M mode echocardiography

1. M-MODE ECHOCARDIOGRPHY
THE LOSS ART

2. M-MODE PHYSICS
B mode echoes from an interface that changes
position will be seen as echoes moving towards
and away from the transducer.
If a trace line is place on this interface and the
resulting trace is made to drift across the face of
a CRT screen a motion pattern is obtained.

3. M-MODE PHYSICS
The resulting display shows motion of a reflector
over distance and time – a distance time graph
The change in distance (dy) over a period of time
dt is represented by the slope of the reflector line
of motion.
dy/dt = slope = velocity

4. M-MODE PHYSICS
If this motion pattern is obtained on moving
cardiac structures then the resulting images
constitute M-mode echocardiography.
M-mode echocardiography is use to evaluate the
morphology of structures, movement and
velocity of cardiac valves and walls and timing of
cardiac events.

5. Distance
Time
M-mode Tracing

6. M-mode Evaluation
Amplitude
Velocity
Time intervals
Morphology

7. Amplitude = Y2 –Y1
Y1
Y2
Amplitude Measurement
Distance
Time

8. Time interval = T2 – T1
T2T1
Time Measurement
Distance
Time

9. dy = Y2 –Y1
Y1
Y2
Slope Measurement
T1 T2
dt = T2 – T1
Slope = dy/dt = velocity

10. M-mode at the Mitral Valve
The mitral valve has 2 leaflets – anterior and
posterior.
Specific letters corresponding to systole and
diastole are assigned to the m-mode tracing
of the mitral valve.

11. EKG Tracing
T-wave
QRS complex
P wave
Systole Diastole

12. Distance
Systole
M-mode at Mitral Valve
Diastole
Time

13. Phase of Cardiac Cycle Assigned Letters
Diastole d,e,f, and a
Systole c and d
M-mode at the Mitral Valve

14. Systole
M-mode at Mitral Valve
Diastole
d
c
a
f
e
d
Time
Distance

15. Systole
M-mode at Mitral Valve
Diastole
e
d Time
Distance
d-e amplitude

16. Systole
M-mode at Mitral Valve
Diastole
Septum
e
Time
Distance
EPSS

17. Systole
M-mode at Mitral Valve
Diastole
e
d Time
Distance
d-e slope

18. Systole
M-mode at Mitral Valve
Diastole
f
e
Time
Distance
e-f slope

19. M-mode at Mitral Valve

20. M-mode at the Mitral Valve
Amplitude Description
Normal
Value
EPSS Measure e point to septal
separation
< 5 mm
d-e Measures the maximum
excusion of the mitral valve
following diastolic opening.
17 to 30 mm

21. M-mode at the Mitral Valve
Slope Description Normal Value
d-e Measure rate of initial
opening of the mitral valve
in early diastole.
240 to 380
mm/s
e-f Measures the rate of early
closure of the mitral valve
following diastolic
opening.
50 to 180 mm/s

22. M-mode Findings at the MV
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation

23. M-mode Findings at the MV
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

24. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
B-bump on the
AC shoulder.

25. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Premature Closure
Premature Closure- closure
on or before the onset of the
QRS complex.

26. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Systolic anterior motion
of the AMVL

27. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Systolic anterior motion
of the AMVL

28. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
MV prolapse
posterior leaflet

29. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
MV Prolapse –
both leaflet

30. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Flail posterior leaflet

31. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Aortic Regurgitation

32. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Sinus Rhythm
Mitral Stenosis

33. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Atrial Fibrillation
Mitral Stenosis

34. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Atrial Myxoma

35. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Vegetation

36. Distance
SystoleDiastole
Time
Mitral Regurgitation

37. Distance
SystoleDiastole
Time
Mitral Regurgitation

38. Distance
Systole
Mitral Regurgitation
Diastole
Time
Atrial Myxoma

39. Distance
SystoleDiastole
Time
Atrial Myxoma
Mitral Regurgitation

40. Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Atrial Myxoma

41. Color M-mode

42. Color M-mode
Propagation Velocity, Vp

43. M- Mode
Aortic Valve

44. M-mode at the Aortic Valve
The aortic valve has 3 cusps – right coronary,
left coronary and non-coronary cusps.
The cusps imaged in the PLAX view are the
right coronary and the non-coronary cusps.

45. M-mode at the Aortic Valve
Coronary cusp
Non-coronary cusp
Anterior aortic root
Posterior aortic root
Left Atrium

46. M-mode at the Aortic Valve
LA dimension
Cusp Separation
Aortic root

47. M-mode at the Aortic Valve
LA dimension
Cusp SeparationAortic root Measurements are made from
leading edge to leading edge.

