ECHO mechanics, views, steps of procedure, findings in different types of cardiac failure etc - Study material for Nursing and allied health fields

1. ECHO FINDINGS IN
CARDIAC FAILURE
By;
Mr. Manulal V S
Nursing Officer
Government Medical College Hospital
Thiruvananthapuram, Kerala
India

5. ECHOCARDIOGRAM
An echocardiogram (often called an "echo") is a
graphic outline of the heart's movement.
During this test, high-frequency sound waves,
called ultrasound, provide pictures of the heart's
valves and chambers. This allows the doctor to
see the pumping action of the heart.
Echo is often combined with tests called Doppler
ultrasound and color Doppler to check the blood
flow through the heart's valves.

6. ECHOCARDIOGRAM
In this test, a transducer directs
ultrahigh-frequency sound waves toward
cardiac structure, which reflect these waves.
The echoes are converted to images that are
displayed on a monitor and recorded on a
strip chart or videotape. Results are correlated
with clinical history, physical examination, and
findings from the additional test.

7. Undoubtedly, echocardiography is the single
most useful test in patients with symptoms
of heart failure. It is essential in the diagnosis
and identification of underlying etiology of
heart failure.
An echocardiogram uses sound waves to
produce images of the heart.

8. Types of ECHO
• Transthoracic Echocardiogram (TTE). It is the most common type of
echocardiogram and is noninvasive. A device called transducer is placed on
the patient’s chest and transmits ultrasound waves into the thorax. These
waves bounce off the structures of the heart, creating images and sounds
that are shown in a monitor.
• Transesophageal Echocardiogram (TOE). It is a special type of
echocardiography that uses an endoscope to assist the transducer down to
the esophagus where it produces a more detailed image of the heart than a
transthoracic echocardiogram.
• Stress Echocardiogram. An echocardiogram that is performed while the
patient is using a treadmill or stationary bicycle. This type can be used to
measure the function of the heart both at rest and while exercising.
• Dobutamine Stress Echocardiogram. For patients who are unable to
exercise on a treadmill, a drug called dobutamine is given instead through a
vein that stimulates the heart in a similar manner as exercise. This type of
echocardiogram is used to evaluate coronary artery disease and measures
the effectiveness of cardiac therapeutic regimen.
• Doppler echocardiogram. Measures and assess the blood flow through the
heart and blood vessels.

9. Echo provides anatomical and
haemodynamic informations about;
• Heart chamber size.
• Chamber function (Systolic & diastolic).
• Valvular motion and function.
• Intra cardiac and extra cardiac masses and
fluid collections.
• Direction of blood flow and haemodynamic
information (Valvular stenosis and pressure
gradients).

10. ECHO- Ultrasound mechanics
Probe = Piezo Electric Material (Electric Crystals,
i.e, Lead Zirconate Titanate Crystal is most
commonly using in Echo).
This probe will transmit and receive sound
signals .
Propagation Velocity =Velocity of sound in
blood (1540M/S) .
Frequency = 2to 7 Mega Hertz, for adults .
For Paediatrics, will go for higher frequency,
anyway upto 7 Mega Hertz .

11. Confused ……???

12. ECHO-Imaging modalities (Modes)
• 2 –D Mode = Most commonly used mode. Can
see the longitudinal and horizontal view.
• 3 – D Mode = Here we can see the longitudinal,
horizontal and Posterior views.
• M – Mode (Motion Mode) = For recording the
motion and dimensions of intracardiac structures,
and two-dimensional (cross-sectional), for
recording lateral motion and providing the
correct spatial relationship between structures.

13. M-mode at mid-LV level

14. Doppler in ECHO
• A doppler ultrasound in echo can be used to
estimate the blood flow through blood vessel
by bouncing high frequency sound waves.
• A regular ultra sound uses sound waves to
produce images, but can’t show blood flow .

15. Doppler in ECHO
• CW (Continuous wave)doppler = It is not
localizing any specific point , can specify any point
along the length or with of the ultrasound beam
.This is useful for measuring high velocities.
• Pulsed Wave(PW) Doppler = This allows a flow
disturbance to be localized or blood velocity from
a small region to be measured .
CW and PW Doppler allow a graphical
representation of velocity against time and are
also referred to as Spectral Doppler.

16. Doppler in ECHO
• Colour Flow Mapping (CFM) Doppler) = This is
an automated 2-D version of PW doppler.It
calculates blood velocity and direction at
multiple point with colour. Velocities away
from the transducer are in blue , those
towards it in red. This is known as BART
conversion (Blue Away, Red Towards)

18. ECHO – Procedure.
• Place patient in a supine position.Patient is
placed in a supine position and a conductive
gel is applied to the third or fourth intercostal
space to the left of the sternum. The
transducer is placed directly over it.
• Transducer is placed

19. ECHO – Procedure.
• Motion mode is used In motion mode (M-mode), a
single, pencil-like ultrasound beam strikes the heart
and produces a vertical view, which is useful for
recording the motion and dimensions of intracardiac
structures.
• Change in position
In two-dimensional echocardiography, a cross-
sectional view of the cardiac structures is used for
recording the lateral motion and spatial relationship
between structures. For a left lateral view, the patient
is placed on his left side.
• Transducer is angled.

20. ECHO – Procedure.
• Record findings.During the test, the screen is
observed; significant findings are recorded on a
strip chart recorder or a video tape recorder.
• Doppler echocardiography.
Doppler echocardiography also may be used
where color flow stimulates red blood cell flow
through the heart valves. The sound of blood
flow also may be used to assess heart sounds and
murmurs as they relate to cardiac
hemodynamics.

