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Echo > Module 4 : PLAX 2D Views and Measurements > Flashcards

Module 4 : PLAX 2D Views and Measurements Flashcards

1
Q

what view can every measurement be taken in

A

parasternal long axis

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2
Q

PLAX structures anterior to posterior

A
  • pericardium
  • +/- pericardial fluid
  • RV anterior wall
  • RV cavity
  • interventricular septum
  • AV
    • right coronary cusp
    • non coronary cusp
  • aortic sinus
  • LV cavity
  • MV
    • anterior mitral valve leaflet
    • posterior mitral valve leaflet
  • left atrium
  • posterior LV wall (posterolateral wall)
  • descending thoracic AO
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3
Q

1st protocol image

A
  • PLAX extra depth
  • depth set to 20-25 cm
  • PURPOSE IS TO LOOK FOR PERICARDIAL OR PLEURAL EFFUSIONS
  • Frame Rate not important in this image
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4
Q

2nd protocol image

A
  • PLAX with normal depth
  • ensure all structures are clearly seen
  • LV/RV , endocardium, MV, AV, AO, sinus all clear
  • don’t need all of apex
  • try to make perpendicular
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5
Q

what to do before you measure

A
  • ensure sector depth is no deeper than posterior wall of descending thoracic aorta
  • sector width is narrow enough to produce 20 fps
  • try to make LV walls perpendicular to beam
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6
Q

cine loop characteristics

A
  • stores 1-5 beats

- use to show motion and blood flow

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7
Q

still image characteristics

A
  • used for measurments
  • used when do not need to show motion or blood flow
  • used when a particular frame shows the structure better than wall motion
    + very small things
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8
Q

end diastole PLAX measurements

A 
- end diastole is when ventricle is at its biggest and both valves are closed
   \+ IVS (interventricular septum)
   \+ LVIDd ( LV internal dimension)
   \+ LVPW (LV posterior lateral wall)
   \+ aortic sinus
   \+ ascending aorta 
   \+ sometimes sinotubular junction 
DONE AT CHORDAE
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9
Q

end systole PLAX measurements

A
  • end systole is when ventricle is smallest and both valves are closed
    + LVIDs
    + LA
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10
Q

mid systole PLAX measurements

A
  • right when valves first open

+ LVOT diameter (left ventricular outflow tract)

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11
Q

how does being perpendicular to IVS improve accuracy of measurements

A
  • it improves the axial resolution rather than lateral resolution so you can assess where the walls are more accurately
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12
Q

levels of the LV

A
  • base
  • mid
  • apex
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13
Q

base level of LV

A
  • from the mitral valve to the superior tip of the pap muscle
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14
Q

mid level of LV

A
  • from the top to the bottom of the papillary muscle
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15
Q

apex level of LV

A
  • inferior to the pap muscle
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16
Q

interventricular septum measurement

A
  • measure perpendicular to the LV wall
  • measure the IVS from the fine line where the IVS switches from RV to LV to the LV wall chamber
  • IVS and posterior wall thickness should be roughly the same thickness
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17
Q

SIZE OF NORMAL IVS IN MEN

A

< 10mm

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18
Q

SIZE OF NORMAL IVS IN WOMEN

A

< 9mm

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19
Q

left ventricular internal diameter diastole (IVIDd) measurement

A
  • also called LV minor axis
  • from endocardium of the IVS to the endocardium of the LVPW
  • measured in the basal segment only
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20
Q

SIZE OF NORMAL IVIDd MEN

A

< 59mm

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21
Q

SIZE OF NORMAL IVIDd WOMEN

A

< 53mm

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22
Q

LV posterior wall measurement

A
  • also called INFEROLATERAL WALL

- measure from the anterior border oft eh LV chamber to the beginning of the right echoes of the pericardium

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23
Q

SIZE OF NORMAL LV POSTERIOR WALL MEN

A

< 10mm

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24
Q

SIZE OF NORMAL LV POSTERIOR WALL FEMALE

A

< 9mm

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25
Q

aortic measurements

A
  • in normal routine only measure aortic sinus and ascending aorta
  • only measure others if dilated
26
Q

aortic sinus measurements

A
  • leading to leading edge

- widest part of bulb

27
Q

ascending aorta measurements

A
  • about 2 cm distal to sinotubular junction (STJ) with leading to leading edge
28
Q

SEVERE AORTIC SINUS OR ASCENDING AORTA DILATION

A

> /= 50mm

29
Q

left ventricular outflow tract (LVOT)

A
  • measured in mid systole or just after aortic valves open fully
  • 5mm inferior to AV cusp insertion point on the LV side of the AV
  • ANY ERRORS IN THIS MEASUREMENT WILL AMPLIFY ERRORS IN OTHER CALCULATIONS LIKE SV/CO/AVA
30
Q

