Echocardiography

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1. < 30% EF severely reduced 12. apical 2

chamber view
2. > 70% EF hyperdynamic
3. 2 types of Color Flow doppler, spectral doppler
Doppler (which can be pulsed wave or
echocardiography continuous wave)
4. 2 windows of parasternal window, apical window
cardiac imaging
5. 3 chamber view

another apical view

13. Apical 3 LV, RV outflow tract, mitral valve, aortic
chamber (A3C) valve, ascending aorta, descending aorta
view
14. Apical 4 LV, RV, left atrium, right atrium, mitral valve,
Chamber (A4C) tricuspid valve
view
15. apical 4
chamber view
*can see apex of left ventricle better
which is needed to fully assess its
function
6. 3 leaflets of the non-coronary cusp, right coronary cusp,
aortic valve left coronary cusp
7. 30-44% EF moderately reduced indicator mark is toward posterior of
8. 45-54% EF mildly reduced patient (like bed is behind them)

9. abnormal cut off < 17 mm 16. apical 4

for Tricuspid chamber view
Annular Plane
Systolic Excusion
(TAPSE) is
10. Apical 2 chamber LV, left atrium, mitral valve
view
11. apical 2 chamber
view

upside down

another apical view

17. apical 4 view 21. apical 5 chamber
view

dif than 5
dif
18. apical 4 view
22. apical four-
chamber view

probe position (tip of sector cone):

apical 4 chamber view
Ventricular Apex
19. Apical 5 LV, RV, left atrium, right atrium, mitral valve,
chamber view tricuspid valve, aortic valve Indicator mark: Toward bed (behind
20. apical 5 them)
chamber view 23. apical window

1 type of cardiac imaging window

24. assessment of -Fractional Area Change
right ventricular
function (2) -TAPSE
25. captures the continuous wave doppler
velocity of every
RBC along a line
of interest
26. Cardiac US sector (cone-shaped) format
display is in a
27. classification of left > 70% is hyper dynamic 36. Imaging planes
ventricular dysfunction for visualization
55-70% normal of select cardiac
structures
45-54% mildly reduced

30-44% moderately reduced see if on LOs

37. the imaging plane parallel to the direction of blood flow
< 30% severely reduced should be chosen as possible
28. colors on color flow doppler blue flow is away from the so that the
US probe and red/orange ultrasound beam
flow is toward the US probe is as

29. contain a crystal that ultrasound 38. ___ is a property frequency

converts electrical signals of the US
into sound waves, and vise- transducer that
versa cannot be easily
adjusted with
30. Continuous wave doppler is very rapid velocities (i.e. ultrasound
ideal for measuring aortic valve) machine controls
31. Continuous Wave Doppler of - a single peak is seen 39. low frequencies deep structures and obese patients, but
Aortic Valve following the QRS complex on US allow at the expense of resolution
(systolic flow) imaging of

-minimal signal is seen 40. measures a pulsed wave doppler

32. doppler echocardiography:
objects moving toward
observer
33. the doppler equation
34. the frequency of sound
waves reflected off a moving
object varies depending
upon whether the object is
moving toward or away from
the observer
35. High frequencies (low
wavelengths) provide
during diastole limited range of
velocities -
-difficult to obtain good limited by pulse
alignment with blood flow repetition
for velocity measurements - frequency
A5C and A3C are usually 41. measures Tricuspid Annular Plane systolic excision
best longitudinal (TAPSE)
increase in frequency displacement of
the tricuspid valve
annulus with
systole
V (RBC velocity) = speed of
sound in blood (reflected -relies on M-
frequency - transducer mode: a type of
frequency) / 2 FT (Cos angle echocardiography
between ultrasound beam which takes rapid,
and blood flow) repeated images
doppler echocardiography along a single
line
42. measures velocity pulsed wave doppler
at a specific
intracardiac depth
43. normal EF 55-70%
high resolution, but at the
expense of being able to
see deeper structures
44. objects moving decrease in frequency 54. Parasternal short
away from axis aortic valve
observer on
doppler
echocardiography
45. objects nearest nearest the indicator mark on the screen
the indicator mark
on the US probe
will be
46. on doppler moving toward observer - INCREASE in
echocardiography frequency parasternal short axis view
objects moving
55. Parasternal short LV, RV, papillary muscles
toward and away moving away from observer -
axis - Mid-LV
DECREASE in frequency
(PSAX) ECHO
47. optimal for pulsed wave doppler
56. Parasternal short
measuring low
axis mitral valve
velocities while
minimizing noise
from more rapid
velocities nearby
48. optimal view for A5C, A3C
measuring aortic
valve
49. optimal views for A4C, A5C, A2C, A3C
mitral valve
parasternal short axis mitral
50. optimal views for PSAX - AV
57. Parasternal short
pulmonic valve
axis view
51. optimal views for A4C, A5C, PSAX-AV
tricuspid valve
52. parasternal long
axis view

