Background
Methods
Literature review on prevalence of cardiac conditions
Weighting of cardiac ultrasound application
Weight | Disease prevalence | Diagnostic impact of US | US difficulty and technical requirements |
---|---|---|---|
1 | Rare (< 5%) | Minor or no management change | Technically advanced, often requiring special equipment like TEE probe, cw-Doppler, cardiac software |
2 | Relatively common (5–15%) | Management change | Moderate, may require color-Doppler |
3 | Very common (> 15%) | Urgent management change (possibly life threatening) | Technically easy, only basic b/w US |
Results
Epidemiology of heart disease in sub-Saharan Africa
First author, year | Patients with HF (n) | Hypertension (%) | Dilated cardiomyopathy (%)a | Ischemic (%) | Valvular (%) | Right-sided HF/cor pulmonale (%) | Effusion (%) | Endomyocardial fibrosis (%) | Congenital (%) |
---|---|---|---|---|---|---|---|---|---|
Ansa, 2016 | 339 | 48.6 | 35.4 | 1.4 | |||||
Appiah, 2017 | 1916 | 52.3 | 19.8 | 4 | 7.6 | 0.4 | |||
Bonsu, 2017 | 1488 | 61.2 | 19.9 | 12.9 | |||||
Boombhi, 2017 | 148 | 30.2 | 28.6 | 6.4 | 11.9 | 8.7 | 4 | ||
Damasceno, 2012 | 1006 | 45.4 | 18.8 | 7.7 | 14.3 | 6.8 | 1.3 | ||
Dokainish, 2017 | 1294 | 35 | 14.2 | 20 | 11 | 0.1 | |||
Kingery, 2017 | 588 | 42.8 | 19.3 | 6.2 | 16.6 | 7.6 | |||
Kwan, 2013 | 192 | 8 | 54 | 25 | 1.4 | 0.7 | 5 | ||
Makubi, 2014 | 427 | 45 | 22.4 | 9 | 12 | ||||
Massoure, 2013 | 45 | 13 | 7 | 62 | |||||
Mwita, 2017 | 193 | 40.4 | 19.6 | 5.7 | 9.3 | 6.2 | |||
Nkoke, 2017 | 529 | 43.2 | 17.6 | 9.6 | 11.7 | 8.8 | 3.8 | 2.1 | |
Ogah, 2013 | 452 | 78.5 | 7.5 | 0.4 | 2.4 | 4.4 | 3.3 | 0.9 | 0.4 |
Ojji, 2013 | 1515 | 60.6 | 12 | 0.4 | 9.4 | ||||
Onwuchekwa, 2009 | 423 | 56.3 | 7.3 | 0.2 | 4.3 | 2.1 | |||
Pio, 2014 | 297 | 43.1 | 5.9 | 19.2 | 11.8 | 2.7 | 1.7 | 2.7 | |
Stewart, 2008 | 844 | 33 | 28 | 9 | 8 | 27 |
The cardiac ultrasound in resource-limited settings (CURLS) protocol
Echocardiographic finding | Prevalence (P) | Impact (I) | Difficulty (D) | PxIxD | Rank |
---|---|---|---|---|---|
LV hypertrophy | 3 | 2 | 2 | 12 | 1 |
Rheumatic mitral disease (stenosis suggested by large LA) | 2 | 2 | 3 | 12 | 1 |
Cardiomyopathy, severe | 3 | 2 | 2 | 12 | 1 |
Cor pulmonale | 2 | 2 | 3 | 12 | 1 |
Pericardial effusion | 1 | 3 | 3 | 9 | 2 |
Regurgitation (MV, AV, TV by color Doppler) | 2 | 2 | 2 | 8 | 3 |
Rheumatic mitral stenosis (valve morphology only) | 2 | 2 | 1 | 4 | 4 |
Rheumatic aortic stenosis (valve morphology only) | 2 | 2 | 1 | 2 | 4 |
Endocarditis (large vegetations seen on TTE) | 1 | 2 | 2 | 4 | 4 |
RV function grading (e.g., TAPSE) | 2 | 2 | 1 | 4 | 4 |
Mitral stenosis grading (PHT) | 2 | 2 | 1 | 4 | 4 |
Aortic stenosis grading (continuation equation) | 2 | 2 | 1 | 4 | 4 |
Regional hypokinesia | 2 | 2 | 1 | 4 | 4 |
LV function grading (e.g., ejection fraction) | 3 | 1 | 1 | 3 | 5 |
Endocarditis (TEE) | 1 | 2 | 1 | 2 | 6 |
Endomyocardial fibrosis | 1 | 1 | 2 | 2 | 6 |
Congenital heart diseases | 1 | 2 | 1 | 2 | 6 |
Pulmonary artery pressure (dTR) | 2 | 1 | 1 | 2 | 6 |
Box 1: Cardiac ultrasound in resource-limited settings (CURLS) protocol—5 questions
CURLS protocol: 5 questions | Interpretation |
---|---|
1. Is a pericardial effusion present? | Yes: consider cardiac tamponade No: consider alternative cause of heart failure |
2. Is the left ventricular function reduced? | Yes: consider cardiomyopathy of various causes No: consider alternative cause of heart failure |
3. Is the right ventricle larger than the left ventricle? | Yes: consider pulmonary artery hypertension or pulmonary embolism No: consider alternative cause of heart failure |
4. Is the left atrium larger than the left ventricle? | Yes: consider mitral stenosis or regurgitation, possibly caused by rheumatic heart disease No: Consider alternative cause of heart failure |
5. Is the left ventricle wall (septum) thicker than 12 mm? | Yes: consider hypertension, or aortic stenosis/regurgitation No: consider alternative cause of heart failure |
Ultrasound image | Effusion | Dilated CMP | Right-sided heart failure | Valvular (mitral) | LV Hypertrophy |
---|---|---|---|---|---|
Scanning method | Subxiphoid view Optional: 4-chamber view | Subxiphoid view Optional: 4-chamber view | Subxiphoid view Optional: 4-chamber view, parasternal short | Subxiphoid view Optional: 4-chamber view, parasternal long | Subxiphoid view Optional: parasternal long |
Key US features | Anechoic fluid surrounding the hearta In severe cases collapse of RV (tamponade) | Reduced inward movement of the LV wall Generalized dilatation of both atria and ventricles | Dilated RV in comparison to the left (ratio > 0.7) D-shaped LV in the parasternal short axis | Dilated LA Thickened mitral valve Mitral regurgitation on Doppler | Thickened LV (septum > 12 mm) Dilated LA Possibly secondary dilated right heart |
Differential diagnosis | TB Malignancy Uremia Massive fluid overload Viral Auto-immune | HIV CMP Idiopathic dilated CMP (post-infectious) Peripartum CMP Alcoholic CMP Ischemic heart disease (severe) | Pulmonary embolism Pulmonary hypertension of other cause | Rheumatic heart disease | Hypertension Aortic stenosis Genetic hypertrophic CMP |