2. z
Introduction
Echocardiography is an Examination of the heart
using ultrasound
Non-invasive and painless
Membutuhkan skill khusus dan kualitas
pemeriksaan bergantung pada operator
Measurement is OBJECTIVE but interpretation is
SUBJECTIVE
Kaddoura S. Echo Made Easy. 2nd edition. UK: Elsevier; 2009.
4. z
TRANSDUCER MOVEMENTS
TILT
The transducer
maintains the same
axis orientation to the
heart but moves to a
different imaging
plane.
SWEEP
Multiple transducer
movements are used
to record a long video
clip to show multiple
anatomic structures.
ROTATE
The transducer
maintains a stationary
position while the
index marker is
moved to a new
position.
SLIDE
The transducer
moves across the
patient’s skin to a
new position.
ROCK
Within the same
imaging plane, the
transducer changes
orientation either
toward or away from
the orientation
marker.
ANGLE
The transducer is
kept at the same
location on the chest,
and the sound beam
is directed to show a
new structure.
7. z
Metode
Echocardiography
2-D echo
Potong lintang ‘real time’ dari struktur yang dinilai
Motion mode (M-mode)
Diperoleh dari perekaman pengiriman dan penerimaan
gelombang suara dalam satu garis lurus
Dapat melihat pergerakan katup dan dinding jantung
Doppler (PW dan CW)
Melihat pergerakan aliran darah
Frekuensi yang dipantulkan menggambarkan kecepatan dan
aliran darah
Bisa menggunakan colour flow mapping
Kaddoura S. Echo Made Easy. 2nd edition. UK: Elsevier; 2009.
19. z
Parasternal Short Axis (PSAX)s
ICS 2-4 parasternal kiri
Marker dot mengarah ke bahu kiri
(90 derajat dari PLAX)
Terdapat 4 ketinggian
Katup aorta
Katup mitral
Muskulus papilaris LV
Apeks LV
20. z
• Kaddoura S. Echo Made Easy. 2nd edition.
UK: Elsevier; 2009.
24. z
Apical 4-Chamber
Kaddoura S. Echo Made Easy. 2nd edition. UK: Elsevier; 2009.
Posisi di apex
jantung (ICS 5)
Marker dot
mengarah ke
bahu kiri atau
jam 3
26. z
Apical 5-Chamber
Dari 4-chamber view, miringkan
transducer agar gelombang ke
arah anterior
Berguna dalam mengevaluasi AS
dan AR
Kaddoura S. Echo Made Easy. 2nd edition. UK: Elsevier; 2009.
37. z
Doppler colour flow mapping
BART: Blue Away, Red Towards
Semakin tinggi kecepatan, warna
semakin terang
Kaddoura S. Echo Made Easy. 2nd edition. UK: Elsevier; 2009.
40. z
Nilai Normal
Echo Dewasa
Dipengaruhi oleh
Tinggi badan
Jenis kelamin
Usia
Aktivitas fisik
Kaddoura S. Echo Made Easy. 2nd edition. UK: Elsevier; 2009.
41. z
peak Doppler velocities
Rumus Bernoulli
P = pressure (mmHg)
V = velocity (m/sec)
Kaddoura S. Echo Made Easy. 2nd edition. UK: Elsevier; 2009.
Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: Eae/ase recommendations for clinical practice. Eur J Echocardiogr. 2009;10(1):1-25. doi:10.1093/ejechocard/jen303
42. z
Vmax & Gradien
Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: Eae/ase recommendations for clinical practice. Eur J Echocardiogr. 2009;10(1):1-25. doi:10.1093/ejechocard/jen303
43. z
Mengukur Tekanan Sistolik LV
Jika tidak terdapat LVOTO, maka tekanan sistolik LV (LVSP) sama dengan tekanan
sistolik aorta (SBP)
Jika terdapat LVOTO atau AS, maka LVSP = SBP + AS/LVOT gradient
Mengukur Tekanan Diastolik LV
• Left ventricle end diastolic pressure (LVEDP) dapat dihitung dengan
tekanan diastolik aorta (DBP) dan AR gradient.
• LVEDP = DBP – AR gradient
• Jika DBP 80 mmHg dan terdapat jet AR 4 m/s, maka AR gradient = 4x4x4 = 64 mmHg
• DBP – LVEDP = 64 mmHg
• LVEDP = 80-64 mmHg = 16 mmHg
Kronzon I. Echo doppler assessment of right and left ventricular hemodynamics. New York; 2018.
44. z
Mengukur Tekanan Sistolik LA
Left atrial systolic pressure (LASP) dapat dihitung dengan LVSP dan MR
gradient.
LASP = LVSP – MR gradient
Jika diketahui SBP 120 mmHg (=LVSP)
Jet MR 5 m/s mitral gradient 100 mmHg
LVSP – left atrial systolic pressure (LASP) = 100 mmHg (4x5x5)
LASP = LVSP - 100 mmHg = 20 mmHg
Mengukur Tekanan Diastolik LA
• Left atrial diastolic pressure (LADP) dapat dihitung dengan LVDP dan MS gradient.
• LADP = LVDP + MS gradient
Kronzon I. Echo doppler assessment of right and left ventricular hemodynamics. New York; 2018.
45. z
Mengukur Tekanan Diastolik RV
Jika tidak terdapat TS, maka RV diastolic pressure (RVDP)
sama dengan RA pressure (RAP)
Jika terdapat TS, maka RVDP = RAP – TS gradient
Kronzon I. Echo doppler assessment of right and left ventricular hemodynamics. New York; 2018.
