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M-MODE ECHOCARDIOGRPHY THE LOSS ART. M-MODE PHYSICS B mode echoes from an interface that changes position will be seen as echoes moving towards and away.

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Presentation on theme: "M-MODE ECHOCARDIOGRPHY THE LOSS ART. M-MODE PHYSICS B mode echoes from an interface that changes position will be seen as echoes moving towards and away."— Presentation transcript:

1 M-MODE ECHOCARDIOGRPHY THE LOSS ART

2 M-MODE PHYSICS B mode echoes from an interface that changes position will be seen as echoes moving towards and away from the transducer. If a trace line is place on this interface and the resulting trace is made to drift across the face of a CRT screen a motion pattern is obtained.

3 M-MODE PHYSICS The resulting display shows motion of a reflector over distance and time – a distance time graph The change in distance (dy) over a period of time dt is represented by the slope of the reflector line of motion. dy/dt = slope = velocity

4 M-MODE PHYSICS If this motion pattern is obtained on moving cardiac structures then the resulting images constitute M-mode echocardiography. M-mode echocardiography is use to evaluate the morphology of structures, movement and velocity of cardiac valves and walls and timing of cardiac events.

5 Distance Time M-mode Tracing

6 M-mode Evaluation Amplitude Velocity Time intervals Morphology

7 Amplitude = Y2 –Y1 Y1 Y2 Amplitude Measurement Distance Time

8 Time interval = T2 – T1 T2 T1 Time Measurement Distance Time

9 dy = Y2 –Y1 Y1 Y2 Slope Measurement T1T2 dt = T2 – T1 Slope = dy/dt = velocity

10 M-mode at the Mitral Valve The mitral valve has 2 leaflets – anterior and posterior. Specific letters corresponding to systole and diastole are assigned to the m-mode tracing of the mitral valve.

11 EKG Tracing T-wave QRS complex P wave SystoleDiastole

12 Distance Systole M-mode at Mitral Valve Diastole Time

13 Phase of Cardiac CycleAssigned Letters Diastoled,e,f, and a Systolec and d M-mode at the Mitral Valve

14 Systole M-mode at Mitral Valve Diastole d c a f e d Time Distance

15 Systole M-mode at Mitral Valve Diastole e d Time Distance d-e amplitude

16 Systole M-mode at Mitral Valve Diastole Septum e Time Distance EPSS

17 Systole M-mode at Mitral Valve Diastole e d Time Distance d-e slope

18 Systole M-mode at Mitral Valve Diastole f e Time Distance e-f slope

19 M-mode at Mitral Valve

20 M-mode at the Mitral Valve AmplitudeDescription Normal Value EPSSMeasure e point to septal separation < 5 mm d-eMeasures the maximum excusion of the mitral valve following diastolic opening. 17 to 30 mm

21 M-mode at the Mitral Valve SlopeDescriptionNormal Value d-eMeasure rate of initial opening of the mitral valve in early diastole. 240 to 380 mm/s e-fMeasures the rate of early closure of the mitral valve following diastolic opening. 50 to 180 mm/s

22 M-mode Findings at the MV B- bump on the AC shoulder Premature Closure of the MV Systolic anterior motion of the AMVL Mitral Valve Prolapse Mitral Regurgitation

23 M-mode Findings at the MV Flail PMVL Fluttering of the AMVL Mitral Stenosis LA myxoma Vegetations

24 Distance Systole M-mode at Mitral Valve Diastole Time B-bump on the AC shoulder.

25 Distance Systole M-mode at Mitral Valve Diastole Time Premature Closure Premature Closure- closure on or before the onset of the QRS complex.

26 Distance Systole M-mode at Mitral Valve Diastole Time Systolic anterior motion of the AMVL

27 Distance Systole M-mode at Mitral Valve Diastole Time Systolic anterior motion of the AMVL

28 Distance Systole M-mode at Mitral Valve Diastole Time MV prolapse posterior leaflet

29 Distance Systole M-mode at Mitral Valve Diastole Time MV Prolapse – both leaflet

30 Distance Systole M-mode at Mitral Valve Diastole Time Flail posterior leaflet

31 Distance Systole M-mode at Mitral Valve Diastole Time Aortic Regurgitation

32 Distance Systole M-mode at Mitral Valve Diastole Time Sinus Rhythm Mitral Stenosis

33 Distance Systole M-mode at Mitral Valve Diastole Time Atrial Fibrillation Mitral Stenosis

34 Distance Systole M-mode at Mitral Valve Diastole Time Atrial Myxoma

35 Distance Systole M-mode at Mitral Valve Diastole Time Vegetation

36 Distance Systole Diastole Time Mitral Regurgitation

37 Distance Systole Diastole Time Mitral Regurgitation

38 Distance Systole Mitral Regurgitation Diastole Time Atrial Myxoma

39 Distance Systole Diastole Time Atrial Myxoma Mitral Regurgitation

40 Distance Systole M-mode at Mitral Valve Diastole Time Atrial Myxoma

41 Color M-mode

42 Propagation Velocity, Vp

43 M- Mode Aortic Valve

44 M-mode at the Aortic Valve The aortic valve has 3 cusps – right coronary, left coronary and non-coronary cusps. The cusps imaged in the PLAX view are the right coronary and the non-coronary cusps.

45 M-mode at the Aortic Valve Coronary cusp Non-coronary cusp Anterior aortic root Posterior aortic root Left Atrium

46 M-mode at the Aortic Valve LA dimension Cusp Separation Aortic root

47 M-mode at the Aortic Valve LA dimension Cusp Separation Aortic root Measurements are made from leading edge to leading edge.

