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MIDS 197 > Ch 3 M-mode > Flashcards

Ch 3 M-mode Flashcards

1
Q

What was the main mode of imaging before 2D/B-mode imaging?

A

M-mode

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2
Q

Why do we use m-mode?

A

To assess the rapid motion of cardiac structures

(valves, endocarditis chewing on valves, LV/RV wall motion)

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3
Q

Does m-mode have high or low frame rate?

A

High (1800 frames per second)

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4
Q

How many scan lines are produced with m-mode?

A

Single scan line produced repeatedly, in same direction

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5
Q

T/F: M-mode image generated shows non moving structures stationary while moving structures change location

A

True (think of how the valves look different on the image)

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6
Q

What does the x-axis + y-axis represent?

A

X: time
Y: depth

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7
Q

The first reflector the scan line hits is the most anterior or posterior structure in the m-mode tracing?

A

Anterior - each subsequent structure follows afterwards

(ex. RV, IVS, LV, LVPW, pericardium)

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8
Q

What does sweep speed change?

A

Number of cardiac cycles shown on horizontal axis

(lower speed = many wave forms in 1 image, higher speed = less wave forms)

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9
Q

When would we use a higher sweep speed?

A

When pt has high heart rate, so we can visualize event timing easier

(Fast HR = higher sweep speed)

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10
Q

When would we use a lower sweep speed?

A

When pt has slow heart rate

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11
Q

What is the standard sweep speed set at?

A

50 mm/s

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12
Q

At what angle should the cursor be placed to the structure of interest?

A

At 90 degrees (must be perpendicular)

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13
Q

What happens if our image is off axis + we do an m-mode?

A

Cursor will not be perpendicular to structure of interest, therefore measurements + tracings are considered inaccurate :(

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14
Q

What is the downside to using m-mode?

A

Image often off axis + done obliquely, creating an inaccurate tracing

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15
Q

What does GAIN enhance?

A

Brightness of returning signals

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16
Q

Can we adjust the GAINS on the overall image + on m-mode?

A

Yes

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17
Q

What does adjusting our depth do?

A

Allows for clearer visualization of the structure of interest

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18
Q

Should we optimize our 2D image before activating m-mode?

A

Yes!

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19
Q

What is anatomical m-mode (AMM)?

A

When the m-mode cursor can be rotated (opposed to in a fixed origin at the top of the 2D image like in regular m-mode)

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20
Q

Another name for anatomical m-mode?

A

Steerable m-mode

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21
Q

Why does anatomical m-mode create more accurate measurements?

A

-B/c we can make our cursor perpendicular to the structure if we can not make the structure of interest flat
-Good to use with pt’s in steep or off axis views

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22
Q

How do we obtain an m-mode of the AO/LA?

A

-Perform in PLAX (m/c) or PSAX AV level
-Place cursor over AV, at mid to tip leaflet
-Use ECG to determine timing of cardiac cycle to know where to measure

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23
Q

What happens during ventricular systole on an m-mode of the AO/LA?

A

-AV open (box shape)
-LA fills during atrial diastole (pushes AO wall anteriorly)

24
Q

What happens during ventricular diastole on an m-mode of the AO/LA?

A

-AV closed (no box, thin echogenic line)
-LA contracts during atrial systole (AO wall moves posteriorly)

25
Q

Are caliper measurements still performed on AO/LA m-modes in adults?

A

No

26
Q

How do we obtain an m-mode of the MV?

A

-At PLAX (m/c) or PSAX MV level (center of fish mouth)
-Place cursor on tips of MV leaflets

27
Q

Will the MV leaflets be open or closed during ventricular diastole?

A

Open

28
Q

The AMVL has what appearance with m-mode?

A

M shape

29
Q

The PMVL has what appearance with m-mode?

A

Blunted W shape

30
Q

What does a “B bump” on MV m-mode represent?

A

Signals elevated LV end diastolic pressure (is normally a straight line, no bump)

31
Q

What does EPSS stand for (during MV m-mode)?

