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Background
Echocardiography is an essential investigation in patients with suspected heart failure. An echocardiogram provides assessment of cardiac chamber size and structure, ventricular function, valvular function and key haemodynamic parameters.
Objective
This article explains the principles of echocardiography and how general practitioners can use echocardiograms to manage patients with heart failure.
Discussion
Echocardiography can provide diagnostic information about the cause of heart failure, and may indicate what further investigations are required and what therapy is indicated. It may also provide important prognostic information. It can be used for noninvasive quantitative monitoring. Identification of impaired systolic function is important as there is evidence based therapy which can improve prognosis in this condition.
Keywords: heart diseases; heart failure; echocardiography
Heart failure is the inability of the heart to provide sufficient cardiac output for the body's needs without an increase in filling pressures. Heart failure can be difficult to diagnose as the symptoms and signs can be nonspecific - it is important to confirm a clinical diagnosis by demonstrating cardiac dysfunction.
All major heart failure guidelines, including the Australian guidelines developed by the National Heart Foundation and Cardiac Society of Australia & New Zealand, recommend echocardiography as an essential first line investigation in the evaluation of suspected heart failure.1 Retrospective studies suggest that patients with a clinical diagnosis of heart failure who have had an echocardiogram have a better outcome than those who have not, presumably due to more appropriate evidence based management.2 This article will discuss why assessment of cardiac structure and function is critical in evaluating heart failure, the specific information gained from an echocardiogram and how to interpret an echocardiogram report. It will concentrate on the use of transthoracic echocardiography as this is typically the first line investigation with transoesophageal echocardiography reserved for specific situations.
In Australia, ischaemic heart disease accounts for about 50% of patients with heart failure.1 Other common causes include hypertension and dilated cardiomyopathy. Underlying valvular heart disease and pericardial disease are less common but important as they may be amenable to surgical treatment. Less common but identifiable by echocardiogram are hypertrophic cardiomyopathy, a cause of left heart failure and pulmonary hypertension, a cause of right heart failure (Table 1).
Previously left ventricular failure was considered a disease of reduced left...