302 Echocardiography

Question 1

Which states of matter reflect ultrasound waves?

Answer 1

Solid and gas

So they appear bright

Question 2

On a doppler scan, what does each colour mean?

Answer 2

Red: blood flow toward the probe
Blue: blood flow away from the probe
Yellow: Turbulent flow

Question 3

What information do we get from an
Echo?

Answer 3

Cardiac structures
* Are all the chambers the correct size?
* Are there connections between the chambers such as an ASD/VSD
* Abnormal masses (malignant or benign)

Cardiac function
* Left ventricle systolic and diastolic function (most common reason) – After a
myocardial infarction or in someone who presents with heart failure symptoms
* Right ventricular function

Valvular function
* Is there evidence of stenosis or regurgitation?
* Is there evidence of infection such as a vegetation – infective endocarditis?

Evidence of excess pericardial fluid and tamponade

Question 4

What are the different points of view on an echocardiogram?

Answer 4

Parasternal long axis
Parasternal short axis
Apical 4ch and 5ch
Apical 2ch and 3ch
Subcostal
Suprasternal

Question 5

What are the limitations of a echocardiogram?

Answer 5

-It can not tell us about the flow in the coronary arteries or electrophysiological problems

-It is not good at looking at posterior structures such as the right atrial appendage where a clot can form

-Difficult due to certain body habitus – High BMI or low BMI or chest wall deformities (e.g pes excavatum/carinatum or changes due to COPD)

-Difficult to get good pictures if the patient is unable to move into the
correct position

-Difficult to image in very fast heart rates such as arrhythmias

Question 6

When is an Echocardiogram not indicated?

Answer 6

-Unchanged murmur in an asymptomatic individual with previous normal echocardiogram
-To assess for Endocarditis when there is a fever with no other suggestive features.
-Evaluation of non-cardiac chest pain
-Patients in whom echocardiography will not affect decision to commence anticoagulation (eg patients in AF with cerebrovascular event and no suspicion of structural heart disease)
-Routine pre-operative echocardiography with no cardiac hx