21. Echocardiographic views(2-D)
• Para sternal view.
-Parasternal long axis view
-Parasternal short axis view
• Apical view
• Subcostal view
• Suprasternal view

22. Parasternal long axis view
• The 2~4th intercostal space
• Just lateral to the sternal border
• Indicator pointing toward the right shoulder

24. Parasternal long axis view
• Proper alignment is essential to obtain
accurate measurements of the LVOT, aorta, LA,
LV wall thickness, and LV systolic and diastolic
diameters

25. Parasternal long axis view

26. Parasternal short axis view -Aortic
valve level
• The second intercostal space
• Just lateral to the sternal border
• Indicator pointing toward the left shoulder

28. Apical 4 chamber view

29. Apical 4 chamber view
Structures can seen ;
• LA,LV.
• RA, RV.
• Tricuspid valve
• Mitral Valve .

30. Apical 4 chamber view

31. Apical 4 chamber view

32. Apical 5 chamber view .
Structures can seen ;
• LA,LV.
• RA, RV.
• Tricuspid valve
• Mitral Valve .
• Aortic Valve .
(Structures of 4 chamber view + Aortic Valve . ) .

33. Apical 3 chamber view

34. Apical 3 chamber view
Structures can seen ;
• LA,LV.
• Mitral Valve .
• Aortic Valve.
• Aorta .

35. Apical 2 chamber view

36. Apical 2 chamber view
Structures can seen ;
• LA,LV.
• Mitral Valve .

37. Apical 2 chamber view

38. Subcostal view
Probe is placed below sternum in
abdominal level.
•RV diastolic wall thickness
• Interatrial communication
• Pericardial effusion

40. Subcostal view

41. Subcostal view

42. Suprasternal view
Views from above to sternum

43. Suprasternal view

45. ECHO – Heart Failure
Scenarios(some causes)

46. ECHO – Heart Failure
Scenarios(some causes)
Heart Failure may be of ;
• Heart Failure with Preserved Ejection Fraction
(EF)More than 50 % .
• Heart Failure with Reduced Ejection Fraction
(EF) less than 40 % .

47. ECHO – Heart Failure
Scenarios(some causes)
Heart Failure due to Dialated Cardio
Myopathy. (DCM )
Echo findings
• LV & LA Dialated.
• RV & RA Dialated .
• Decreased EF, Less than 40%.
• MR,TR (due to enlarged anulus of the valve )

48. ECHO – Heart Failure
Scenarios(some causes)
Heart Failure due to Hypertrophic Cardio
Myopathy.
Echo findings
• LV hypertrophy & LA Dilated.
• LV Outflow Tract (LVOT) obstruction – Gradient
is seen (Dagger Shaped)

49. ECHO – Heart Failure
Scenarios(some causes)
Heart Failure due to Restrictive Cardio
Myopathy.
Echo findings
• Speckled appearance of myocardium .
• Heart size is Normal .

50. ECHO – Heart Failure
Scenarios(some causes)
Heart Failure due to Restrictive Cardio
Myopathy.
Echo findings
• Speckled appearance of myocardium .
• Heart size is Normal .

51. ECHO – Heart Failure
Scenarios(some causes)
Heart Failure due to Arrhythmias .
Echo findings
• LV& RA Dilated .
• Ventricular size is Normal .
• MR, TR .

52. ECHO – Heart Failure
Scenarios(some causes)
Heart Failure due to Structural diseases .
Echo findings
• Specific structural abnormalities specific to
that structure.

53. ECHO – Heart Failure
Scenarios(some causes)
Heart Failure due to Structural diseases .
Echo findings
A stiff left ventricle with decreased
compliance and impaired relaxation, which
leads to increased end diastolic pressure.
The diagnosis of diastolic heart
failure is best made with Doppler
echocardiography.

54. ECHO- Role of Nurse .
• The responsibilities of a
nurse during
echocardiography
includes explanation of the
procedure to the patient,
monitoring during
tranesophageal and stress
examinations, and
establishing intravenous
access for medication
administration.

55. Role of Nurse - Before the procedure
• Explain the procedure to the patient. Inform the patient that echocardiography is
used to evaluate the size, shape, and motion of various cardiac structures. Tell who
will perform the test, where it will take place, and that it’s safe, painless, and is
noninvasive.
• No special preparation is needed. Advise the patient that he doesn’t need to restrict
food and fluids for the test.
• Ensure to empty the bladder. Instruct patient to void prior and to change into a
gown.
• Encourage the patient to cooperate. Advise the patient to remain still during the
test because movement may distort results. He may also be asked to breathe in or out
or to briefly hold his breath during the exam.
• Explain the need to darkened the examination field. The room may be darkened
slightly to aid visualization on the monitor screen, and that other procedure (ECG
and phonocardiography) may be performed simultaneously to time events in the
cardiac cycles.
• Explain that a vasodilator (amyl nitrate) may be given. The patient may be asked
to inhale a gas with a slightly sweet odor while changes in heart functions are

56. Role of Nurse - During the procedure
• Inform that a conductive gel is applied to the
chest area. A conductive gel will be applied to his
chest and that a quarter-sized transducer will be
placed over it. Warn him that he may feel minor
discomfort because pressure is exerted to keep
the transducer in contact with the skin.
• Position the patient on his left side. Explain that
transducer is angled to observe different areas of
the heart and that he may be repositioned on his
left side during the procedure.

58. Role of Nurse - After the procedure
• Remove the conductive gel from the patient’s
skin. When the procedure is completed,
remove the gel from the patient’s chest wall.
• Inform the patient that the study will be
interpreted by the physician. An official report
will be sent to the requesting physician, who
will discuss the findings with the patient.
• Instruct patient to resume regular diet and
activities. There is no special type of care given
following the test.
• Recording and Reporting .

62. BEST OF LUCK…
THANK YOU VERY MUCH ….