Echocardiography an introduction

1. ECHOCARDIOGRAPHY
AN INTRODUCTORY LECTURE TO
PARAMEDICAL STAFF
Dr Awadhesh Kr Sharma

2. Dr Awadhesh Kumar Sharma
• Dr Awadhesh Kumar Sharma is a young, diligent and dynamic interventional cardiologist. He
did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from
MLB Medical college Jhansi. Then he did his superspecilization degree DM in Cardiology from
PGIMER & DR Ram Manohar Lohia Hospital New Delhi. He had excellent academic record
with Gold medal in MBBS,MD and first class in DM. He was also awarded chief ministers
medal in 2009 for his academic excellence by former chief minister of UP Hon. Mayawati in
2009.He is also receiver of GEMS international award. He had many national & international
publications. He had special interest in both invasive & non invasive cardiology. He had
performed more then 5000 invasive cardiac intervention procedures successfully till date
including coronary angiography, simple & complex angioplasty, peripheral vessels
angiography & angioplasty, carotid angiography & angioplasty, ASD ,PDA device closures,
Mitral & pulmonary valvotomy. He is also in editorial board of many national & international
journal- Journal of clinical medicine & research(JCMR),Clinical cardiology update, EC
Pulmonology and Respiratory Medicine. He is also active member of reviewer board of many
journals. He is also international associate fellow of American college of cardiology. He is
active member of many professional bodies including Indian Medical Association,
Cardiological Society of India, APVIC, ICC, API. He had worked in NABH Approved Gracian
Superspeciality Hospital Mohali as Consultant Cardiologist since 2014-2016. Currently he is
working as Assistant Professor of cardiology at LPS Institute of Cardiology, GSVM Medical
college, Kanpur(UP)under Govt of UP.

3. INTRODUCTION
• ECHO is an ultrasound of the heart using an
echo machine equipped with a range of
probes.
• Basic types-
1. M-Mode
2. 2-D (2 Dimensional)
3. Color Doppler
4. TDI(Tissue Doppler Imaging)

4. Basic Principal
• It uses high-pitched sound waves to produce
an image of the heart.
• The sound waves are sent through a device
called a transducer and are reflected off the
various structures of the heart.
• These echoes are converted into pictures of
the heart that can be seen on a video
monitor.

5. Basic Principal

6. Basic Principal
• Ultrasound gel is applied to the transducer to
allow transmission of the sound waves from
the transducer to the skin
• The transducer transforms the echo
(mechanical energy) into an electrical signal
which is processed and displayed as an
image on the screen.
• The conversion of sound to electrical energy
is called the piezoelectric effect

7. Basic Principal

8. The Modalities of Echo
8
The following modalities of echo are used clinically:
1. Conventional echo
Two-Dimensional echo (2-D echo)
Motion- mode echo (M-mode echo)
2. Doppler Echo
Continuous wave (CW) Doppler
Pulsed wave (PW) Doppler
Colour flow(CF) Doppler
All modalities follow the same principle of ultrasound
Differ in how reflected sound waves are collected and analysed

9. Two-Dimensional Echo
(2-D echo)
9
This technique is used to "see" the actual
structures and motion of the heart structures at
work.
Ultrasound is transmitted along several scan
lines(90-120), over a wide arc(about 900) and many
times per second.
The combination of reflected ultrasound signals
builds up an image on the display screen.
A 2-D echo view appears cone- shaped
on the monitor.

10. M-Mode echocardiography
10
An M- mode echocardiogram is not a
"picture" of the heart, but rather a diagram
that shows how the positions of its structures
change during the course of the cardiac
cycle.
M-mode recordings permit measurement of
cardiac dimensions and motion patterns.
Also facilitate analysis of time relationships
with other physiological variables such as
ECG, and heart sounds.

11. Doppler echocardiography
11
Doppler echocardiography is a method for
detecting the direction and velocity of moving
blood within the heart.
Pulsed Wave (PW) useful for low velocity flow
e.g. MV flow
Continuous Wave (CW) useful for high velocity
flow e.g aortic stenosis
Color Flow (CF) Different colors are used to
designate the direction of blood flow. Red is flow
toward, and blue is flow away from the
transducer (BART) with turbulent flow shown as
a mosaic pattern.

12. UTITILY OF ECHO
• To assess chamber size, thickness and
function.
• To assess all cardiac valves.
• To assess hemodynamics.
• To diagnose congenital heart diseases

13. Machines
13
There are 5 basic components of an ultrasound scanner that are required for
generation, display and storage of an ultrasound image.
1. Pulse generator - applies high amplitude voltage to energize the crystals
2. Transducer - converts electrical energy to mechanical (ultrasound) energy
and vice versa
3. Receiver - detects and amplifies weak signals
4. Display - displays ultrasound signals in a variety of modes
5. Memory - stores video display

15. 15

16. Transthoracic Echo
16
A standard echocardiogram is also known as a transthoracic
echocardiogram (TTE), or cardiac ultrasound.
The subject is asked to lie in the semi recumbent position on his or her
left side with the head elevated.
The left arm is tucked under the head and the right arm lies along the
right side of the body
Standard positions on the chest wall are used for placement of the
transducer called “echo windows”

17. 17

18. Parasternal Long-Axis View
(PLAX)
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Transducer position: left sternal edge;
2nd – 4th intercostal space
Marker dot direction: points towards
right shoulder
Most echo studies begin with this view
It sets the stage for subsequent echo
views
Many structures seen from this view

19. PLAX VIEW

20. Parasternal Short Axis View
(PSAX)
20
Transducer position: left sternal edge; 2nd
– 4th intercostal space
Marker dot direction: points towards left
shoulder(900 clockwise from PLAX view)
By tilting transducer on an axis between
the left hip and right shoulder, short axis
views are obtained at different levels,
from the aorta to the LV apex.

21. SAX VIEW-AORTIC LEVEL

22. SAX- AORTIC LEVEL

23. Papillary Muscle (PM)level
23
PSAX at the level of the
papillary muscles showing
how the respective LV
segments are identified,
usually for the purposes of
describing abnormal LV wall
motion
LV wall thickness can also be
assessed

24. SAX – MITRAL LEVEL

25. SAX – MITRAL LEVEL

26. Apical 4-Chamber View
(AP4CH)
26
Transducer position: apex of
heart
Marker dot direction: points
towards left shoulder
The AP5CH view is obtained
from this view by slight
anterior angulation of the
transducer towards the chest
wall. The LVOT can then be
visualised

27. AP4 Chamber view

28. Apical 2-Chamber View
(AP2CH)
28
Transducer position: apex of the
heart
Marker dot direction: points
towards left side of neck (450
anticlockwise from AP4CH view)
Good for assessment of
LV anterior wall
LV inferior wall

29. AP2 CHAMBER VIEW

30. A2C VIEW

31. Apical 5 Chamber VIEW

32. Sub–Costal 4 Chamber
View(SC4CH)
32
Transducer position: under the xiphisternum
Marker dot position: points towards left
shoulder
The subject lies supine with head slightly low
(no pillow). With feet on the bed, the knees
are slightly elevated
Better images are obtained with the abdomen
relaxed and during inspiration
Interatrial septum, pericardial effusion, desc
abdominal aorta

33. Sub costal 4 chamber view

34. Subcostal Inferior vena cava view

35. Suprasternal View
35
Transducer position: suprasternal notch
Marker dot direction: points towards left jaw
The subject lies supine with the neck
hyperexrended. The head is rotated slightly
towards the left
The position of arms or legs and the phase
of respiration have no bearing on this echo
window
Arch of aorta

36. Suprasternal view

38. Thanks