Echo 2: Echo measurements and reporting Flashcards
What indicates ventricular end diastole?
-Frame before the mitral valve closes
-Frame with greatest LV cavity size
-Start of the ECG QRS complex
-Peak of the global longitudinal strain curve
What indicates ventricular end systole?
-Frame before the the mitral valve opens
-Frame where aortic valve closes
-Nadir of the global longitudinal strain curve
Why should measurements of ventricular systole and diastole be measured over multiple beats?
-Variation in cardiac cycle
-Averaged over 5-10 beats at 60-80bpm
-Atrial fibrillation
Advantages of standardised approach to measurement?
-Minimises pathology being missed
-Allows serial studies to be compared
-Research and audits
-Minimises inter and intra-observer variability
-Ensures correct information available to clinicians
What is normal wall thickness in ventricles?
<12mm
What is normal left ventricular internal diameter in men and women during diastole?
Men: <56mm
Women: <51mm
Causes of LV dilation and increased wall thickness
LV dilation:
-Ischaemia
-Valve regurgitation
-Cardiomyopathy
Wall thickness:
-Hypertension
-Aortic stenosis
-Cardiomyopathy
4 stages of LVH
-Normal LV wall thickness to internal diameter
-Concentric remodelling
-LVH
-Eccentric hypertrophy - dilated LV compared to wall thickness
What are the 3 proximal aortic measurements?
-Sinus of Valsalva
-Sinotubular junction
-Ascending aorta
-Measured end diastole, inner edge to inner edge
-Indexed to patient height and gender
Which aortic dimension is measured at mid-systole?
LVOT diameter
What are you looking for when you scan aortic arch and descending aorta?
-Type A aortic dissection (proximal to isthmus)
-Type B aortic dissection (distal to isthmus)
-Coarctation
-Dilation
-PDA
Aorta size indications
Aortic/mitral and Pulmonary/tricuspid assessment on echo
-Thin (<5mm) and mobile leaflets
-No areas of calcification, thickening, restricted or excessive motion
-No attached masses
-Presence of regurgitation/stenosis on Doppler
What are the 4 components of regurgitation?
-Flow convergence - PISA
-Flow acceleration - Vena contracta
-Turbulence - Jet area
-Downstream effects - Pulmonary vein flow
Why should probe be aligned with blood flow?
-When maligned >15-20 degrees, large underestimation of velocities
Mild vs Moderate vs Severe regurgitation
17 segment model
Phases of diastole
-Rapid early filling (E wave)
-Diastasis - no flow through valve
-Late filling (A wave) - atrial contraction/kick
4 grades of diastolic dysfunction
2 features of ventricular contraction
Longitudinal
-apex remains static
-how far does base of ventricle move towards apex
Radial
-how much do the walls contract inwards
How do you measure longitudinal and radial function of right ventricle?
Radial: Fractional area change
Longitudinal:
-TAPSE (Tricuspid Annular Plane Systolic Excursion)
-RVS’ (Right Ventricular Systolic Annular Velocity)
How do coronary arteries relate to walls of heart?
Aortic stenosis peak velocity categories
