cardiac anatomy

1. Echocardiography
-why do we need it?

2. Overview
• 90% of echo requests are for LV function
assessment
– Qualitative and quantitative
• Remainder for valvular and structural problems

3. Function
• The Heart is a PUMP & forms part of the
Cardiovascular system
•Right and left side of the heart
•Work in synchrony

4. Basic Anatomy of the Heart

5. Chambers
• Right Atrium (RA)
• Right Ventricle (RV)
– Filling Chambers
• Left Atrium (LA)
• Left Ventricle (LV)
– Pumping chambers

6. Vessels
• Vessels:
– Aorta (Ao)
– Pulmonary artery
– Inferior & Superior
Vena Cava (IVC &
SVC)
– Pulmonary Veins
(PV)

7. Valves
• Atrioventrucular
• Semilunar

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

9. Septum
• Interventricular
septum (IVS)
• Interatrial
septum (IAS)

10. Left Ventricular Walls

11. Coronary Arteries
Left Anterior Descending Artery
Circumflex Artery
Right Circumflex Artery

12. The Cardiac Cycle
• Ventricular filling • Ventricular emptying
– DIASTOLE – SYSTOLE
– AV valves are opened – AV valves are closed
– SV are closed – SV are opened
•

13. The Heart in
DIASTOLE

14. The Heart in
SYSTOLE

15. Two-Dimensional
Echocardiography (2D)
• Access to the heart can be very difficult
• Windows available:
– Parasternal
– Apical
– Subcostal
– Suprasternal
– Transoesophageal

19. 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

20. Parasternal Short Axis (Aortic Valve Level)
• Right Ventricle
• Left Atrium
• Tricuspid Valve
• Pulmonic Valve
• Pulmonary Artery
• Aortic Valve
• Right Atrium

21. Parasternal Short Axis (Mitral Valve Level)
• Right Ventricular Wall
• Right Ventricle
• Interventricular Septum
• Left Ventricle
• Mitral Valve
• Posterior Wall
• Pericardium

22. Parasternal Short Axis (Papillary Level)
• Right Ventricular Wall
• Right Ventricle
• Interventricular Septum
• Left Ventricle
• Papillary Muscles
• Posterior Wall

23. 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

24. 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

25. Apical Two Chamber
• Left Ventricular
Apex
• Left Ventricle
• Inferior Wall
• Anterior Wall
• Mitral Valve
• Left Atrium
• Pulmonary Veins

26. Apical Long Axis
• Left Ventricular
Apex
• Left Ventricle
• Inferior Wall
• Anterior Wall
• Mitral Valve
• Left Atrium
• AO

27. SUBCOSTAL

28. SUPRASTERNAL

29. Hands on!!!!!

30. M-Mode echocardiography
• 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

31. 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

32. M-Mode AO/LA
• PLAX or PSAX

33. M-Mode MITRAL VALVE
• PLAX or PSAX

34. M-Mode LEFT VENTRICLE
• PLAX or PSAX

35. Hands on!!!!!

36. DOPPLER
• 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

37. FLOW PATTERNS
MITRAL VALVE FLOW
• Blood flow from the LA to the LV
• Diastole
• Displayed above the baseline

38. FLOW PATTERNS
AORTIC VALVE FLOW
• Blood ejected from the LV into the Ao
• Systole
• Displayed below the baseline

39. FLOW PATTERNS
TRICUSPID VALVE FLOW
• Blood flow from the RA to the RV
• Diastole
• Displayed above the baseline

40. FLOW PATTERNS
PULMONARY VALVE FLOW
• Blood ejected from the RV into the PA
• Systole
• Displayed below the baseline

41. COLOR FLOW DOPPLER
in Echocardiography
• 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”

42. AORTIC INSUFFICIENCY

43. MITRAL STENOSIS/INSUFFICIENCY

44. Hands on!!!!!

45. PATHOLOGIES

46. Ultrasound in Cardiac
Assessments
• Valve Disease
• Cardiomyopathy
• Endocarditis
• Prosthetic Heart valve assessment
• Pericardial effusion
• Systemic Hypertension
• Pulmonary Hypetension
• Ischemic Heart Disease
• Septal Defects
• Tumours

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

48. Mitral Stenosis

49. Mitral Regurgitation

50. Aortic Valve
• Disease
– Aortic Stenosis
– Aortic Regurgitation
– Bicuspid Valve

51. Aortic Regurgitation

52. Tricuspid Valve
• Disease
– Stenosis
– Regurgitation

53. Tricuspid Regurgitation

54. PulmonaryValve
• Disease
– Stenosis
– Regurgitation