1. ADULT ECHOCARDIOGRAPHY COURSE
Harry H. Holdorf PhD, MPA, RDMS (Ab, OB/Gyn, BR), RVT (VT), LRT(AS), N.P.

2. Table of Contents Objectives
INTRODUCTION
Table of Contents
Objectives

4. Adult Echocardiography T of C
Abbreviations
Anatomy and Hemodynamics
Cardiac Physiology
Technique and Patient Care
The aortic valve
The pulmonic valve
The mitral valve
The tricuspid valve
Valvular heart disease
Coronary Anatomy
Prosthetic valves
Cardiomyopathies
Diastolic Dysfunction

5. Table of contents cont…
14. The pericardium
15. Hypertensive Heart Disease
16. Ischemic Heart Disease
17. Adult Congenital Heart Disease
18. Foreign Bodies, Masses, and Myxomas
19. EKG-Electrocardiogram
20. Lectures on Adult Echocardiography
21. Final Exam prep 1
22. Final Exam prep 2
23. Final Exam

6. Objectives
Interact appropriately with the patient, physicians and staff. Identify the pertinent clinical questions and the goal of the examination. Recognize significant clinical information and historical facts from the patient and the medical records, which may impact the diagnostic examination. Review data from current and previous examinations to produce a written/oral summary of technical findings, including relevant interval changes, for the reporting physician’s reference. Select the correct transducer type and frequency for examination(s) being performed. Adjust instrument controls including examination presets, scale size, focal zone(s), overall gain, time gain compensation, and frame rate to optimize image quality.

7. Demonstrate knowledge and understanding of Doppler ultrasound principles, spectral analysis, and color flow imaging relevant to and in the AE specialty.
Demonstrate knowledge and understanding of anatomy, physiology, pathology and pathophysiology relevant to and in the AE specialty.
Demonstrate the ability to perform sonographic examinations of the appropriate organs and areas of interest according to professional and employing institution protocols relevant to and in the AE specialty.
Recognize, identify and document the abnormal sonographic patterns of disease processes, pathology, and pathophysiology of the organs and areas of interest.
Modify the scanning protocol based on the sonographic findings and the differential diagnosis relevant to and in the AE specialty.
Perform related measurements from sonographic images or data.
Utilize appropriate examination recording devices to obtain pertinent documentation of examination findings.

8. Lecture one ABBREVIATIONS

9. Abbreviations AR Aortic Regurgitation (AI) Ao Aorta AoV Aortic valve
ASD Atrial Septal Defect
ASH Asymmetric Septal Hypertrophy
AV Atrioventrical
BBB Bundle Branch Block
BP Blood Pressure
BPM Beats Per Minute
BSA Body Surface Area
CHF Congestive Heart Failure
CI Cardiac Index
CM Cardiomyopathy
CO Cardiac Output

10. COPD Chronic Obstructive Pulmonary Disease
CPI Cardiovascular Principles and Instrumentation
CS Coronary Sinus
CVA Cerebral Vascular Accident
CW Continuous Wave Doppler
DA Ductus Arteriosus
DM Diastolic Murmur
DOE Dyspnea and Exertion
ed End Diastolic
EF Ejection Fraction
ECG Electorcardiogram (EKG)
FO Foramen Ovale
HCM Hypertrophic Cardiomyopathy
HOCM Hypertrophic Obstructive Cardiomyopathy

11. IHSS Idiopathic Hypertrophic Subaortic Stenosis
IVC Inferior Vena Cava
L Liter
LA Left Atrium
LAD Left Anterior Descending Coronary Artery
LAX Long Axis View
LSB Left Sternal Border
LV Left Ventricle
LVEDP Left Ventricular End Diastolic Pressure
LVET Left ventricular Ejection Time
LVH Left Ventricular Hypertrophy
LVOT Left Ventricular Outflow Tract
MHz Megahertz
MAC Mitral Annular Calcification
MI Myocardial Infarction
ml Milliliter

12. mm Hg Millimeters of Mercury
MR Mitral Regurgitation
MS Mitral Stenosis
MV Mitral Valve
MVA Mitral Valve Area
MVP Mitral Valve Prolapse
O2 Oxygen
OS Opening Snap
PA Pulmonary Artery
PDA Patient Ductus Arteriosus
PE Pericardial Effusion
PEP Pre-Ejection Period
PHTN Pulmonary Hypertension
PR Pulmonic Regurgitation
PS Pulmonic Stenosis

