Investigation of Congestive Heart Failure by Chest X-ray and Echocardiogram

Peribronchial cuffing
Cardiothoracic Ratio ( abnormal >0.50)
Normal Chest X-Ray


For Heart Failure, Chest X-ray is helpful,but they are quite hard to be interpreted

Classic finding of congestive heart failure on CXR:

1. Increase heart size (cardiomegaly) -cardiothoracic ratio > 0.50
2. Large hila with indistinct margin - hilum is a depression on the medial surface of the lung that form the opening through which bronchus, blood vessels and nerve pass by. Hilum is enlarged due to increase of pulmonary venous pressure
3. Prominent of superior pulmonary vein ; cephalization of flow ( happens when the pulmonary venous pressure is about 15-20mmHg) Cephalization of flow is the redistribution of blood flow to the upper lung field and a sign of pulmonary odema.
   
4. Fluid in interlobar fissures
5. Pleura effusion- a collection of fluid in the pleural space
6. Kerley B lines (several fine horizontal lines of few centimetres above the angle in the CXR that is made by the recess between the ribs and lateral most portion of diaphragm)
7. Alveolar oedema
8. Pericardial cuffing

Echocardiogram with Doppler examination

• provide an objective assessment of cardiac structure and function
• calculation of LV ejection fraction (EF) can be obtained. This is the stroke volume (EDV-ESV) expressed as percentage of the LV EDV

What is Doppler examination?

• assessment of the blood flow (direction and velocity) while M-mode & 2D Echocardiogram only evaluate the size,thickness and movement of HF (chamber,valve etc.)

Info from Echocardiogram and Doppler examinaton

1. Size of chambers(volume of the cavity & thickness of the wall) -when LV pump function is reduced in patient with HF,LV & RV tends to dilate or enlarge. Severity of enlargement can be diagnosed.
2. Pumping function -can assess if the pumping power is reduced to a mild or severe degree.This measure is known as Ejection Fraction. Normal EF (55-65%) while EF less than 45% represents some decrease in EF. EF<>
3. Valve function-Echocardiography identifies the structure, thickness and movement of each heart valve. It can help determine if the valve is normal, scarred from an infection or rheumatic fever, thickened, calcified (loaded with calcium), torn, etc. It can also assess the function of prosthetic or artificial heart valves.
   Doppler is also very useful in diagnosing the presence and severity of valve stenosis (pronounced stee-no-sis) or narrowing. Remember, unlike echocardiography, Doppler follows the direction and velocity of blood flow rather than the movement of the valve leaflets or components. Thus, reversed blood direction is seen with leakages while increased forward velocity of flow with a characteristic pattern is noted with valve stenosis.
   
4. Volume Status- inferior vena cava is distended or increase in size in patient with HF
   

http://www.heartsite.com/html/echocardiogram.html (echocardiogram)
www.postgradmed.com/issues/1997/01_97/bales.htm


Lawrence Oh