Clinical Insights
A Clearer Picture with Contrast Echo
Echocardiography provides valuable information about cardiac structure, valve function and heart muscle performance. When standard images are unclear, ultrasound contrast improves visualization of the left ventricular borders, allowing more reliable assessment of ejection fraction and regional wall motion. It can also help distinguish suspected apical thrombus from trabeculation or imaging artifact—reducing diagnostic uncertainty and supporting appropriate treatment decisions.
Case Insights
Background: A 44-year-old male presented to our outpatient cardiology clinic for a follow-up echocardiogram. The prior day, he had visited the Emergency Department (ED) with acute retrosternal chest pain and shortness of breath (SOB). His ED workup—including electrocardiogram (ECG), high-sensitivity troponins, and chest X-ray—was entirely unremarkable. He was discharged as low-to-intermediate risk with instructions for immediate outpatient cardiac evaluation.
Diagnostic Findings: Despite his normal ED biomarkers, the patient remained mildly symptomatic upon arrival. Transthoracic echocardiography (TTE) immediately revealed significant structural pathology:
Systolic Dysfunction: The left ventricle was dilated with profound anterior and apical hypokinesis.
Ejection Fraction: Calculated at 30%–35%, confirming a new-onset diagnosis of Heart Failure with Reduced Ejection Fraction (HFrEF).
The Role of Contrast: An ultrasound contrast agent (microbubbles) was administered to achieve complete left ventricular opacification. Under contrast enhancement, the microbubbles flowed uniformly against the endocardial border, filling the entire apex.. Contrast imaging showed artifact and trabeculation with no apical thrombus visualized, helping avoid unnecessary anticoagulation.
Clinic Updates
SAME WEEK APPOINTMENTS NOW AVAILABLE
Dr. Rajanayagam, Internal Medicine, now has same-week appointments for hypertension, chronic kidney disease, and metabolic management. Your patients are seen quickly and returned to you with clear recommendations.
Referral Tip of the Month
Include the Full Clinical Picture
For post-ED cardiac referrals, include the discharge summary, available test results and details of any persistent symptoms. Clearly outline the clinical concern to help our team assess urgency and determine whether further imaging, such as echocardiography, is appropriate..
Have you referred to us before? We'd love to here from you.
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