Echocardiogram

Dr Emily Player

2D Echo

• Structural and functional test of the heart• Uses Ultrasound• Sound waves are sent from the probe/ transducer by

piezoelectric crystals (£££) 1

• The waves travel back at various speeds producing an image

• US can’t travel through air therefore aqueous gel required to transmit signal

• Each signal sent as a plane and many lines of information are sent back, therefore a real time image is gained 1

Doppler

• Doppler- Uses moving structures i.e. blood flow the time

difference is known as doppler shift 1

- An equation is applied to the doppler shift (Fr-Ft) providing velocities of blood flow

- Blood flow velocity = c (Fr – FT)/2 FT (cos θ) 1

- Colour, PW and CW doppler- BART Blue- away from transducer. Red- towards

Indications in ITU

• LV function• Significant Valve abnormalities• Tamponade/ effusion• RV dilatation• Volume status- Thrombus, rupture, aneurysmal LV

Performing an Echo

Before you Start1. Position patient- USS does

not travel through bone and air

2. Monitor Cardiac cycle with ECG

3. Left or Right sided echo4. Patient ID 5. Aqueous Gel

Figure 1: Source 2

The Echo Windows

Parasternal Views C1- Long Axis – pointer to R shoulder- Short Axis- pointer to L shoulder- Position probe approximately at V2

chest lead on ECG- Remember rib spaces

Apical Views C2- 4 and 5 chambers- pointer to L

axilla- 2 and 3 chambers- rotate 90°Subcostal C3- Probe flat, pointer to L horizontal

Figure 2: Source 3

Echo Windows

Parasternal Long Axis [4] Parasternal Short Axis [5]

Echo Windows [6]

http://echocardiographer.org/TTE.html

Echo Windows

Apical 4 Chamber View [7] Apical 5 Chamber View [8]

Echo Windows

Apical 2 Chamber View [9] Apical 3 Chamber View [10]

Echo Windows

Subcostal [11], [12] Suprasternal [13]

Assessing the LV

• 3D Object• M Mode• Simpsons Method of Discs• Global Impression• Regional Wall Motion Abnormalities• VTI, fractional shortening• Tissue Doppler

LV Normal measurements [14], [15]

Normal

Mild Mod Severe

LV wall thicknessIVSd / PWd (cm)

0.6–1.2

1.3–1.5

1.6–1.9

>2.0

LV dimension, womenLVIDd (cm)

3.9–5.3

5.4–5.7

5.8–6.1

>6.2

LVIDd / BSA (cm/m2)

2.4–3.2

3.3–3.4

3.5–3.7

>3.8

LV dimension, menLVIDd (cm)

4.2–5.9

6.0–6.3

6.4–6.8

6.9

2.2–3.1

3.2–3.4

3.5–3.6

3.7LVIDd / BSA (cm/m2)

Simpsons Method of Discs [14]

Parameter Formula Value (range)

LV end-diastolic volume (LVEDV) ml/m2

49-85

LV end-systolic volume ml/m2

17-37

Stroke volume (SV) ml/m2

LVEDV-LVESV

26-54

Ejection fraction (EF) (%) SV/LVEDV 49-71

LV function assessment using Simpson's method1

Regional Wall Abnormalities [14]

Video Links

• http://www.criticalecho.com/content/tutorial-5-assessment-lv-systolic-function

• http://www.bing.com/videos/search?q=echo+LV+function+regional+wall&FORM=HDRSC3#view=detail&mid=D9B34BADCC4C0BBF6ACBD9B34BADCC4C0BBF6ACB (apical wall)

• http://www.bing.com/videos/search?q=echo+LV+function+regional+wall&FORM=HDRSC3#view=detail&mid=025440278D623A9003C4025440278D623A9003C4 (lateral wall)

• http://www.bing.com/videos/search?q=echo+LV+function+regional+wall&FORM=HDRSC3#view=detail&mid=10ADDDEAA7F5D4E3AD6410ADDDEAA7F5D4E3AD64 (septal wall)

Right Ventricle [16]

RV dimensions (apical 4 chamber)

Abnormal

Basal RV diameter (RVD1) (cm)

>4.2

Mid RV diameter (RVD2) (cm)

>3.5

Base to apex length (RVD3) (cm)

>8.6

References 1.http://emedicine.medscape.com/article/1820912-technique#aw2aab6b4b1aa, accessed on 25.02.152. http://www.mayoclinic.org/tests-procedures/echocardiogram/multimedia/echocardiogram/img-20007334, accessed on 25.02.153.http://www.henryfordultrasounduniversity.com/wp-content/uploads/2010/06/pg26_EchocardiographicWindows2.jpg, accessed on 25.02.154. http://www.yale.edu/imaging/echo_atlas/views/, accessed on 25.02.155. http://www.finalfrca.co.uk/wp-content/uploads/2013/10/PLAX.gif, accessed on 25.02.156. https://afghanheart.files.wordpress.com/2013/09/short-axis-view-echo.jpg, accessed on 25.02.157. http://www.yale.edu/imaging/echo_atlas/views/four_chamber.html, accessed on 25.02.158. https://web.stanford.edu/group/ccm_echocardio/cgi-bin/mediawiki/index.php/Apical_5_chamber_view, accessed on 25.02.159. http://www.yale.edu/imaging/echo_atlas/views/apical_2c.html, accessed on 25.02.1510. http://webservice1.mvm.ed.ac.uk/imaging/demo/echo-section/basic_echo_3chamber.html, accessed on 25.02.1511. http://www.ultrasoundcriticalcare.com/cardiac-subcostal-view/, accessed on 25.02.1512. https://cardiophile.org/echocardiographic-profile-in-pulmonary-hypertension-2/, accessed on 25.02.1513. http://echocardiographer.org/TTE.html, accessed on 25.02.1514. http://www.bsecho.org/evaluation-of-systolic-function-of-the-left-ventricle/, accessed on 25.02.1515. http://www.emergencyultrasound.org.uk/resources/05+LV+Function+web.pdf, accessed on 21.03.1516. http://www.criticalecho.com/content/tutorial-5-assessment-lv-systolic-function, accessed on 21.03.15