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IN
ECHOCARDIOGRAPHYJanette LaFroscia
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EchocardiographyINTRODUCTION
• Echocardiograms are one of the most commonly performed cardiac studies
• Provide comprehensive information about cardiac structure and function
• Aid in establishing diagnosis and guiding treatment
• Can be ordered by all physicians, not just cardiologists
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Transthoracic Echocardiography- TTE
• Hand-held ultrasound probe positioned in specific areas (windows) to visualize heart
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Transesophageal Echocardiography-TEE
• Performed by inserting a small (~1/2 inch) ultrasound probe into the esophagus
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Intracardiac Echocardiography-ICE
• Thin catheter (8 Fr) with ultrasound transducer at tip, inserted directly into the RA through femoral venous access
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Orientation
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BASICSULTRASOUND PHYSICS
• TEE and ICE: Higher frequency sound waves generate high resolution images• Waves do not travel far, but allows for
imaging of finer details• TEE uses frequency of 7 MHz, ICE uses
5-10 MHz
• TTE: Lower frequency sound waves generate lower resolution images• Allows for deeper penetration of waves
through more tissue, adequate for most situations
• TTE uses frequency of 3 MHz
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Comparison
TTE
TEE
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Indications for Echo
• Assessment of LV function• Most common reason an echo is ordered• Most useful measurement is Ejection Fraction
• Difference in LV volume at end-systole and end-diastole
• Normal range is 55%-65%
• Wall motion abnomalities (WMA) can be described
• Hypokinesis- LV contraction is diminished• Akinesis- no contraction• Dyskinesis- uncoordinated contraction
http://www.youtube.com/watch?v=amCLvflTUCINormal LV function PLAXhttp://www.youtube.com/watch?v=V0kepFF4AEsNormal LV function APICAL4
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Hozumi T et al. Heart 2003;89:1163-1168
©2003 by BMJ Publishing Group Ltd and British Cardiovascular Society
WMA
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Indications for Echo
• Murmurs
• Abnormal heart sounds caused by abnormal blood flow through the heart
• Valvular heart disease• Increased flow across normal valve• Shunts due to congenital or acquired
defects• Tumors
http://www.medicanalife.com/watch_video.php?v=f88e591176322f2Myxoma
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Indications for Echo• Aortic Valve Disease
• Aortic Stenosis• Assess valve opening and mobility of
cusps• Note presence of calcium or
thickening• Measure velocity of blood flow across
valve • Calculate valve area
• Aortic Regurgitation• Assessed using Doppler
http://www.echojournal.org/video/16/Aortic-ValveNormal AO valvehttp://www.youtube.com/watch?v=MJoEyHxoi5YAortic stenosis, 2D and 3D
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Aortic Stenosis
CONTINUOUS WAVE DOPPLER
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Indications for Echo
• Mitral Valve Disease
• Mitral Regurgitation• Assess closure of valve leaflets• Assess with Doppler
• Mitral Stenosis• Caused by rheumatic heart disease• Check for abnormal thickening and
opening of leaflets
http://www.youtube.com/watch?v=yN8z01DAgVYMitral valve PSAXhttp://www.youtube.com/watch?v=amCLvflTUCIMitral valve PLAX
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Indications for Echo
• Atrial Fibrillation
• Can be related to valvular disease, CAD, diastolic dysfunction, or cardiomyopathy
• Echos can assess any underlying problems and guide treatment
• Best to control rate before study• Patients with major structural
abnormalities, significant LV systolic dysfunction, or LA diameter >4.5 cm are less likely to maintain SR after CV
http://www.youtube.com/watch?v=XgJoO_f7xZgAF
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Indications for Echo
• Stroke/TIA
• Up to 20% of CVA’s may be caused by cardiac emboli
• TTE rarely shows a direct source of emboli (such as thrombus, vegetations, or tumors)
• Shows abnormalities which predispose a patient to embolization (such as MV disease, PFO, or LV aneurysm)
• TEE is an effective screening tool to detect LAA thrombus before CV of AF and AF ablation procedures
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TEE Screening for LAA Thrombus
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TEE Screening for LAA Thrombus
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TEE Screening for LAA Thrombus
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Indications for Echo
• Infective Endocarditis• Bacterial infection of heart valves
• Established bacteria is called a vegetation• Damaged and abnormal valves are at
higher risk• Acute (staph) versus subacute (strep)• Symptoms: fever, murmur, emboli, stroke• IV drug abuse can increase risk of bacterial
endocarditis• Can also be used in setting of suspected
device system infectionhttp://www.youtube.com/watch?v=RN9jzqg2z98 Mitral Vegetation
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Indications for Echo
• Assessment of Artificial Valves
• Can be used for tissue and mechanical valves
• Check for regurgitation and leaking of blood around valve annulus
• Check velocity of blood flow through the valve
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Indications for Echo
MISCELLANEOUS
• Assessment of ASD/VSD/PFO
• Pericarditis/Pericardial Effusion/Cardiac Tampanade
http://www.youtube.com/watch?v=KoMBYodwXpY&feature=results_main&playnext=1&list=PL7E09221BF7CC64C9
• Suspected Aortic Dissection
http://www.youtube.com/watch?v=p2WPALg2W7Q VSD
http://www.youtube.com/watch?v=nD8DrZCPFBI&feature=related Dissection in ascending aorta
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Indications for Echo
MISCELLANEOUS
• Visualization of interatrial septum for transseptal procedures- ICE
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Conclusion
SUMMARY
• Echocardiography is a valuable tool in the diagnosis and
management of cardiac patients
• Consider the indication and chose echocardiography method accordingly
• An echo study needs to be performed by skilled technologists and physicians for accurate results
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Echocardiograms
VIDEOShttp://www.youtube.com/watch?v=B3un6pFV8So (normal echo)
http://www.youtube.com/watch?v=N61stug0oBM&feature=related (AS, LVH, Rt side dilatation, PPM, MR, AI)
http://www.youtube.com/watch?v=mlsbfqZljSE&feature=related (LV thrombus)
http://www.youtube.com/watch?v=izDZnG4T8bc (bubble study)
http://folk.ntnu.no/stoylen/strainrate/Ultrasound/ Ultrasound Review
ARTICLEShttp://www.eplabdigest.com/article/4148 ICE Overview