probe position (tip of sector cone):

anterior

Indicator Mark: toward patient's left

shoulder
-Right Ventricle (RV) most anterior
-Left Ventricle (LV) most posterior 58. parasternal
-Right Atrium (RA) not visualized window
-Left Ventricle, MV, AOV, Chordae, etc.
53. parasternal long probe position (tip of actor cone):
axis window anterior

-indicator mark : toward patient's right

shoulder

1 type of cardiac imaging window

59. pressure gradients across
cardiac valves can be
calculated using a
modified form of the
Bernoulli equation
60. Pulsed Wave doppler of
mitral valve
61. qualitative doppler
technique that provides
direction of blood flow
62. quantitative doppler
techniques are readouts
as
63. quantitative LV ejection
fraction calculation
64. relationship between
frequency and
wavelength
65. RV fractional area change
66. severely reduced ejection
fraction
67. simultaneous recording of
ECG helps with timing of
events in cardiac cycle
68. the sound waves in US are
transmitted into tissue and
are described by their
69. speed of sound in tissues
pressure velocity relationship:
Pressure gradient = 4 (measured
blood velocity)^2
-2 peaks observed
--the first peak (E wave) occurs
near the end of the T wave and
corresponds to early diastolic
filling
--the second peak (A wave)
occurs just after the P wave
and corresponds to flow from
atrium to ventricle during atrial
contraction
color flow doppler
graph of velocity vs time
EF = volume end diastolic -
volume end systolic / volume
end diastolic
speed of sound = wavelength
of the transmitted wave x
frequency of the transmitted
wave
FAC = (EDA - ESA) / EDA
FAC (%) < 35% is the abnormal
cutoff
< 30%
color flow doppler
wavelength, frequency,
amplitude
lung = 500.
soft tissue = 1540.
muscle = 1580.
blood = 1560.
70. Structures seen in left atrium, right atrium, RV,
Parasternal Short Axis - aortic valve, tricuspid valve,
Aortic Valve (PSAX-AV) pulmonic valve, pulmonary
artery
71. Structures seen in LV, RV, mitral valve
Parasternal Short Axis -
Mitral Valve ECHO
72. Structures seen in LV, RV, outflow tract, mitral
Paternal Long Axis valve, aortic valve, ascending
(PLAX) Echo view aorta, descending aorta
73. transmits ultrasound pulsed wave doppler
waves and then pauses to
"listen" for reflected
waves
74. Tricuspid Annular Plane distance (minimum to maximum
Systolic Escursion excursion), NOT a slope or time
(TAPSE) is a ___ measurement
measurement
75. Tricuspid Annular Plane -measures longitudinal
systolic excision (TAPSE) displacement of the tricuspid
valve annulus with systole
-relies on M-mode: a type of
echocardiography which takes
rapid, repeated images along a
single line
76. ultrasound allows a single receive the sound waves that are
transducer to both reflected back
transmit sound waves into
a tissue and
77. Ultrasound principles 1. transducer cannot transmit and
listen at the same time
2. waves are sent in pulses,
followed by a pause to "listen"
for returning sound waves as
they are reflected off tissue
surfaces
78. uses 2 ultrasound continuous wave doppler
crystals, one which
continuously transmits
and one that
continuously receives