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BASIC ECHOCARDIOGRAPHY HOW TO DO? Before echocardiography Patients clinical data Symptoms - Why do we examine? Chest pain, dyspnea, etc. Blood pressure Past medical history HTN, IHD,

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  1. BASIC ECHOCARDIOGRAPHY – HOW TO DO? 속편한내과 하성일

  2. Before echocardiography  Patient’s clinical data  Symptoms - Why do we examine? ◼ Chest pain, dyspnea, etc.  Blood pressure  Past medical history ◼ HTN, IHD, cardiac surgery, etc.  P/Ex ◼ Cardiac murmur, etc.  EKG  ChestPA  Previous echocardiographic findings

  3. Before echocardiography  Patient’s privacy  Attendants – Nr. or family(mother, etc.)  Appropriate clothing & fitting room  Keep the door open  Keep the ultrasound gel warm

  4. Patient position  Which prefer???

  5. Echo probe

  6. How to grip your probe?

  7. TERM  Transducer motion  Movement ◼ To a different position on the chest  Tilting or point ◼ Transducer tip with a rocking motion to image different structures in the same tomographic plane  Angulation ◼ Transducer from side to side to obtain different tomographic planes somewhat parallel to the original image plane  Rotating ◼ The image plane at a single position to obtain intersecting tomographic planes

  8. Manipulation

  9. Manipulation – overall gain Low High

  10. Manipulation – overall gain High Low

  11. Manipulation – TGC (time gain compensation)

  12. Manipulation – TGC (time gain compensation)

  13. Manipulation – auto gain

  14. Manipulation – auto gain High gain Auto gain Low gain

  15. Manipulation – Color doppler scale Normal Abnormal

  16. Manipulation - depth

  17. Manipulation - depth

  18. How to get standard echo view?

  19. Anatomy

  20. Echocardiographic window Suprasternal window Parasternal window Apical window Subcostal window

  21. Standard Echo View  Parasternal  Long axis view  Short axis view  Apical  4 chamber view  3 chamber view  2 chamber view  5 chamber view  Subcostal view  Suprasternal view

  22. Parasternal long axis view http;//www.jss.org

  23. Parasternal long axis view http;//www.jss.org

  24. Parasternal long axis view http;//www.jss.org

  25. Parasternal long axis view

  26. Parasternal long axis view

  27. Parasternal short axis view – mitral level http;//www.jss.org

  28. Parasternal short axis view – mitral level http;//www.jss.org

  29. Parasternal short axis view – aortic valve level http;//www.jss.org

  30. Parasternal short axis view – aortic valve level http;//www.jss.org

  31. Parasternal short axis view - mitral valve level http;//www.jss.org

  32. Parasternal short axis view – papillary muscle level http;//www.jss.org

  33. Parasternal short axis view – papillary muscle level http;//www.jss.org

  34. Parasternal short axis view – apical level http;//www.jss.org

  35. Apical view  4 chamber view  3 chamber view  2 chamber view  5 chamber view http;//www.jss.org

  36. Rotation!!!

  37. Apical view – 4 chamber view http;//www.jss.org

  38. Apical view – 4 chamber view

  39. Apical view – 4 chamber view Foreshortening Normal

  40. Apical view - 3 chamber view http;//www.jss.org

  41. Apical view - 2 chamber view http;//www.jss.org

  42. Apical view - 2 chamber view

  43. Apical view - 5 chamber view

  44. Subcostal view(4 chamber) http;//www.jss.org

  45. Subcostal view(IVC) http;//www.jss.org

  46. Subcostal view(Aorta) http;//www.jss.org

  47. Suprasternal view http;//www.jss.org

  48. Summary view

  49. Why each standard echo view is important?

  50. Basal echocardiography  2D  Valve anatomy and function  Wall motion  Congenital anomaly

  51. Parasternal long axis view DCMP Aortic annuloectasia  2D HCMP Pericardial effusion

  52. Parasternal short axis view – papillary muscle level  2D Pericardial effusion

  53. Parasternal short axis view – aortic valve level  2D Atrial septal aneurysm LA thrombi in afib

  54. Apical view – 4 chamber view  2D Pulmonary thromboembolism Apical HCMP

  55. Apical view – 5 chamber view  2D LA thrombi in MS

  56. Apical view - 2 chamber view  2D LAA thrombi in HF LAA thrombi in HF d/t Afib d/t afib

  57. Subcostal view  Aorta(2D) Aortic dissection Aortic dissection AAA with thrombi AAA with thrombi

  58. Subcostal view  IVC(2D) IVC plethora(+) in HF d/t afib

  59. Parasternal long axis view  Valve anatomy and function Mitral stenosis Aortic regurgitation MVP MVP with MR Infective endocarditis Infective endocarditis

  60. Parasternal short axis view – aortic valve level  Valve anatomy and function Aortic stenosis Aortic regurgitation

  61. Parasternal short axis view - mitral valve level  Valve anatomy and function Mitral stenosis

  62. Apical view – 4 chamber view  Valve anatomy and function Mitral stenosis Mitral regurgitation

  63. Apical view - 3 chamber view  Valve anatomy and function MR & AR

  64. Apical view - 2 chamber view  Valve anatomy and function MVP with eccentric MR

  65. Parasternal long axis view  Wall motion Anterior MI(LAD territory) Posterolateral MI(LCx territory)

  66. Parasternal short axis view - mitral valve level  Wall motion Inferior MI(RCA territory)

  67. Parasternal short axis view – papillary muscle level  Wall motion Anterolateral MI(LCx territory)

  68. Parasternal short axis view – apical level  Wall motion Anterior MI(LAD territory)

  69. Apical view – 4 chamber view  Wall motion Anteroseptal MI(LAD territory) Anterolateral MI(LCx territory)

  70. Apical view - 3 chamber view  Wall motion Anteroseptal MI(LAD territory) Posterolateral MI(LCx territory)

  71. Apical view - 2 chamber view  Wall motion Anterior MI(LAD territory) Inferior MI(RCA territory)

  72. Parasternal long axis view  Congenital anomaly Persistent left superior vena cava

  73. Parasternal short axis view – aortic valve level  Congenital anomaly Bicuspid AV VSD ASD PDA

  74. Apical view – 4 chamber view  Congenital anomaly VSD Cor triatriatum Ebstein anomaly ASD

  75. Subcostal view  Congenital anomaly ASD with L-R shunt

  76. Suprasternal view  Congenital anomaly PDA with L-R shunt

  77. Which is normal???

  78. Which is normal???

  79. Basal echocardiography with 2D is important – your eyeball power!!!

  80. Reference  The EAE Textbook of Echocardiography, 2011  Textbook of Clinical echocardiography, 6 th ed.  The echo manual, 3 rd ed.  Feigenbaum’s echocardiography, 7 th ed.  Japanese society of sonographers

  81. Thank you for your attention!!!

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