Hi folks,
I wonder if anyone can give me experiences about how you can diagnose
heart rhythm only from echo. E.g. diagnoses of sinusrhythm is possible
with my eye. Today I noticed that in the two chamber view the apex
moves in a typical way when the atrium contracts. Routinely I can see
different forms of av-block. I watched that in narrow complex tachycardia
you can distinguish atrial flutter from av-node-reentry tachycardia
from a special movement of the intraatrial septum in the four chamber
view, so that it really flutters when the atrium flutters.
Ok, only some observations.
I would be delighted hearing from your experiences.
Sincerely, Rainer
Raibud-el.pingu…@t-online.de (Rainer Budde) wrote:
>Hi folks,
>I wonder if anyone can give me experiences about how you can diagnose
>heart rhythm only from echo. E.g. diagnoses of sinusrhythm is possible
>with my eye. Today I noticed that in the two chamber view the apex
>moves in a typical way when the atrium contracts. Routinely I can see
>different forms of av-block. I watched that in narrow complex tachycardia
>you can distinguish atrial flutter from av-node-reentry tachycardia
>from a special movement of the intraatrial septum in the four chamber
>view, so that it really flutters when the atrium flutters.
>Ok, only some observations.
>I would be delighted hearing from your experiences.
>Sincerely, Rainer
Rainer:
Plenty of ways. You can detect A-fib/flutter and differentiate A-fib
from A-flutter easily by noting the motion of the open mitral or
tricuspid valve on 2-D, and prove it with M-mode. Pulmonary valve
M-mode usually works too, but only in the abscence of PHTN. BBB
septal motion patterns were described in the early lit.
Tachyarrythmias and bradycardia are obvious to the eye, and the rate
determinable on M-mode of any ventricular wall or any valve. 1st
degree A-V block can be detected by looking at the elapsed time
between LV inflow A wave cessation and the onset of ejection (in the
absence of ventricular constriction), either by M-mode (if you have a
double cursor) or with a conventional pulsed Doppler sample volume
placed in the overlapping streams of inflow/ejection in, say, the
apical 5-chamber. 2nd degree block is detected by noting a Wenckebach
pattern or just a regular dropped beat in structural motion or flow,
and complete block by noting independent atrioventricular rhythm
patterns in any plane allowing appreciation of simultaneous atrial and
ventricular function, such as the parasternal long axis. V-fib and
asystole are pretty obvious on 2-D, and can be differentiated with
M-mode.
The little ECG rhythm strip you run during the exam does a better job,
though, if you fix the settings and lead so that all components of the
trace are displayed.
John Cooper
Prez, Honcho & Slave
Sound Appliations, Inc.