Module 12 : Apical 2D Measurements Flashcards
before you measure what 4 things should you do
1) look at proportions
2) optimise 2D
3) heel toe the probe to swing the structure of interest for measurement
4) ensure endocardium is clear
Simpsons Biplane EF
- aka method of disks
- uses two orthogonal diameters to create disks throughout the traced LV or LA volumes placed at 5mm intervals
- volumes are calculated from the tracings and the EJECTION FRACTION is calculates
AVERAGES THE TRACING IN THE A4C AND A2C END-DIASTOLE ADN END-SYSTOLE TRACINGS TO CREATE EF
4 tips for tracing in all 4 apical views
1) trace from one side of the MV annulus around the endocardium to the other side of the annulus
2) do not trace through pap muscles
+ is trace around them would underestimate chamber size
3) adjust vertical axis from the middle of the MV annulus diameter to the apex
4) reduce depth to just past the MV annulus
adjusting the vertical axis tips
- be parallel to the long axis of the chamber
+ draw a line from the middle of the MV annulus to the apex - IVS angle can be used as a guide to visualize the long axis
Steps to calculate Simpsons EF
1) trace LV in apical 4 chamber at end diastole
2) trace LV in apical 4 chamber at end systole
3) trace LV in apical 2 chamber at end diastole
4) trace LV in apical 2 chamber at end systole
Step 1 - trace LV in A4C at end diastole
- trace endocardial border
- trace straight through pap muscles
- align LV apex before tracing
- LENGTH SHOULD BE WITHIN A CM OF APICAL 2 CHAMBER LENGTH IN DIASTOLE
step 2 - trace LV in A4C at end systole
- trace from one side fo the MV annulus to the other
- adjust the vertical axis(length) to the long axis of the chamber
step 3 - trace LV in A2C at end diastole
- annulus to annulus trace
- exclude pap muscle
- adjust the vertical axis from the middle MV annulus to apex
- length should be within a cm of end diastole length in 4 chamber
step 4 - trace LV in A2C at end systole
- trace with same method as others
- final click should bring up the volumes and biplane EF for A4C and A2C
- the 2 are then average
EF and FS normals and abnormas
- compare the length in diastole with the length in systole
FS normal
25-47
FS severe abnormal
< 15
EF teicholtz (PLAX) normal
> /= 55
EF teicholtz (PLAX) severe abnormal
< 30
EF Simpsons biplane normal
M = 52 - 72 W = 54-74
EF Simpsons biplane sever abnormal
< 30
when not to do biplane EF
WHEN YOU CANNOT SEE TWO ADJEACENT SEGMENTS OF VENTRICLE
LA increasing volume/size factors
- systolic dysfunction (heart not contracting)
- diastolic dysfunction (Heart not relaxing)
- infiltrative muscle disease
- valvular heart disease (stenosis)
- obesity
biplane LA volume NOT SIMPSONS
- measure the volume of the LA in 2 orthogonal planes by tracing left atrium area in APICAL 4 CHAMBER and APICAL 2 CHAMBER
when do we trace LA
only in end systole when it is its largest
LA tracing tips
- exclude pulmonary veins from tracing
- trace from one LA side fo the MV annulus to the other
- align the vertical axis from the middle of the MV annular diameter to the roof of the LA
adjust the vertical axis of the LA
- the vertical axis contributes the length measurement t the method of discs
steps to calculate LA biplane volume
1) trave LA in A4C end systole
2) trace LA in A2C endy systole
step 1 - trace LA in apical 4 chamber at end systole
- optimize 2D
- mat use zoom
- trace at end systole
+ should near end of T wave on ECG
+ CANNOT use same image in the LV EF image
step 2 - trace the LA in apical 2 chamber at end systole
- exclude pulmonary viens
- optimize 2D
- upon last click the area and volume/volume index should appear on screen
LAVI
left atrium volume index
normal LAVI
< 32 ml/m^2
if over LAE (left atrial enlargement) may have occurred
LA diameter PLAX normal - WOMEN
2.7 - 3.8 cm
LA diameter PLAX severe abnormal - WOMEN
> /= 4.7 cm
LAVI normal - WOMEN
= 34
LAVI normal - WOMEN
> /= 48
LA diameter PLAX normal - MEN
3.0 - 4.0 cm
LA diameter PLAX severe abnormal - MEN
> 5.2 cm
LAVI normal - MEN
= 34
LAVI sever abnormal - MEN
> /= 48
RV internal dimension in diastole (RVIDd)
- measure right ventricle at end diastole
+ rotate probe till RV is at its largest
RVIDd base
- basal 1/3 of the RV
- just inferior to the TV leaflets
RVIDd mid
- mid way down the RV from the IVS to the RV free wall
normal RVIDd base
< 41mm
normal RVIDd mid
< 35mm
Right atrium dimension systole
- same timing as LA end systole
- measure across the RA in apical 4 chamber
- usually measure mid level to the orange line in the RA perpendicular to the long axis of the RA
- horisontal line should be equidistant on either side to the TV
normal RA dimension systole
= 44mm
RA volume index
- rotate the probe until the RV and RA is the largest still in the apical 4 chamber view
- trace the entire RA chamber
- cut straight across at the TV annulus
Normal RAVI women
= 21 ml/m^2
normal RAVI men
= 32 ml/m^2
