Echocardiography

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An overview of transthoracic, transesophageal, and intracardiac echocardiography. Includes indications for ordering an echocardiogram, plus pictures and videos.

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  • Diagram of left anterior descending coronary artery (LAD) territory. Ant, anterior; Inf, inferior; Lat, lateral; Post, posterior; Sept, septal.
  • Echocardiography

    1. 1. 1 xx IN
    2. 2. 2 xx2 xx INTRODUCTION •Echocardiograms are one of the most commonly performed cardiac studies •Provide comprehensive information about cardiac structure and function •Aid in establishing diagnosis and guiding treatment •Can be ordered by all physicians, not just cardiologists
    3. 3. 3 xx3 xx •Hand-held ultrasound probe positioned in specific areas (windows) to visualize heart
    4. 4. 4 xx4 xx •Performed by inserting a small (~1/2 inch) ultrasound probe into the esophagus
    5. 5. 5 xx5 xx •Thin catheter (8 Fr) with ultrasound transducer at tip, inserted directly into the RA through femoral venous access
    6. 6. 6 xx6 xx
    7. 7. 7 xx7 xx ULTRASOUND PHYSICS •TEE and ICE: Higher frequency sound waves generate high resolution images •Waves do not travel far, but allows for imaging of finer details •TEE uses frequency of 7 MHz, ICE uses 5-10 MHz •TTE: Lower frequency sound waves generate lower resolution images •Allows for deeper penetration of waves through more tissue, adequate for most situations •TTE uses frequency of 3 MHz
    8. 8. 8 xx8 xx TTE TEE
    9. 9. 9 xx9 xx •Assessment of LV function •Most common reason an echo is ordered •Most useful measurement is Ejection Fraction •Difference in LV volume at end-systole and end-diastole •Normal range is 55%-65% •Wall motion abnomalities (WMA) can be described •Hypokinesis- LV contraction is diminished •Akinesis- no contraction •Dyskinesis- uncoordinated contraction http://www.youtube.com/watch?v=amCLvflTUCI Normal LV function PLAX http://www.youtube.com/watch?v=V0kepFF4AEs Normal LV function APICAL4
    10. 10. 10 xx Hozumi T et al. Heart 2003;89:1163-1168 ©2003 by BMJ Publishing Group Ltd and British Cardiovascular Society WMA
    11. 11. 11 xx11 xx •Murmurs •Abnormal heart sounds caused by abnormal blood flow through the heart •Valvular heart disease •Increased flow across normal valve •Shunts due to congenital or acquired defects •Tumors http://www.medicanalife.com/watch_video.php?v=f88e591176322f2 Myxoma
    12. 12. 12 xx12 xx •Aortic Valve Disease •Aortic Stenosis •Assess valve opening and mobility of cusps •Note presence of calcium or thickening •Measure velocity of blood flow across valve •Calculate valve area •Aortic Regurgitation •Assessed using Doppler http://www.echojournal.org/video/16/Aortic-Valve Normal AO valve http://www.youtube.com/watch?v=MJoEyHxoi5Y Aortic stenosis, 2D and 3D
    13. 13. 13 xx13 xx CONTINUOUS WAVE DOPPLER
    14. 14. 14 xx14 xx •Mitral Valve Disease •Mitral Regurgitation •Assess closure of valve leaflets •Assess with Doppler •Mitral Stenosis •Caused by rheumatic heart disease •Check for abnormal thickening and opening of leaflets http://www.youtube.com/watch?v=yN8z01DAgVY Mitral valve PSAX http://www.youtube.com/watch?v=amCLvflTUCI Mitral valve PLAX
    15. 15. 15 xx15 xx •Atrial Fibrillation •Can be related to valvular disease, CAD, diastolic dysfunction, or cardiomyopathy •Echos can assess any underlying problems and guide treatment •Best to control rate before study •Patients with major structural abnormalities, significant LV systolic dysfunction, or LA diameter >4.5 cm are less likely to maintain SR after CV http://www.youtube.com/watch?v=XgJoO_f7xZg AF
    16. 16. 16 xx16 xx •Stroke/TIA •Up to 20% of CVA’s may be caused by cardiac emboli •TTE rarely shows a direct source of emboli (such as thrombus, vegetations, or tumors) •Shows abnormalities which predispose a patient to embolization (such as MV disease, PFO, or LV aneurysm) •TEE is an effective screening tool to detect LAA thrombus before CV of AF and AF ablation procedures
    17. 17. 17 xx17 xx
    18. 18. 18 xx18 xx
    19. 19. 19 xx19 xx
    20. 20. 20 xx20 xx •Infective Endocarditis •Bacterial infection of heart valves •Established bacteria is called a vegetation •Damaged and abnormal valves are at higher risk •Acute (staph) versus subacute (strep) •Symptoms: fever, murmur, emboli, stroke •IV drug abuse can increase risk of bacterial endocarditis •Can also be used in setting of suspected device system infection http://www.youtube.com/watch?v=RN9jzqg2z98 Mitral Vegetation
    21. 21. 21 xx21 xx •Assessment of Artificial Valves •Can be used for tissue and mechanical valves •Check for regurgitation and leaking of blood around valve annulus •Check velocity of blood flow through the valve
    22. 22. 22 xx22 xx MISCELLANEOUS •Assessment of ASD/VSD/PFO •Pericarditis/Pericardial Effusion/Cardiac Tampanade http://www.youtube.com/watch?v=KoMBYodwXpY&feature=results_m ain&playnext=1&list=PL7E09221BF7CC64C9 •Suspected Aortic Dissection http://www.youtube.com/watch?v=p2WPALg2W7Q VSD http://www.youtube.com/watch?v=nD8DrZCPFBI&feature=related Dissection in ascending aorta
    23. 23. 23 xx23 xx MISCELLANEOUS •Visualization of interatrial septum for transseptal procedures- ICE
    24. 24. 24 xx24 xx SUMMARY •Echocardiography is a valuable tool in the diagnosis and management of cardiac patients •Consider the indication and chose echocardiography method accordingly •An echo study needs to be performed by skilled technologists and physicians for accurate results
    25. 25. 25 xx25 xx VIDEOS http://www.youtube.com/watch?v=B3un6pFV8So (normal echo) http://www.youtube.com/watch?v=N61stug0oBM&feature=related (AS, LVH, Rt side dilatation, PPM, MR, AI) http://www.youtube.com/watch?v=mlsbfqZljSE&feature=related (LV thrombus) http://www.youtube.com/watch?v=izDZnG4T8bc (bubble study) http://folk.ntnu.no/stoylen/strainrate/Ultrasound/ Ultrasound Review ARTICLES http://www.eplabdigest.com/article/4148 ICE Overview

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