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transthoracic echocardiogram (TTE)
Also see echocardiography.
Indications:
- initial diagnostic test for suspected or known structural heart disease
- heart failure
- cardiomyopathy
- valvular heart disease
- symptomatic patients
- asymptomatic patients with
- grade 3/6 or higher systolic murmur
- holosystolic murmer
- diastolic murmur or continuous murmur
- congenital heart disease
- pulmonary hypertension
- aortic disease
- pericardial disease
- rheumatic fever
Contraindications:
- visualization of aortic arch
- cannot rule out aortic dissection [1]
Advantages:
1) identifies presence & severity of structural heart disease
2) quantification of
a) LV size & function
b) RV size & function
c) pulmonary artery pressures
d) valvular stenosis, including mitral stenosis
e) valvular insufficiency
f) intracardiac shunts
3) identifies pericardial disease
4) good visualization of aortic root & proximal ascending aorta
5) no known adverse effects
6) widely available, portable, fast
Disadvantages:
1) operator-dependent data acquisition
2) interpretation requires expertise
3) variability in instrumentation
4) image quality limits diagnosis in some patients*
* microbubble contrast may improve image quality [1]
Procedure:
* video [4]
Specific
focused cardiac ultrasound (FoCUS)
General
echocardiography
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18.
American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- Matulevicius SA, Rohatgi A, Das SR et al
Appropriate use and clinical impact of transthoracic
echocardiography.
JAMA Intern Med. 2013 Sep 23;173(17):1600-7
PMID: 23877630
- FDA News Release. Feb 7, 2020
FDA Authorizes Marketing of First Cardiac Ultrasound Software That
Uses Artificial Intelligence to Guide User
https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-first-cardiac-ultrasound-software-uses-artificial-intelligence-guide-user
- Hiraki N, Tanaka TD, Yoshimura M
A Man With Left Ventricular Hypertrophy
JAMA Cardiology. 2022;7(2):225-226. December 22, 2021
PMID: 34935854
https://jamanetwork.com/journals/jamacardiology/fullarticle/2787016
- JN Learning JAMA Network (Video)
https://edhub.ama-assn.org/jn-learning/video-player/18663312