Introduction to Echocardiography.pdf

INTRODUCTION TO ECHOCARDIOGRAPHY WHAT IS ECHOCARDIOGRAPHY? The use of ultrasound in order to study the function and the morphology of the heart without being invasive. EQUIPMENT Echocardiology table EQUIPMENT Ultrasound gel Alcohol PATIENT PREPARATION Shave the patient. Right side - 4th-6th intercos...

INTRODUCTION TO ECHOCARDIOGRAPHY WHAT IS ECHOCARDIOGRAPHY? The use of ultrasound in order to study the function and the morphology of the heart without being invasive. EQUIPMENT Echocardiology table EQUIPMENT Ultrasound gel Alcohol PATIENT PREPARATION Shave the patient. Right side - 4th-6th intercostal spaces in dogs and 3rd-5th intercostal spaces in cats. Left side – 4th intercostal space to just caudal to the ribs for small animals. Alcohol and gel for thinner haired patients. PATIENT POSITIONING EQUIPMENT TRANSDUCER POSITIONING ANATOMY AND CIRCULATION RIGHT PARASTERNAL LONG AXIS VIEW RIGHT PARASTERNAL LONG AXIS VIEW Right Cranial and dorsal Caudal and ventral Left RIGHT PARASTERNAL LONG AXIS VIEW Evaluate mitral and tricuspid valves Subjective view of function of the left ventricle Overall morphology of the heart RV LV RA LA RIGHT PARASTERNAL LONG AXIS VENTRICULAR OUTFLOW (5 CHAMBER VIEW) RIGHT PARASTERNAL LEFT VENTRICULAR OUTFLOW VIEW Evaluate the left ventricular outflow tract RV Aortic valve LV AO LA RIGHT PARASTERNAL TRANSVERSE (SHORT AXIS)VIEWS RIGHT PARASTERNAL TRANSVERSE (SHORT AXIS) VIEW Evaluate the thickness of the left ventricular wall Compare the size of the right vs left ventricles Left ventricle (mushroom) RIGHT PARASTERNAL TRANSVERSE (SHORT AXIS) Evaluate the mitral valve morphology and motion Mitral valve (fish mouth) RIGHT PARASTERNAL TRANSVERSE (SHORT AXIS) VIEW Evaluate the right ventricular outflow tract Morphology and motion of the pulmonic valve RIGHT PARASTERNAL TRANSVERSE (SHORT AXIS) VIEW SHOWING THE HEART B ASE Size of the left atrium Pulmonic valve Size of the pulmonary artery Right ventricular outflow tract MEASUREMENTS Objective measurements can be obtained using ultrasound: M mode (motion mode): cardiac structure change with systole and diastole in a graph form. Depth on the Y axis and Time on the X axis. 2-D measurements of cardiac structures. M MODE OF THE LEFT VENTRICLE M MODE OF THE LEFT VENTRICLE Evaluate the thickness of the interventricular septum and the left ventricular free wall. Evaluate the size of the left ventricle during systole and diastole. Aides in determining the contractility of the heart or systolic function. Fractional shortening: LV(d)-LV(s)/LV(d)x100 Normal FS for dog 3346% Right ventricle Interventricular septum Left ventricle Left ventricular free wall M MODE OF THE LEFT VENTRICLE M MODE SHOWING EPSS(E POINT TO SEPTAL SEPARATION)OF THE MITRAL VALVE Evaluation of left ventricular filling and function. Increased EPSS means decreased ejection fraction Normal EPSS is less than 7.7 mm. M MODE OF THE AORTA AND THE LEFT ATRIUM Aorta is measured at the end of diastole. Left atrium is measured at the largest chamber size. Expressed as a ratio, LA:Ao ratio. Normal is less than1.59 in dogs and 1.39 in cats. Aorta Left atrium 2-D MEASUREMENT OF AORTA AND LEFT ATRIUM Evaluate the size of the left atrium in relation to the aorta, LA:AO ratio Measure the aorta along the noncoronary cusp and right coronary cusp. Measure the left atrium along the left coronary cusp. Evaluate the size of the main pulmonary artery. LEFT PARASTERNAL APIC AL 4 CHAMBER VIEW LEFT PARASTERNAL APIC AL 4 CHAMBER VIEW Evaluate blood flow through the mitral and tricuspid valves via colour flow and spectral doppler. LV RV Evaluate the motion and anatomy of the valves. LA RA LEFT PARASTERNAL APIC AL 5 CHAMBER VIEW Evaluate the left ventricular outflow tract, aortic valve and the doppler evaluation of the blood flow within the aorta. THE USE OF DOPPLER Sound waves used to detect the red blood cells as they circulate. Colour flow doppler – show directional flow. Blue – away from the transducer Red – towards the transducer Spectral doppler – velocity and direction of blood flow. COLOUR FLOW DOPPLER Normal blood flow in the main pulmonary artery SPECTRAL DOPPLER Try to line up the sound beam as parallel with the blood flow as much as possible. Blood flowing away from the transducer is seen below the baseline Aorta Main pulmonary artery Blood flowing towards the transducer is seen as peaks above the baseline Mitral valve Tricuspid valve SPECTRAL DOPPLER The velocity of blood flow in the main pulmonary artery. SPECTRAL DOPPLER Velocity of the blood flow in the aorta SPECTRAL DOPPLER Velocity of the blood flow leaving the left atrium and going to left ventricle across the mitral valve E – early diastolic flow A – late diastolic flow E A SPECTRAL DOPPLER Velocity of blood flow at the tricuspid valve