Acquired Heart Disease

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Acquired heart disease encompasses cardiac conditions that develop after birth, in contrast to congenital heart disease. Echocardiography plays a central role in the diagnosis, assessment of severity, and monitoring of acquired cardiac conditions.

Classification

Acquired heart diseases can be classified into several major categories:

Category Examples Key Echo Findings
Valvular Heart Disease Stenosis, regurgitation Valve morphology, gradients, regurgitant volumes
Coronary Artery Disease Myocardial infarction, ischemia Wall motion abnormalities, LV function
Cardiomyopathies DCM, HCM, RCM Chamber dimensions, wall thickness, systolic/diastolic function
Pericardial Disease Pericarditis, effusion, tamponade Pericardial fluid, respiratory variation
Cardiac Masses Thrombus, tumors, vegetations Mass location, size, mobility, attachment
Aortic Disease Aneurysm, dissection Aortic dimensions, intimal flap
Infective Endocarditis Native and prosthetic valve Vegetations, abscess, regurgitation

Valvular Heart Disease

Valvular heart disease is among the most common indications for echocardiography.

Valve-Specific Pages

Grading Severity

See Classification of valve stenosis and regurgitation for standardized grading criteria.

Ischemic Heart Disease

Echocardiography is essential for evaluating patients with known or suspected coronary artery disease.

Key Echocardiographic Findings

  • Regional wall motion abnormalities - hypokinesis, akinesis, dyskinesis
  • Left ventricular ejection fraction
  • LV remodeling - dilation, aneurysm formation
  • Mechanical complications - VSD, papillary muscle rupture, free wall rupture
  • LV thrombus - especially in anterior MI with apical akinesis

Wall Motion Scoring

Score Wall Motion
1 Normal or hyperkinetic
2 Hypokinetic - reduced thickening
3 Akinetic - absent thickening
4 Dyskinetic - paradoxical motion
5 Aneurysmal - diastolic deformation

Cardiomyopathies

Main article: Cardiomyopathies

Types

  • Dilated cardiomyopathy - LV dilation with reduced systolic function
  • Hypertrophic cardiomyopathy - asymmetric septal hypertrophy, SAM, LVOT obstruction
  • Restrictive cardiomyopathy - diastolic dysfunction with preserved systolic function
  • Arrhythmogenic right ventricular cardiomyopathy - RV dilation, aneurysms
  • Non-compaction cardiomyopathy - trabeculations, crypts

Pericardial Disease

Main article: Pericardial_Disease

Conditions

  • Pericardial effusion - echo-free space, fibrin strands
  • Cardiac tamponade - RA/RV diastolic collapse, respiratory variation greater than 25 percent
  • Constrictive pericarditis - septal bounce, annulus reversus
  • Pericardial cysts and masses

Cardiac Masses

Thrombus

  • Most common in LV apex post-MI, LA appendage in AF
  • Distinguish from artifact, trabeculations, tumors

Tumors

  • Benign: Myxoma most common primary tumor, papillary fibroelastoma, lipoma
  • Malignant: Primary rare vs metastatic more common

Vegetations

  • Oscillating masses on valve leaflets
  • Associated regurgitation, abscess formation

Aortic Disease

Aortic Aneurysm

Measure at standardized levels:

  • Sinuses of Valsalva
  • Sinotubular junction
  • Ascending aorta
  • Aortic arch
  • Descending aorta

Aortic Dissection

  • Intimal flap visualization
  • True vs false lumen identification
  • Entry and re-entry tears
  • Involvement of coronary ostia and branch vessels
  • TEE superior to TTE for thoracic aorta assessment

Infective Endocarditis

Modified Duke Criteria - Echo Findings

Major Criteria:

  • Oscillating intracardiac mass on valve or supporting structures
  • Abscess
  • New partial dehiscence of prosthetic valve
  • New valvular regurgitation

TEE vs TTE

TEE has higher sensitivity greater than 90 percent compared to TTE 60-75 percent for detecting vegetations, especially for prosthetic valves and complications.

Related Cases

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