M mode echocardiography

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M mode echocardiography

  1. 1. M-MODE ECHOCARDIOGRPHYTHE LOSS ART
  2. 2. M-MODE PHYSICSB mode echoes from an interface that changesposition will be seen as echoes moving towardsand away from the transducer.If a trace line is place on this interface and theresulting trace is made to drift across the face ofa CRT screen a motion pattern is obtained.
  3. 3. M-MODE PHYSICSThe resulting display shows motion of a reflectorover distance and time – a distance time graphThe change in distance (dy) over a period of timedt is represented by the slope of the reflector lineof motion.dy/dt = slope = velocity
  4. 4. M-MODE PHYSICSIf this motion pattern is obtained on movingcardiac structures then the resulting imagesconstitute M-mode echocardiography.M-mode echocardiography is use to evaluate themorphology of structures, movement andvelocity of cardiac valves and walls and timing ofcardiac events.
  5. 5. DistanceTimeM-mode Tracing
  6. 6. M-mode EvaluationAmplitudeVelocityTime intervalsMorphology
  7. 7. Amplitude = Y2 –Y1Y1Y2Amplitude MeasurementDistanceTime
  8. 8. Time interval = T2 – T1T2T1Time MeasurementDistanceTime
  9. 9. dy = Y2 –Y1Y1Y2Slope MeasurementT1 T2dt = T2 – T1Slope = dy/dt = velocity
  10. 10. M-mode at the Mitral ValveThe mitral valve has 2 leaflets – anterior andposterior.Specific letters corresponding to systole anddiastole are assigned to the m-mode tracingof the mitral valve.
  11. 11. EKG TracingT-waveQRS complexP waveSystole Diastole
  12. 12. DistanceSystoleM-mode at Mitral ValveDiastoleTime
  13. 13. Phase of Cardiac Cycle Assigned LettersDiastole d,e,f, and aSystole c and dM-mode at the Mitral Valve
  14. 14. SystoleM-mode at Mitral ValveDiastoledcafedTimeDistance
  15. 15. SystoleM-mode at Mitral ValveDiastoleed TimeDistanced-e amplitude
  16. 16. SystoleM-mode at Mitral ValveDiastoleSeptumeTimeDistanceEPSS
  17. 17. SystoleM-mode at Mitral ValveDiastoleed TimeDistanced-e slope
  18. 18. SystoleM-mode at Mitral ValveDiastolefeTimeDistancee-f slope
  19. 19. M-mode at Mitral Valve
  20. 20. M-mode at the Mitral ValveAmplitude DescriptionNormalValueEPSS Measure e point to septalseparation< 5 mmd-e Measures the maximumexcusion of the mitral valvefollowing diastolic opening.17 to 30 mm
  21. 21. M-mode at the Mitral ValveSlope Description Normal Valued-e Measure rate of initialopening of the mitral valvein early diastole.240 to 380mm/se-f Measures the rate of earlyclosure of the mitral valvefollowing diastolicopening.50 to 180 mm/s
  22. 22. M-mode Findings at the MVB- bump on the AC shoulderPremature Closure of the MVSystolic anterior motion of the AMVLMitral Valve ProlapseMitral Regurgitation
  23. 23. M-mode Findings at the MVFlail PMVLFluttering of the AMVLMitral StenosisLA myxomaVegetations
  24. 24. DistanceSystoleM-mode at Mitral ValveDiastoleTimeB-bump on theAC shoulder.
  25. 25. DistanceSystoleM-mode at Mitral ValveDiastoleTimePremature ClosurePremature Closure- closureon or before the onset of theQRS complex.
