Echocardiographic modality which is almost near to obsolete,

2. M-Mode Echocardiography

3. M-Mode Echo
Used in combination with 2-dimentional
Rapid sampling of a region results in
placing sequential parallel data lines so
close together that individual points of
brightness appear as continuous horizontal
lines.
90 degrees to sample- “ice pick”

4. M-Mode Echo
This narrow field allows fewer pulses with
a higher frame rate and therefore better
temporal resolution
Factors that shorten the time required to
make a frame will act to improve temporal
resolution.

5. Improving Temporal Resolution
Minimize depth of view
Use single focus
Narrow sector
Minimize line density
As temporal resolution improves, image
quality may degrade.

19. Mitral Valve Disease
M-Mode Echo

22. Anterior Mitral Valve
Prolapse(Mid-Late Systole)

24. Mitral Stenosis

25. Aortic Insufficiency with
fluttering of Mitral Valve

26. Mitral Valve Endocarditis

28. Aortic Valve Disease
M-Mode Echo

29. Critical Aortic Stenosis

30. Early closure of AV due to Severe
LV dysfun

31. St Jude Prosthetic Aortic Valve

32. Pulmonic Valve Disease
M-Mode Echo

33. Pulmonary HTN with “Flying W sign”

34. Left Ventricle
M-Mode Echo

36. Dilated Cardiomyopathy

37. “B” bump due to elevated EDP

38. Hypertrophic
Cardiomyopathy

39. Paradoxic Septal Motion

41. M-MODE ECHOCARDIOGRPHY
THE LOSS ART

42. M-MODE PHYSICS
B mode echoes from an interface that changes
position will be seen as echoes moving towards
and away from the transducer.
If a trace line is place on this interface and the
resulting trace is made to drift across the face of
a CRT screen a motion pattern is obtained.

43. M-MODE PHYSICS
The resulting display shows motion of a reflector
over distance and time – a distance time graph
The change in distance (dy) over a period of time
dt is represented by the slope of the reflector line
of motion.
dy/dt = slope = velocity

44. M-MODE PHYSICS
If this motion pattern is obtained on moving
cardiac structures then the resulting images
constitute M-mode echocardiography.
M-mode echocardiography is use to evaluate the
morphology of structures, movement and
velocity of cardiac valves and walls and timing of
cardiac events.

45. Distance
Time
M-mode Tracing

46. M-mode Evaluation
Amplitude
Velocity
Time intervals
Morphology

47. Amplitude = Y2 –Y1
Y1
Y2
Amplitude Measurement
Distance
Time

48. Time interval = T2 – T1
T2T1
Time Measurement
Distance
Time

49. dy = Y2 –Y1
Y1
Y2
Slope Measurement
T1 T2
dt = T2 – T1
Slope = dy/dt = velocity

50. M-mode at the Mitral Valve
The mitral valve has 2 leaflets – anterior and
posterior.
Specific letters corresponding to systole and
diastole are assigned to the m-mode tracing
of the mitral valve.

51. EKG Tracing
T-wave
QRS complex
P wave
Systole Diastole

52. Distance
Systole
M-mode at Mitral Valve
Diastole
Time

53. Phase of Cardiac Cycle Assigned Letters
Diastole d,e,f, and a
Systole c and d
M-mode at the Mitral Valve

54. Systole
M-mode at Mitral Valve
Diastole
d
c
a
f
e
d
Time
Distance

55. Systole
M-mode at Mitral Valve
Diastole
e
d Time
Distance
d-e amplitude

56. Systole
M-mode at Mitral Valve
Diastole
Septum
e
Time
Distance
EPSS

57. Systole
M-mode at Mitral Valve
Diastole
e
d Time
Distance
d-e slope

58. Systole
M-mode at Mitral Valve
Diastole
f
e
Time
Distance
e-f slope

59. M-mode at Mitral Valve

60. M-mode at the Mitral Valve
Amplitude Description Normal Value
EPSS Measure e point to septal
separation
< 5 mm
d-e Measures the maximum excusion
of the mitral valve following
diastolic opening.
17 to 30 mm
d-e Measure rate of initial opening of
the mitral valve in early diastole.
240 to 380
mm/s
e-f Measures the rate of early closure
of the mitral valve following
diastolic opening.
50 to 180
mm/s

