Echocardiography Introduction

The presentation of J.R. is typical of patients with their first episode of AF. AF is the most common sustained arrhythmia and is characterized by a loss of organized atrial electrical and mechanical activity. The associated loss of the atrial systolic contribution to left ventricular filling leads to reduced ventricular filling and depressed cardiac output with resultant symptoms of dyspnea and fatigue. In addition, atrial stasis predisposes to the formation of atrial thrombi, most commonly in the left atrial

From: Contemporary Cardiology: Essential Echocardiography: A Practical Handbook With DVD Edited by: S. D. Solomon © Humana Press, Totowa, NJ

Table 1

Transthoracic Echocardiographic Findings in AF

Finding

Significance

Left atrial enlargement

Left ventricular hypertrophy Mitral valve disease

Left atrial spontaneous contrast, "smoke"

Pericardial effusion

More common in patients with atrial fibrillation (AF). Progressive dilation is associated with sustained atrial fibrillation.

Patients with hypertension and LVH are at increased risk of AF.

Mitral stenosis and mitral regurgitation are common causes of left atrial enlargement, which predisposes to AF.

Spontaneous contrast, or "smoke," is common in conditions of stasis and can be seen in patients with AF. Spontaneous contrast is caused by aggregation of red cells. The higher the transducer frequency, the greater the likelihood of seeing "smoke."

Patients with pericarditis are prone to atrial arrhythmias.

appendage (LAA), and subsequent migration and clinical stroke or peripheral thromboembolism. AF is thought to be responsible for 10% of all clinical strokes and 50% of all cardiac sources of embolism. Rheumatic valvular AF is associated with an 18-fold increase in clinical thromboembolism, but even non-rheumatic AF is associated with a sixfold increase. Residual left atrial thrombi are seen in almost 50% of patients presenting with a stroke in the setting of newly recognized AF.

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