1. Echocardiography in CHD Strat Liddiard

2. CHD NSF Standard 11 nDoctors should arrange for people with suspected heart failure to be offered the appropriate investigations (e.G. Electrocardiography, echocardiography) that will confirm or refute the diagnosis. nFor those in whom heart failure is confirmed, its cause should be identified. nThe treatments most likely to both relieve symptoms and reduce their risk of death should be offered.

3. Age Distribution and Echo Findings

4. The Report nMild apical, septal and anterior systolic left ventricular dysfunction. Mild central mitral reflux into a slightly dilated left atrium (LAD = 4.1 cms). The aortic valve is thickened with a gradient of 15 mm Hg. Estimated right ventricular systolic pressure is 36 mm Hg. ?

5. The Report nMild apical, septal and anterior systolic left ventricular dysfunction. Mild central mitral reflux into a slightly dilated left atrium (LAD = 4.1 cms). The aortic valve is thickened with a gradient of 15 mm Hg. Estimated right ventricular systolic pressure is 36 mm Hg. nConsistent with mild heart failure no aortic stenosis. No other important findings. Consider treatment for heart failure.

6. Treatment and Follow up nInitiation of treatment –ACEI –B-blockers nFollow -up –Practice nurses? –Heart failure nurse? –General practitioner?

7. Benefits of Primary Care Echocardiography Benefits of Primary Care Echocardiography nMore patients have echos. nPeople needing treatment are found. –19 unsuspected cases of of LVD were found (first 200). nCardiologists time can be saved. – 69 referrals were not made. (First 200). nTreatment was changed appropriately. –48 more patients received ACEI. –9 patients had contraindications to ACEI. nTargeting treatment may be cost neutral.