  26. 26. DistanceSystoleM-mode at Mitral ValveDiastoleTimeSystolic anterior motionof the AMVL
  27. 27. DistanceSystoleM-mode at Mitral ValveDiastoleTimeSystolic anterior motionof the AMVL
  28. 28. DistanceSystoleM-mode at Mitral ValveDiastoleTimeMV prolapseposterior leaflet
  29. 29. DistanceSystoleM-mode at Mitral ValveDiastoleTimeMV Prolapse –both leaflet
  30. 30. DistanceSystoleM-mode at Mitral ValveDiastoleTimeFlail posterior leaflet
  31. 31. DistanceSystoleM-mode at Mitral ValveDiastoleTimeAortic Regurgitation
  32. 32. DistanceSystoleM-mode at Mitral ValveDiastoleTimeSinus RhythmMitral Stenosis
  33. 33. DistanceSystoleM-mode at Mitral ValveDiastoleTimeAtrial FibrillationMitral Stenosis
  34. 34. DistanceSystoleM-mode at Mitral ValveDiastoleTimeAtrial Myxoma
  35. 35. DistanceSystoleM-mode at Mitral ValveDiastoleTimeVegetation
  36. 36. DistanceSystoleDiastoleTimeMitral Regurgitation
  37. 37. DistanceSystoleDiastoleTimeMitral Regurgitation
  38. 38. DistanceSystoleMitral RegurgitationDiastoleTimeAtrial Myxoma
  39. 39. DistanceSystoleDiastoleTimeAtrial MyxomaMitral Regurgitation
  40. 40. DistanceSystoleM-mode at Mitral ValveDiastoleTimeAtrial Myxoma
  41. 41. Color M-mode
  42. 42. Color M-modePropagation Velocity, Vp
  43. 43. M- ModeAortic Valve
  44. 44. M-mode at the Aortic ValveThe aortic valve has 3 cusps – right coronary,left coronary and non-coronary cusps.The cusps imaged in the PLAX view are theright coronary and the non-coronary cusps.
  45. 45. M-mode at the Aortic ValveCoronary cuspNon-coronary cuspAnterior aortic rootPosterior aortic rootLeft Atrium
  46. 46. M-mode at the Aortic ValveLA dimensionCusp SeparationAortic root
  47. 47. M-mode at the Aortic ValveLA dimensionCusp SeparationAortic root Measurements are made fromleading edge to leading edge.
  48. 48. M-mode at the Aortic ValveDilated LADilated aortic rootDecreased excursionPremature openingPremature closingExaggerated anterior motion of Aortic Root
  49. 49. M-mode at the Aortic ValveReduced anterior motion of Aortic RootThickeningCalcificationVegetationsBicuspid valveProsthetic valveAortic Regurgitation
  50. 50. M-mode at the Aortic ValvePremature OpeningOpening of the AV before theonset of the QRS complexSeen in Elevated LV-EDP
  51. 51. M-mode at the Aortic ValvePremature ClosureClosure of the AV beforethe onset of the T waveSeen in IHSS
  52. 52. M-mode at the Aortic ValveBicuspid ValveEccentric closure lineSeen when there is aBicuspid aortic valve
  53. 53. M-mode at the Aortic ValveDecreased Cusp SeparationSeen in Aortic Stenosis
  54. 54. M-mode at the Aortic ValveSeen in aortic sclerosisThickened, calcified aorticvalve leaflet.
