1. Echocardiogram
Dr Emily Player

2. 2D Echo Structural and functional test of the heart Uses Ultrasound
Sound waves are sent from the probe/ transducer by piezoelectric crystals (£££) 1
The waves travel back at various speeds producing an image
US can’t travel through air therefore aqueous gel required to transmit signal
Each signal sent as a plane and many lines of information are sent back, therefore a real time image is gained 1
Size of crystal relates to frequency of transducer, therefore increased image quality increased cost
US signal send across the plane, as it hits various structures waveforms are sent back to transducer the piezoelectric crystals receive the signal and converts it to an electrical signal for processing (proportional to distance from transducer)
Multiple signals are sent within 1 second to have a high frame rate in order to record a real time moving structural image

3. Doppler
Doppler
Uses moving structures i.e. blood flow the time difference is known as doppler shift 1
An equation is applied to the doppler shift (Fr-Ft) providing velocities of blood flow
Blood flow velocity = c (Fr – FT)/2 FT (cos θ) 1
Colour, PW and CW doppler
BART Blue- away from transducer. Red- towards
Difference in frequency from signal transmitted from probe then it is scattered as it hits moving blood cells and signal received back produces doppler shift.

4. Indications in ITU LV function Significant Valve abnormalities
Tamponade/ effusion
RV dilatation
Volume status
Thrombus, rupture, aneurysmal LV

5. Performing an Echo Before you Start Figure 1: Source 2
Position patient- USS does not travel through bone and air
Monitor Cardiac cycle with ECG
Left or Right sided echo
Patient ID
Aqueous Gel

6. The Echo Windows Parasternal Views C1 Figure 2: Source 3
Long Axis – pointer to R shoulder
Short Axis- pointer to L shoulder
Position probe approximately at V2 chest lead on ECG
Remember rib spaces
Apical Views C2
4 and 5 chambers- pointer to L axilla
2 and 3 chambers- rotate 90°
Subcostal C3
Probe flat, pointer to L horizontal

7. Echo Windows
Parasternal Long Axis [4]
Parasternal Short Axis [5]

8. Echo Windows [6]

9. Echo Windows
Apical 4 Chamber View [7]
Apical 5 Chamber View [8]

10. Echo Windows
Apical 2 Chamber View [9]
Apical 3 Chamber View [10]

11. Echo Windows
Subcostal [11], [12]
Suprasternal [13]

12. Assessing the LV 3D Object M Mode Simpsons Method of Discs
Global Impression
Regional Wall Motion Abnormalities
VTI, fractional shortening
Tissue Doppler
One of the more clinically useful methods for following left ventricular function is to evaluate the velocity time integral (VTI) of the left ventricular outflow tract or ascending aorta.
The principle states that if the cross-sectional area of the chamber is known, then the product of that cross-sectional area and the mean flow velocity equates to the volumetric flow. As the heart is a pulsatile flow system, in which the flow velocity occurs during systole, the volume calculated equals the forward LV volume in the aorta. This forward stroke volume can then be multiplied by the heart rate to obtain the cardiac output (Figure 10).

13. LV Normal measurements [14], [15]
Mild
Mod
Severe
LV wall thickness
IVSd / PWd (cm)
0.6–1.2
1.3–1.5
1.6–1.9
>2.0
LV dimension, women
LVIDd (cm)
3.9–5.3
5.4–5.7
5.8–6.1
>6.2
LVIDd / BSA (cm/m2)
2.4–3.2
3.3–3.4
3.5–3.7
>3.8
LV dimension, men
4.2–5.9
6.0–6.3
6.4–6.8
6.9
2.2–3.1
3.2–3.4
3.5–3.6
3.7

14. Simpsons Method of Discs [14]
LV function assessment using Simpson's method1
Parameter
Formula
Value (range)
LV end-diastolic volume (LVEDV) ml/m2
49-85
LV end-systolic volume ml/m2
17-37
Stroke volume (SV) ml/m2
LVEDV-LVESV
26-54
Ejection fraction (EF) (%)
SV/LVEDV
49-71

15. Regional Wall Abnormalities [14]

16. Video Links
(apical wall)
(lateral wall)
(septal wall)

17. Right Ventricle [16] RV dimensions (apical 4 chamber) Abnormal
Basal RV diameter (RVD1) (cm)
>4.2
Mid RV diameter (RVD2) (cm)
>3.5
Base to apex length (RVD3) (cm)
>8.6

18. References
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