Physicians

• Heart murmurs
• Heart failure
• Hypertension
• Hypertensive heart disease
• Heart attack
• Stroke/ tia
• Syncope
• Atrial fibrillation/flutter
• Other cardiac arrhythmias
• Abnormal ECG
• Assessment of dyspnea
• Assessment of edema
• Assessment of cardiomegaly seen on chest radiograph
• Assessment of left ventricular function
• Assessment of native heart valves
• Assessment of prosthetic heart valves
• Cardiomyopathies.
• Family history of cardiomyopathy
• Family history of premature sudden cardiac death
• Pericardial disease/pericardial effusion.
• Congenital heart disease.
• Pulmonary hypertension.
• Cardiac tumors
• Preoperative assessment

• Stress echocardiography using a semi-supine bicycle ergometer is useful in the evaluation and diagnosis of several conditions, including:

  • The test helps to diagnose the presence or absence of coronary artery disease.
  • Evaluation of chest pain in patients who have:
    • A nondiagnostic exercise stress test
    • An abnormal resting ECG (including LVH and bundle branch blocks)
  • Evaluation of dyspnea (cardiac versus noncardiac)
  • Diastolic stress testing: to diagnose exertional dyspnea due to LV diastolic dysfunction.
  • Evaluation of pulmonary hypertension /screening for pulmonary hypertension in patients with systemic sclerosis and patients with exercise-induced pulmonary hypertension (another cause of exertional dyspnea).
  • Hemodynamic evaluation of patients with:
    • Hypertrophic cardiomyopathy
    • Mitral stenosis
    • Prosthetic valve

• Assessment of chest pain
• Assessment of exercise functional capacity
• Evaluation of patients with exertional dyspnea of unclear etiology
• Risk stratification
• Evaluation of patients of resting sinus bradycardia and symptoms suggestive of chronotropic incompetence
• Evaluation of patients with rate-responsive pacemakers

• Syncope
• Palpitations
• Arrhythmia
• Evaluation of the effectiveness of antiarrhythmic therapy
• Evaluation of suspected adverse effects of antiarrhythmic therapy (proarrhythmia)
• Silent ischemia

• Suspecting “White coat syndrome” hypertension
• Monitor efficacy of antihypertensive medication
• Assessment of nocturnal blood pressure pattern (diurnal variation)

• Assessment of chest pain
• Assessment of coronary artery disease
• Assessment of extent and severity of coronary artery disease
• Detection of silent ischemia
• Preoperative risk stratification (especially in peripheral vascular disease)
• Risk stratification post-myocardial infarction
• Assessment of the functional significance of borderline angiographic lesions
• Assessment of myocardial viability

• Evaluation of chest pain
• Angina/Myocardial infarction/Coronary artery disease
• Evaluation of heart murmurs
• Evaluation of dyspnea (cardiac versus non-cardiac)
• Evaluation of edema
• Evaluation of syncope
• Suspected or established coronary artery disease
• Abnormal ECG
• Assessment of native heart valves of patients with known Valvular heart disease or heart murmur(s)
• Evaluation of sinus tachycardia of unclear etiology
• Evaluation of palpitations/arrhythmia (including atrial fibrillation)
• Assessment of prosthetic valves
• Suspected or established heart failure
• Hypertension/Hypertensive heart disease.
• Suspected or established cardiomyopathy
• Family history of cardiomyopathy
• Cardiomegaly (seen on a chest X-ray)
• Suspected or established congenital heart disease.
• Preoperative assessment (before non-cardiac surgery)

Two dimensional (2D) speckle tracking echocardiography (STE) is a new imaging modality.

• It permits offline calculation of myocardial velocities and deformation parameters such as strain and strain rate (SR). In general, STE may allow an unprecedented in-depth evaluation of myocardial systolic and diastolic dynamics across a broad range of physiologic and pathologic conditions beyond traditional echocardiographic techniques.
• STE is a valuable tool in evaluating LV systolic function and provides information on top of ejection fraction. It also proved useful to investigate LV diastolic dysfunction.
• Longitudinal strain provides a quantitative myocardial deformation analysis of each LV segment, also allowing for early systolic dysfunction detection in patients with a preserved LVEF.
• STE can detect subclinical myocardial dysfunction in asymptomatic diabetic patients before the overt appearance of diabetic cardiomyopathy.
• Another potential clinical application of speckle-tracking echocardiography is for differentiation of hypertrophic cardiomyopathy from athlete’s LV hypertrophy based on the lower longitudinal strain values in patients with hypertrophic cardiomyopathy who have a normal LVEF.
• Identification of Subclinical Myocardial Dysfunction during Chemotherapy is another important use for STE. In contrast to only LVEF analysis, new STE parameters have been shown to reliably detect preclinical abnormalities in both regional and global myocardial function at an early stage.
• Speckle-tracking echocardiography is a sophisticated new echocardiographic technique that, working with standard 2-dimensional images devoid of the limitations of Doppler techniques, provides a comprehensive analysis of global and regional myocardial deformation evaluated in all spatial directions. In addition, speckle-tracking echocardiography enables evaluation of LV rotational and torsional dynamics, aspects of LV function that were exclusively analyzed by MRI before the introduction of this technique.