how to read echocardiography of heart.pptx

for medical students

1. Echocardiography

2. It can measure cardiac output and is a sentisive test to find fiuid around the heart (pericardial effusion). Definition Echocardiogram is a diagnostic test which uses ultrasound waves to make images of the heart chambers,valves and surrounding structures.

3. Developed in the 1950s. Pioneers: Dr. Inge Edler and Dr. Carl Hellmuth Hertz. History of Echocardiocardiography

4. Basic Principles Ultrasound waves and their interaction with heart tissues. Echoes are reflected back and captured to form images.

5. Components Pulse generator-applies high amplitude voltage to energize the crystals Transducer -converts electrical energy to mechanical(USG)energy and vice versa Receiver-detects and amplifies weak signals Display- displays ultrasound signals in a variety of modes Memory-stores video display

6. Types Transthoracic echocardiogram(TTE) Transoesophageal echocardiogram (TEE) Stress echocardiogram doppler echocardiogram

7. Transthoracic Echocardiography (TTE) Non-invasive, primary method. Probe placed on the chest wall.

8. Transesophageal Echocardiography (TEE) Invasive, higher resolution. Probe inserted into the esophagus

9. Stress Echocardiography Assesses heart function under stress (exercise or medication). Identifies ischemia and viability.

10. Doppler Echocardiography Measures blood flow velocities. Color Doppler, Pulse-wave Doppler, Continuous-wave Doppler.

11. Transthoracic echocardiogram(TTE)

12. Indication Cardiac chamber size and contents Ejection fraction Pericardial sac i.e.pericardial effusion,constrictive pericarditis Ascending aorta accessment of known or suspected adult congenital heart disease. Evaluation of suspected complication of myocardial ischaemia/infarction. Evaluation of valvular or structural heart disease.

13. Indication Infective endocarditis Suspected tumor or thrombus Cardiomyopathy Pulmonary Hypertension

14. Normal Heart Anatomy Chambers: Atria and ventricles. Valves: Mitral, aortic, tricuspid, pulmonic.

15. Common Detected Pathologies Valvular diseases. Cardiomyopathies. Congenital heart defects. Pericardial effusion.

16. Echocardiographic Views Parasternal long-axis and short-axis. Apical views. Subcostal and suprasternal views

17. WINDOW OF ECHO Evaluation of the heart with echocardiography requires "Acoustic windows"of the heart. Bone reflects the ultrasound waves and so call structures directly behind bone are not visible with ultrasound.

18. Parasternal Long-Axis View(PLAX) Transducer position:left sternal edge;2nd-4th intercostal space. Marker dot direction;points towards right shoulder Most echo studies begin with this view It sets the stage for subsequent echo views Many structures seen from this view.

19. Measurement in PLAX view can be used to quantify the heart: Left ventricular size and wall thickness Left atrial linear dimension(as opposed to area) Left ventricular outflow tract diameter (used to calculate aortic valve area by the continuity equation) Aortic annulus,sinus of Valsalva,and aortic root sizes

20. Parasternal Short Axis View(PSAX) Transducer position:left sternal edge;2nd -4th intercostal space. Marker dot direction:points towards left shoulder(90* clockwise from PLAX view) By tilting transducer on an axis between the left hip and right shoulder,short axis view are obtained at different levels,from the aorta to the LV apex. The aortic valve,right ventricular inflow and outflow tracts visible with the tricuspid valve

21. Papillary Muscle(PM)level PSAX at the level of papillary muscles showing how the respective LV segments are identified ,usually for the purposes of describing abnormal LV wall motion. LV wall thickness can also be assessed.

22. Apical 4-chamber View(AP4CH) Transducer position:apex of heart Marker dot direction:points towards left shoulder The AP5CH view is obtained from this view by slight anterior angulation of the transducer towards the chest wall. The LVOT can then be visualized.

23. Apical 2-Chamber View (AP2CH) Transducer position:apex of heart Marker dot direction:points towards left side of neck(45* anticlockwise from AP4CH view) Good for assessment of LV anterior wall and LV inferior wall.

24. Sub-Costal 4Chamber View(SC4CH) Transducer position:under the xiphisternum Marker dot position:points towards left shoulder The subject lies supine with head slightly low(no pillow).With feet on the bed,the knees are slightly elevated Better images are obtained with the abdomen relaxed and during inspiration Interatrial septum,pericardial effusion,descending abdominal aorta

25. Suprasternal View Transducer position:suprasternal norch Marker dot direction:points towards left jaw The subject lies supine with the neck hyperextended.The head is rotated slightly towards the left The position of arms or legs and the phase of respiration have no bearing on this echo window Arch of aorta,ascending aorta,pulmonary artery

26. Transoesophageal Echocardiography (TEE) Definition: TEE is a type of echocardiography where the ultrasound transducer is positioned in the esophagus. Purpose: Provides detailed images of the heart’s structure and function.

27. Indications Clinical Uses: Diagnosing heart valve diseases Detecting blood clots or masses in the heart Assessing congenital heart defects Evaluating the heart's function during surgery

28. Procedure Preparation: Fasting for 6-8 hours prior. Sedation: Patient is sedated to minimize discomfort. Insertion: A flexible probe is passed down the esophagus to the level of the heart.

