Table 4 Clinical signs of heart failure or cardiomegaly on chest X-ray: narrowing differential diagnoses by cardiac ultrasound to guide management/and respective management (video clips of a normal heart and for each pattern are available as Additional file 2)
Ultrasound image | Effusion | Dilated CMP | Right-sided heart failure | Valvular (mitral) | LV Hypertrophy |
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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 |
