Echocardiogram Dr Emily Player 2 D Echo Structural

Echocardiogram Dr Emily Player

2 D Echo • Structural and functional test of the heart • Uses Ultrasound • Sound waves are sent from the probe/ transducer by piezoelectric crystals (£££) • 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 1

Doppler • Doppler - Uses moving structures i. e. blood flow the time difference is known as doppler shift - 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) - Colour, PW and CW doppler - BART Blue- away from transducer. Red- towards 1 1

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

Performing an Echo Before you Start 1. Position patient- USS does not travel through bone and air 2. Monitor Cardiac cycle with ECG 3. Left or Right sided echo 4. Patient ID 5. Aqueous Gel Figure 1: Source 2

The Echo Windows Parasternal Views C 1 - Long Axis – pointer to R shoulder Short Axis- pointer to L shoulder Position probe approximately at V 2 chest lead on ECG Remember rib spaces Apical Views C 2 - 4 and 5 chambers- pointer to L axilla - 2 and 3 chambers- rotate 90° Subcostal C 3 - 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 • • 3 D Object M Mode Simpsons Method of Discs Global Impression Regional Wall Motion Abnormalities VTI, fractional shortening Tissue Doppler

LV Normal measurements [14], [15] Norm Mild al Mod Severe LV wall thickness IVSd / PWd (cm) 0. 6– 1. 2 1. 3– 1. 5 1. 6– 1. 9 >2. 0 LV dimension, women LVIDd (cm) 3. 9– 5. 3 5. 4– 5. 7 5. 8– 6. 1 >6. 2 LVIDd / BSA (cm/m 2) 2. 4– 3. 2 3. 3– 3. 4 3. 5– 3. 7 >3. 8 LV dimension, men LVIDd (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. 7 LVIDd / BSA (cm/m 2)

Simpsons Method of Discs [14] LV function assessment using Simpson's method 1 Parameter Formula LV end-diastolic volume (LVEDV) ml/m 2 LV end-systolic volume ml/m 2 Stroke volume (SV) ml/m 2 Ejection fraction (EF) (%) Value (range) 49 -85 17 -37 LVEDVLVESV SV/LVEDV 26 -54 49 -71

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=HDRSC 3#view=detail&mid=D 9 B 34 B ADCC 4 C 0 BBF 6 ACBD 9 B 34 BADCC 4 C 0 BBF 6 ACB (apical wall) • http: //www. bing. com/videos/search? q=echo+LV+function +regional+wall&FORM=HDRSC 3#view=detail&mid=025440 278 D 623 A 9003 C 4025440278 D 623 A 9003 C 4 (lateral wall) • http: //www. bing. com/videos/search? q=echo+LV+function +regional+wall&FORM=HDRSC 3#view=detail&mid=10 ADD DEAA 7 F 5 D 4 E 3 AD 6410 ADDDEAA 7 F 5 D 4 E 3 AD 64 (septal wall)

Right Ventricle [16] RV dimensions (apical 4 chamber) Abnormal Basal RV diameter (RVD 1) (cm) >4. 2 Mid RV diameter (RVD 2) (cm) >3. 5 Base to apex length >8. 6 (RVD 3) (cm)

References 1. http: //emedicine. medscape. com/article/1820912 -technique#aw 2 aab 6 b 4 b 1 aa , accessed on 25. 02. 15 2. http: //www. mayoclinic. org/tests-procedures/echocardiogram/multimedia/echocardiogram/img-20007334 , accessed on 25. 02. 15 3. http: //www. henryfordultrasounduniversity. com/wpcontent/uploads/2010/06/pg 26_Echocardiographic. Windows 2. jpg , accessed on 25. 02. 15 4. http: //www. yale. edu/imaging/echo_atlas/views/, accessed on 25. 02. 15 5. http: //www. finalfrca. co. uk/wp-content/uploads/2013/10/PLAX. gif, accessed on 25. 02. 15 6. https: //afghanheart. files. wordpress. com/2013/09/short-axis-view-echo. jpg , accessed on 25. 02. 15 7. http: //www. yale. edu/imaging/echo_atlas/views/four_chamber. html, accessed on 25. 02. 15 8. https: //web. stanford. edu/group/ccm_echocardio/cgi-bin/mediawiki/index. php/Apical_5_chamber_view , accessed on 25. 02. 15 9. http: //www. yale. edu/imaging/echo_atlas/views/apical_2 c. html, accessed on 25. 02. 15 10. http: //webservice 1. mvm. ed. ac. uk/imaging/demo/echo-section/basic_echo_3 chamber. html , accessed on 25. 02. 15 11. http: //www. ultrasoundcriticalcare. com/cardiac-subcostal-view/, accessed on 25. 02. 15 12. https: //cardiophile. org/echocardiographic-profile-in-pulmonary-hypertension-2/ , accessed on 25. 02. 15 13. http: //echocardiographer. org/TTE. html, accessed on 25. 02. 15 14. http: //www. bsecho. org/evaluation-of-systolic-function-of-the-left-ventricle/ , accessed on 25. 02. 15 15. http: //www. emergencyultrasound. org. uk/resources/05+LV+Function+web. pdf, accessed on 21. 03. 15 16. http: //www. criticalecho. com/content/tutorial-5 -assessment-lv-systolic-function , accessed on 21. 03. 15