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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 Artery
Circumflex Artery
Right 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
Cardiac anatomy
Cardiac anatomy
Cardiac anatomy
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 PATTERNS
MITRAL VALVE FLOW
• Blood ejected from the LV into the Ao
• Systole
• Displayed below the baseline
FLOW PATTERNS
AORTIC VALVE FLOW
• Blood flow from the RA to the RV
• Diastole
• Displayed above the baseline
FLOW PATTERNS
TRICUSPID VALVE FLOW
• Blood ejected from the RV into the PA
• Systole
• Displayed below the baseline
FLOW PATTERNS
PULMONARY 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 DOPPLER
in 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

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