29. Advantages High-Resolution Images: Closer proximity to the heart than transthoracic echocardiography (TTE). Detailed Visualization: Better view of the posterior heart structures.

30. Risks and Complications Common Risks: Sore throat, minor bleeding. Rare Complications: Esophageal perforation, infection. Contraindications Absolute: Esophageal abnormalities, recent esophageal surgery. Relative: Severe respiratory distress, uncooperative patient.

31. TEE in Surgery Intraoperative Use: Monitoring heart function during cardiac surgeries. Real-Time Guidance: Assisting in complex procedures like valve repairs.

32. Patient Preparation and Aftercare Preparation Tips: Fasting, understanding the procedure. Aftercare: Monitoring for complications, dietary restrictions post-procedure.

33. Stress Echocardiography Definition: Stress echocardiography combines ultrasound imaging with physical or pharmacological stress to evaluate heart function. Purpose: To identify coronary artery disease and assess cardiac performance under stress

34. Indications Clinical Uses: Diagnosis of ischemic heart disease Assessment of myocardial viability Evaluation of cardiac function in patients with known heart disease Preoperative evaluation for non-cardiac surgery

35. Types of Stress Exercise Stress: Typically performed using a treadmill or stationary bike. Pharmacologic Stress: Medications like dobutamine or adenosine used to simulate exercise in patients unable to physically exercise.

36. Procedure Preparation: Patient should fast for a few hours before the test. Baseline Echocardiogram: Initial images taken at rest. Stress Induction: Exercise or medication administered to increase heart workload. Post-Stress Imaging: Echocardiogram performed immediately after reaching target heart rate.

37. Advantages Non-Invasive: Compared to other diagnostic tests like angiography. Functional Assessment: Provides real-time images of the heart under stress. Safety: Generally well-tolerated with a low risk of complications.

38. Risks and Complications Minor Risks: Nausea, dizziness, or minor allergic reactions to medications. Serious Complications: Rare, but can include arrhythmias, myocardial infarction, or severe hypertension.

39. Contraindications Absolute: Recent myocardial infarction, severe aortic stenosis, uncontrolled arrhythmias. Relative: Severe hypertension, unstable angina.

40. Clinical Applications Coronary Artery Disease: Detecting obstructive lesions. Post-Intervention Monitoring: Evaluating effectiveness of procedures like angioplasty or bypass surgery. Functional Capacity: Assessing how well the heart tolerates stress.

41. Patient Preparation and Aftercare Preparation Tips: Guidelines for fasting, medication adjustment. Aftercare: Monitoring for any adverse effects post-test, instructions for resuming normal activities.

42. Doppler Echocardiography Definition: Doppler echocardiography is an imaging technique that uses the Doppler effect to evaluate the movement of blood through the heart and vessels. Purpose: Provides information on blood flow, velocity, and direction, complementing structural imaging.

43. Principles of Doppler Effect Concept: The Doppler effect measures changes in the frequency of sound waves reflected from moving objects, such as red blood cells. Application: Allows assessment of blood flow dynamics within the heart and vessels.

44. Types of Doppler Echocardiography Continuous Wave (CW) Doppler: Measures high-velocity blood flow. Pulsed Wave (PW) Doppler: Measures flow velocities at specific locations. Color Doppler: Visualizes flow direction and speed using color mapping. Tissue Doppler Imaging (TDI): Assesses myocardial velocities and diastolic function.

45. Indications Clinical Uses: Evaluating valvular heart diseases (stenosis, regurgitation) Assessing congenital heart defects Measuring cardiac output and diastolic function Detecting intracardiac shunts

46. Procedure Preparation: No specific preparation required. Imaging Process: Transducer placed on the chest to obtain blood flow images and velocities. Duration: Typically takes 30-60 minutes.

47. Advantages Non-Invasive: Safe and well-tolerated by patients. Detailed Hemodynamic Information: Provides comprehensive data on blood flow and heart function. Real-Time Imaging: Immediate assessment of cardiac conditions.

48. Risks and Limitations Safety: Generally considered safe with no significant risks. Limitations: Dependent on operator skill, limited by patient anatomy (e.g., obesity, lung disease).

49. Doppler Modes Color Doppler: Shows flow direction (red towards, blue away from the transducer). Spectral Doppler: Displays velocity waveforms for quantitative analysis.

50. Key Parameters: Velocity, gradient, flow patterns. Training Required: Requires specialized training for accurate assessment. Interpretation

51. Doppler in Valvular Disease Stenosis: Measure pressure gradients across valves. Regurgitation: Assess severity and impact on heart function

52. Doppler in Congenital Heart Disease Defects: Identify abnormal connections and shunts. Flow Quantification: Measure the extent of abnormal flow.

53. Doppler in Heart Failure Diastolic Function: Evaluate filling pressures and relaxation abnormalities. Prognosis: Provides insights into disease severity and prognosis

54. Advances in Doppler Echo 3D Doppler: Enhanced spatial resolution for better visualization. Contrast-Enhanced Doppler: Improved detection of blood flow in small or obscure regions.

55. Patient Preparation and Aftercare Preparation Tips: Comfortable clothing, avoid heavy meals. Aftercare: Typically none, normal activities can be resumed immediately.

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