Echocardiography

Atrial fibrillation
AF with normal echocardiogram
- Refer: most will be cardioverted
- Start Aspirin 300mg/day
AF with impaired LV &/or dilated L atrium
- Warfarinise
- Check echo report re LV impairment or L atrial enlargement
- Refer for cardioversion if less than1yr duration
AF with mitral stenosis
- warfarinise always
- Refer
- Not usually cardioverted
Murmurs
No abnormality
- Murmur virtually never important.
Aortic stenosis/regurgitation and mitral stenosis/regurgitation
- Refer with copy of echo report and ECG. If mild, OPD visit may not be neccessary. Severe AS/AR with impaired LV requires urgent appt.
ASD/VSD
- Refer all with echo report
Cardiac failure
Cardiac failure with mild/moderately impaired LV
- ACEI can usually be started out of hospital.
- Consider referral if:
  - Patient also has angina
  - Inadequate symptom control
  - Significant associated lesions on echo
Cardiac failure with severely impaired LV
- Refer
- Diuretics and nitrates
- ACEI should be started in hospital
Normal left ventricular function
Good news! Reassess symptoms and diagnosis. If breathless, may be exertional ischaemia so consider coronary disease. Refer if obscure.

LVES	2.5-4.1cm	Systolic LV dimension at LV base
LVED	3.5-5.6cm	Diastolic LV dimenstion at LV base
IVS	0.7-1.2cm	Thickness of septum in diastole
PW	0.7-1.2cm	Thickness of posterior wall in diastole
LA	1.5-4.0cm	Dimension of left atrium
Aortic root	2.0-3.7cm	Dimension of aortic root at aortic valve