61. M-mode Findings at the MV
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

62. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
B-bump on the
AC shoulder.
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

63. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Premature Closure
Premature Closure- closure
on or before the onset of the
QRS complex.
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

64. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Systolic anterior motion
of the AMVL
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

65. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
MV prolapse
posterior leaflet
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

66. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
MV Prolapse –
both leaflet
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

67. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Flail posterior leaflet
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

68. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Aortic Regurgitation
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

69. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Mitral Stenosis
Sinus Rhythm
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

70. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Mitral Stenosis
Atrial FibrillationB- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

71. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Atrial Myxoma
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

72. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Vegetation
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

73. Distance
SystoleDiastole
Time
Mitral Regurgitation
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

74. Distance
SystoleDiastole
Time
Mitral Regurgitation
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

75. Distance
Systole
Mitral Regurgitation
Diastole
Time
Atrial Myxoma
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

76. Distance
SystoleDiastole
Time
Atrial Myxoma
Mitral Regurgitation
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

77. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Atrial Myxoma

78. Color M-mode

79. Color M-mode
Propagation Velocity, Vp

80. M- Mode
Aortic Valve

81. M-mode at the Aortic Valve
The aortic valve has 3 cusps – right coronary,
left coronary and non-coronary cusps.
The cusps imaged in the PLAX view are the
right coronary and the non-coronary cusps.

82. M-mode at the Aortic Valve
Coronary cusp
Non-coronary cusp
Anterior aortic root
Posterior aortic root
Left Atrium

83. M-mode at the Aortic Valve
LA dimension
Cusp Separation
Aortic root

84. M-mode at the Aortic Valve
LA dimension
Cusp SeparationAortic root Measurements are made from
leading edge to leading edge.

85. M-mode at the Aortic Valve
Dilated LA
Dilated aortic root
Decreased excursion
Premature opening
Premature closing
Exaggerated anterior motion of Aortic Root

86. M-mode at the Aortic Valve
Reduced anterior motion of Aortic Root
Thickening
Calcification
Vegetations
Bicuspid valve
Prosthetic valve
Aortic Regurgitation

87. M-mode at the Aortic Valve
Premature Opening
Opening of the AV before the
onset of the QRS complex
Seen in Elevated LV-EDP

88. M-mode at the Aortic Valve
Premature Closure
Closure of the AV before
the onset of the T wave
Seen in IHSS

89. M-mode at the Aortic Valve
Bicuspid Valve
Eccentric closure line
Seen when there is a
Bicuspid aortic valve

90. M-mode at the Aortic Valve
Decreased Cusp Separation
Seen in Aortic Stenosis

91. M-mode at the Aortic Valve
Seen in aortic sclerosis
Thickened, calcified aortic
valve leaflet.

92. M-mode at the Aortic Valve
Seen in Mitral Stenosis
Reduced anterior
motion of aortic root

93. M-mode at the Aortic Valve
Exaggerated anterior
motion of aortic root
Seen in Mitral Regurgitation

94. Aortic
Regurgitation

95. Aortic
Regurgitation

96. Aortic
Regurgitation

97. M - Mode
Left Ventricle

98. M-mode at Left Ventricle

99. M-mode at Left Ventricle
Thickening of the IVS and LVPW
Movement of the IVS and LVPW

100. • RVWd
• RVIDd
M-mode Measurement

101. • IVSd
• IVS excursion
• IVSs
M-mode Measurement

102. • LVIDd
• LVIDd index
• LVIDs
• LVIDs index
M-mode Measurement

103. • LVPWd
• LVPW excursion
• LVPW max excursion velocity
• LVPWs
M-mode Measurement

