Final Feigenbaum’s Echocardiography DIGITAL

Feigenbaum’s Echocardiography

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Feigenbaum’s Echocardiography

A

B

C

D

FIGURE 5.44. Time velocity integral (TVI) in the left ventricular outflow tract recorded in four different patients. A: Note the TVI of 27 cm recorded in a patient with normal cardiac function and a diminished TVI of 10 cm recorded in a patient with a cardiomyopathy and reduced stroke volume ( B ). C: The variation in TVI seen in a patient with severe left ventricular systolic dysfunction. The first beat to the left is a post–premature ventricular contraction (PVC) beat showing augmentation. Note the alternating TVIs after this beat, which is the corollary of pulsus alternans. D: Recorded in a patient with mild valvular aortic stenosis. Note the augmented peak velocity and TVI after the compensatory pause after a PVC (complex 3). Also note the marked reduc- tion in both velocity and TVI for the PVC beat. In this instance, only the TVI and peak velocity associated with beat number 1 represent the true gradient.

side. In general, a er this initial activation, there is relatively smooth progression of activation of contraction. In the presence of a com- plete le bundle branch block, the initial septal activation sequence is reversed and the right side of the ventricular septum is initially activated. is causes right septal activation before activation of the body of the le ventricle and results in initial right-to-le (anterior to posterior) movement of the ventricular septum. e wall motion abnormality associated with le bundle branch block may be most easily appreciated with M-mode echocardiogra- phy (Fig. 5.46). It consists of initial downward motion of the ven- tricular septum followed by anterior or paradoxical septal motion and then subsequent thickening of the ventricular septum and pos- terior motion toward the center of the heart. e magnitude of this abnormal motion can be subtle and is occasionally noted only on detailed inspection of an M-mode sweep through the ventricular

A

NONISCHEMIC REGIONAL WALL MOTION ABNORMALITY

Table 5.6

Conduction system based Left bundle branch block Ventricular pacing Premature ventricular contractions Ventricular pre-excitation (Wolf–Parkinson–White syndrome) Abnormal ventricular interaction

Right ventricular volume overload Right ventricular pressure overload Pericardial constriction Miscellaneous Tardokinesis Early relaxation After cardiac surgery Congenital absence of the pericardium Posterior compression Ascites Hiatal hernia Pregnancy

B

FIGURE 5.45. Apical four-chamber view recorded in a young, healthy individual immediately postexercise, demonstrating early relaxation of the apical septum. The upper panel ( A ) was recorded at end-systole and shows normal hyperdynamic motion of all visualized segments. The lower panel ( B ) was recorded 50 ms later and reveals abrupt outward motion of the apical septum ( arrows ) consistent with early relaxation. Note that the mitral valve remains closed. In the subsequent frame, the remaining walls relax normally as well.

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