13. PV Pulmonary Valve (or vein)
PVC Premature Ventricular Contraction
PVD Peripheral Vascular Disease
PW Pulsed Wave Doppler
Q Flow
RA Right Atrium
RAP Right Arterial Pressure
RCA Right Coronary Artery
RUSB Right Upper Sternal Border
RV Right Ventricle
RVH Right Ventricular Hypertrophy
RVOT Right Ventricular Outflow Tract
RVSP Right Ventricular Systolic Pressure
SA Sinoatrial

14. SAM Systolic Anterior Motion
SAX Short Axis View
SBE Subacute Bacterial Endocarditis
SBP Systolic Blood Pressure
SV Stroke Volume
SVC Superior Vena Cava
TGV Transposition of the Great Vessels
TR Tricuspid Regurgitation
TS Tricuspid Stenosis
TV Tricuspid Valve
UA Umbilical Artery
UV Umbilical Vein
VSD Ventricular Septal Defect
WPW Wolf-Parkinson-White Syndrome

15. Aortic Regurgitation AR

16. Aorta

17. Aortic Valve

18. ASD

19. Asymmetric Septal Hypertrophy

20. Atrioventricular AV

21. Bundle Branch Block BBB

22. Blood Pressure

23. Beats per minute

24. Body surface area
In simple terms Body Surface Area is the area covered by one’s skin
the largest organ of the body
It is often a clinical measure used by physicians
to calculate the drug dosages and for administration of intravenous fluids

25. Congestive heart failure

26. Cardiac Index
A large person has a higher cardiac output than a small person. The cardiac index represents cardiac output that has been adjusted to a person's size.
Dividing cardiac output by the person's body surface area, or BSA, will provide the cardiac index.
Cardiac output correlates better with body surface area than weight. Cardiac output that is expressed per square meter of body surface area is termed cardiac index.

27. Cardiomyopathy

28. Cardiac Output

29. Chronic Obstructive Pulmonary Disease (COPD)

30. Cardiovascular Principles and Instrumentation

31. Coronary Sinus

32. Cerebral Vascular Accident

33. Continuous Wave Doppler

34. Ductus Arteriosus

35. Diastolic Murmur

36. Dyspnea and Exertion

37. End Diastolic

38. Ejection Fraction

39. Electrocardiogram (EKG)

40. Foramen Ovale PFO

41. Hypertrophic Cardiomyopathy

42. Hypertrophic Obstructive Cardiomyopathy

43. Idiopathic Hypertrophic Subaortic Stenosis

44. Inferior Vena Cava

45. Liter = heart pumps 5-7 liters of blood per minute

46. Left Atrium

47. Left Anterior Descending Coronary Artery

48. Long Axis View

49. Left Sternal Border

50. Left Ventricle

51. Left Ventricular End Diastolic Pressure
Left Ventricular end-diastolic pressure (LVEDP):
The pressure in the Left ventricle at the end of diastole, (usually measured in the left ventricle) as an approximation of the end-diastolic volume, or preload.

52. Left Ventricular Ejection Time
The time for the ejection of blood from the left ventricle, beginning with aortic valve opening and ending with aortic valve closure.

53. Left Ventricular Hypertrophy

54. Left Ventricular Outflow Tract

55. Megahertz

56. Mitral Annular Calcification

57. Myocardial Infarction

58. Milliliter

59. Millimeters of Mercury

60. Mitral Regurgitation

61. Mitral Stenosis

62. Mitral Valve

63. Mitral valve area
Aortic Annulus Size        cm Mitral Annulus Size         cm Aortic VTI                     cm Mitral VTI                      cm

64. Mitral Valve Prolapse
MVP: Mitral valve prolapse is a condition in which the two valve flaps of the mitral valve do not close smoothly or evenly. Mitral valve prolapse is also known as click-murmur syndrome, Barlow's syndrome or floppy valve syndrome. When the heart contracts, part of one or both flaps collapse backward into the left atrium. In some cases, the prolapsed valve lets a small amount of blood leak backward through the valve, which may cause a heart murmur.

