Module 5 : M-Mode and Measurements

Question 1

M-mode Frame rate

Answer 1

• has a frame rate in the thousands
• ability to make fast moving structures appear continuous
• uses only a single scan line to sample at extremely high rates

Question 2

M-mode good for imaging what?

Answer 2

• MV, TV, PV, AV
• correlating electrical events sich as ventricular motion
• precise measurements of cardiac dimensions (because you are perpendicular)

Question 3

M-Mode resolution

Answer 3

has a much higher temporal resolution compared to 2D

Question 4

M- mode levels

Answer 4

3 levels
+ Aorta and left atrium
+ MV
+LV base

+ also m-mode at the tricuspid annulus in the apical 4 chamber view

Question 5

General principles of M-MOde

Answer 5

#1 MUST BE PERPENDICULAR TO THE STRUCTURE OF INTEREST
   \+  do not measure with m - mode if you think you are not perpendicular
   \+ could lead to an over estimation of dimension

Question 6

AV/LA m-mode purpose (aortic valve/left atrium)

Answer 6

• assess Ao Root wall motion
• assess variations in LA size (related to rhythm)
• assess LA size in systole (enlarged?)
• assess AV cusp morphology (thickened?)
• assess AV cusp excursion (opening)

Question 7

M-mode AV/LA level cursor line

Answer 7

transects through the AV cusps parallel to AV valve plane

Question 8

what m-mode looks like at the AV/LV valve

Answer 8

NEED TO SEE THE AORTIC BOX
LINES TOGETHER MEANS VALVES CLOSED
OPENING OF BOXE IS OPENING OF VALVES
- anterior line is the RIGHT CORONARY CUSP
- posterior line is the LEFT CORONARY CUSP

Question 9

AO/LA measurements

Answer 9

- AO root 
   \+ end diastole or QRS complex
   \+ leading to leading 
- LA
   \+ end systole 
* leading to leading

Question 10

M-Mode of the MV purpose

Answer 10

• to assess MV morphology (thickening)
• to assess MV motion (stenosis/prolapse)
• asses the severity of an aortic valve leak which would affect movement of the MV
• indirect assessment of LV systolic function
• NO MEASUREMENTS

Question 11

M - mode of the MV

Answer 11

• always forms an M on top
• opens before QRS complex
• double bump not as noticeable on posterior

Question 12

parts of the M of the M-mode

Answer 12

• first bump = early filling
• diastasis = end of first bump
• little bump = late filling

Question 13

MV waves labeled

Answer 13

D, E, F, A, C ON BOTH ANTERIOR AND POSTERIOR LEAFLETS

  \+ D = opening in the very beginning 
  \+ E = early filling 
  \+ F = diastasis begins 
  \+ A = atrial contraction 
  \+ C = closure

Question 14

structures in MV m-mode anterior to posterior

Answer 14

• right ventricle
• interventricular septum
• left ventricle chamber
• anterior MV leaflet
• posterior MV leaflet
• posterior wall of LV

Question 15

EPSS

Answer 15

• E Point to Septal Seperation
• increases if ventricle dilated
• gap between the MV and the IVS when the MV is fully open

Question 16

M-mode mitral valve stenosis

Answer 16

• reduce Mv leaflet excursion and thickened leaflets

Question 17

M-mode of LV

Answer 17

• taken at the LV base at level of the chordae tendinae

- must attempt to IVS as last as possible before recording

Question 18

M-Mode of LV assesses

Answer 18

• wall motion
• ejection fraction/ fractional shortening
• sublet wall motion abnormalilites of the IVS

Question 19

LV M-mode structures anterior to posterior

Answer 19

RV anterior wall
RV chamber 
IVS
LV chamber
posterior septal wall 
pericardium

Question 20

M-mode LV measurements - diastole (QRS)

Answer 20

• IVSd = RV side fo the LV septum to the LV
• LVIDd = anterior IVS to the posterior wall
• LVPWd = LV cavity to the epicardium

Question 21

M-mode LV measurements - systole (T wave)

Answer 21

• LVIDs = at its smallest, posterior displacement of the IVS to the anterior displacement of the posterior wall

Question 22

fractional shortening equation

Answer 22

LVIDd - LVIDs / LVEDd x 100

Question 23

M-mode of pulmonary valve

Answer 23

• performed infrequently
• may be used to diagnose pulmonary hypertension
• only see right cusp
• IF ABNORMAL
  + will have an absent A = no little bump before opening

Question 24

Anatomical M mode (AMM)

Answer 24

• can correct for poor alignment to any structure by crossing over multiple scan lines

Question 25

tricuspid annular plane systolic excursion TAPSE

Answer 25

• assess the tricuspid annulus movement throughout the cardiac cycle
• measurement of global RV systolic function
  + tells us how well RV is contracting

Question 26

normal TV movement

Answer 26

> 17mm toward and away from the apex