Echocardiography is becoming a widely used tool for the diagnosis and treatment of cardiac conditions. Understanding the physics of echocardiography is very essential for its correct application. Doppler is an equally useful modality in echocardiography for the assessment of blood flow. The aim of this article is to outline the basic physics of echocardiography and Doppler and a brief description of various echocardiography machine controls used for the optimization of echocardiography images.

Transesophageal echocardiography (TEE) is a valuable tool for understanding cardiac anatomy and physiology. It has an advantage as a real-time dynamic monitoring tool to assess cardiac function. Due to its better spatial resolution, the cardiac structures are well delineated. It is preferred over transthoracic echocardiography (TTE) for better visualization of the posterior cardiac structures and more so in suboptimal acoustic TTE windows. The clinical utility of TEE in diagnosing and guiding therapeutic interventions in both cardiac surgical and critically ill patients has been widely reported. The knowledge of acquiring comprehensive TEE views ensures that the clinician does not miss out on any vital information. It also ensures that all the views have been acquired systematically in a limited time frame.

The left ventricle (LV) is a complex structure, and understanding functional complexity is crucial while evaluating the systolic function. Systolic function is the predominant determinant of stroke volume and cardiac output and has substantial clinical implications. Internal dimension, volumes, and fractional shortening are routinely used in clinical practice to assess LV systolic function. Ejection fraction (EF) estimation using two-dimensional (2D) echocardiography is ubiquitous. However, the reliability of EF in prognostication and decision among patients with normal to mildly reduced EF is questionable. Therefore, other 2D or three-dimensional (3D) echocardiographic variables and strain measurements are continuously evolving to supplement and complement EF. However, we need to generate sufficient normative data in normal patients and those with various cardiac pathologies to validate and strengthen the clinical utility of strain.

Cardiac failure is an increasingly prevalent community health issue that affects both developed and developing countries globally. The increasing incidence and prevalence of cardiac failure have been attributed to longer life expectancy and ongoing population aging. About 6.2 million adults in America aged 20 years and above were noted to have heart failure (HF) between 2013 and 2016, an increase from the 5.7 million cases between 2009 and 2012. The incidence of congestive cardiac failure (CCF) is estimated to be around 10 per 1,000 after 65 years of age, with 550,000 new cases reported annually. HF affects 14 million people in Europe and is thought to affect 20 million people on the Indian subcontinent. Up to 40–50% of patients with CCF suffer from diastolic dysfunction; the systolic function is normal or almost normal. There is now a realization that cardiac performance depends not only on systolic factors of contractile force generation but also on how well the heart can relax and fill during diastole.

The use of point-of-care ultrasound (POCUS), including echocardiography in acute settings, has markedly expanded in recent years. Hemodynamic assessment using echocardiography in a Shock state is the most known one. It is gradually becoming unreplaceable due to its benefits, low costs, and negligible adverse effects. Serial exams following a structured approach are advisable. It provides insight into the cause and type of shock as well as the underlying hemodynamic derangement. Recent innovations mean echocardiography is easier to conduct and provides more informative data. Skilled acute physicians are better placed for such individualized management. In this review, we summarize the current application of echocardiography in shock and revisit some promising future modalities.

Echocardiography is the principal method for the estimation of the structure and function of the mitral valve (MV). Impedance to mitral inflow is caused essentially by mitral stenosis (MS) of rheumatic origin. Less common causes involve tumors, principally myxomas, calcification of the mitral annulus, carcinoid heart disease, and congenital MS. When associated with exclusive valvular and subvalvular affliction, severe MS is diagnosed with a pressure half-time (PHT) of >150 ms and valve area ≤1.5 cm². In MS of rheumatic origin, echocardiography enables evaluation of the likelihood of success for percutaneous balloon valvotomy. Echocardiography allows appraisal of the degree of mitral regurgitation (MR) and helps discern various causes such as prolapse or flail of MV segments, endocarditis of mitral leaflets, rheumatic etiology, ischemic MR, or functional MR as seen in cardiomyopathy.