46. z
MEASURING IVC
M-Mode
IVC CVP ~ RA Pressure
Normal IVC diameter:
Inspiration: 0.46 to 1.54cm
Expiration: 0.97 to 2.26cm
Sniff Test
maximum size < 2.1 cm and a collapse >50% during sniff =
right atrial pressure 0–5 mm Hg
maximum size > 2.1 cm; collapses >50% during sniff = 5–10
mm Hg
maximum size > 2.1; collapses <50% during sniff = 10–20 mm
Hg
49. z
Mengukur Tekanan Distolik PA
Pada keadaan normal, RVDP = RAP
Pulmonary artery diastolic pressure (PADP) dapat dihitung dengan cara:
PADP-RVDP = PR gradient --> PADP = RVDP + PR gradient
Bila tidak ada PADP = RAP + PR gradient
Kronzon I. Echo doppler assessment of right and left ventricular hemodynamics. New York; 2018.
50. z
Mengukur Tekanan Sistolik RV
Right ventricle systolic pressure (RVSP) = RAP + Tricuspid valve
gradient (TVG)
TVG = RVSP-RAP = 4 x VTr
2
Jika VTr = 2m/s dan RAP 0, maka RVSP = 16 mmHg (4x2x2)
Kronzon I. Echo doppler assessment of right and left ventricular hemodynamics. New York; 2018.
51. z
Mengukur Tekanan Sistolik PA
Jika tidak terdapat PS, maka PASP=RVSP
Jika terdapat PS, maka PASP = RVSP – PS gradient
Kronzon I. Echo doppler assessment of right and left ventricular hemodynamics. New York; 2018.
52. z
Wall motion score
index (wmsi)
- Add points, divide by 17
- >1.7 heart failure
https://ecgwaves.com/topic/regional-myocardial-contractile-function-wall-
motion-abnormality/
54. z
Penilaian Fungsi Sistolik LV
Dapat dinilai dengan M-mode, 2-D, dan Doppler
2-D echo
Menilai fungsi sistolik LV secara visual, baik regional maupun global
Wall motion (4 chamber dan parasternal short axis)
Normal
Hipokinetik
Akinetik
Diskinetik
M-mode
Mengukur dimensi ruang LV, pergerakan dinding, dan penebalan
dinding
Kaddoura S. Echo Made Easy. 2nd edition. UK: Elsevier; 2009.
55. z
Ejection Fraction (EF)
Perubahan volume LV diantara
sistol dan diastole
Normal 50-85%
• Fractional shortening (FS)
• Perubahan dimensi LV
diantara sistol dan diastole
• Normal 30-45%
Simpson method: rule of disks
Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: Eae/ase recommendations for clinical practice. Eur J Echocardiogr. 2009;10(1):1-25. doi:10.1093/ejechocard/jen303
57. z
Tricuspid annular plane systolic
excursion (TAPSE)
Merupakan fungsi RV global yang menggambarkan
pemendekan apex-to-base
TAPSE berhubungan dengan RVEF
Diukur di 4 chamber view
Mengukur pergerakan annulus trikuspid lateral ke arah apeks
saat sistolik
Abnormal bila <1.7 cm
70. z
Aortic Stenosis
2-D echo
Kuspis menebal, kalsifikasi, pergerakan berkurang atau berbentuk “dome”
LV hipertrofi
Post-stenotic dilation
Doppler
Derajat berat AS dinilai dengan valve area, peak velocity, peak pressure gradient, dan mean
pressure gradient
Komponen yang dibutuhkan untuk penilaian AS adalah aortic vmax, aortic gradient,
aortic valve area
76. z
Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: Eae/ase recommendations for clinical practice. Eur J Echocardiogr. 2009;10(1):1-25. doi:10.1093/ejechocard/jen303
77. z
Vmax & Gradien
Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: Eae/ase recommendations for clinical practice. Eur J Echocardiogr. 2009;10(1):1-25. doi:10.1093/ejechocard/jen303
78. z
Continuity equation
Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: Eae/ase recommendations for clinical practice. Eur J Echocardiogr. 2009;10(1):1-25. doi:10.1093/ejechocard/jen303
VTI = velocity time integral
79. z
Aortic Regurgitation
M-mode dan 2-D echo membantu menegakkan penyebab AR seperti dilatasi aortic
root, abnormalitas katup (bikuspid, reumatik), diseksi aorta, serta dampak dari AR
seperti dilatasi LV
Komponen yang dibutuhkan untuk penilaian AR adalah % jet width of LVOT, vena
contracta (VC), regurgitant volume (RVol), regurgitant fraction (RF), ERO (effective
regurgitant orifice)
80. z
Transesophageal Echocardiography (TEE)
Keuntungan TEE
Tidak terhalang oleh tulang iga dan
dinding dada
Frekuensi yang digunakan dapat lebih
tinggi 🡪 Kualitas gambar lebih baik
Lebih mudah untuk melihat bagian
posterior seperti LAA, aorta desendens,
vena pulmoner
Kelemahan TEE
Invasif
Risiko trauma esophagus
Risiko aspirasi
Membutuhkan sedasi
83. z
Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, Reeves ST, Shanewise JS, Siu
SC, Stewart W, Picard MH. Guidelines for performing a comprehensive transesophageal
echocardiographic examination: recommendations from the American Society of
Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc
Echocardiogr. 2013 Sep;26(9):921-64. doi: 10.1016/j.echo.2013.07.009. PMID: 23998692.
87. z
Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, Reeves ST, Shanewise JS, Siu SC, Stewart W, Picard MH. Guidelines for performing a comprehensive transesophageal echocardiographic examination:
recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013 Sep;26(9):921-64. doi: 10.1016/j.echo.2013.07.009. PMID:
23998692.