104. M-mode at Left Ventricle
RVWT

105. M-mode at Left Ventricle
RVIDd

106. M-mode at Left Ventricle
IVSd

107. M-mode at Left Ventricle
LVIDd

108. M-mode at Left Ventricle
LVPWd

109. M-mode at Left Ventricle
IVS excursion

110. M-mode at Left Ventricle
IVSs

111. M-mode at Left Ventricle
LVIDs

112. M-mode at Left Ventricle
LVPWs

113. M-mode at Left Ventricle
LVPW excursion

114. M-mode at Left Ventricle
LVPW max velocity
= slope

115. M-mode at Left Ventricle

116. • FS
• EF
• LV mass
• RWT
M-mode LV Calculation

117. • % IVS thickening
• % LVPW thickening
• IVS/LVPW ratio
M-mode LV Calculation

118. M-mode LV Calculation
FS = LVIDd – LVIDs
LVIDd

119. M-mode LV Calculation
EF = LVIDd3
– LVIDs3
LVIDd3

120. M-mode LV Calculation
RWT = IVSd + LVPWd
LVIDd

121. M-mode LV Calculation
IVS % thickening = (IVSs – IVSd) x 100
IVSd

122. M-mode LV Calculation
LVPW % thickening = (LVPWs – LVPWd) x 100
LVPWd

123. M-mode LV Calculation
LV Mass = 1.04 {(LVIDd + IVSd + LVPWd)3
– (LVIDd)3
} x 0.8 + 0.6g

124. Increase LVW thickness

125. Increased Wall
Thickness
Symmetrical
Concentric
Hypertrophy
Asymmetrical
Infiltrative
Diseases
Concentric
Remodeling
Hypertrophic
Cardiomyopathy
Increased Wall ThicknessIncrease LVW thickness

126. LV Hypertrophy - Hypertension
Pressure Overload
Concentric LVH
Increase Wall thickness
Normal Mss
Increase Wall thickness
Increased Mass
Remodeling

127. Increase Wall thickness
Normal LV Mass Increased LV Mass
Measure LV Mass
Concentric Remodeling Concentric Hypertrophy
LV Hypertrophy - Hypertension

128. Increase Wall thickness
Increased LV Mass
Concentric Hypertrophy
LV Hypertrophy – Aortic Stenosis
Pressure Overload
LVH

129. Eccentric LV Hypertrophy
Increased LV size with
Spherical shape
Normal LV Mass Increased LV Mass
Measure LV Mass
No LV hypertrophy Eccentric Hypertrophy

130. Measurement
Assessment
Concentric
Hypertrophy
Concentric
Remodeling
Eccentric
Hypertrophy
Wall Thickness Increased Increased Normal
Relative Wall
Thickness
Increased Increased Normal - Decreased
LV Chamber size Normal Normal Increased
LV Chamber shape Elliptical Elliptical Spherical
LV mass Increased Normal Increased
LV Hypertrophy

131. Paradoxical Septal Motion

132. •RV hypertrophy
•RV dilatation
•LBBB
•Post Cardiac Surgery
Paradoxical Septal Motion

133. Ischemia

134. Ischemia
Normal Wall thickness
No systolic thickening
Reduced Motion

135. Post Infarct

136. Post Infarct
Thin echogenic wall
No systolic thickening
Reduced Motion

137. Pericardial Effusion

138. Pericardial Effusion
Infection
Postviral pericarditis
Bacterial
Tuberculosis

139. Pericardial Effusion
Malignant
Metastatic disease – lymphoma &
melanoma
Direct extension – lung and breast
Primary cardiac malignancy

140. Pericardial Effusion
Inflammatory
Post MI (Dressler’s Syndrome)
Uremia
Collagen vascular disease
Post cardiac surgery

141. Pericardial Effusion
Intracardiac-Pericardial communication
Blunt or penetrating chest trauma
Post catheter procedures
LV rupture (post MI)

142. Pericardial Thickening

143. Pericardial Thickening
Constrictive pericarditis
Occurs following
Surgery
Radiation therapy
Repeated episodes of pericarditis