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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.