Introduction to Echo

Question 1

What is an echo

Answer 1

use of ultrasound to examine the heart.

Question 2

what are three types of ultrasound tool

Answer 2

curvilinear (curved array probe)
phased array
linear array

Question 3

Linear-Array Transducers

Answer 3

• Images obtained with linear arrays always have a flat superficial surface and are designated on the image with the letter L followed by the transmit frequency.
• High-frequency sound does not penetrate deeply into tissues, so high-frequency probes are only useful for superficial structures.

Question 4

Curved-Array Transducers

Answer 4

can be used for endoluminal scanning and probes with a larger radius of curvatures can be used for general abdomen and obstetrical scanning
• Images obtained with curved arrays always have a curved superficial surface and are designated on the image with the letter C followed by the transmit frequency.

Question 5

Phased-Array Transducer

Answer 5

• The phased-array probe is smaller and therefore capable of scanning in areas where acoustic access is limited, such as between ribs.

Question 6

manipulation of manoeuvres

Answer 6

Pressure
Alignment
Rotation
Tilting

Question 7

Imaging windows

Answer 7

refers to an anatomic position on the patient’s body where an ultrasound transducer is placed to visualize specific structures

Question 8

For Transthoracic Ecchocardiography (TTE) there are three standard imaging windows

Answer 8

• 1. Parasternal.
• 2. Apical.
• 3. Subcostal.

Question 9

The parasternal long axis

Answer 9

the transducer is placed in the 3rd-4th intercostal space
the transducer orientation marker is pointing towards the patients right shoulder
depth of 12-16cm
for assessment of the pericardial and pleural effusion go to 20-24cm

Question 10

the parasternal short axis

Answer 10

rotate the transducer 90 degrees clockwise
the transducer orientation marker is pointing to the patients left shoulder
the transducer is perpendicular to the chest wall
a depth of 12-16cm

Question 11

The M-mode (Motion Mode)

Answer 11

designed to document and analyze tissue motion

• This mode is particularly important in studying cardiac valve and wall motion and in documenting foetal heart rate and activity.

Question 12

the parasternal short axis - papillary muscle level

Answer 12

rotate the transducer 90 degrees clockwise
transducer orientation marker points to the patients left shoulder

tilt the transducer slightly downward towards the patients left flank
death 12-16cm

Question 13

parasternal short axis - aortic valve level

Answer 13

rotate the transducer 90 degrees clockwise
transducer orientation marker points to the patients left shoulder

tilt the transducer face slightly upward towards the patients right shoulder
depth 12-16cm

Question 14

apical four-chamber

Answer 14

the transducer is placed on the apical pulse
tilt the face of the transducer up until the ultrasound beam cuts through the long axis of the heart
transducer orientation marker is at 3 o’clock
depth 14-18cm

Question 15

apical five-chamber

Answer 15

from the apical four chamber view, tilt the face slightly upward until the aortic valve appears
transducer orientation marker is at 3oclock
depth 14-18cm

Question 16

subcostal four-chamber

Answer 16

patient is supine
transducer is placed 2-3 cm below the xyphoid process
direct the transducer towards the patients chin
the transducer orientation marker is at 3 o’clock
hold the transducer palm down to facilitate cephald angulation of the ultrasound beam
depth 16-24cm

Question 17

subcostal IVC

Answer 17

from subcostal four chamber view, rotate the transducer 90 degrees counter clockwise, always keeping the right atrium on the screen
transducer orientation marker is at 12 o’clock
death is 16-24 cm

Question 18

Basic Echo in Resuscitation (POCUS) In the shocked, dyspnoeic, or arrested
patient it looks for (or rules out)

Answer 18

• Pericardial effusion (with or without signs of tamponade)
• An enlarged RV (with or without hypokinesis and paradoxical septal motion)
• LV size, in conjunction with IVC (eg small LV suggests hypovolaemia)
• LV systolic function (rough estimate only

Question 19

Marfan Syndrome

Answer 19

• Marfan syndrome is one of the more common disorders of connective tissue that can affect the Eyes, Skeleton, Lungs, Heart and Blood Vessels, and may be life-threatening.
• The effects of Marfan syndrome varies between individuals, some people only being mildly affected.

Question 20

Cardiovascular complications of Marfan’s Syndrome.

Answer 20

Dilatation of ascending and sometimes descending aorta, incompetence of aortic and mitral valves, aneurysm and dissection of aorta.

Question 21

Optimal management of Marfan’s Syndrome

Answer 21

• echocardiogram
• additional imaging if required (TOE, MRI, CT)
 • b blockers/ACEI
• Surgical referral if aortic root at
Sinus of valsalva exceeds
5.5 cm or
5% growth per year (2 mm in adults)

Question 22

Neonatal Echcocardiography

Answer 22

for detection of duct dependent congenital heart disease in particular

Question 23

Transoesophageal echocardiogram

Answer 23

• If it’s difficult to get a clear picture of a patient’s heart with a standard echocardiogram or if there is reason to see the heart and valves in more detail, a transesophageal echocardiogram can be performed.