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• Guidelines for the clinical application of echocardiography have been formulated by the American College of Cardiology and the American Heart Association in collaboration with the American Society of Echocardiography.
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Cardiovascular Disease in the Newborn

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  • • To monitor normally occurring physiologic changes during the transitional circulation of the newborn.

    • Helps define structural anomaly, if present.

    • Helps determine hemodynamics and ventricular function.

    • To assess the presence and degree of pulmonary artery hypertension in premature infants with respiratory failure related to lung disease.

    • Doppler echocardiography can show ductal patency as well as amount and direction of shunting.

    • Cyanosis in newborns without evidence of severe lung disease but whose chest radiograph, ECG, and extremity blood pressures are abnormal.

    • Arrhythmias, nonimmune hydrops, and sepsis.

    • Chromosomal abnormalities and certain extracardiac anomalies.

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Murmurs in Infants and Children

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  • • Innocent heart murmurs do not warrant echocardiography.

    • • Still’s murmur.

      • Flow murmur of the pulmonary artery.

      • Peripheral pulmonic stenosis.

      • Supraclavicular murmur.

      • Systolic flow murmur.

    • Maintain low threshold for obtaining echocardiogram in children with a murmur and abnormal results on accompanying studies (eg, ECG, chest radiograph).

    • Diastolic murmur or gallop.

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Acquired Heart Disease

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  • • Examples include Kawasaki disease, rheumatic fever, myocarditis, and endocarditis.

    • Provides important information regarding the following:

    • • Chamber sizes.

      • Valve and ventricular function.

      • Pericardial involvement.

      • Presence of intracardiac masses.

    • Can also be used for serial evaluation throughout the disease process and to determine whether therapy is effective.

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Systemic Disease

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  • • To evaluate patients with connective tissue diseases, such as Marfan syndrome and Ehlers-Danlos syndrome, which are associated with valve prolapse, aortic root dilation, and dissection.

    • To assess ventricular function in patients with certain neuromuscular disorders, such as Duchenne’s muscular dystrophy, that can affect the heart muscle.

    • To assess left ventricular hypertrophy and dysfunction in children with chronic renal disease and long-standing systemic hypertension.

    • To obtain baseline and serial echocardiograms to assess for cardiomyopathy in patients receiving chemotherapeutic agents, which can be cardiotoxic.

    • Useful in additional disease processes including HIV, serial assessment for rejection in cardiac transplant patients, and screening of patients with a family history of cardiomyopathy.

    • Newly diagnosed thromboembolic disease.

    • • Searches for sources of thrombus and potential intracardiac shunts.

      • Routine transthoracic echocardiogram is often inconclusive and therefore, a contrast study may be necessary.

      • If either study is inconclusive, a transesophageal echocardiogram may be necessary.

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Arrhythmia

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  • • Determines whether there is associated structural heart disease (eg, Ebstein’s anomaly, mitral valve prolapse, and cardiac tumors).

    • Evaluates cardiac function (ie, myocarditis, cardiomyopathy).

    • If tachycardia has been present for an extended period of time, an echocardiogram may help determine whether an intracardiac thrombus is present and if ventricular ...

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