65. Oxygen

66. Opening snap

67. Pulmonary Artery

68. Patient Ductus Arteriosus
Patent ductus arteriosus (PDA) is a condition in which the ductus arteriosus does not close. 
The ductus arteriosus is a blood vessel that allows blood to go around the baby's lungs before birth. Soon after the infant is born and the lungs fill with air, the ductus arteriosus is no longer needed. It usually closes in a couple of days after birth. If the vessel doesn't close, it is referred to as a PDA.
PDA leads to abnormal blood flow between the aorta and pulmonary artery, two major blood vessels that carry blood from the heart.

69. Pericardial Effusion

70. Pre-Ejection Period
The period between when the ventricular contraction occurs and the semilunar valves open and blood ejection into the aorta commences.

71. Pulmonary Hypertension

72. Pulmonic Regurgitation

73. Pulmonic Stenosis

74. Pulmonary Valve (or vein)

75. Premature Ventricular Contraction

76. Peripheral Vascular Disease

77. Pulsed Wave Doppler

78. Flow (Q)

79. Right Atrium

80. Right Atrial Pressure

81. Right Coronary Artery

82. Right Upper Sternal Border

83. Right Ventricle

84. Right Ventricular Hypertrophy

85. Right Ventricular Outflow Tract

86. Right Ventricular Systolic Pressure

87. Sinoatrial

88. Systolic Anterior Motion (SAM)
Systolic anterior motion (SAM) of the mitral valve (MV) can be a life-threatening condition. The SAM can result in severe left ventricular outflow tract obstruction and/or mitral regurgitation and is associated with an up to 20% risk of sudden death. 
Systolic anterior motion (SAM) describes the dynamic movement of the mitral valve (MV) during systole anteriorly towards the left ventricular outflow tract (LVOT).

89. Short Axis View Bicuspid Aortic Valve

90. Subacute Bacterial Endocarditis
Subacute Bacterial Endocarditis (SBE) is a bacterial infection that produces growths on the endocardium (the cells lining the inside of the heart). Subacute bacterial endocarditis usually (but not always) is caused by a type of bacteria; it occurs on damaged valves, and, if untreated, can become fatal within six weeks to a year.

91. Systolic Blood Pressure

92. Stroke Volume

93. Superior Vena Cava

94. Transposition of the Great Vessels

95. Tricuspid Regurgitation

96. Tricuspid Stenosis

97. Tricuspid Valve

98. Umbilical Artery
The umbilical vein is a vein present during fetal development that carries oxygenated blood from the placenta to the growing fetus.

99. Umbilical Vein

100. Ventricular Septal Defect

101. Wolf-Parkinson-White Syndrome
WPW is caused by the presence of an abnormal accessory electrical conduction pathway between the atria and the ventricles.
Electrical signals traveling down this abnormal pathway (known as the bundle of Kent) may stimulate the ventricles to contract prematurely, resulting in a unique type of supraventricular tachycardia referred to as an atrioventricular reciprocating tachycardia.

102. Most cardiac output is reduced because of:
Restrictive physiology (Hypertrophy of the ventricles)

103. In the typical 4 chamber view, why can an inter-atrial septum appear so fat?
Amyloid Deposits

104. Color flow Doppler can demonstrate…
Normal tricuspid regurgitation
Moderate tricuspid regurgitation
Mild tricuspid regurgitation
Hint: Moderate regurgitation on Doppler takes up more than one-half of the chamber

105. Prosthetic mitral valves
Tilting disk
Ball and cage
St. Jude
The ball and cage is not put in anymore. (Makes too much noise) They last for years, though.
Wire on the image?
Probably a pace-maker wire

106. Q: One of the best features of the ball and cage prosthetic valve is:
Durability
Low gradient
No need for blood thinners
Low chance of infection A.

107. Sometimes, the degree of mitral regurg is indeterminate because of:
Noise
Artifact
Reverberation

108. An asymptomatic 36 y/o male has which common associated defect?
ASD

109. Expect to see a wide variety of Pathology Dilated CM Carcinoid Amyloid CM Ao Dissection Tetralogy of Fallot Ischemic CM Apical HCM Effusions Ebstein’s Marfan 2 HOCM Flail MV VSD Non Compacted LV Pseudoaneurysm MV vege (TEE) Stress Cases Pulmonary HTN Bicuspid Ao LA myxoma (TEE) PDA MVR – Ball/cage RV Vol. overload Sub Ao Membrane Cleft MV

110. Finished with lecture one
Next: Anatomy Review