Echocardiography

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Basic Echocardiography (for Educational Purposes)

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Echocardiography

  1. 1. B Y : D E E P A K G H I M I R E M E D I C A L – I N T E R N S O U T H W E S T E R N U N I V E R S I T Y S C H O O L O F M E D I C I NE P R E S E N T E D O C T O B E R , 2 0 1 5 P E R C E P T O R I N C H A R G E : V I C E N T E G . B A L B U E N A , M D BASIC ECHOCARDIOGRAPHY
  2. 2. ECHOCARDIOGRAPHY
  3. 3. Cardiac Anatomy Base Apex
  4. 4. Circulation through the Heart
  5. 5. The Cardiac cycle
  6. 6. 4 phases of Diastole 1. Isovolemic relaxation 2. Rapid ventricular filling 3. Slow ventricular filling 4. Atrial contraction
  7. 7. 4 phases of Systole 1. Isovolemic contraction 2. Rapid ventricular ejection 3. Slow ventricular ejection
  8. 8. The Cardiac cycle
  9. 9. DIMENSIONS & MEASUREMENT  Internal diameter  LV : <5 cm  RV : 2.2 – 4.0 cm  RA: 3.5 – 4.0 4cm  Internal diameter :  LA, RA & Ao root : < 4cm
  10. 10. Imaging Modalities  1. 2D- Echocardiography  2. M-mode Echocardiography
  11. 11. Echocardiography  A non-invasive diagnostic technique  Widely used in clinical cardiology.  Involves the use of ultrasound  Used to assess cardiac structure and hemodynamic function function. Fig. Echocardiography machine
  12. 12. Indications of 2D Echocardiography • May be divided into structural imaging and hemodynamic imaging (*ASE) • Indication for Structural imaging • Pericardial imaging (P. Effusion) • L/R ventricles & cavities (RVH/LVH or wall motion abnormality or thrombi) • Image of valves ( Stenosis or prolapse) • Great vessels (aortic dissections) • Congenital & Traumatic heart diseases • Hypertension, suspected IHD, murmurs, Pulmonary disease • Arrythmias, palpitations, syncope or Neurological disease
  13. 13. Indications of 2D Echocardiography • May be divided into structural imaging and hemodynamic imaging (*ASE) • Indication for hemodynamic imaging through Doppler techniques: • Blood flow through heart valves (stenosis/ regurgitation) • Blood flow through the cardiac chambers (C.O) • Systolic and diastolic functions
  14. 14. Pocket-sized Echocardiography Machine
  15. 15. Echocardiography  Physics :  Makes use of Ultrasound ( sound >20 Khz frequency)  Usual frequency used : 1– 5 Mhz  Measures two quantities 1. Time Delay between transmission of pulse and reception of echo 2. Intensity of reflected echo
  16. 16. Principle of Image generation
  17. 17. Gray Scale Image  Gray scale Image is generated Based on intensity of reflected echo Fig: Pericardial effusion Black Fluid or blood White Calcifications on cardiac valves/ pericardium Gray Myocardium
  18. 18. Factors in Echocardiography
  19. 19. Transducers
  20. 20. Use of lens in tranducer
  21. 21. Image Quality Fig: Image generated by 3 Mhz tranducer Fig: Image generated by 5 Mhz tranducer
  22. 22. Modes of Display
  23. 23. M-Mode echocardiography
  24. 24. MOTION-MODE (M-MODE) ECHO  Better display of :  Motion and thickness of ventricular walls  Changing size of cardiac chamber  Opening and closure of valves is better
  25. 25.  Echocardiography provided information about Structure of heart and great vessels  Doppler imaging provides information about the function, physiology and hemodynamics
  26. 26. Echo vs. Doppler studies
  27. 27. Pulse Continuous
  28. 28. Phased array transducer  The typical frequency range: 1-5 MHz  Has an orientation marker  Corresponds with the Image
  29. 29. Transthoracic Acoustic Window  Trans-Thoracic Echo (TTE) 1. Parasternal view 2. Apical view 3. Subcostal view  Trans-Esophageal Echo (TEE)  Assess posterior cardiac structures
  30. 30. Parasternal Long Axis View (PLAX) * marker orientated towards the right clavicle (approximately 11 o’clock)
  31. 31. Parasternal Long Axis View (PLAX) Structure Assessment RV (right ventricle) Size and function LV (left ventricle) Size and function (septum) Ao (ascending aorta) Size AV (aortic valve) Motion, opening and calcification MV (mitral valve) Motion, opening and calcification Pericardium Fluids
  32. 32. Assessment : 1. Pericardial space 2. RV 3. Septum 4. LV 5. Anterior MV leaflet 6. Aortic root 7. LA
