CVT 103 Lecture ECHO

Question 0

Ultrasound physics basics

Answer 0

2-D images (plus M-mode) 2.5 or 3.5 MHz Piezoelectric crystal Range detection—time is distance, etc. Pixels Gray scale Sector beam

Question 1

Ultrasound procedure to evaluate heart anatomy and function, and evaluate for:

Answer 1

Valvular stenosis Valvular insufficiency Valvular prolapse Valvular vegetations Pericardial effusion Cardiac tumors Septal defects Malfunctioning prosthetic valves Idiopathic hypertrophic subaortic stenosis Cardiac thrombus

Question 2

Parasternal long axis view:

Answer 2

4th left IC space Perpendicular to chest wall should give MV almost always

Beam-edge indicator toward right shoulder (right-shoulder/left-hip axis)

Question 3

Features to look for in PSLA:

Answer 3

RV free wall
RV 
IV Septum 
LV 
Aortic root, valve (RCC, NCC) 
MV (anterior & posterior leaflets) 
Posterior wall 
Pericardium

Question 4

Parasternal short axis views:

Answer 4

Rotate clockwise 90° from long-axis plane

Beam-edge indicator toward left shoulder

Question 5

3 views in the short axis:

Answer 5

Aortic root

Mitral valve

LV at level of papillary muscles

Question 6

How do you get a picture of the PSSA MV:

Answer 6

aim straight down

Question 7

How do you get a picture of the PSSA Ao:

Answer 7

aim toward right shoulder

Question 8

how do you get a picture of the PSSA LV:

Answer 8

aim toward left hip

Question 9

Optimizing images (long axis):

Rock the beam to…

Rotate the beam to…

Angle the beam to…

Slide the probe to…

Answer 9

Rock the beam to make more level

Rotate the beam to open Ao root and LV

Angle the beam to shoot down through LV and Ao

Slide the probe to find best window

Question 10

Optimizing images (short axis):

Rock the beam to…

Angle the beam to…

Rotate the beam to…

Slide the probe to…

Answer 10

Rock the beam to center LV or Ao root

Angle the beam to find Ao/MV/LV (i.e., get beam through all structures)

Rotate the beam to get truly cross-sectional (symmetrical chamber; no opening of wall on one side)

Slide the probe to find best window

Question 11

M-mode: Motion mode

Answer 11

Sends one-dimensional beam through structures; depth and motion of structures are displayed on Y axis. X axis is time.

Question 12

M-mode measurements Mitral valve

MV excursion:

Answer 12

Vertical distance from D point to E point. (NOT diagonal distance.)

Draw horizontal line from E peak to left.

Drop vertical to D point.

WNL: 18–22 mm

Question 13

M Mode measurements:

Aortic root

Answer 13

Drop a line vertically from QRS. This is end-diastole.

AO root and LA ED diameters: calipers along ED line.

LA systolic diameter: use widest part of LA.
NOTE: For LA and Ao root diameter measurements, include thickness of far wall of aortic root.

Aortic valve excursion: distance between open leaflets.

WNL: LASD 26–38 mm A0Root 26–38 mm A0 valve excursion 13–22 mm

Question 14

M Mode measurements

Left ventricle

Answer 14

Again, drop the vertical from the QRS for LV ED diameter.

Systolic diameter: narrowest LV dimension.

Ejection fraction is a percent calculation based on Pumbo formula: (EDD3) – (SD3) (EDD3)
(Multiply the result by 100 to change decimal to percent.)

WNL: ~66–80% Also: septum and PW thickness

Question 15

Controls:

Answer 15

Master gain 
TGC (a.k.a. “DGC”) 
Transmit zone (focal zone) 
Compress (a.k.a. “log compress” a.k.a. “dynamic range”) 
Depth 
Beam cursor/trackball for m-mode 
M-mode on/off 
Sweep speed 
Record/print

Question 16

Blue color flow means blood flow is going _________ the probe

Answer 16

away

Question 17

Red color flow means blood flow is going ______ the probe

Answer 17

toward