BASIC ECHOCARDIOGRAPHY HOW TO DO? Before echocardiography - PowerPoint PPT Presentation

BASIC ECHOCARDIOGRAPHY – HOW TO DO? 속편한내과 하성일

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

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

Patient position  Which prefer???

Echo probe

How to grip your probe?

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

Manipulation

Manipulation – overall gain Low High

Manipulation – overall gain High Low

Manipulation – TGC (time gain compensation)

Manipulation – TGC (time gain compensation)

Manipulation – auto gain

Manipulation – auto gain High gain Auto gain Low gain

Manipulation – Color doppler scale Normal Abnormal

Manipulation - depth

Manipulation - depth

How to get standard echo view?

Anatomy

Echocardiographic window Suprasternal window Parasternal window Apical window Subcostal window

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

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

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

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

Parasternal long axis view

Parasternal long axis view

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

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

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

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

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

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

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

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

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

Rotation!!!

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

Apical view – 4 chamber view

Apical view – 4 chamber view Foreshortening Normal

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

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

Apical view - 2 chamber view

Apical view - 5 chamber view

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

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

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

Suprasternal view http;//www.jss.org

Summary view

Why each standard echo view is important?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Subcostal view  Congenital anomaly ASD with L-R shunt

Suprasternal view  Congenital anomaly PDA with L-R shunt

Which is normal???

Which is normal???

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

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

Thank you for your attention!!!