48 M-mode at the Aortic Valve Dilated LA Dilated aortic root Decreased excursion Premature opening Premature closing Exaggerated anterior motion of Aortic Root

49 M-mode at the Aortic Valve Reduced anterior motion of Aortic Root Thickening Calcification Vegetations Bicuspid valve Prosthetic valve Aortic Regurgitation

50 M-mode at the Aortic Valve Premature Opening Opening of the AV before the onset of the QRS complex Seen in Elevated LV-EDP

51 M-mode at the Aortic Valve Premature Closure Closure of the AV before the onset of the T wave Seen in IHSS

52 M-mode at the Aortic Valve Bicuspid Valve Eccentric closure line Seen when there is a Bicuspid aortic valve

53 M-mode at the Aortic Valve Decreased Cusp Separation Seen in Aortic Stenosis

54 M-mode at the Aortic Valve Seen in aortic sclerosis Thickened, calcified aortic valve leaflet.

55 M-mode at the Aortic Valve Seen in Mitral Stenosis Reduced anterior motion of aortic root

56 M-mode at the Aortic Valve Exaggerated anterior motion of aortic root Seen in Mitral Regurgitation

57 Aortic Regurgitation

58

59

60 M - Mode Left Ventricle

61 M-mode at Left Ventricle

62 Thickening of the IVS and LVPW Movement of the IVS and LVPW

63 RVWd RVIDd M-mode Measurement

64 IVSd IVS excursion IVSs M-mode Measurement

65 LVIDd LVIDd index LVIDs LVIDs index M-mode Measurement

66 LVPWd LVPW excursion LVPW max excursion velocity LVPWs M-mode Measurement

67 M-mode at Left Ventricle RVWT

68 M-mode at Left Ventricle RVIDd

69 M-mode at Left Ventricle IVSd

70 M-mode at Left Ventricle LVIDd

71 M-mode at Left Ventricle LVPWd

72 M-mode at Left Ventricle IVS excursion

73 M-mode at Left Ventricle IVSs

74 M-mode at Left Ventricle LVIDs

75 M-mode at Left Ventricle LVPWs

76 M-mode at Left Ventricle LVPW excursion

77 M-mode at Left Ventricle LVPW max velocity = slope

78 M-mode at Left Ventricle

79 FS EF LV mass RWT M-mode LV Calculation

80 % IVS thickening % LVPW thickening IVS/LVPW ratio M-mode LV Calculation

81 FS = LVIDd – LVIDs LVIDd

82 M-mode LV Calculation EF = LVIDd 3 – LVIDs 3 LVIDd 3

83 M-mode LV Calculation RWT = IVSd + LVPWd LVIDd

84 M-mode LV Calculation IVS % thickening = (IVSs – IVSd) x 100 IVSd

85 M-mode LV Calculation LVPW % thickening = (LVPWs – LVPWd) x 100 LVPWd

86 M-mode LV Calculation LV Mass = 1.04 {(LVIDd + IVSd + LVPWd) 3 – (LVIDd) 3 } x 0.8 + 0.6g

87 Increase LVW thickness

88 Increased Wall Thickness Symmetrical Concentric Hypertrophy Asymmetrical Infiltrative Diseases Concentric Remodeling Hypertrophic Cardiomyopathy Increased Wall ThicknessIncrease LVW thickness

89 LV Hypertrophy - Hypertension Pressure Overload Concentric LVH Increase Wall thickness Normal Mss Increase Wall thickness Increased Mass Remodeling

90 Increase Wall thickness Normal LV MassIncreased LV Mass Measure LV Mass Concentric RemodelingConcentric Hypertrophy LV Hypertrophy - Hypertension

91 Increase Wall thickness Increased LV Mass Concentric Hypertrophy LV Hypertrophy – Aortic Stenosis Pressure Overload LVH

92 Eccentric LV Hypertrophy Increased LV size with Spherical shape Normal LV MassIncreased LV Mass Measure LV Mass No LV hypertrophyEccentric Hypertrophy

93 Measurement Assessment Concentric Hypertrophy Concentric Remodeling Eccentric Hypertrophy Wall Thickness Increased Normal Relative Wall Thickness Increased Normal - Decreased LV Chamber sizeNormal Increased LV Chamber shapeElliptical Spherical LV massIncreasedNormalIncreased LV Hypertrophy

94 Paradoxical Septal Motion

95 RV hypertrophy RV dilatation LBBB Post Cardiac Surgery Paradoxical Septal Motion

96 Ischemia

97 Normal Wall thickness No systolic thickening Reduced Motion

98 Post Infarct

99 Thin echogenic wall No systolic thickening Reduced Motion

100 Pericardial Effusion

101 Infection Postviral pericarditis Bacterial Tuberculosis

102 Pericardial Effusion Malignant Metastatic disease – lymphoma & melanoma Direct extension – lung and breast Primary cardiac malignancy

103 Pericardial Effusion Inflammatory Post MI (Dressler’s Syndrome) Uremia Collagen vascular disease Post cardiac surgery

104 Pericardial Effusion Intracardiac-Pericardial communication Blunt or penetrating chest trauma Post catheter procedures LV rupture (post MI)

105 Pericardial Thickening

106 Constrictive pericarditis Occurs following Surgery Radiation therapy Repeated episodes of pericarditis


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