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Basic Echocardiography. Wendy Blount, DVM Nacogdoches TX. Echo Technique - Anatomy. Tricuspid valve Septal leaflet Parietal leaflet Pulmonic Valve Right cusp Left cusp Intermediate cusp. Mitral valve Leaflets are less distinct Aortic Valve Right cusp Left cusp Septal cusp.

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Basic echocardiography

Basic Echocardiography

Wendy Blount, DVM

Nacogdoches TX


Echo technique anatomy
Echo Technique - Anatomy

Tricuspid valve

  • Septal leaflet

  • Parietal leaflet

    Pulmonic Valve

  • Right cusp

  • Left cusp

  • Intermediate cusp

  • Mitral valve

  • Leaflets are less distinct

  • Aortic Valve

  • Right cusp

  • Left cusp

  • Septal cusp


Echo technique anatomy1
Echo Technique - Anatomy

RV

  • Conus arteriosus

  • 3 papillary muscles

    LV

  • 2 papillary muscles


Echocardiography
Echocardiography

Equipment

  • Transducer – small footprint

  • Fan-shaped beam or sector

  • High frequency for small animals

  • Low frequency for large animals

  • Machines range from 2.5-10 Mhz

  • 5-7 MHz will work fine for most dogs and cats for echo


Echocardiography1
Echocardiography

Equipment

  • Double window with simultaneous B and M modes (video)

  • Can do measurements on B-mode or M-mode

  • Need a cursor which can measure mm, or cm marks on the images

  • Ability to capture images is important


Echocardiography2
Echocardiography

Preparation

  • Thin coated animals – alcohol, part the hairs, gel

  • Thick coated animals – shave the window – at the sternum, just behind the elbow

  • Sedation only if needed

    • Acepromazine – 0.025 mg/lb (max 1 mg)

    • Buprenex – 0.01-0.02 mg/kg

      • Or butorphanol 0.1 mg/lb

    • Mix together and give IV (handout)


Echocardiography3
Echocardiography

Positioning for 8 standard views

  • Right lateral recumbency

  • Cardiac table is nice but not necessary

  • Sonographer needs a stool or chair

  • Placement of probe:

    • Feel the apical beat, and put your probe there (probe marker cranial)

    • Imagine the longitudinal axis of the heart, probe at 90o (short axis views)

    • Adjust 1 intercostal space Cr or Cd PRN

    • Rarely move the probe head – just fan and twist (video)


1 short axis left ventricle
1. Short Axis – Left Ventricle

  • Fan from base to apex, until you have just passed the mitral valve, and the LV papillary muscles appear (mushroom view)

  • Rotate until PM are the same size

  • If you are getting a rib shadow, try one intercostal space cranial or caudal

  • Fan cranial and caudal to center the heart on the screen


1 short axis left ventricle1
1. Short Axis – Left Ventricle

Abbreviations - Structures

  • P – pericardium

  • RV – right ventricle

  • IVS – intraventricular septum

  • LV – left ventricle

  • PPM – posterior papillary muscle

  • APM – anterior papillary muscle


1 short axis left ventricle2
1. Short Axis – Left Ventricle

Measurements

  • IVSTd- IntraVentricular Septum Diastole

  • LVIDd - LV Inner Diameter Diastole

  • LVPWd – LV Posterior Wall Diastole

  • IVSTs- IntraVentricular Septum Systole

  • LVIDs - LV Inner Diameter Systole

  • LVPWs – LV Posterior Wall Systole


1 short axis left ventricle3
1. Short Axis – Left Ventricle

Measurements

  • IVSTd =IVSd =VSd

  • LVIDd=LVd =LVLd

  • LVPWd=LVFWd=LVWd

  • IVSTs =IVSs =VSs

  • LVIDs=LVs =LVLs

  • LVPWs=LVFWs=LVWs


1 short axis left ventricle4
1. Short Axis – Left Ventricle

Measurements - Calculated

  • FS – fractional shortening

    (LVIDd – LVIDs)

    LVIDd

    • Assumes perpendicular to myocardium

    • Assumes contractility is uniform in the LV

    • Extremes in preload and afterload can affect FS, as well as myocardial function


1 short axis left ventricle5
1. Short Axis – Left Ventricle

Measurements - Calculated

  • FS – fractional shortening

  • AKA shortening fraction (SF)