LVOT DIAMETER IN 80% OF POP

A

18-22mm

31
Q

LVOT DIAMETER AVERAGE

A

20mm

32
Q

LVOT and stroke volume (SV) and cardiac output (CO)

A
  • LVOT can be used to calculate cardiac output and stroke volume using doppler method
33
Q

cross sectional area formula

A
  • LVOT (D) ^2 x (1/4)PI = Cross Sectional Area (CSA)
34
Q

stroke volume equation using doppler formula

A

SV = (1/4 PI) x D^2 x VTI

35
Q

left ventricle internal diameter systole (LVIDs)

A
  • measured when ventricle is smallest and valves are shut
  • from posterior edge of IVS to anterior edge of the posterior wall
  • machine will produce a linear EF (ejection fraction) calculation when complete
36
Q

NORMAL LVIDs MEASUREMENT

A

20-38mm

37
Q

left atrium dimension (LA)

A
  • taken at end systole
  • ratio to aortic sinus should be 1:1
  • visually if either one looks large than the other it may be dilated
  • from posterior border of the aortic root to the anterior border of the posterior LA wall
  • lower gain helps this measurement
38
Q

NORMAL LA SIZE MEN

A

<40mm

39
Q

NORMAL LA SIZE WOMEN

A

<38mm

40
Q

fractional shortening

A
  • measurement of LV function

- a linear calculation that gives information about the systolic function of the heart

41
Q

fractional shortening equations

A

FS = LVIDd - LVIDs / LVIDd x 100

42
Q

NORMAL FRACTIONAL SHORTENING

A

25-47%

43
Q

linear ejection fraction

A
  • takes dimensions and extrapolates a volume from them
    + only works for basal layer need to have uniform motion
  • makes general assumptions
    + the EF is reasonably accurate if there are no regional wall motion abnormalities
    + assumes callipers are correctly placed and perpendicular to long axis of LV
44
Q

estimation of EF - specific assumptions

A
  • ventricle is a prolate ellipse shape (bullet)
  • long axis length is twice the short axis width
  • symmetric contractility
45
Q

teichholz formula

A
  • the machine calculates for you for a linear ejection fraction
46
Q

teicholtz EF modified

A

[{EDV (end diastolic volume)^3 - ESV (end systolic volume)^3}
/ EDV^3] x 100

47
Q

how to get EDV and ESV from a dimension

A

EDV = LVIDd ^3
ESV = LVIDs ^3 THEN CONVERT mm TO cm
+ not super accurate but close enough

48
Q

NORMAL EF

A

> /= 55%

49
Q

Right ventricular inflow tract view (RVIT)

A
  • try sliding more lateral and angle towards right hip
  • BOTH TV LEAFLETS MUST BE SEEN
  • pap not well seen
  • no 2D measurements taken in this view
  • just looking at tricuspid valve
50
Q

RVIT structures anterior to posterior

A
  • Right ventricle
  • tricuspid valve
  • Right atrium
  • coronary sinus
  • IVC
51
Q

right ventricular outflow tract (RVOT) view

A
  • focus is the Pulmonary valve and the main pulmonary artery

- no 2D measurements in normal exam

52
Q

LV mass

A
  • the weight of the LV myocardium in grams
  • uses epicardial volume minus the endocardial volume what is left is myocardial volume
  • assumes normal ventricular geometry
  • volume of LV walls x myocardial density = mass
53
Q

LV mass index

A
  • varies with body size can range from 150gm to 350 gm

-

54
Q

LVMI

A
  • LV mass indes indexes LV mass to BSA (body surface area)

LV mass / BSA

55
Q

LVMI NORMAL FOR MEN

A

<115 g/m^2

56
Q

LVMI NORMAL FOR WOMEN

A

< 95 g/m^2

57
Q

relative wall thickness (RWT)

A
  • calculation takes your measurements of the posterior wall and indexes them to the LV chamber size
58
Q

RWT basic principle

A
  • bigger chamber (bigger person) will have thicker walls naturally
  • when walls hypertrophy or dilate this calculation becomes abnormal
59
Q

RWT formula

A

2 x LVPW/LVIDd

60
Q

NORMAL RANGE FOR RWT

A

0.22 - 0.42 mm

61
Q

Chamber quantification guidelines

A

1 normal geometry =LVMI = 95(w) 115(m) & RWT = 0.42
2 concentric remodelling = LVMI = 95(w) 115(m) &
RWT > 0.42
3 concentric hypertrophy = LVMI > 95(w) 115(m) &
RWT > 0.42
4 eccentric geometry = LVMI >95(w) 115(m) & RWT = 0.42

+ 1 is normal
+ 2 has normal mass but thick walls
+ 3 has abnormal mass and thick walls
+ 4 has abnormal mass but normal walls

Echo (19 decks)

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