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首页 超声心动图袖珍指南:经胸检查

超声心动图袖珍指南:经胸检查.pdf

超声心动图袖珍指南:经胸检查

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2013-04-19 0人阅读 举报 0 0 0 暂无简介

简介:本文档为《超声心动图袖珍指南:经胸检查pdf》,可适用于自然科学领域

BernardEBulwer,MD,MScNoninvasiveCardiovascularResearchCardiovascularDivisionBrighamandWomen’sHospitalBoston,Massachusetts,USAJoseMRivero,MDChiefCardiacSonographerCardiovascularDivisionBrighamandWomen’sHospitalBoston,Massachusetts,USATheTransthoracicExaminationECHOCARDIOGRAPHYPOCKETGUIDEFMXXBulwerqxd:AMPageiJonesandBartlett’sbooksandproductsareavailablethroughmostbookstoresandonlinebooksellersTocontactJonesandBartlettPublishersdirectly,call,fax,orvisitourwebsite,wwwjbpubcomSubstantialdiscountsonbulkquantitiesofJonesandBartlett’spublicationsareavailabletocorporations,professionalassociations,andotherqualifiedorganizationsFordetailsandspecificdiscountinformation,contactthespecialsalesdepartmentatJonesandBartlettviatheabovecontactinformationorsendanemailtospecialsalesjbpubcomCopyright©byJonesandBartlettPublishers,LLCAllrightsreservedNopartofthematerialprotectedbythiscopyrightmaybereproducedorutilizedinanyform,electronicormechanical,includingphotocopying,recording,orbyanyinformationstorageandretrievalsystem,withoutwrittenpermissionfromthecopyrightownerTheauthors,editor,andpublisherhavemadeeveryefforttoprovideaccurateinformationHowever,theyarenotresponsibleforerrors,omissions,orforanyoutcomesrelatedtotheuseofthecontentsofthisbookandtakenoresponsibilityfortheuseoftheproductsandproceduresdescribedTreatmentsandsideeffectsdescribedinthisbookmaynotbeapplicabletoallpeoplelikewise,somepeoplemayrequireadoseorexperienceasideeffectthatisnotdescribedhereinDrugsandmedicaldevicesarediscussedthatmayhavelimitedavailabilitycontrolledbytheFoodandDrugAdministration(FDA)foruseonlyinaresearchstudyorclinicaltrialResearch,clinicalpractice,andgovernmentregulationsoftenchangetheacceptedstandardinthisfieldWhenconsiderationisbeinggiventouseofanydrugintheclinicalsetting,thehealthcareproviderorreaderisresponsiblefordeterminingFDAstatusofthedrug,readingthepackageinsert,andreviewingprescribinginformationforthemostuptodaterecommendationsondose,precautions,andcontraindications,anddeterminingtheappropriateusagefortheproductThisisespeciallyimportantinthecaseofdrugsthatareneworseldomusedProductionCreditsPublisher:ChristopherDavisVP,ManufacturingandInventoryControl:SeniorAcquisitionsEditor:AlisonHankeyThereseConnellSpecialProjectsEditor:KathyRichardsonComposition:DSCS,LLCEditorialAssistant:JessicaAcoxCoverDesign:KristinEParkerEditorialAssistant:SaraCameronPrintingandBinding:ReplikaPressSeniorProductionEditor:TraceyChapmanCoverPrinting:ReplikaPressSeniorMarketingManager:BarbBartoszekLibraryofCongressCataloginginPublicationDataBulwer,BernardEEchocardiographypocketguide:thetransthoracicexaminationBernardEBulwer,JoseMRiveropcmIncludesbibliographicalreferencesandindexISBN:(pbk)ISBN:(pbk)EchocardiographyHandbooks,manuals,etcIRivero,JoseMIITitleDNLM:EchocardiographyHandbooksWGBeRCUB’dcPrintedinIndiaWorldHeadquartersJonesandBartlettPublishersTallPineDriveSudbury,MAinfojbpubcomwwwjbpubcomJonesandBartlettPublishersCanadaOrmindaleWayMississauga,OntarioLVJCanadaJonesandBartlettPublishersInternationalBarbHouse,BarbMewsLondonWPAUnitedKingdomFMXXBulwerqxd:AMPageiiTotheAwesomeGiverofsight,Who,whenIwasblind,mademesee,andwhenbound,setmefreeTo:ScottandJoseforopeningthedoorstoechocardiographyandNoor,Soonil,Nino,YaChing,Mama,andmyentirefamily,ErnestBunnyStaine,JohnMarthaWoods,withoutwhomthisworkwouldhaveremainedbutadream,notrealityBEBulwerDEDICATIONFMXXBulwerqxd:AMPageiiiPrefaceviiAcknowledgmentsixPARTEchocardiographyBasicsINTRODUCTIONECHOCARDIOGRAPHICANATOMY,WINDOWS,ANDIMAGINGPLANESINSTRUMENTATIONANDBASICPRINCIPLESOFECHOCARDIOGRAPHYBLOODFLOWHEMODYNAMICS,CARDIACMECHANICS,ANDDOPPLERECHOCARDIOGRAPHYPARTTheTransthoracicEchocardiographyExaminationORIENTATION,MANEUVERS,ANDTHEEXAMINATIONPROTOCOLLEFTPARASTERNALVIEWSAPICALVIEWSSUBCOSTALVIEWSSUPRASTERNALNOTCHVIEWSRIGHTPARASTERNALLONGAXISVIEWECHOCARDIOGRAPHYINTHEAGEOFULTRAPORTABILITYPARTReferenceGuideReferencesIndexCONTENTSOVERVIEWFMXXBulwerqxd:AMPagevAnewimpetushasemergedforarealisticstepbysteppresentationofthetransthoracicechocardiographyexaminationWideravailability,increasedportability,andexpandingapplicationshaveissuedanewmandateforpracticalteachingaidsforboththecardiologistandnoncardiologistEchocardiography,orcardiacultrasonography,hasanestablishedroleinthediagnosisandmanagementofpatientswithsuspectedandestablishedheartdiseaseMiniaturizationofthistechnologyhasgivennewmeaningtotheword“stethosscope”theabilitytovisualizecardiacstructureandfunction,afeatfarmoreclinicallyusefulthanthetraditionalauscultationofheartsoundsThearrivalofsuchhandheldandpocketsizeddevicesmeansthatmedicalstudents,residents,fellows,andnoncardiologistsneedthebasicskillstoperformandinterpretatleastafocusedechocardiographyexaminationSuchskillsshouldleadtoadeeperunderstandingofcardiacstructureandfunctionatthepatient’sbedsideanapproachespousedbytheAmericanSocietyofEchocardiography(incompetenthands)Thiscantranslateintoimprovedpointofcarediagnosis,lessdelaystodiagnosis,optimalreferrals,andreducedcostsEchocardiographyisthesonographer’sscalpelatoolthatgreatlyenhancesourunderstandingofinvivocardiacanatomy,physiology,andhemodynamicsAssuch,itcangreatlycomplementmedicaleducationandalliedhealthtrainingWiththesegoalsinmind,EchocardiographyPocketGuide:TheTransthoracicExaminationpresentsahighlyillustratedstepbystepintroductiontothebasicsofthetransthoracicexaminationThetypicalsonographerscanstheheartusinghisorherrighthandwhileseatedonthepatient’srightSuchviewsareshownthroughouttodemonstratetheexaminationViewsfromthepatient’sleftsidearealsopresented,asmanysonographerspreferscanningfromthisperspectiveViewsusingthestandardanatomicalposition,withthepatienterectandfacingtheexaminer,areincludedtomaintainharmonywithtraditionalanatomyeducationandothercardiacimagingtechniques,suchascomputerizedtomography(CT)andmagneticresonanceimaging(MRI)Thisguide’sprimaryfocusisthenormalexaminationHowever,itmakesfrequentreferencestosalientpathologicfindingsthatcanbeseen,andshouldbesought,oneachviewastheexaminationproceedsInthispursuit,tabularsummariesandpanoramicillustrationsofnormalandabnormalfindingsofcardiacstructureandfunctionfollowthepresentationofeachviewThisreflectsthesystematicthoughtprocessthatisexecutedbyexpertsonographersastheexaminationproceedsEchocardiographicfindingstypicallyrequireconfirmationusingmultipleviews,andthisthreedimensionalperspectiveisemphasizedThemajorPREFACEFMXXBulwerqxd:AMPageviiviiiPREFACEfocusistheadultexamination,butadditionalimageprojectionsthatareusedinthepediatricexaminationforevaluatingcongenitalheartdiseasearesprinkledthroughoutAReferenceGuideofnormalvaluesforthequantificationofcardiacchamberdimensionsappearsattheendofthisvolumeWehopethisguidefulfillsitsdesignBEBandJMRFMXXBulwerqxd:AMPageviiiTothewonderfulcardiacsonographersoftheCardiovascularDivision,BrighamandWomen’sHospitalSpecialthankstoFaranakFarrohi,KurtJacobsen,andKhadijaOuannasToProfessorCharlesandChristianaMalgwiToallwhoencouragedusalongthewaytomakethisworkareality,inwaysspokenandunspoken,toyouweareindebtedSingularthanksgotoMrLeightonBrady,cardiacsonographerattheBrighamandWomen’sHospital,formodelinghissuperbphysiquetodemonstratethenormalechocardiographicexaminationACKNOWLEDGMENTSFMXXBulwerqxd:AMPageixEchocardiographyBasicsPARTCHBulwerqxd:AMPageIntroductionECHOCARDIOGRAPHY:DEFINITIONEchocardiography,orcardiacultrasonography,usesultrasoundechoesreflectedfromthehearttogenerateimagesofcardiacstructureandfunctionIntwodimensional(D)orcrosssectionalechocardiography,thetransducerscansthroughtheanatomicalscanplaneThereflectedultrasoundechoesareprocessedanddisplayedinrealtimeasapieshapedscansectorDopplerechocardiographydisplaysbloodflowvelocitiesasacolorflowmaporasaspectrumofvelocitiesduringthecardiaccycleModernechocardiographyinstrumentsFigureFigureCHAPTERFigureBasicoverviewofechocardiography––cardiacultrasoundimagingUltrasoundishighfrequencyinaudiblesound,withfrequenciesgreaterthankHz(cyclespersecond)Tocreatetheultrasoundimage,ultrasoundmustbetransmitted,reflected,processed,anddisplayedCHBulwerqxd:AMPageCHAPTERINTRODUCTIONusephasedarraytransducertechnologyPhasedarraytransducershavetwoimportantdesignfeaturesthataresuitedforechocardiography:Theyoccupyasmall“footprint,”whichisidealforscanningthroughthenarrowintercostalspaces(astheribsgreatlyattenuatetheultrasoundbeam)Theirelectronicbeamsteeringfeaturefacilitatesscanningthroughacomparativelywideanatomicalscanplane,despitetheirsmallfootprintCHBulwerqxd:AMPageBasicTypesofEchocardiographyBASICTYPESOFECHOCARDIOGRAPHYTwofundamentalpropertiesofultrasoundareusedtoderiveinformationaboutcardiacstructureandfunctionAnatomicalorBmodeechocardiographyreliesprimarilyontherelativestrengthsoramplitudes(waveheightabovebaseline)ofthereflectedultrasoundechoestodeterminetheir“echoreflectivity,”ordegreeofbrightness,ontheimagedisplayDopplerechocardiography,incontrast,analyzesthechangeorshiftinfrequency(ofthereceivedechoescomparedtothetransmittedechoes)todeterminethevelocitiesofbloodflowandmyocardialtissuemotionTheuseofultrasoundcontrastagents(contrastechocardiography)canenhanceBmodeandDopplerechocardiographySpeckletrackingechocardiographyisananalyticaltechniquethattracksmovementofBmodestructuresthroughoutthecardiaccycletoprovideinformationaboutcardiacmotion,velocity,anddeformationTableTableBMODEECHOCARDIOGRAPHYANDDOPPLERECHOCARDIOGRAPHYCOMPAREDBmodeechocardiographyDopplerTissueDoppler(Mmode,D,D)echocardiographyechocardiographyClinicalutilityCardiacstructureCardiacfunctionCardiacfunctionDisciplineAnatomyPhysiologyandMyocardialmechanicshemodynamicsTargettissuesMyocardium,BloodcellsMyocardiumregionofinterestpericardium,(bloodflow)(tissuemotion)endocardium,heartvalves,greatvesselsParametersMorphology(relativeDirection,velocity,Direction,velocity,measuredsize,shape)flowpatterndeformationOptimalultrasoundPerpendicularParallelParallelbeamalignmentD:twodimensionalD:threedimensionalBmode:brightnessmodeMmode:motionmode(onedimensionalmotionmodeovertime)CHBulwerqxd:AMPageCHAPTERINTRODUCTIONCLINICALVALUEOFECHOCARDIOGRAPHYEchocardiographyisthemostwidelyusedcardiacimagingtechniqueIthasaclinicallyprovenroleinthediagnosisandmanagementofpatientswithsuspectedorestablishedcardiovasculardiseaseTableAF:atrialfibrillationTIA:transientischemicattackCXR:chestXrayECG:electrocardiogramSVT:supraventriculartachycardiaVT:ventriculartachycardiaCardiacmurmurs:systolic,diastolic,continuous,thrills,midsystolicclickCardiomegalyorenlargedcardiacsilhouetteonCXRHypertensionHypotensionArrhythmias,espifsustained,eg,AF,SVT,VTLowvoltageonECGHeartfailure(CHF)Coronaryarterydisease(CAD)CardiomyopathiesArrhythmias:AF,SVT,VTpacingdeviceevaluationStrokeValvularheartdiseaseInfectiveendocarditisPericardialdiseasePulmonaryembolismPulmonaryhypertensionDiseasesoftheaortaHypertensionDiabetesFamilyhistoryofcardiomyopathiesCongenitalheartdiseaseLeftventricularhypertrophy(LVH)(hypertension)AbdominalaorticaneurysmLVHinfamilialcardiomyopathies,eg,hypertrophiccardiomyopathyAthleteswithfamilyhistoryofsuddencardiacdeathLeftatrialenlargementLeftventricular(LV)dysfunctionRightventricular(RV)dysfunctionValvularheartdiseasePericardialeffusionTableTHECLINICALAPPLICATIONSOFECHOCARDIOGRAPHYSymptomsorClinicalMedicalpresentationsignsconditionsScreeningSuspectedcardiacetiologyinpatientswith:•Dyspnea•Chestpain•Lightheadedness•TIA•Cerebrovascularevents•Syncope•Cyanosis•Hypotension•Hemodynamicinstability•RespiratoryfailureAcutecoronarysyndromes(ACS)HypertensionCardiacarrestHeartfailure(CHF)MultipletraumaCHBulwerqxd:AMPageAdvantagesofEchocardiographyADVANTAGESOFECHOCARDIOGRAPHYEchocardiographyisthemostversatilecardiacimagingtechniqueItcanprovideawiderangeofclinicallyusefulinformationinavarietyofsettings,andatlesscost,withmorerapidresults,ascomparedtoothercardiacimagingtechniquesHighlyportablebatterypoweredinstruments,knownashandcarriedultrasound(HCU),canbeusedoutsidethehospitalsettinginlocationssuchascommunityclinics,resourcepoorenvironments,ambulances,andaircraft(evenspacecraft)Upandcomingpocketsizeddeviceshavebeendubbedasthe“ultrasoundstethoscopes”ofthefutureTableTableADVANTAGEOFECHOCARDIOGRAPHYCOMPAREDTOOTHERCARDIACIMAGINGTECHNIQUESAdvantagesExcellentdiagnosticutilitySafe,highlyportable,andversatileImmediateresultsLessexpensiveandwideravailabilityNoradiationMinimalpatientdiscomfortEstablishedroleinthediagnosis,management,riskstratification,andprognosisinpatientswithsuspectedorestablishedcardiovasculardiseaseSafetyestablishedinadults,pregnancy,andchildrenInpatientandoutpatientuseHighlyportableandbatterypoweredformscanbeusedincommunityandremotesettingsTransesophagealechocardiographyisusedinrealtimeduringcardiacsurgery(withoutinterruptingsurgicalprocedures)Ultrasoundstethoscopeandfuturistic“cellphone”ofcardiacimagingconceptHighlyportableNewultraportablehandcarriedandpocketsizedinstrumentsslatedtobecomethefutureultrasound“stethoscope”Comparedtocardiaccomputerizedtomography(CT),cardiacmagneticresonanceimaging(CMRI),andnuclearcardiologyimagingSafeinpregnancyandchildhoodComparedtocardiacCTandnuclearcardiologyimagingNoneedforbreathholdingaswithCMRIRapidimageacquisitiontimes:NewDechocardiographyimagingcanbeobtainedduringoneheartbeatdrasticallyreducingimageacquisitiontimesReducedneedforscanningexpertise:NewDechocardiographyinstrumentsrequirelessscanningexpertiseCHBulwerqxd:AMPageCHAPTERINTRODUCTIONSKILLSANDCOMPETENCY:THEREQUISITESStandardsforperformanceandinterpretationofechocardiographicstudieshavebeenestablishedandendorsedbyexpertbodiesliketheAmericanSocietyofEchocardiography(ASE),theAmericanCollegeofCardiology(ACC),theAmericanHeartAssociation,andtheirEuropeanandBritishcounterpartsTableTableREQUISITESKILLSANDCOMPETENCYINECHOCARDIOGRAPHYBasicCognitiveSkillsRequiredforCompetenceinEchocardiography(ACCAHAASE,)•Knowledgeofphysicalprinciplesofechocardiographicimageformationandbloodflowvelocitymeasurements•Knowledgeofinstrumentsettingsrequiredtoobtainanoptimalimage•Knowledgeofnormalcardiacanatomy•KnowledgeofpathologicchangesincardiacanatomyduetoacquiredandCHD•Knowledgeoffluiddynamicsofnormalbloodflow•KnowledgeofpathologicalchangesinbloodflowduetoacquiredheartdiseaseandCHDCHD:congenitalheartdiseaseCognitiveSkillsRequiredforCompetenceinAdultTransthoracicEchocardiography(ACCAHAASE,)•Basicknowledgeoutlinedabove•Knowledgeofappropriateindicationsforechocardiography•Knowledgeofthedifferentialdiagnosticproblemineachcaseandtheechocardiographictechniquesrequiredtoinvestigatethesepossibilities•Knowledgeofappropriatetransducermanipulation•Knowledgeofcardiacauscultationandelectrocardiographyforcorrelationwithresultsoftheechocardiogram•Abilitytodistinguishanadequatefromaninadequateechocardiographicexamination•Knowledgeofappropriatesemiquantitativeandquantitativemeasurementtechniquesandabilitytodistinguishadequatefrominadequatequantitation•Abilitytocommunicateresultsoftheexaminationtothepatient,medicalrecord,andotherphysicians•KnowledgeofalternativestoechocardiographyCHBulwerqxd:AMPageEchocardiographicAnatomy,Windows,andImagingPlanesINTHEDESCRIPTIONOFTHEHUMANBODY,alltermsareusedinrelationtotheanatomicposition,whichbyconventionisdefinedasoneinwhichthebodyisviewedinitserectposition,thehead,eyes,andtoesdirectedanteriorly,thearmsbythesideandsupinatedthedescriptionsofcardiacanatomyareoftenuniqueintheirdisregardforthiscardinalprincipleWallaceAMcAlpine,MD,FRCSHeartandCoronaryArteries()ANATOMICALVERSUSECHOCARDIOGRAPHICIMAGINGPLANESCHAPTERFigureThemajoraxisoftheheart,thelongaxisoftheleftventricle(LV),isobliquelypositionedandtypicallyrotated~°awayfromthemedianplaneinnormaladultsThisaxisprojectsalongalineextendingfromtherightmidclavicletothepalpableLVapicalimpulse(upperleft)Thismajorcardiacaxisservesastheanatomicalreferenceforthestandardechocardiographicimagingplanes:longaxis(LAX),shortaxis(SAX),andfourchamber(C)planes(bottomright)CHBulwerqxd:AMPageCHAPTERECHOCARDIOGRAPHICANATOMY,WINDOWS,ANDIMAGINGPLANESSURFACEANATOMYOFTHEHEARTTableSURFACEANATOMYOFTHEHEARTASuprasternalnotch(SSN)EXiphisternum(xiphoidprocess)BManubrosternalangle(ofLouis)FLeftupperheartmargin:inferiorborderndcostalcartilageofndleftcostalcartilageSuperiorinferiormediastinumborderortransthoracicplaneSuperiorvenacava(SVC)beginsArchofaor

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