  55. 55. M-mode at the Aortic ValveSeen in Mitral StenosisReduced anteriormotion of aortic root
  56. 56. M-mode at the Aortic ValveExaggerated anteriormotion of aortic rootSeen in Mitral Regurgitation
  57. 57. AorticRegurgitation
  58. 58. AorticRegurgitation
  59. 59. AorticRegurgitation
  60. 60. M - ModeLeft Ventricle
  61. 61. M-mode at Left Ventricle
  62. 62. M-mode at Left VentricleThickening of the IVS and LVPWMovement of the IVS and LVPW
  63. 63. • RVWd• RVIDdM-mode Measurement
  64. 64. • IVSd• IVS excursion• IVSsM-mode Measurement
  65. 65. • LVIDd• LVIDd index• LVIDs• LVIDs indexM-mode Measurement
  66. 66. • LVPWd• LVPW excursion• LVPW max excursion velocity• LVPWsM-mode Measurement
  67. 67. M-mode at Left VentricleRVWT
  68. 68. M-mode at Left VentricleRVIDd
  69. 69. M-mode at Left VentricleIVSd
  70. 70. M-mode at Left VentricleLVIDd
  71. 71. M-mode at Left VentricleLVPWd
  72. 72. M-mode at Left VentricleIVS excursion
  73. 73. M-mode at Left VentricleIVSs
  74. 74. M-mode at Left VentricleLVIDs
  75. 75. M-mode at Left VentricleLVPWs
  76. 76. M-mode at Left VentricleLVPW excursion
  77. 77. M-mode at Left VentricleLVPW max velocity= slope
  78. 78. M-mode at Left Ventricle
  79. 79. • FS• EF• LV mass• RWTM-mode LV Calculation
  80. 80. • % IVS thickening• % LVPW thickening• IVS/LVPW ratioM-mode LV Calculation
  81. 81. M-mode LV CalculationFS = LVIDd – LVIDsLVIDd
  82. 82. M-mode LV CalculationEF = LVIDd3– LVIDs3LVIDd3
  83. 83. M-mode LV CalculationRWT = IVSd + LVPWdLVIDd
  84. 84. M-mode LV CalculationIVS % thickening = (IVSs – IVSd) x 100IVSd 
  85. 85. M-mode LV CalculationLVPW % thickening = (LVPWs – LVPWd) x 100LVPWd 
  86. 86. M-mode LV CalculationLV Mass = 1.04 {(LVIDd + IVSd + LVPWd)3– (LVIDd)3} x 0.8 + 0.6g
  87. 87. Increase LVW thickness
  88. 88. Increased WallThicknessSymmetricalConcentricHypertrophyAsymmetricalInfiltrativeDiseasesConcentricRemodelingHypertrophicCardiomyopathyIncreased Wall ThicknessIncrease LVW thickness
  89. 89. LV Hypertrophy - HypertensionPressure OverloadConcentric LVHIncrease Wall thicknessNormal MssIncrease Wall thicknessIncreased MassRemodeling
  90. 90. Increase Wall thicknessNormal LV Mass Increased LV MassMeasure LV MassConcentric Remodeling Concentric HypertrophyLV Hypertrophy - Hypertension
  91. 91. Increase Wall thicknessIncreased LV MassConcentric HypertrophyLV Hypertrophy – Aortic StenosisPressure OverloadLVH
  92. 92. Eccentric LV HypertrophyIncreased LV size withSpherical shapeNormal LV Mass Increased LV MassMeasure LV MassNo LV hypertrophy Eccentric Hypertrophy
  93. 93. MeasurementAssessmentConcentricHypertrophyConcentricRemodelingEccentricHypertrophyWall Thickness Increased Increased NormalRelative WallThicknessIncreased Increased Normal - DecreasedLV Chamber size Normal Normal IncreasedLV Chamber shape Elliptical Elliptical SphericalLV mass Increased Normal IncreasedLV Hypertrophy
  94. 94. Paradoxical Septal Motion
  95. 95. •RV hypertrophy•RV dilatation•LBBB•Post Cardiac SurgeryParadoxical Septal Motion
  96. 96. Ischemia
  97. 97. IschemiaNormal Wall thicknessNo systolic thickeningReduced Motion
  98. 98. Post Infarct
  99. 99. Post InfarctThin echogenic wallNo systolic thickeningReduced Motion
  100. 100. Pericardial Effusion
  101. 101. Pericardial EffusionInfectionPostviral pericarditisBacterialTuberculosis
  102. 102. Pericardial EffusionMalignantMetastatic disease – lymphoma &melanomaDirect extension – lung and breastPrimary cardiac malignancy
  103. 103. Pericardial EffusionInflammatoryPost MI (Dressler’s Syndrome)UremiaCollagen vascular diseasePost cardiac surgery
  104. 104. Pericardial EffusionIntracardiac-Pericardial communicationBlunt or penetrating chest traumaPost catheter proceduresLV rupture (post MI)
  105. 105. Pericardial Thickening
  106. 106. Pericardial ThickeningConstrictive pericarditisOccurs followingSurgeryRadiation therapyRepeated episodes of pericarditis

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