  33. 33. Parasternal Long Axis View (PLAX)
  34. 34. Parasternal Long Axis View (PLAX) Fig. Calcification of mitral annulus
  35. 35. Pericardial effusion
  36. 36. Parasternal short-axis view (PSAX) * PLAXS  rotate clockwise 90 degrees ( to long axis of LV) T
  37. 37. PLAX & PSAX
  38. 38. PSAX  The probe can be tilted to examine the SAX view at different levels:  1. Level of papillary muscles  2. Mitral valve  3. Level of aortic valve
  39. 39. PSAX
  40. 40. Apical Four Chamber View (A4C) * marker is at around 3 o’clock.
  41. 41. Apical Four Chamber View (A4C) Assessment : 1. Pericardial space 2. LV 3. Septum 4. RV 5. RA 6. Interartrial septum 7. LA 8.MV annulus
  42. 42. Apical Four Chamber View (A4C)
  43. 43. Apical Five Chamber View
  44. 44. Apical view
  45. 45. Apical Two Chamber View (A2C)  45 to 90 degrees anticlockwise rotation of transducer probe marker from apical view to to 12 o’clock.  Visualizes the true anterior and true inferior walls of the LV
  46. 46. Apical Two Chamber View (A2C)
  47. 47. Subcostal Long Axis View * Transducer in Right sub xiphiod area & side marker in 3 o’clock position
  48. 48. Subcostal Long Axis View Assessment : 1. Pericardial space 2. RV 3. Septum 4. MV annulus 5. LV 6. IVC
  49. 49. Trans-Esophageal Echocardiography  Used to assess posterior structures like LA or Aorta
  50. 50. Contrast echocardiography Before and after contrast
  51. 51. Indications of 2d Echocardiography in evaluation of Heart murmurs  PLAX  MR, AR , VDS  PSAX (multiple level)  AR, TR, PS, PR, VSD  Apical :  4chamber : MR, TR  2 chamber: MR  Long axis: MR, AR, AS, LVOT  5 chamber: LV outflow, AR, AS  Subcostal :  4chamber- RV inflow, TR, ASD  Short axis (Basal) TR, PS, PR  Mid venticular: IVC, HV  Suprasteral:  Aortic arch, Aortic flow  Right Parasternal Lx  Ascending aorta, AS
  52. 52. Two-Dimensional Echocardiography  Cardiac chambers  Chamber size  Left ventricular Hypertrophy  Regional wall motion abnormalities  Valve  Morphology and motion  Pericardium  Effusion  Tamponade  Masses  Great vessels  Transesophageal Echocardiography  Inadequate transthoracic images  Aortic disease  Infective endocarditis  Source of embolism  Valve prosthesis  Intraoperative
  53. 53. 2D Echocardiography  An ideal imaging modality for assessing left ventricular (LV) size and function.  The “gold standard” for imaging valve morphology and motion  The imaging modality of choice for the detection of pericardial effusion  The definitive diagnosis of a suspected aortic dissection usually requires a TEE.
  54. 54. DOPPLER ECHOCARDIOGRAPHY  Uses ultrasound reflecting off moving RBC to measure the velocity of blood flow across valves, within cardiac chambers, and through the great vessels.  Normal and abnormal blood flow patterns can be assessed noninvasively.
  55. 55. DOPPLER ECHOCARDIOGRAPHY  The different colors indicate the direction of blood flow:  Red toward the transducer  Blue away from the transducer  Green superimposed when there is turbulent flow. Blue Away Red Towards (BART)
  56. 56. DOPPLER ECHOCARDIOGRAPHY  Valve gradients in stenosis ( Inc. velocity )  Valvular regurgitation (retrograde flow)  Intracardiac pressures (PAH)  Cardiac output (area X velocity)  Diastolic filling  Congenital heart disease (shunts)
  57. 57. VSD
  58. 58. Aortic Regurgitation Fig: TEE: Dilated ascending aorta Fig. TEE: Aortic Regurgitation
  59. 59. Other use of Echo  Hypovolemia  kissing LV chambers  Collapsing IVC
  60. 60. Temponade  Cardiac Temponade  IVC dilation  Diastolic RV collapse.
  61. 61. Cardiac masses and Tumors
  62. 62. Pleural Effusion
  63. 63. Echocardiography  The quality of an echo is highly operator dependent and proportional to experience and skill.  The value of information derived depends heavily on operation and interpretation
  64. 64. Sources and Assistance  Harrison Principle of Internal medicine, 19th ed  Harrison Principle of Internal medicine, 18th ed  Fiegenbaum's Echocardiography 6th edition  Introduction to Transthoracic echocardiography  Stanford University School of Medicine  Radiology staff of SHH, SWU
  65. 65. Good Morning !

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