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GP Handbook
GPwSI Heart Failure Service Echo Modalities Normal Values Referral Form Report Form Abbreviations
A BSE Accredited Department Member The NHS Confederation |
The ReportAll Echotech scans are full investigations and adhere to the BSE Education Committee recommendations for 'a minimum dataset for a standard adult transthoracic echocardiogram'. BSE Education Committee October 2005. All reports adhere to strict reporting guidelines devised by the Echotech Clinical Lead and the Echotech Clinical Operations Director and are reviewed at monthly clinical governance meetings. The guidelines have been devised to promote both the quality and consistency of all Echotech reports, encourage a systematic approach to reporting and facilitate the accurate comparison of echocardiograms performed by different Echotech Cardiac Physiologists at different sites. The Echotech reporting guidelines include reference values detailed in the BSE guideline for chamber and valve quantification. BSE Education Committee May 2008. The Echotech report is primary care focussed and is therefore written in clear, descriptive terms, stating all key findings, whether normal or abnormal, detailing both morphology and function for each cardiac structure. The use of tick boxes is used extensively to further enhance the clarity of the report. The underlying basis for a particular box being ticked (e.g. moderate AS) is then made clear in the technical report section. The report also states a conclusion / summary which:
If the patient requires cardiology referral, following the echo, the statement 'Suggest Cardiology Referral' appears in RED BOLD lettering at the top of the report. If the patient requires urgent cardiology referral, following the echo, the statement 'Suggest URGENT Cardiology Referral' appears in RED BOLD lettering at the top of the report. The statements; 'suggest cardiology referral' and 'suggest urgent cardiology referral' are based on clear criteria, which are detailed in the Echotech Reporting Guidelines and GP Handbook. For the full Echotech 'Reporting Guidelines' document please contact Echotech. The Cardiac Physiologist's role To write a detailed technical report, stating all findings whether normal or abnormal, answering specific questions asked by the physician.
A technicians report will give detailed information on:
Any questions from the physician will be answered in a technical report style, for example:
Valve Structure
Reporting LV Systolic Dysfunction (LVSD) In echocardiography, LV ejection fraction (LVEF) is calculated as a marker of systolic function. Generally, an LVEF less than 55% represents impaired systolic function. This can be calculated in several ways by echocardiography. Left ventricular end diastolic dimension (LVEDd) and left ventricular end systolic dimension (LVEDs) are usually measured from parasternal long axis M-mode recordings of the LV, with the cursor at the tips of the mitral valve. From this, LV volumes at end diastole and end systole are calculated using the Teicholz formula. The LVEF is then derived from this as a measure of the change in LV volume during systole. LVEF may also be calculated using the modified biplane Simpson technique. The endocardial border of the LV is traced in both systole and diastole and volumes calculated using Simpson's rule. Global LV systolic dysfunction (LVSD) may be graded as mild, moderate or severe.
LV Segments Each wall has 3 sections/portions; basal, mid and distal, which in a report may be noted to have a degree of movement.
Reporting LV Diastolic Dysfunction (LVDD) An assessment is especially useful when left ventricular systolic function is normal. Pulsed wave Doppler of mitral valve flow is the most commonly used method of assessing diastolic function. In the presence of sinus rhythm two waves, E and A are produced, reflecting early filling of the left ventricle in diastole and atrial contraction respectively. The E:A ratio and E deceleration time (ms) are measured. The Doppler pattern may be either: Normal However, the normal and abnormal patterns are physiological descriptions and patients may move between them depending on the state of their disease, loading conditions or treatment. It is therefore possible for a pseudonormal transmitral pattern Doppler pattern to occur in a patient with significant diastolic dysfunction. Therefore, in the case of a normal transmitral Doppler pattern, other echo modes of assessment must be made before one can confidently exclude diastolic dysfunction. These include a Doppler assessment of pulmonary vein flow and an E:Ea ratio from Tissue Doppler Imaging. Their role in the assessment of LV diastolic dysfunction is detailed in the algorithm below.
Normal Left Ventricular Hypertrophy (LVH) Left atrium & right heart Doppler / blood flow Severity of Aortic stenosis
An aortic valve area (AVA) will only be calculated if the LV function is impaired, as the pressure gradient will under-estimate the severity. For mitral stenosis a mean mitral valve gradient (in mmHg) will be stated. Severity of Mitral stenosis
Other abnormal findings If any other abnormality is detected it will be reported on. This may include:
Technical Problems and Limitations Due to the way echocardiography collects images, certain patients are technically difficult.
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