    • >30% in the dog

    • >40% in the cat

    • >45% if MR is compensated


1 short axis left ventricle6
1. Short Axis – Left Ventricle

Measurements - Tips

  • Make sure you don’t include PM in the LVPW measurement

    • If you do, your LVPW will be artifactually thicker

    • Clue – check for this if LVPW is much thicker than IVS

  • Make sure you are not too far apical

    • If you are, your LVID will be artifactually small

    • And LVPW will be artifactually thick


1 short axis left ventricle7
1. Short Axis – Left Ventricle

Measurements - Tips

  • Measure three times

    • Take the average

    • Throw out any outliers

  • Several sets of normals published

    • 1-2mm outside normal may not always be significant


2 short axis apex
2. Short Axis – Apex

Structures

  • Pericardium

  • May or may not see RV

  • LV apical lumen

    No measurements here


3 short axis chordae tendinae
3. Short Axis – Chordae Tendinae

Structures

  • Pericardium

  • RV

  • LV

  • CH - Chordae Tendinae (posterior & anterior)

    No measurements here


4 short axis mitral valve
4. Short Axis – Mitral Valve

Structures

  • Pericardium

  • RV

  • RV Papillary Muscles

  • LV

  • MV - Mitral Valve (Posterior & Anterior)


4 short axis mitral valve1
4. Short Axis – Mitral Valve

Measurement

  • EPSS – E-Point to Septal Separation

    • Can denote decreased LV systolic function

    • Less than 6 mm in large dogs

    • Less than 3-5 mm in small dogs and cats


5 short axis aortic valve
5. Short Axis – Aortic Valve

Structures

  • RVOT – Right Ventricular Outflow Tract

  • TV – Tricuspid Valve

  • PV – Pulmonic Valve

  • Ao – Aortic Valve

  • LA – Left Atrium


5 short axis aortic valve1
5. Short Axis – Aortic Valve

Measurements

  • Ao – at largest dimension (systole)

  • LA – at largest dimension (diastole)

  • LA:Ao –

    • 0.8 to 1.3 in dogs

    • 0.8 to 1.4 in cats


6 short axis pulmonary artery
6. Short Axis – Pulmonary Artery

Structures

  • RA – Right Atrium

  • Ao – Aorta (ascending)

  • PA– Pulmonary Artery

    • LPA – left pulmonary artery

    • RPA – right pulmonary artery

  • CaVC – Caudal Vena Cava


7 long axis 4 chamber
7. Long Axis – 4 Chamber

Technique

  • Get short axis “mushroom” view

  • Rotate 90 degrees counterclockwise


7 long axis 4 chamber1
7. Long Axis – 4 Chamber

Structures

  • RV – Right Ventricle

  • RA – Right Atrium – difficult to view completely

  • TV – Tricuspid Valve

  • LV – Left Ventricle

  • LA – Left Atrium

  • MV – Mitral Valve, PM – papillary muscle



8 long axis lvot
8. Long Axis – LVOT

Technique

  • Find 4 Chamber view

  • Angle the “dot” toward the shoulders

  • Elevate the cord end of the probe


8 long axis lvot1
8. Long Axis – LVOT

Structures

  • RV, TV, RA

  • LV, PM, MV

  • Very edge of the LA

  • LVOT – AV (LC, SC), ascending Ao

  • RPA – Right Pulmonary Artery


8 long axis lvot2
8. Long Axis – LVOT

Video

Normal Dog Video


Dog rv measurement values
Dog RV Measurement Values

  • RVWd – less than LVWd

  • RVIDd – 1/3 or less of LVIDd

    (handout)


Cat echo normal values
Cat Echo Normal Values

  • IVSTd – 3-6 mm

  • LVIDd – 10-21 mm

  • LVPWd – 3-6 mm

  • IVSTs - 4-9

  • LVIDs – 4-11 mm

  • LVPWs – 4-10 mm

  • Aos – 6-12 mm

  • LAd – 7-15 mm

  • FS - >40%

  • EPSS - 0-3 mm

  • EF ->70%

  • LA:Ao – 0.8-1.4

  • RVIDd - 3-7 mm

  • RVWd - <3 mm

  • (form)


Ferret echo normal values mean
Ferret Echo Normal Values (Mean)

  • LVIDD – 11.0 mm

  • LVIDS - 6.4 mm

  • LVPW - 3.3 mm

  • FS - 42%

  • EPSS - 0


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