Please help interpreting echocardiogram results

[xopenex]

Hello,

I am not familiar with the echocardiographic measurements, and am trying to learn about them. I look these measurements up online, but google has a million worthless results, to every one relevant result, and i have had a very difficult time trying to figure out how to understand this information. I am not going to be a cardiologist, but i am doing a mock case presentation in class, and figured it would help if I had a basic understanding of the following results.

If someone would please tell me what information about the results are significant and relative to the patient history i would greatly appreciate it!

thank you in advance!



Brief History: 55 year old male, presented to ED with 5 chest pain for 5 days, within normal weight range, sedentary lifestyle, diabetic, smoked for about 20 years and quit 15 years ago, drinks a 6 pack of beers a week. patient diagnosed with NSTMI, diabetes mellitus, hypertension, and dyslipidemia.





CLINICAL DIAGNOSIS:
Chest Pain (786.50); Anterolateral infarct, acute (410.01); Rhythm: Sinus:
77 BPM: BP: 155/86

** ECHOCARDIOGRAPHIC MEASUREMENTS **
================================================================================
OBSERVED NORMAL OBSERVED NORMAL
================================================================================
LVd(cm): 4.6 (3.5-5.7 cm; <= 3.2 cm/m2) RV:
LVs(cm): 2.7 FS(%): 41 (24-48%)
VSd(cm): 1.2 (0.6-1.1 cm) EF(%): 40 (55-70%)
PWd(cm): 1.2 (0.6-1.1 cm) BSA(m2): 2.22 (1.45-2.22 m2)
AoR(cm): 3.5x3.1 (2.0-3.7 cm; <= 2.2 cm/m2) TAPE#: XCELERA
LA(cm): 3.6x4.1 (1.9-4.0 cm; <= 2.2 cm/m2)
--------------------------------------------------------------------------------
** SUMMARY **
LEFT VENTRICLE (LV)
Severe Hypokinesis of the mid anterior septum
Hypokinesis and preserved thickness of mid anterior septum
Severe Hypokinesis of the mid anterior wall
Hypokinesis and preserved thickness of the mid anterior wall
Severe Hypokinesis of the left ventricular apex
Hypokinesis and preserved thickness of the left ventricular apex
Normal contractions of the remaining LV segments
Mild Concentric hypertrophy
Normal sized left ventricle
Moderate Decrease in left ventricular systolic function and ejection fraction
Diastolic left ventricular dysfunction with impaired relaxation Doppler
pattern (grade I)
RIGHT VENTRICLE (RV)
Mild to Moderate Dilatation
Hypertrophy
Moderate Hypokinesis of the right ventricle
AORTA
Normal-sized ascending aorta
LEFT ATRIUM (LA)
Normal left atrial dimension
RIGHT ATRIUM (RA) - RIGHT HEART
Mild Right atrial dilatation
MITRAL VALVE (MV)
Mild Thickening and/or increased echo-density of the anterior mitral leaflet
Mild Thickening and/or increased echo-density of the posterior mitral leaflet
Moderate Calcification of mitral annulus
Trace Mitral regurgitation
AORTIC VALVE (AV)
Thickening and/or increased echo-density of the aortic valve (good opening)
TRICUSPID VALVE (TV)
Mild Tricuspid regurgitation
Normal appearance of tricuspid valve
PULMONARY VALVE (PV) - PULMONARY ARTERY
Normal appearance of pulmonic valve
PERICARDIUM
No significant pericardial effusion
ECHO-DOPPLER HEMODYNAMIC DATA
Dilation of IVC. Mild elevation of RA pressure
Normal left atrial pressure
Moderate Elevation of pulmonary artery pressure
Moderate Decrease in cardiac output
MISCELLANEOUS
No masses or cardiac source of emboli on transthoracic echocardiography
Technically difficult and suboptimal Doppler study
Technically difficult 2-D study without complete measurements
Study was satisfactory for interpretation
ADDITIONAL COMMENTS
1. Status post LAD Stent.
2. Moderate pulmonary hypertension with dilated and hypokinetic RV.

** DOPPLER MEASUREMENTS **

[MITRAL VALVE]
E(m/s) A(m/s) E/A DT(ms) MR(1-4+) MitA-dur(ms) PV AR-dur(ms)
------ ------ ---- ------ -------- ------------ -------------
0.80 0.80 1.00 180.00 1+ 185.00 90.00
MA-E'(cm/s)
-----------
5.00

[TRICUSPID VALVE]
TR(1-4+) TR(m/s) RV syst.pressure(mmHg)
-------- ------- ----------------------
1+ 3.10 50

[PULMONARY VALVE]
V1(m/s) V2(m/s) V2/V1 TVI of V1(cm)
------- ------- ----- -------------
0.80 1.20 1.50 11.00

[AORTIC VALVE]
V1(m/s) V2(m/s) V2/V1 TVI of V1(cm)
------- ------- ----- -------------
0.90 1.50 1.70 13.00

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[IMdocT]

someone might be moving this thread to another section.

non-cardiologists don't really know what to do with the various measurements in an echocardiogram. we usually look at the conclusions that the cardiologist places in the reports. the major thing that stands out in your pasted report is the hypokinesis, also called wall motion abnormality. that is a finding that can be consistent with a myocardial infarction. but from your description of the case, it's not clear if he had an MI in the past or if someone is diagnosing him with an MI at this admission. I assume he has had one before or else had coronary artery disease because the report also says he has a stent. if he already has a history of heart disease then it would be important to compare this one with his most recent echo if one exists.

 

[xopenex]

Thank you for your response IMdocT.


maybe i should have posted to the cardiology thread? i'll see if i can transfer the post.

thanks again Dr.

 

[jdh71]

Yeah the cards guys will be your best resource. But it looks like an ischemic cardiomyopathy, meaning his coronary arteries are no good, so it's messing with the heart's ability to pump. He's got some diastolic dysfunction, which is bad enough to translate into mildly elevated right sided pressures, and the valves don't look too bad.