48. M-mode at the Aortic Valve
Dilated LA
Dilated aortic root
Decreased excursion
Premature opening
Premature closing
Exaggerated anterior motion of Aortic Root

49. M-mode at the Aortic Valve
Reduced anterior motion of Aortic Root
Thickening
Calcification
Vegetations
Bicuspid valve
Prosthetic valve
Aortic Regurgitation

50. M-mode at the Aortic Valve
Premature Opening
Opening of the AV before the
onset of the QRS complex
Seen in Elevated LV-EDP

51. M-mode at the Aortic Valve
Premature Closure
Closure of the AV before
the onset of the T wave
Seen in IHSS

52. M-mode at the Aortic Valve
Bicuspid Valve
Eccentric closure line
Seen when there is a
Bicuspid aortic valve

53. M-mode at the Aortic Valve
Decreased Cusp Separation
Seen in Aortic Stenosis

54. M-mode at the Aortic Valve
Seen in aortic sclerosis
Thickened, calcified aortic
valve leaflet.

55. M-mode at the Aortic Valve
Seen in Mitral Stenosis
Reduced anterior
motion of aortic root

56. M-mode at the Aortic Valve
Exaggerated anterior
motion of aortic root
Seen in Mitral Regurgitation

57. Aortic
Regurgitation

58. Aortic
Regurgitation

59. Aortic
Regurgitation

60. M - Mode
Left Ventricle

61. M-mode at Left Ventricle

62. M-mode at Left Ventricle
Thickening of the IVS and LVPW
Movement of the IVS and LVPW

63. •RVWd
•RVIDd
M-mode Measurement

64. •IVSd
•IVS excursion
•IVSs
M-mode Measurement

65. •LVIDd
•LVIDd index
•LVIDs
•LVIDs index
M-mode Measurement

66. •LVPWd
•LVPW excursion
•LVPW max excursion velocity
•LVPWs
M-mode Measurement

67. M-mode at Left Ventricle
RVWT

68. M-mode at Left Ventricle
RVIDd

69. M-mode at Left Ventricle
IVSd

70. M-mode at Left Ventricle
LVIDd

71. M-mode at Left Ventricle
LVPWd

72. M-mode at Left Ventricle
IVS excursion

73. M-mode at Left Ventricle
IVSs

74. M-mode at Left Ventricle
LVIDs

75. M-mode at Left Ventricle
LVPWs

76. M-mode at Left Ventricle
LVPW excursion

77. M-mode at Left Ventricle
LVPW max velocity
= slope

78. M-mode at Left Ventricle

79. •FS
•EF
•LV mass
•RWT
M-mode LV Calculation

80. •% IVS thickening
•% LVPW thickening
•IVS/LVPW ratio
M-mode LV Calculation

81. M-mode LV Calculation
FS = LVIDd – LVIDs
LVIDd

82. M-mode LV Calculation
EF = LVIDd
3
– LVIDs
3
LVIDd
3

83. M-mode LV Calculation
RWT = IVSd + LVPWd
LVIDd

84. M-mode LV Calculation
IVS % thickening = (IVSs – IVSd) x 100
IVSd
 

85. M-mode LV Calculation
LVPW % thickening = (LVPWs – LVPWd) x 100
LVPWd
 

86. M-mode LV Calculation
LV Mass = 1.04 {(LVIDd + IVSd + LVPWd)
3
– (LVIDd)
3
} x 0.8 + 0.6g

87. Increase LVW thickness

88. Increased Wall
Thickness
Symmetrical
Concentric
Hypertrophy
Asymmetrical
Infiltrative
Diseases
Concentric
Remodeling
Hypertrophic
Cardiomyopathy
Increased Wall ThicknessIncrease LVW thickness

89. LV Hypertrophy - Hypertension
Pressure Overload
Concentric LVH
Increase Wall thickness
Normal Mss
Increase Wall thickness
Increased Mass
Remodeling

90. Increase Wall thickness
Normal LV Mass Increased LV Mass
Measure LV Mass
Concentric Remodeling Concentric Hypertrophy
LV Hypertrophy - Hypertension

91. Increase Wall thickness
Increased LV Mass
Concentric Hypertrophy
LV Hypertrophy – Aortic Stenosis
Pressure Overload
LVH

92. Eccentric LV Hypertrophy
Increased LV size with
Spherical shape
Normal LV Mass Increased LV Mass
Measure LV Mass
No LV hypertrophy Eccentric Hypertrophy

93. Measurement
Assessment
Concentric
Hypertrophy
Concentric
Remodeling
Eccentric
Hypertrophy
Wall Thickness Increased Increased Normal
Relative Wall
Thickness
Increased Increased Normal - Decreased
LV Chamber size Normal Normal Increased
LV Chamber shapeElliptical Elliptical Spherical
LV mass Increased Normal Increased
LV Hypertrophy

94. Paradoxical Septal Motion

95. •RV hypertrophy
•RV dilatation
•LBBB
•Post Cardiac Surgery
Paradoxical Septal Motion

96. Ischemia

97. Ischemia
Normal Wall thickness
No systolic thickening
Reduced Motion

98. Post Infarct

99. Post Infarct
Thin echogenic wall
No systolic thickening
Reduced Motion

100. Pericardial Effusion

101. Pericardial Effusion
Infection
Postviral pericarditis
Bacterial
Tuberculosis

102. Pericardial Effusion
Malignant
Metastatic disease – lymphoma &
melanoma
Direct extension – lung and breast
Primary cardiac malignancy

103. Pericardial Effusion
Inflammatory
Post MI (Dressler’s Syndrome)
Uremia
Collagen vascular disease
Post cardiac surgery

104. Pericardial Effusion
Intracardiac-Pericardial communication
Blunt or penetrating chest trauma
Post catheter procedures
LV rupture (post MI)

105. Pericardial Thickening

106. Pericardial Thickening
Constrictive pericarditis
Occurs following
Surgery
Radiation therapy
Repeated episodes of pericarditis