Echocardiography Flashcards
Parasternal view
The walls close to the thoracic walls is the RV
the most distal is the posterior wall
Parasternal long axis view
examine IVS
we can identify left ventricular hypertrophy
max thickness of IVS
10 mm
IVS > 11 mm
left ventricular hypertrophy
IVS we can measure the thickness of the
Posterior wall by comparing thickeness of IVS + thickness of posterior wall we can determine if it is concentric or eccentric hypertrophy
we can see asymmetrical hypertrophy
Measure diameter of left atrium
- left atrial dilatation
more accurate measurement of LA dimensions - LA volume measure of four chamber apical view - Measure diameter of aortic annulus , aortic trude aortic valsava , ascending aorta
M mode
structures of the heart illustrated during axis of time
the 1st chamber encountered by the M mode line is
Right ventricle
the 2nd chamber encountered by the M mode line is
IVS - you can see in systole
diastole : relaxation of IVS
Doppler
flow through the chambers of the heart
flow from
mitral valve to the left atrium
high velocity - > turbulent flow
Mitral regurgitation is systolic the flow __
in the left ventricular outflow tract appear during diastole
the flow in LVAD
aortic regurgitation
Parasternal short axis view
Mitral valve
Middle of the ventricle and to the apical view of the left ventricle
1st short axis view
At the base of the heart
Great vessels of the heart
Short axis view
Center of the image
Short axis view of the aortix valve with three leaflets
Short axis view
Center of the image
Short axis view of the aortic valve with three leaflets
1st image of short view
left ventricle and mitral valve
short axis view of the left ventricle
circular shape
short axis view of right ventricle
semilunar shape which embraces the left ventricle
The first of the apical views
Apical four chamber view
very good to examine the tricuspid valve
mitral valve
The right ventricle has __ walls than the left ventricle
thinner
2 chamber apical view
left atrium and
left ventricle : inferior + anterior wall
transthoracic echocardiography we cant see the
left atrial appendage
( because very posterior structure ? )
Assesment of left atrial appendage
is the structure of the left atrium which is very important from clinical point of view because this is the place that maybe thrombi may be formed
- We use transesophageal echocardiography : for structures more posteriorly located like atria + left atrial appendage
Apical 3 chamber view
Left ventricle : posterior + anterior septum
left atrium
right ventricle
causes of systolic dysfunction
Coronary heart disease : MI
causes of systolic dysfunction
Coronary heart disease : MI
hypokinetic anterior wall
normal kinetic inferior wall
Suprasternal view
Aortic arch
Supra-aortic arteries
Subcostal view
Inferior vena cava and we always measure its diameter. That’s because if it is dialted then the right ventricular pressure is high
we use the apical 4 chamber view + 2 chamber view in order to assess the
LV global systolic function
parameter : ejection fraction
The fraction of blood that is ejected during systole during the contraction
Ejection fraction
is a ratio b/w the stroke volume and diastolic volume.
In order to calculate the stroke volume we will have to know the end diastolic volume and end systolic volume
how we calculate the ejection fraction in practice
we contour the endocardial border of the LV both in apical 4 chamber view + 2 chamber view both in diastole and systole
Doppler echocardiography
Blue color - mitral regurgitation - mitral valve is closed
Blue because the direction of the flow is from the probe to the distal part of the image
Red color - the mitral valve is open - during diastole - blood from the LA to the LV- blood flow from the left atrium to the probe
Colour echocardiography ->
Spectral Doppler ->
- Qualitative examination of flow
2. We can assess the velocity of the flow through the heart valves which is very important from practical point of view
if we know the velocity of the flow then we can calculate the pressure difference from 2 cavities
Taking for example tricuspid regurgitation.
If we have high pressure gradient b/w the RV and the RA that means that the velocity of the tricuspid regurgitation will be higher.
We have Bernoulli eq that translates velocities into pressure.Gradient of pressure equals four more than the described velocities.
ΔP = 4V2-> P(VD)= 4V2 + P(AD)
With echocardiography we can measure noninvasively the pressure in
the pulmonary artery .
We can diagnose pulmonary hypertension
by applying Bernoulli eq-> the difference of the pressure b/w the RV and the RA is proportional with the velocity.
Right ventricular contraction
- Longitudinal contraction
TAPSE ( Tricuspid Annulus PLan Systolic Excursion )
N>15 mm
CV Magnetic Resonance
Doesnt rely on the ultrasounds ( we dont need good acoustic window).
It uses physical properties of the tissues + the amount of water in the tissues respectively in order to image the heart structures.
CV Magnetic Resonance is the gold standard for measuring the
LV wall thickness + LV volume and ejection fraction
+ RV volume + ejection fraction??
In 2D transthoracic echocardiography
we cant measure the RV
ejection fraction ,we use a surrogate parameter (?)
Contrast CV Magnetic Resonance ( CMR)
Based on Gadolinium -> a contrast which accumulates in the extracellular space in the interstitium .It doesnt enter the cell , if the membrane of the cell is intact .
In cases of scar tissue Gadolinium accumulates in the
Extracellular space because scar tissue is hypocellular tissue .
Myocardial scars ->Myocardial Fibrosis : a consequence of MI or Myocarditis or simplified fibrosis
Subepicardial scar specific to
Myocarditis
By CMR we able to differentiate b/w
Myocarditis + MI
with CMR we can also see
LV thrombus ( apex of the LV ?)
CMR gold standard for
Endocarditis
CMR in comparison with echochardiography give us the opportunity for
Tissue characterisation.
We can see what’s inside the tissue.Helpful to see :
- Myocardial scar
- Myocardial edema
CMR is called
noninvasive myocardial biopsie
Echocardiography
MRI
we assess:
- Dimension and function
- Dimension + function + tissue characterisation
