ECHOCARDIOGRAPHY
BY:
DEEPAK GHIMIRE
MEDICAL INTERN
SOUTHWESTERN UNIVERSITY
SCHOOL OF MEDICINE
PRESENTED OCTOBER ,2015
PERCEPTOR INCHARGE: VICENTE G. BALBUENA,MD
ECHOCARDIOGRAPHY
Cardiac Anatomy
Base
Apex
4 phases of Diastole
Isovolemic relaxation
2. Rapid ventricular filling
3. Slow ventricular filling
4. Atrial contraction
1.
4 phases of Systole
Isovolemic contraction
2. Rapid ventricular ejection
3. Slow ventricular ejection
1.
Imaging Modalities
1. 2D- Echocardiography
2. M-mode Echocardiography
Echocardiography
A non-invasive diagnostic technique
Widely used in clinical cardiology.
Involves the use of ultrasound
Used to assess cardiac structure and
Indications of 2D Echocardiography
May be divided into structural imaging and
Indications of 2D Echocardiography
May be divided into structural imaging and
Echocardiography
Physics :
generated Based on
intensity of reflected echo
Black
Fluid or blood
White
Calcifications on cardiac
valves/ pericardium
Gray
Myocardium
Factors in Echocardiography
Transducers
Image Quality
Modes of Display
M-Mode echocardiography
Pulse
Continuous
Parasternal view
Apical view
Subcostal view
structures
Assessment
RV (right
ventricle)
LV (left
ventricle)
Ao (ascending
aorta)
Size
AV (aortic
valve)
Motion, opening
and calcification
MV (mitral
valve)
Motion, opening
and calcification
Pericardium
Fluids
Assessment :
1. Pericardial space
2. RV
3. Septum
4. LV
5. Anterior MV leaflet
6. Aortic root
7. LA
Pericardial effusion
PSAX
The probe can be tilted to examine the
PSAX
2. LV
3. Septum
4. RV
5. RA
6. Interartrial septum
7. LA
8.MV annulus
Apical view
LV
* Transducer in Right sub xiphiod area & side marker in 3 oclock position
2. RV
3. Septum
4. MV annulus
5. LV
6. IVC
Trans-Esophageal Echocardiography
Used to assess
posterior
structures like
LA or Aorta
Contrast echocardiography
Indications of 2d Echocardiography in
evaluation of Heart murmurs
PLAX
MR, AR , VDS
Subcostal :
Apical :
4chamber : MR, TR
2 chamber: MR
Long axis: MR, AR, AS,
LVOT
5 chamber: LV outflow,
AR, AS
Suprasteral:
Right Parasternal Lx
Ascending aorta, AS
Two-Dimensional Echocardiography
Cardiac chambers
Chamber size
Left ventricular
Hypertrophy
Regional wall motion
abnormalities
Valve
Morphology and motion
Pericardium
Effusion
Tamponade
Masses
Great vessels
Transesophageal
Echocardiography
Inadequate transthoracic
images
Aortic disease
Infective endocarditis
Source of embolism
Valve prosthesis
Intraoperative
2D Echocardiography
An ideal imaging modality for assessing left
DOPPLER ECHOCARDIOGRAPHY
Uses ultrasound reflecting off moving RBC to
assessed noninvasively.
DOPPLER ECHOCARDIOGRAPHY
The different colors indicate the direction of blood flow:
DOPPLER ECHOCARDIOGRAPHY
Valve gradients in stenosis ( Inc. velocity )
Valvular regurgitation (retrograde flow)
Intracardiac pressures (PAH)
Cardiac output (area X velocity)
Diastolic filling
Congenital heart disease (shunts)
VSD
Aortic Regurgitation
kissing LV
chambers
Collapsing IVC
Temponade
Cardiac Temponade
IVC dilation
Diastolic RV collapse.
Pleural Effusion
Echocardiography
The quality of an echo is highly operator
Good Morning !