Introduction to Echo Flashcards
What is an echo
use of ultrasound to examine the heart.
what are three types of ultrasound tool
curvilinear (curved array probe)
phased array
linear array
Linear-Array Transducers
- 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.
Curved-Array Transducers
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.
Phased-Array Transducer
• The phased-array probe is smaller and therefore capable of scanning in areas where acoustic access is limited, such as between ribs.
manipulation of manoeuvres
Pressure
Alignment
Rotation
Tilting
Imaging windows
refers to an anatomic position on the patient’s body where an ultrasound transducer is placed to visualize specific structures
For Transthoracic Ecchocardiography (TTE) there are three standard imaging windows
- Parasternal.
- Apical.
- Subcostal.
The parasternal long axis
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
the parasternal short axis
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
The M-mode (Motion Mode)
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.
the parasternal short axis - papillary muscle level
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
parasternal short axis - aortic valve level
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
apical four-chamber
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
apical five-chamber
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
subcostal four-chamber
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
subcostal IVC
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
Basic Echo in Resuscitation (POCUS) In the shocked, dyspnoeic, or arrested
patient it looks for (or rules out)
- 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
Marfan Syndrome
- 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.
Cardiovascular complications of Marfan’s Syndrome.
Dilatation of ascending and sometimes descending aorta, incompetence of aortic and mitral valves, aneurysm and dissection of aorta.
Optimal management of Marfan’s Syndrome
• 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)
Neonatal Echcocardiography
for detection of duct dependent congenital heart disease in particular
Transoesophageal echocardiogram
• 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.