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INTRODUCTION
Cardiovascular diseases remain the leading causes of mortality worldwide, contributing to
increased burden not only in High-income countries but more critically in Low-and
Middle-income nations eg: Nigeria. The WHO estimates that over 75% of cardiovascular deaths
occur in these Low-income contexts, often propelled by shortcomings in healthcare
infrastructure, limited access to advanced imaging modalities, and most importantly delays in
diagnosis (1). This is particularly concerning, since early diagnosis remains the standard for
improving prognosis and subsequent treatment. Meanwhile, efforts are being made to achieve
efficient utilization of available diagnostic modalities.
Among the available diagnostic modalities in this discipline, Electrocardiography (ECG) and
Echocardiography (ECHO) seem to be the most essential and valuable. While individually
powerful, their diagnostic value augments significantly, when used synergistically. This limits
the number of cases involving missed or delayed diagnoses and readily, offers a better approach
to cardiac assessment.
This seminar seeks to explore the complementary and comparative roles of
Electrocardiography and Echocardiography in Cardiovascular Diagnostics, the basic principles
behind the operation of each modality, their clinical applications. It will also discuss the strengths
and limitations of the use of either modality, the complementary and comparative insights of
their operation. This paper , on the contrary does not overpromise but seeks to remain within the
confines of the basic operational mechanisms of these modalities. It also does not provide
extensive delving, prompting readers to take on more research studies. Ultimately, this
intellectual piece aims to reinforce the necessity of integrating both modalities to enhance
diagnosis and improve on patient outcome
While it was not mentioned earlier, the seminar will essentially highlight a key aspect that is
vital to the discourse of this paper: the anatomy of the heart. The heart is a muscular component
of the cardiovascular system, situated in the sternum that pumps blood throughout the human
body. It consists of complex conduits (arteries and veins) that travel the whole human body,
carrying blood and as a result helps to maintain a balance between cardiac output and venous
return (2,3,4). It is imperative that we analyze the structure, function, conduction system, blood
supply, nerve and lymphatic supply of the heart. Again, on a pathological front, we will also
elaborate on the impairments and abnormalities peculiar to the heart, prior to settling on an
overview of Cardiovascular Diseases (CVD) and their burden.
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Fig 1: A structural anatomy of the human heart (10)
Cardiovascular Diseases and their burden
They comprise a distinct and vast group of disorders that affect the heart and blood vessels.
They cut across all geographic and socio-economic boundaries; and collectively impair the
heart's pumping capacity; resulting in severe life-threatening complications including, but not
limited to myocardial infarction, sudden cardiac death and stroke. Cardiovascular diseases
constitutes: Coronary Artery Disease, Valvular heart diseases, Arrhythmia: among others (5)
Worldwide, it is estimated that CVDs cause approximately 17.9 million deaths each year;
which is roughly one-third of all global deaths (1). The burden is significantly pronounced in
Low-and Middle-income nations that experience frequent cardiovascular deaths. CVDs have
emerged to be formidable public health concerns in Low-income settings such as: Nigeria and
evidence of this is supported by recent studies that reveal an alarming rise in the occurrence of
hypertension, ischemic heart disease and cardiomyopathies (6). Disposing factors include:
urbanization, drastic lifestyle changes, poor access to preventive healthcare services, poor health
literacy and resultant late diagnosis.
To address the burden of CVDs, a unified approach is required to prioritize accessibility,
public health awareness, broad screening programs and above all, early diagnosis. The need for
this cannot be overemphasized, because CVDs tend to cause diminished quality of life, rocketing
healthcare expenditures and when it occurs at relatively younger ages, stifles productivity and
healthy living (7). At the core of this proposed approach, is the demand for improvements in the
scope of Cardiovascular Diagnostics, which presents in the form of Electrocardiography (ECG)
and Echocardiography. These modalities allow for early identification and risk assessment of
CVDs. This leads us into a preliminary insight into Dual-Modality Evaluation.
Introduction to Dual-Modality Evaluation
The concept of Dual-Modality Evaluation has surfaced as an intricate approach to clinical
diagnostics in general. Dual modality indicates the strategic incorporation of two different
diagnostic tools to purposefully reveal the multifaceted nature of disease processes that affect the
body. In essence, this notion reflects the inadequacy of a single method of diagnosis in capturing
the full functioning of complex systems such as the heart.
Dual-modality approach remains invaluable in reducing diagnostic blindspots in challenging
fields like Radiography, Radiology and Preventive Cardiology. Example in the field of
Radiography and medical imaging, dual-modality approach continues to be the standard; in
effect improving diagnostic accuracy, providing supplementary and complementary information,
as well as overcoming the confines of employing just one method Eg: in PET/CT, SPECT/CT
and PET/MRI which provides both functional and anatomical details (8).
Within the context of preventive medical imaging and cardiology, Dual-Modality Evaluation
has provided more insight into cardiac pathology, abnormalities of cardiac mechanical and
electrical regulatory function and hemodynamic aspects of cardiac motion. The two widely used
modalities in this scope comprises : Electrocardiography (ECG) and Echocardiography (ECHO).
Electrocardiography (ECG): This is a non-invasive tool used to measure the electrical activity
of the heart (9). It can also be abbreviated as ECG or EKG - stemming from the German
rendition of the Electrocardiogram. In ECG, electrodes are positioned on the surface of the
patient's skin and the wires are then connected to a portable monitoring device that measures the
electrical impulses produced by the heart conduction system. This provides insight into the pace
and rhythm of the heart, displayed in form of waves.
Fig 2: A Close-up of an EKG machine showing patient's heart rate (11)
Echocardiography (ECHO): This is a diagnostic tool, similar to Ultrasound Imaging
Technology that uses high-frequency sound waves to attain a structural and functional image of
the heart. It employs the use of a transducer which is placed on the patient's chest, rendering a
multi-dimensional image of the heart chambers, size, shape, valvular functions and blood flow
(9).
Fig 3: 2D, 3D, 4D Echocardiogram machines for hospitals (12)
They both have different principles of operation, measurement standards and possess
amplified unique capacities to decipher and diagnose certain types of CVDs and some other
underlying complications. It remains to see how they augment on each other's strengths, improve
on disparities and limitations; and again, their diagnostic accuracy when applied to different
cases. The above, with the inclusion of the challenges of implementation, acquisition and
interpretation will be further elaborated upon in the subsequent chapter; to provide deeper
insights.
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