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Echo Normal Values for Echocardiography exams
- 1. JOIN TODAY WWW. ECHO4EXAMS .CO.UK ! QUESTIONS OVER 100+ TRUE/FALSE AT TING 4.99 STAR QUESTIONS TO PRACTICE DETAILED EXPLANATIONS CLEAR, SUCCINCT EXPLANATIONS TO ALL QUESTIONS £2 QUICK REFERENCE GUIDE SUMMARY OF IMPORTANT POINTS TO REMEMBER
- 2. www.echo4exams.co.uk Quick Revision Points - Valvular Heart Disease Table of contents 1. Valves Aortic valve 1. Aortic stenosis 2. Aortic regurgitation Mitral valve 1. Mitral stenosis 2. Mitral regurgitation Tricuspid valve 1. Tricuspid stenosis 2. Tricuspid regurgitation Pulmonary valve 1. Pulmonary stenosis 2. Pulmonary regurgitation Right atrial pressure 1. Valves Valve disease is commonly encountered in clinical practice, and forms one of the commonest reasons for an echocardiogram. It is important to remember the common causes of various valvular conditions and guidance on defining the severity of the lesion. The guidance below is based on British Society of Echocardiography recommended values. This document is a snippet of the content on www.echo4exams.co.uk. Visit the site for exam questions and detailed explanations. ® ©Echo4exams.co.uk (part of E-medilearn.org Limited )
- 3. www.echo4exams.co.uk Aortic valve 1. Aortic stenosis Causes ● Bicuspid valve - common in Europe, usually associated with calcification ● Calcification ● Rheumatic heart disease - common in rest of the world Evaluation Parameter Normal Mild Moderate Severe Peak Velocity (m/s) < 2.5 2.6 - 2.9 3.0 - 4.0 >4.0 Peak pressure drop (mmHg) - < 35 36 - 64 > 65 Mean pressure drop (mmHg) - < 25 25 - 40 > 40 Valve area (cm2) > 2.0 1.5 - 2.0 1.0 - 1.4 < 1.0 Critical valve stenosis = Valve area < 0.6 cm2 2. Aortic regurgitation Causes 1. Valvular a. Infective endocarditis b. Rheumatic heart disease c. Congenital bicuspid valve d. Aortic valve calcification e. Myxomatous degeneration of aortic valve 2. Aortic root a. Dilated aortic root - Marfans syndrome, Ehler Danlos syndrome b. Dilatation secondary to hypertension Evaluation Doppler parameter Mild AR Moderate AR Severe AR ® ©Echo4exams.co.uk (part of E-medilearn.org Limited )
- 4. www.echo4exams.co.uk Pressure half time > 500 ms < 200 ms Vena contracta < 0.3 cm > 0.6 cm Jet width/LVOT < 25% > 65% Regurgitant orifice area < 0.1 cm2 0.11 - 0.29 cm2 =/> 0.3 cm2 Aortic flow reversal early diastolic or none Holodiastolic Regurgitant volume < 30 mL/beat 31 - 59 mL/beat =/> 60 mL/beat Mitral valve 1. Mitral stenosis Causes ● Rheumatic heart disease Evaluation Parameter Normal Mild Moderate Severe Valve area (cm2) 4-6 1.6 - 2.0 1.0 - 1.5 < 1.0 Mean pressure gradient (mmHg) <5 5 - 10 > 10 Pressure half time (ms) 40 - 70 71 - 139 140 - 219 > 220 Pulmonary artery pressure (mmHg) < 30 30 - 50 > 50 2. Mitral regurgitation Causes ● Mitral valve prolapse ● Dilated cardiomyopathy ● Ischemic heart disease ● Papillary muscle rupture Evaluation Parameter Mild Moderate Severe Jet area (cm2) <4 > 10 ® ©Echo4exams.co.uk (part of E-medilearn.org Limited )
- 5. www.echo4exams.co.uk Vena Contracta (cm) < 0.3 >/= 0.7 PISA radius (Nyquist 40 cm/s) < 0.4 > 1.0 Regurgitant volume (mL) < 30 31 - 59 >/= 60 Jet area / LA (%) < 20 % > 40 % Tricuspid valve 1. Tricuspid stenosis Causes ● Rheumatic heart disease (thickened valve leaflets) ● Carcinoid syndrome (normal valve leaflets) ● Valve thickening and calcification ● Obstruction due to thrombus or tumor Evaluation Parameter Normal Severe Mean pressure drop (mmHg) >/ = 5 Valve area (cm2) > 7.0 < 1.0 2. Tricuspid regurgitation Causes Valvular pathology Right heart pathology ● Infective endocarditis ● Pulmonary hypertension ● Rheumatic heart disease ● Cor pulmonale ● Mitral stenosis – causing pulmonary ● Ischemic heart disease hypertension ● Pacing lead ● Ebstein anomaly ● Cardiomyopathy ● Carcinoid syndrome ● ASD/VSD – causes RV volume ● Pathology of subvalvular apparatus overload o Rupture of chordate tendinae o Papillary muscle dysfunction ● Connective tissue disease / Rheumatoid arthritis ® ©Echo4exams.co.uk (part of E-medilearn.org Limited )
- 6. www.echo4exams.co.uk Evaluation Parameter Mild Moderate Severe Jet area <5 5 - 10 > 10 PISA radius (cm) < 0.5 0.6 - 0.9 > 0.9 RA/RV/IVC Normal Normal/dilated Dilated CW jet Soft, parabolic Dense, triangular Hepatic vein flow Predominantly systolic Reversed in systole Pulmonary valve 1. Pulmonary stenosis Causes ● Part of congenital syndromes ○ Noonan’s syndrome ○ Tetralogy of Fallot ○ Rubella ● Acquired ○ Rheumatic fever ○ Carcinoid syndrome ● Subvalvular pulmonary stenosis may be associated with ○ Ventricular septal defect ○ Tetralogy of Fallot ○ Transposition of great arteries Evaluation Mild Moderate Severe Valve area (cm2) >1 0.5 - 1 < 0.5 Peak gradient (mmHg) < 36 36 - 64 > 64 Peak velocity (m/s) <3 3-4 >4 ® ©Echo4exams.co.uk (part of E-medilearn.org Limited )
- 7. www.echo4exams.co.uk 2. Pulmonary regurgitation Causes ● Carcinoid syndrome (with tricuspid valve disease) ● Endocarditis ● Congenital valve abnormalities ● Pulmonary valve prolapse Evaluation Parameter Mild Mod Severe Jet size (cm) Narrow Wide and large Regurgitant fraction (%) < 40 40 - 60 > 60 RVOT vti / LVOT vti Raised Significantly elevated Right atrial pressure 0 -5 mmHg 5-10 mmHg 10-15 mmHg 15-20 mmHg > 20 mmHg IVC Size (cm) < 1.5 1.5 - 2.5 1.5 - 2.5 > 2.5 > 2.5 Variation with Collapses > 50% < 50% < 50% collapse No collapse respiration fully collapse collapse RA size Normal Normal Mildly dilated Moderately Severely dilated dilated Hepatic vein Mildly dilated Severely dilated OR Diameter of IVC on expiration IVC collapse on inspiration Estimated Right Atrial pressure (cm) (%) (mmHg) <2 Full collapse 0-5 <2 > 50 5 - 10 >2 25 - 50 10 - 15 >2 < 25 15 - 20 ® ©Echo4exams.co.uk (part of E-medilearn.org Limited )