Echocardiography in CHD

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Echocardiography in CHD

• Strat Liddiard

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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.

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Age Distribution and Echo Findings
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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.
• ?

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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.

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Treatment and Follow up

• Initiation of treatment
• ACEI
• B-blockers
• Follow -up
• Practice nurses?
• Heart failure nurse?
• General practitioner?

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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.