Introduction to Echocardiography

Question 1

Linear-array transducers

Answer 1

• high frequency
• for viewing superficial structures
• musculoskeletal system

Question 2

Curved-array transducers

Answer 2

• low frequency
• short radius: endoluminal scanning
• extended field of view than linear
• large radius: abdomen and obstetrical scanning

Question 3

Phased-array transducers

Answer 3

• low frequency
• extended field of view
• smaller so good imaging for the heart as it can get between the ribs

Question 4

PART probe manipulation

Answer 4

• pressure
• alignment
• rotation
• tilting

Question 5

What are the imaging windows for transthoracic echocardiography?

Answer 5

• parasternal
• apical
• subcostal

Question 6

Parasternal imaging window long axis

Answer 6

• transducer placed in 3-4th intercostal space

- orientation marker pointing to patient’s right shoulder

Question 7

What is M-mode meant to analyse?

Answer 7

motion

Question 8

Parasternal imaging window short axis- mitral valve level

Answer 8

• *continuation from long axis

- rotate orientation marker 90 degrees clockwise so orientation marker is towards patient’s left shoulder

Question 9

Parasternal imaging window short axis- papillary muscle level

Answer 9

• *continuation from long axis
• rotate 90 degrees clockwise so oritentation marker is towards patient’s left shoulder
• tilt transducer slightly downward

Question 10

Parasternal imaging window short axis- aortic valve level

Answer 10

• *continuation from long axis
• rotate 90 degrees clockwise so oritentation marker is towards patient’s left shoulder
• tilt transducer slightly upwards

Question 11

Apical imaging window 4-chamber

Answer 11

• transducer placed on apical impulse
• tilt face of transducer up until ultrasound beam cuts through long axis of heart
• orientation marker at 3 o’clock

Question 12

Apical imaging window 5-chamber

Answer 12

• *continuation from apical 4-chamber view
• tilt face of transducer upward until aortic valve appears
• orientation marker at 3 o’clock

Question 13

Subcostal imaging window 4-chamber

Answer 13

• patient supine
• transducer placed slightly below xyphoid process
• direct transducer toward patient’s chin/left choulder
• oritentation marker at 3 o’clock
• hold transducer palm down

Question 14

Subcostal imaging window IVC

Answer 14

• *continuation from subcostal 4-chamber
• rotate transducer 90 degrees anti-clockwise
• orientation marker at 12 o’clock
• check to see IVC merging into RA

Question 15

What are we looking for in basic echo for a resuscitated patient?

Answer 15

looks for/rules out:

• pericardial effusion
• enlarged RV
• LV size in conjunction with IVC
• LV systolic function

Question 16

What is Marfan’s syndrome?

Answer 16

• disorder of connective tissue
• affects eyes, skeleton, lungs, heart and blood vessels
• can be life-threatening

Question 17

What are the cardiovascular complications of Marfan’s syndrome?

Answer 17

• dilatation of ascending and sometimes descending aorta
• incompetence of aortic and mitral valves
• aneurysm and dissection of aorta

Question 18

Management for Marfan’s sydrome

Answer 18

• regular clinical review
• echocardiogram
• additional imaging if required
• b-blockers/ACE inhibitors
• surgical referral if aortic root at sinus of valsalva exceeds:
• 5.5cm/5% growth per year for adults

Question 19

When is transoesophageal echocrdiogram used?

Answer 19

• if you can’t get a clear picture of the patient’s heart with standard echocardiogram
• if there is reason to see the heart and valves in more detail