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Echocardiography in CHD
Strat Liddiard
CHD NSF Standard 11
 Doctors should arrange for people with
suspected heart failure to be offered the
appropriate investigations (e.G.
Electrocardiography, echocardiography) that will
confirm or refute the diagnosis.
 For those in whom heart failure is confirmed, its
cause should be identified.
 The treatments most likely to both relieve
symptoms and reduce their risk of death should
be offered.
Age Distribution and Echo Findings
No. of Patients
Age and LVD
100
80
NoLVD
YesLVD
60
40
20
0
00
<1
0
<9
0
<8
0
<7
0
<6
0
<5
0
<4
0
<3
0
<2
Age Bands
The Report
 Mild apical, septal and anterior systolic left
ventricular dysfunction. Mild central mitral reflux
into a slightly dilated left atrium (LAD = 4.1 cms).
The aortic valve is thickened with a gradient of 15
mm Hg. Estimated right ventricular systolic
pressure is 36 mm Hg.
?
The Report

Mild apical, septal and anterior systolic left ventricular dysfunction. Mild central mitral reflux into a
slightly dilated left atrium (LAD = 4.1 cms). The aortic valve is thickened with a gradient of 15 mm
Hg. Estimated right ventricular systolic pressure is 36 mm Hg.
 Consistent with mild heart failure no aortic
stenosis. No other important findings. Consider
treatment for heart failure.
Treatment and Follow up
 Initiation of treatment
– ACEI
– B-blockers
 Follow -up
– Practice nurses?
– Heart failure nurse?
– General practitioner?
Benefits of Primary Care
Echocardiography
 More patients have echos.
 People needing treatment are found.
– 19 unsuspected cases of of LVD were found (first
200).
 Cardiologists time can be saved.
– 69 referrals were not made. (First 200).
 Treatment was changed appropriately.
– 48 more patients received ACEI.
– 9 patients had contraindications to ACEI.
 Targeting treatment may be cost neutral.