Cardiac Electrosonography

This book focuses on a new clinical algorithmic approach to acute patient care based on the combination of electrocardiography (ECG) and echocardiography performance and interpretation, now renamed: ECG-sonography or electrosonography. The combination of these two basic skills improves patient management by healthcare providers in the acute setting. ECG is one of the oldest diagnostic tools in evaluating patients with cardiovascular symptoms and multiple and complex criteria for its interpretation have been developed over the past decades. The use of point of care ultrasound based on handheld echocardiography has recently emerged as an important clinical tool, particularly in the emergency department (ED) and intensive care unit. These studies are mainly performed by non-cardiologists including intensivists and ED physicians in addition to the physical exam and standard diagnostic tests such as the chest X-ray and laboratory tests to evaluate patients quickly and efficiently. Cardiac Electrosonography provides a new algorithmic approach to ECG interpretation and a simple tutorial of echocardiography performance and interpretation with a major focus on handheld echocardiography. It includes representative cases of patients presenting to the ED with a specific, acute cardiovascular symptom and demonstrates appropriate use of both ECG and echocardiography to improve patient management and outcome. It therefore represents an essential guide to this hybrid procedure for all practicing and trainee cardiologists and all healthcare professionals who manage these patients. About This Book Contents Editors and Contributors Tutorials for Cardiac Electrosonography 1 Patient-Centered Care Cardiac Electrosonography Abstract 1 Introduction 1.1 Pathway for the Use of Electrosonography in Patients with Acute Chest Pain (Fig. 3) 1.2 Pathway for the Use of Electrosonography in Patients with Shortness of Breath (Fig. 4) 1.3 Pathway for the Use of Electrosonography in Patients with Syncope (Fig. 5) Definition of True Syncope Classification of Syncope When There is a Certain or Suspected Diagnosis Risk Stratification for Admission to the Hospital Management of Cardiac Syncope Electrosonography in Cardiac Syncope Electrocardiogram (ECG) Echocardiography Management of Patients with Unexplained Syncope but with no Evidence on Electrosonography for Cardiac Etiology References 2 Tutorial for ECG Performance and Interpretation Abstract 1 Introduction—Generation of an ECG Tracing 1.1 ECG Waves, Segments and Intervals 1.2 The Normal ECG and Incorrect Lead Connection 1.3 Determining the Heart Rate from the ECG 2 The ECG in Heart Disease: A Systematic Approach to ECG Interpretation 3 Analysis of Heart Rhythm 3.1 Normal Sinus Rhythm 4 Approach to the ECG with Tachycardia 4.1 Narrow Complex Tachycardia 4.2 Wide Complex Tachycardia Diagnostic approach to wide complex tachycardia: Additional Features Distinguishing the QRS Complex in VT from LBBB or RBBB The Basel Algorithm 4.3 Polymorphic VT and VF 5 Approach to the ECG with Bradycardia 5.1 Sinus Node Disease Escape Rhythm 5.2 Conduction System Disease Atrioventricular Block Intraventricular Conduction Disease 6 The ECG in Ischemic Heart Disease 6.1 Ischemia 6.2 Myocardial Infarction ST Elevation Myocardial Infarction 6.3 Localization of the Infarct ST Depression in the Context of ST Elevation MI 7 Pericardial Disease 7.1 Pericardial Effusion 7.2 Pericarditis 8 The ECG in Pulmonary Embolism 9 The ECG in Stroke 10 Structural Abnormalities 10.1 LVH—Left Ventricular Hypertrophy 10.2 RVH—Right Ventricular Hypertrophy 10.3 Atrial Abnormalities 10.4 The ECG in Cardiomyopathy Hypertrophic Cardiomyopathy Sarcoidosis Amyloidosis 11 Channelopathies and Sudden Cardiac Death 11.1 HCM (See Above) 11.2 Long and Short QT 11.3 Brugada Syndrome 11.4 Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) 11.5 Wolff-Parkinson-White (WPW) Syndrome 12 Electrolyte Imbalance 12.1 Potassium Hyperkalemia Hypokalemia 12.2 Calcium 13 Summary References 3 Tutorial for Transthoracic Echocardiography Performance and Interpretation Abstract 1 Introduction 2 The Standard Transthoracic Echocardiogram 2.1 Subject Preparation 2.2 Image Optimization 2.3 Doppler Examination 3 Basic Ultrasound Controls (Fig. 11) 4 The Echocardiographic Views 5 Evaluation of Common Valvular Heart Disease References 4 Tutorial for Chest Sonography: Performance and Interpretation Abstract 1 Overview of Chest Sonography 1.1 Basic Principles 1.2 Lung Surface Anatomy 1.3 Lung and Pleural Examination 1.4 Probe Positioning 2 Normal and Abnormal Lung and Pleural Signs 2.1 Lung Sliding 2.2 A-lines 2.3 B-lines 2.4 Alveolar Consolidation 2.5 Pleural Effusion 3 Clinical Applications 3.1 Detection of Lung Alveolar-Interstitial Syndrome (AIS) 3.2 Detection of Pneumothorax 3.3 Detection of Pulmonary Edema/Vascular Congestion 4 Summary References Clinical Cases in Cardiac Electrosonography 5 Clinical Cases of Electrosonography in Patients with Acute Chest Pain Abstract 1 Introduction 2 Case 1 3 Case 2 4 Case 3 5 Case 4 6 Case 5 7 Case 6 8 Case 7 9 Case 8 10 Case 9 11 Case 10 12 Case 11 13 Case 12 14 Case 13 15 Case 14 16 Case 15 17 Case 16 References 6 Clinical Cases of Electrosonography in Patients with Shortness of Breath Abstract 1 Introduction 2 Case 1 3 Case 2 4 Case 3 5 Case 4 6 Case 5 7 Case 6 8 Case 7 9 Case 8 10 Case 9 11 Case 10 12 Case 11 13 Case 12 14 Case 13 References 7 Clinical Cases of Electrosonography in Patients with Syncope and Palpitations Abstract 1 Case 1 2 Case 2 3 Case 3 4 Case 4 5 Case 5 6 Case 6 7 Case 7 8 Case 8 9 Case 9 10 Case 10 11 Case 11 12 Case 12 13 Case 13 14 Case 14 References 8 Clinical Cases of Electrosonography in Patients with Neurological Symptoms Abstract 1 Case 1 2 Case 2 3 Case 3 4 Case 4 5 Case 5 References 9 Clinical Cases of Electrosonography in Adult Congenital Heart Disease Abstract 1 Case 1 2 Case 2 3 Case 3 4 Case 4 5 Case 5 6 Case 6 References 10 Clinical Cases of Chest Sonography Abstract 1 Case 1 2 Case 2 3 Case 3 4 Case 4 5 Case 5 6 Case 6 7 Case 7 8 Case 8 9 Case 9 10 Case 10 References