ACE (ADVANCED

CARDIAC ECHO)


Indicator

Low frequency (3~5

MHZ Probe)

CurvedLow frequency (2.53.5 MHZ Probe)

ANATOMY

PROBE MANIPULATION
Sliding
Rocking
Tilting
Rotation

SLIDING

ROCKING

TILTING

ROTATION

ECHO WINDOWS
SS

SS

SC

P
A

SC

MAIN CARDIAC VIEWS

Parasternal
Subcostal
Apical

SUBCOSTAL VIEW
Indicator: left flank

Transducer
placement

Desired Image

What the image shows

SUBCOSTAL VIEW

Illustration by Patrick J Lynch

www.infomed.yale.edu

IVC VIEW

SUPRASTERNAL NOTCH VIEW

SUPRASTERNAL NOTCH VIEW

PARASTERNAL LONG AXIS

Indicator: right shoulder

PARASTERNAL LONG AXIS

Illustration by Patrick J Lynch

www.infomed.yale.edu

PARASTERNAL LONG AXIS DIASTOLE

Measure LV diameter
- Normal: 57 mm
Measure LV walls
- Normal: 11 mm
Assess for Pericardial
Effusion
- anterior to RV or posterior
to LV

PARASTERNAL LONG AXIS SYSTOLE

Measure LA diameter
Normal: 40 mm

Aortic root approx.

same size as LA

PARASTERNAL SHORT AXIS

Indicator: left shoulder

LA

SA

APICAL 4 CHAMBER
Indication: left shoulder

Transducer
placement

Desired Image

What the image shows

APICAL 2 CHAMBER

Illustration by Patrick J Lynch

www.infomed.yale.edu

EYEBALLING

LEFT VENTRICLE
Diameter

WALL THICKNESS

Average about 1 cm (0.6~0.9)

LEFT ATRIUM

About LV major axis (<4 cm)

RIGHT VENTRICLE
Crescent shape
Diameter <3 cm (apical 4
chamber view),
<2 cm (parasternal long
axis view)
Size about 2/3 of LV

WALL THICKNESS

<0.5 cm (subcostal long axis, free wall)

SUMMARY
0.5 (RV wall thickness, SLAX)
1 (LV wall thickness, PLAX)
2 (RV diameter, PLAX)
3 (RV diameter, A4CH)
4 (LA diameter, PLAX)
5 (LV diameter, PLAX)

ACUTE V.S. CHRONIC

Wall thickening
Ventricle hypertrophy
Atrium dilatation

WALL MOTION
Normal
Hyperkinetic
Akinetic
Dyskinetic: may fail to
contract, bulges outward at
systole
Hypokinetic

M-MODE
M-line

Motion over Time

TIME

M-MODE

distance

time

30 AND 20

LV SEGMENTATION

TRICUSPID ANNULAR PLANE SYSTOLIC

EXCURSION (TAPSE)

Hypokinesia
<18 mm

D SHAPE SIGN
(FLATTENED SEPTUM)

PARADOXICAL SEPTAL MOTION

MCCONNELLS SIGN
Akinesia of the mid free wall (base and mid segment)
Normal motion at the apex

COLOR DOPPLER

Flow toward transducer = RED

Flow away from transducer = BLUE

MITRAL VALVE

Anterior and Posterior leaflet (<3 mm)

AORTIC VALVE

Leaflet thickness (<3 mm)

HOW TO SUSPECTED AORTIC DISSECTION

FROM ECHOCARDIOGRAPHY?
Symptoms
Aortic root > 3.8 cm
Aortic flap over root or Descending aorta
Severe AR

TRICUSPID VALVE

PULMONARY VALVE

SIZE OF THE PERICARDIAL

EFFUSION
Not Precise
Small: confined to posterior space, < 0.5cm
Moderate: anterior and posterior, 0.5-2cm (diastole)
Large: > 2cm

PERICARDIAL V.S. PLEURAL

THANKS TO~~

SPECIAL THANKS TO~~


http://vimeo.com/hqmeded/videos

THANKS FOR YOUR

ATTENTION !!