases–diagnosis Classification: LCC RC683.5.U5 | NLM WG 141.5.E2 | DDC 616.1/207543–dc23 LC record available at https://lccn.loc.gov/2018033966 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. shop.lww.com To all of our colleagues, fellows, and sonographers with whom we have had the honor to be associated for the past 30 years. Know how much your support, dedication, and expertise has meant, not only to us, but to the entire field of echocardiography. Without these relationships, this book would not have been possible. Contents Preface Acknowledgment CHAPTER 1 History of Echocardiography Harvey Feigenbaum Development of Various Echocardiographic Technologies Recording Echocardiograms Cardiac Sonographers Echocardiographic Education and Organizations CHAPTER 2 Physics and Instrumentation Physical Principles Interaction Between Ultrasound and Tissue The Transducer Manipulating the Ultrasound Beam Resolution Creating the Image Transmitting Ultrasound Energy Display Options Tradeoffs in Image Creation Signal Processing Tissue Harmonic Imaging Artifacts Doppler Echocardiography Principles of Doppler Ultrasound Doppler Formats Color Flow Imaging Technical Limitations of Color Doppler Imaging Doppler Artifacts Tissue Doppler Imaging Biologic Effects of Ultrasound CHAPTER 3 Contrast Echocardiography Source of Ultrasound Contrast Contrast Agents Safety of Ultrasound Contrast Ultrasound Interaction With Contrast Agents Detection Methods Machine Settings Intermittent Imaging Low Mechanical Index Imaging Clinical Uses of Ultrasound Contrast Clinical Uses of Saline Contrast Detection of Miscellaneous Conditions Artifacts and Pitfalls Detection and Utilization of Left Ventricular Contrast Miscellaneous Application of Left Ventricular Contrast Enhancement of Doppler Signals Contrast Artifacts Myocardial Perfusion Contrast Echocardiography CHAPTER 4 The Comprehensive Echocardiographic Examination A Quality Echocardiographic Laboratory Appropriate Use Criteria Approach to the Echocardiographic Examination Patient Position Placement of the Transducer Parasternal Long-Axis Views Parasternal Short-Axis Views Apical Views The Subcostal Examination Suprasternal Views Orientation of Two-Dimensional Images Echocardiographic Measurements Left Ventricular Wall Segments M-Mode Examination Transesophageal Echocardiography Transesophageal Echocardiographic Views Three-Dimensional Echocardiography Point-of-Care Cardiac Ultrasound Echocardiography as a Screening Test The Digital Echo Laboratory Training and Competency in Echocardiography CHAPTER 5 Evaluation of Systolic Function of the Left Ventricle General Principles Linear Measurements Indirect M-Mode Markers of Left Ventricular Function Measurements From Standard Two-Dimensional Imaging Automated Edge Detection Assessment of Left Ventricular Function With Three-Dimensional Echocardiography Strain and Strain Rate Imaging (Deformation Imaging) Ventricular Torsion Assessment of Regional Left Ventricular Function Quantitative Techniques Determination of Left Ventricular Mass Physiologic Versus Pathologic Hypertrophy Miscellaneous Techniques for Evaluation of Left Ventricular Function Tissue Doppler Color M-Mode Myocardial Performance Index Determination of Left Ventricular dP/dt Left Ventricular Wall Stress Doppler Evaluation of Global Left Ventricular Function Nonischemic Wall Motion Abnormalities Premature Ventricular Contractions Ventricular Pacing Pericardial Constriction Ventricular Pre-Excitation Postoperative Cardiac Motion Posterior Compression CHAPTER 6 Evaluation of Diastolic Function Basic Diastolic Physiology Grades of Diastolic Dysfunction Normal Diastolic Function Impaired Relaxation (Grade I) Pseudonormalization (Grade II) Restrictive Filling (Grade III) ECHO Doppler Parameters of Diastolic Function Isovolumic Relaxation Time Mitral Inflow Color M-Mode Flow Propagation Velocity (Vp) Tissue Doppler Mitral Annular Velocity Pulmonary Venous Flow Patterns Left Atrial Volume The Valsalva Maneuver Other Markers of Diastolic Dysfunction A Comprehensive Approach to Diastolic Dysfunction Guidelines for the Assessment of Diastolic Dysfunction Approach to the Patient With Reduced Ejection Fraction Approach to the Patient With Normal Ejection Fraction Applying the Algorithms to Patients Impaired Relaxation (Grade I) Pseudonormal (Grade II) Restrictive Filling (Grade III) Serial Changes in Diastolic Function Stress Testing to Assess Diastolic Function The Differential Diagnosis of Heart Failure With Normal Ejection Fraction Evaluation of Diastolic Dysfunction in Specific Patient Groups Sinus Tachycardia Atrial Fibrillation Mitral Valve Disease Hypertrophic Cardiomyopathy Prognosis in Patients With Diastolic Dysfunction CHAPTER 7 Left and Right Atrium, and Right Ventricle Left Atrium Left Atrial Dimensions and Volume Left Atrial Function Atrial Septum Pulmonary Veins Right Atrium Right Atrial Thrombi Right Atrial Blood Flow Right Ventricle Right Ventricular Dimensions and Volumes Right Ventricular Overload Right Ventricular Cardiomyopathy CHAPTER 8 Hemodynamics Use of M-Mode and Two-Dimensional Echocardiography Quantifying Blood Flow Clinical Application of Blood Flow Measurement Measuring Pressure Gradients Applications of the Bernoulli Equation Determining Pressure Half-Time The Continuity Equation Proximal Isovelocity Surface Area Myocardial Performance Index CHAPTER 9 Pericardial Diseases Clinical Overview Echocardiographic and Multimodality Evaluation of the Pericardium Detection and Quantitation of Pericardial Fluid Direct Visualization of the Pericardium Differentiation of Pericardial From Pleural Effusion Cardiac Tamponade Echocardiographic Findings in Cardiac Tamponade Doppler Findings in Tamponade Pericardial Constriction Echocardiographic Diagnosis Doppler Echocardiographic Findings in Constriction Effusive Constrictive Pericarditis Constrictive Pericarditis Versus Restrictive Cardiomyopathy Miscellaneous Pericardial Disorders Postprocedural Effusions Echocardiography-Guided Pericardiocentesis Absence of the Pericardium Pericardial Cysts CHAPTER 10 Aortic Valve Disease Bicuspid Aortic Valve Aortic Stenosis Role of 2D Echocardiography Doppler Assessment of Aortic Stenosis Other Approaches to Quantifying Stenosis Defining the Severity of Aortic Stenosis Classification of Aortic Stenosis Natural History of Aortic Stenosis Clinical Decision Making Aortic Regurgitation Appropriate Use Criteria M-Mode and Two-Dimensional Imaging Establishing a Diagnosis of Aortic Regurgitation Evaluating the Severity of Aortic Regurgitation Acute Versus Chronic Aortic Regurgitation Assessing the Left Ventricle Miscellaneous Abnormalities of the Aortic Valve CHAPTER 11 Mitral Valve Disease

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Continuing the long-standing Feigenbaum tradition as an authoritative, comprehensive echocardiography resource, the thoroughly revised Feigenbaum's Echocardiography, Eighth Edition, helps echocardiographers, fellows, clinicians, and sonographers master the art and science of echocardiography and sta