Echocardiography (ECHO) is an essential diagnostic tool for patients who require extracorporeal membrane oxygenation (ECMO). ECMO provides oxygenation and circulatory support to patients with severe cardiac/respiratory dysfunction. ECHO plays an important role in the management and evaluation of ECMO therapy. ECHO is a relatively noninvasive imaging technique that uses high-frequency sound waves to produce detailed imaging of the heart's structure and functionality. It is used to evaluate various aspects of cardiac function, including cardiac output, ejection fraction (EF), regional wall motion abnormalities (RWMA), and valvular function. ECHO provides vital information about the cardiopulmonary physiological response to ECMO therapy. Apart from helping identify intra and extracardiac thrombi and clots, it is used for the assessment of ECMO cannula placement to optimize blood flow mechanics and gas exchange. One of the advantages of ECHO in ECMO support is its versatility in providing real-time feedback that enables clinicians to optimize therapy and mitigate potential complications during the ECMO run. ECHO helps diagnose and quantify conditions that cause hemodynamic instability, such as undiagnosed valvular lesions, ventricular dysfunction, and aortic dissection. Epiaortic ECHO provides information about aortic atheroma and aids in selecting the best site for aortic cannulation. The placement of venous cannula for venovenous (VV)—ECMO or venoarterial (VA)—ECMO can be affected by anatomical abnormalities of the heart such as left-sided superior vena cava (SVC), Chiari network, prominent eustachian valve, atrial septal defect (ASD) all of which can be diagnosed by ECHO.

Introduction: Aortic root abscess in prosthetic valve endocarditis (PVE) can be a life-threatening situation, especially when associated with dehiscence of the aortic annulus, which is reported in 0.1–1.3% of patients who undergo aortic valve replacement (AVR). Early diagnosis and timely intervention could aid in a positive outcome, even in a deteriorating patient. The “endocarditis team” approach is very beneficial, especially in early diagnosis and surgical therapy. Case description: A 70-year-old gentleman who was awaiting homograft aortic root replacement (ARR) was presented with a sudden onset of respiratory distress requiring emergency intubation, ventilation, and high doses of inotropes/vasoconstrictors. He had previously undergone tissue AVR, 5 months earlier, along with coronary artery bypass grafting. On examination, he was in a low cardiac output state, which correlated with his echo findings of severe biventricular dysfunction, aortic root abscess, loss of aorto-mitral continuity, severe periprosthetic valve regurgitation, and tricuspid valve vegetation. Hence, he was diagnosed with infective endocarditis (IE) complicated with PVE. After a detailed discussion with relatives about the high risk of mortality and morbidity, he underwent an emergency salvage homograft ARR surgery and was discharged from the hospital on day 12. Conclusion: Although we come across many patients with PVE, management of emergency situations with dehiscence of the aortic annulus with root abscess can be a serious situation to tackle, and good teamwork with timely decisions taken will facilitate a good outcome. Clinical significance: Echocardiography helps in the early diagnosis of IE and surgical decision-making for a salvage procedure in case of PVE with intracardiac abscess and dehiscence of aortic annulus.

Non-Hodgkin's lymphoma (NHL) is a malignancy of the lymphoid tissues, involving B cells, T cells, or natural killer cells. Primary cardiac lymphomas originating in the heart are very rare, accounting for <1% of all extranodal lymphomas. Extranodal spread to the heart resulting in a secondary cardiac lymphoma may be seen in 9–24% of patients with lymphoma. Patients may present with B symptoms such as fever, fatigue, night sweats, and weight loss, which may mask symptoms of cardiac involvement. Transesophageal echocardiography may be considered the imaging technique of choice but the definitive diagnosis requires histopathological confirmation. The following report describes the incidental finding of a high-grade NHL of the right atrium (RA).

A 19-year-old male, with history of hypothyroidism, presented with progressive dyspnea along with pedal edema and abdominal distention over 2 years. In the cardiology outpatient setting, transthoracic echocardiography (TTE) revealed pulmonary stenosis, tricuspid regurgitation (TR), dilated right atrial (RA), dilated right ventricle (RV), RV dysfunction and spontaneous echo contrast (SEC) in the RA. There was a sessile mass in the RA near the superior vena cava-right atrial (SVC-RA) junction. Computed tomography (CT) and magnetic resonance imaging (MRI) were not done as the mass was presumed to be a thrombus in view of it being sessile, not related to the interatrial septum, proximity to the RA appendage, and presence of SEC. The patient was diagnosed as having congenital pulmonary stenosis with concomitant TR and a thrombus in the RA. He was started on heparin for thrombolysis and referred to the cardiac surgical team.