A

E point septal separation

(distance b/w E point + posterior IVS, note the space here is normally only 2-7mm wide)

32
Q

What does increased EPSS indicate in the absence of mitral stenosis?

A

-LV dilation
-Systolic dysfunction
-Aortic regurgitation

33
Q

Are caliper measurements still performed on MV m-modes in adults?

A

No

34
Q

How to obtain m-mode of LV?

A

-In PLAX (m/c) or PSAX PM view
-Place cursor perpendicular to PLAX, through center of LV just past the tips of the MV leaflets

35
Q

Does the IVS + LV posterior wall move anteriorly or posteriorly during ventricular systole?

A

IVS: posteriorly
LVPW: anteriorly

(b/c squeezing together)

36
Q

Does the IVS + LV posterior wall move anteriorly or posteriorly during ventricular diastole?

A

IVS: anteriorly
LVPW: posteriorly

(b/c relaxed)

37
Q

Ejection fraction used to be calculated by the difference b/w what?

A

End diastolic diameter (EDD) + end systolic diameter (ESD)

38
Q

Are caliper measurements performed still with LV m-mode in adults?

A

No

39
Q

How do we measure leading edge to leading edge?

A

Outer to inner

(anterior of 1st visualized point to anterior of last visualized point)

40
Q

What are all of the m-mode measurements we take in lab?

A

-AO diameter
-LA diameter
-EPSS (abnormal cases)
-IVSd
-LVIDd
-LVIDs
-LVPWd

(not routinely done in adult echos)

41
Q

How do we measure the aortic root?

A

-At R wave (end diastole), before AV opens
-Outer to inner

42
Q

How do we measure the LA?

A

-At end of T wave (end systole), or largest diameter of LA
-Outer to inner

43
Q

What is the normal range of the EPSS at MV?

A

2-7mm

(remember distance b/w E point + posterior IVS)

44
Q

Why do we only take wall measurements in diastole?

A

B/c we expect the walls to thicken in systole, they should not be thick in diastole which is why we measure then

45
Q

List the measurements we take of the LV with m-mode to calculate the ejection fraction?

A

IVSd: outer edge of RV wall to LV side of the IVS in end diastole

LVIDd: LV side of IVS to inner edge of endocardium of LVPW in end diastole

LVPWd: outer edge of endocardium of LVPW to epicardial surface of LVPW in end diastole

LVIDs: LV side of IVS to inner edge of endocardium of LVPW in end systole

46
Q

What is ejection fraction?

A

Amount of blood pumped from LV in each cardiac cycle

47
Q

Do we have to measure our diastolic + systolic LV measurements on the same heart beat?

A

Yes!

48
Q

Does peak systolic motion of the IVS occur slightly before or after peak systolic motion of the LV posterior wall?

A

Before

49
Q

List 4 disadvantages of using m-mode?

A

-Beam orientation often off axis (leading to inaccurate measurements)

-Single line of sight

-Structure identification

-Technical variability (gains, sweep speed, cursor movement)

50
Q

List 3 advantages to using m-mode?

A

-High frame rates (compared to 2D imaging)

-Provides precise measurements of cardiac dimensions (when cursor perpendicular to structure of interest)

-Evaluates structures further to complement 2D imaging

51
Q

What can color m-mode assess?

A

Timing of regurgitation

52
Q

What is “SAM”?

A

Systolic anterior motion of MV

(massive IVS hypertrophy seen on m-mode)

53
Q

What pathology of the MV can m-mode assist in assessing?

A

MV stenosis

(small fish mouth)

54
Q

How can m-mode assist in looking for a bicuspid AV?

A

Gauge eccentricity of the AV in the case of a bicuspid AV, seen during closure of valve

55
Q

What is the reason that the American Society of Echocardiography primarily no longer recommends m-mode measurements for calculation of EF or chamber sizes?

A

Beam orientation frequently off axis

MIDS 197 (15 decks)

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