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ECHO in Context
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The Changing Left Ventricle

Aortic Valve Disease: New Dimensions in Evaluation and Management

Heart Failure: Echo's Role in and Emerging Health Crisis

Chest Pain in Children & Adults: The Role of Echo

Mitral Regurgitation: New Concept

The Falling Left Ventricle: Diastolic & Systolic Function

Changing the Outcome of Coronary Artery Disease
Digital Integration
Doppler Echo

Chest Pain in Children and Adults

Mitral Regurgitation: New Concepts

Diastolic and Systolic Function

Changing the Outcome of CAD

2000 MV
2001 Chest Pain
2002 Heart Failure

Right Ventricular Hypertrophy
Fig. 7

Right ventricular hypertrophy is commonly associated with any form of right ventricular outflow obstruction or pulmonary hypertension, which may in turn owe its origin to left-sided disease. The echocardiographic signs are thickening of the anterior right ventricular wall and the septum (Fig. 7). Cavity size is usually normal, or slightly enlarged. In many cases there is associated volume overload present due to tricuspid regurgitation, in the absence of this, septal motion is normal.

Unfortunately, M-mode echocardiography is insensitive for detecting right ventricular hypertrophy due to the lack of spatial information. Specificity is poor due to a number of factors, including variable orientation of the right ventricular walls to the ultrasound beam and the numerous other possible causes of septal thickening. Where some right ventricular hypertrophy is present, the papillary muscles attached to the right ventricular wall enlarge, and the path of the ultrasound beam may include these in the apparent septal thickness.

Fig. 8

Any condition affecting the right side of the heart tends to cause some cardiac rotation. The path of the ultrasound beam crosses a different region of the ventricle from normal, resulting in an apparent change in dimensions. Finally, there is the difficulty of an adequate `gold standard' against which to judge echocardiographic findings. Two-dimensional echocardiography overcomes many of these problems. (Fig. 8) shows a parasternal long axis in systole from a patient with right ventricular hypertrophy.

Fig. 9

The subcostal approach is a superior view for interrogating the right ventricle and overcomes the uncertainty of the beam pathway and may improve the specificity. Biventricular hypertrophy, difficult to analyze from ECG recordings, can be demonstrated dramatically by echocardiography (Fig. 9).

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