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Gila Perk - Hemodynamics in the Echocardiography Laboratory

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Gila Perk Hemodynamics in the Echocardiography Laboratory
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The book provides a practically focused review of the latest techniques used for hemodynamic assessment in the echocardiography laboratory. It features a methodical case-based approach covering how to measure hemodynamic parameters successfully, including stroke volume, valve area and regurgitation severity, in a range of scenarios of varying complexity. Step-by-step guidance on how to apply the techniques described are provided. Each chapter also contains didactic features to assist the reader in assimilating the key points in every case, assisting them to develop their knowledge of how to treat patients with both routine and complex hemodynamic issues in the echocardiograply laboratory.

Hemodynamics in the Echocardiography Laboratory therefore represents a concise resource on how to carry out hemodynamic assessments and is a valuable resource for trainees and fellows in cardiology and echocardiography seeking a concise review of the topic.

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Gila Perk - Hemodynamics in the Echocardiography Laboratory
Hemodynamics in the Echocardiography Laboratory
Gila Perk
Hemodynamics in the Echocardiography Laboratory

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Book cover of Hemodynamics in the Echocardiography Laboratory Gila Perk - photo 1
Book cover of Hemodynamics in the Echocardiography Laboratory
Gila Perk
Hemodynamics in the Echocardiography Laboratory
1st ed. 2021
Logo of the publisher Gila Perk Non Invasive Cardiology New York - photo 2
Logo of the publisher
Gila Perk
Non Invasive Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, New York, NY, USA
ISBN 978-3-030-79993-9 e-ISBN 978-3-030-79994-6
https://doi.org/10.1007/978-3-030-79994-6
The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG

The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Contents
The Author(s), under exclusive license to Springer Nature Switzerland AG 2021
G. Perk Hemodynamics in the Echocardiography Laboratory https://doi.org/10.1007/978-3-030-79994-6_1
1. General Principles
Gila Perk
(1)
Non Invasive Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, New York, NY, USA
Abstract

Echocardiography is an important tool in evaluating cardiovascular hemodynamics. There are multiple benefits for utilizing echo for hemodynamics assessment, which include the noninvasive nature of the examination with no known risks, the portable nature of the examinationcan be performed at bedside and repeated as needed, and the complementary information that may be obtained and can help in the comprehensive assessment of the hemodynamic status (e.g., chamber size and function, presence of valve disease, and more). Important principles underlying hemodynamic assessment by echocardiography include the Doppler Principle, Bernoulli Principle, and understanding normal intracardiac pressures, flows, and resistance. The Doppler Principle allows the calculation of blood flow velocity by measuring the Doppler shift of a returning signal that encountered a moving target. Blood flow velocity can in turn be used to calculate intracardiac pressure gradients. Understanding relationships between the various intracardiac pressures can help reach conclusions regarding the hemodynamic status.

Keywords
Doppler principle Doppler equation Bernoulli principle Bernoulli equation Simplified Bernoulli equation Wigger diagrams Intracardiac pressures
Introduction

Echocardiography is an important tool in evaluating cardiovascular hemodynamics.

  • Benefits of utilizing echo for hemodynamics assessment include:

    • Noninvasive nature of the examination; no known risks.

    • Examination can be done at bedside; no need to transfer unstable patient.

    • Ability to repeat the examination if conditions change.

    • Available complementary information to help assess hemodynamic status (e.g., chamber size and function, presence of valve disease, etc.).

  • Important principles underlying hemodynamic assessment by echocardiography include:

  • Doppler Principle

  • Bernoulli Principle

  • Understanding normal intracardiac pressures, flows, and resistance

1.1 Doppler Principle

  • Doppler ultrasound (US) is based on scatter interaction between the US wave and red blood cells (Fig. ).

  • Since blood cells are a moving target, the returning US signal has a different frequency than the emitted signal.

  • The change in frequency (termed the Doppler shift ) is determined by the Doppler equation:

    = x Cos f0emitted frequency Vspeed of the target Cpropagation velocity of - photo 3 x Cos.

    f0emitted frequency, Vspeed of the target, Cpropagation velocity of sound in soft tissue, angle Doppler angle of incidence

    • The Doppler angle of incidence is the angle between the US beam and the direction of flow of the target (i.e., blood flow).

    • In clinical echocardiography, the US beam is aligned as parallel as possible to the measured flow (angle as close to 00 as possible Cos as close to 1 as possible).

    • Attempting to measure and correct for angle of incidence may introduce more error than accuracy.

  • The Doppler shift () is measured by the US machine.

  • Rearranging the Doppler equation to solve for V:

    V = Assuming Cos 1 V By knowing the emitted frequency propagation - photo 4 .

  • Assuming Cos = 1.

    V = By knowing the emitted frequency propagation velocity of sound in soft - photo 5 .

  • By knowing the emitted frequency, propagation velocity of sound in soft tissue, and the measured Doppler shift, blood flow velocity can be calculated.

Fig 11 The Doppler effect When moving blood cells interact with ultrasound - photo 6
Fig. 1.1

The Doppler effect . When moving blood cells interact with ultrasound, the returning wave has a different frequency (f1) than the emitted wave (f0). The change in frequency is the Doppler Shift (f), which can be measured by the US machine. The relationship between the Doppler shift and the blood flow velocity is determined by the Doppler equation

1.2 Bernoulli Principle
The Bernoulli principle states the following:

  • Within a horizontal, laminar (streamline) flow, regions with higher fluid speed have lower pressure, and regions with lower fluid speed have higher pressure.

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