Echocardiography-why do we need it?

Overview

• 90% of echo requests are for LV function assessment– Qualitative and quantitative

• Remainder for valvular and structural problems

Function• The Heart is a PUMP & forms part of the

Cardiovascular system

•Right and left side of the heart•Work in synchrony

Basic Anatomy of the Heart

Chambers

• Right Atrium (RA)

• Right Ventricle (RV)– Filling Chambers

• Left Atrium (LA)

• Left Ventricle (LV)– Pumping chambers

Vessels

• Vessels:– Aorta (Ao)– Pulmonary artery– Inferior & Superior

Vena Cava (IVC & SVC)

– Pulmonary Veins (PV)

Valves

• Atrioventrucular

• Semilunar

Valves

• The function of the cardiac valves is to prevent retrograde flow of blood through the heart

Septum

• Interventricular septum (IVS)

• Interatrial septum (IAS)

Left Ventricular Walls

Coronary Arteries

Left Anterior Descending ArteryCircumflex ArteryRight Circumflex Artery

The Cardiac Cycle

• Ventricular filling – DIASTOLE

– AV valves are opened

– SV are closed

•

• Ventricular emptying– SYSTOLE

– AV valves are closed

– SV are opened

The Heart in DIASTOLE

The Heart in SYSTOLE

Two-Dimensional Echocardiography (2D)

• Access to the heart can be very difficult

• Windows available:– Parasternal– Apical– Subcostal– Suprasternal– Transoesophageal

Parasternal Long Axis

• Right Ventricular Wall

• Right Ventricle

• Interventricular Septum

• Left Ventricle

• Posterior Wall

• Mitral Valve

• Papillary Muscles

• Chordae Tendinae

• Left Atrium

• Aortic Valve

• Ascending Aorta

Parasternal Short Axis (Aortic Valve Level)

• Right Ventricle

• Left Atrium

• Tricuspid Valve

• Pulmonic Valve

• Pulmonary Artery

• Aortic Valve

• Right Atrium

Parasternal Short Axis (Mitral Valve Level)

• Right Ventricular Wall

• Right Ventricle

• Interventricular Septum

• Left Ventricle

• Mitral Valve

• Posterior Wall

• Pericardium

Parasternal Short Axis (Papillary Level)

• Right Ventricular Wall

• Right Ventricle

• Interventricular Septum

• Left Ventricle

• Papillary Muscles

• Posterior Wall

Apical Four Chamber

• Left Ventricular Apex• Interventricular Septum• Right Ventricle• Interatrial Septum• Left Ventricle• Lateral Wall• Mitral Valve• Tricuspid Valve• Papillary Muscles• Chordae Tendinae• Left Atrium• Right Atrium • Pulmonary Veins

Apical Five Chamber

• Left Ventricular Apex• Interventricular Septum• Right Ventricle• Interatrial Septum• Left Ventricle• Lateral Wall• Mitral Valve• Tricuspid Valve• Aortic Valve• LV Outflow Tract• Left Atrium• Right Atrium • Pulmonary Veins

Apical Two Chamber

• Left Ventricular Apex

• Left Ventricle• Inferior Wall• Anterior Wall• Mitral Valve• Left Atrium • Pulmonary Veins

Apical Long Axis

• Left Ventricular Apex

• Left Ventricle• Inferior Wall• Anterior Wall• Mitral Valve• Left Atrium • AO

SUBCOSTAL

SUPRASTERNAL

Hands on!!!!!

• M-Mode is obtained by placing a cursor through structures of interest in the Heart

• Only structures transected by this line are imaged and they are plotted against time to form a tracing

M-Mode echocardiography

• A graph against time of the position of the reflecting structures of the heart relative to the marker is produced

• The M-Mode, or Time Motion, makes accurate measurements of dimensions and velocity of motion

M-Mode echocardiography

• PLAX or PSAX

M-Mode AO/LA

• PLAX or PSAX

M-Mode MITRAL VALVE

• PLAX or PSAX

M-Mode LEFT VENTRICLE

Hands on!!!!!

• To assess blood flow VELOCITY and DIRECTION• PWD is used when the exact location of the blood

flow sampled needs to be known• CWD is used when we need to determine the peak

velocity of blood flow through a particular valve

DOPPLER

• Blood flow from the LA to the LV• Diastole• Displayed above the baseline

FLOW PATTERNSMITRAL VALVE FLOW

• Blood ejected from the LV into the Ao • Systole• Displayed below the baseline

FLOW PATTERNSAORTIC VALVE FLOW

• Blood flow from the RA to the RV• Diastole• Displayed above the baseline

FLOW PATTERNSTRICUSPID VALVE FLOW

• Blood ejected from the RV into the PA • Systole• Displayed below the baseline

FLOW PATTERNSPULMONARY VALVE FLOW

• To assign colors to flow direction and show the entire area of any flow, normal or abnormal, within the Heart

• Quick visual search of flow anomalies.• Standard practice is “BART”

COLOR FLOW DOPPLERin Echocardiography

AORTIC INSUFFICIENCY

MITRAL STENOSIS/INSUFFICIENCY

Hands on!!!!!

PATHOLOGIESPATHOLOGIES

Ultrasound in Cardiac Assessments

Ultrasound in Cardiac Assessments

• Valve Disease

• Cardiomyopathy

• Endocarditis

• Prosthetic Heart valve assessment

• Pericardial effusion

• Systemic Hypertension

• Pulmonary Hypetension

• Ischemic Heart Disease

• Septal Defects

• Tumours

Mitral ValveMitral Valve

• Disease of the Mitral Valve– Mitral Stenosis– Mitral Regurgitation– Mitral Valve Prolapse

Mitral StenosisMitral Stenosis

Mitral RegurgitationMitral Regurgitation

Aortic ValveAortic Valve

• Disease– Aortic Stenosis

– Aortic Regurgitation

– Bicuspid Valve

Aortic RegurgitationAortic Regurgitation

Tricuspid ValveTricuspid Valve

• Disease– Stenosis– Regurgitation

Tricuspid RegurgitationTricuspid Regurgitation

PulmonaryValvePulmonaryValve

• Disease– Stenosis– Regurgitation