What is echocardiography

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Slide 1 :

What is echocardiography? Sheree Napier Senior Cardiac Scientist

Slide 2 :

Echocardiography Echocardiography is a relatively painless test that uses sound waves to create images of the heart. Probe rotations allow the sonographer to acquire multiple images, assessing it from multiple views and windows

Slide 3 :

Echo windows and views

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Acoustic windows Parasternal Long Axis Parasternal Short Axis Parasternal Short Axis Apical Four Chamber Apical Two Chamber Apical Long Axis

Slide 5 :

The Normal Echo – Parasternal Long Axis

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Apical 4 chamber view The Normal Echo – Apical 4 chamber

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Echo assessment Allows the assessment of: Left ventricular size and function, including regional wall motion abnormalities Right ventricular size and function The heart valves – Mitral, Aortic, Tricuspid and Pulmonary (stenosis, regurgitation etc) Intracardiac pressures Lung pressures

Slide 8 :

Indications for Echo MYOCARDIAL INFARCTION Extent and location of area of infarction Assessment of overall systolic function (EF) Assessment of right ventricular involvement Detection of complications of MI

Slide 9 :

Regional wall motion

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Indications for Echo CHEST PAIN Useful when ECG is indeterminate Detection of myocarditis / pericarditis Detection of aortic dissection (TOE often indicated) Exclusion of aortic stenosis, hypertrophic cardiomyopathy, mitral valve prolapse

Slide 11 :

Aortic dissection

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Indications for Echo MURMURS Aortic or pulmonary stenosis (ESM) Mitral or tricuspid regurgitation (PSM) Aortic or pulmonary regurgitation (diastolic murmur) Exclusion of shunts – VSD, ASD, PDA Detection of hypertrophic obstructive cardiomyopathy (ESM)

Slide 13 :

Aortic Stenosis

Slide 14 :

Secundum Atrial Septal Defect

Slide 15 :

Hypertrophic Obstructive Cardiomyopathy (HOCM)

Slide 16 :

Indications for Echo HEART FAILURE Ischaemic vs non-ischaemic cardiomyopathy Exclude diastolic dysfunction as cause Exclude valvular dysfunction

Slide 17 :

Ischaemic cardiomyopathy Dilated cardiomyopathy

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Indications for Echo Exclude pericardial effusion / tamponade Detection of endocarditis Assessment of pulmonary pressures in suspected pulmonary hypertension

Slide 19 :

LV RV LA Pericardial Effusion

Slide 20 :

Tricuspid Valve Vegetation RV RA

Slide 21 :

Pulmonary Hypertension

Slide 22 :

Interpreting an Echo Report Left ventricle Size Systolic function (EF, regional wall motion) Diastolic function (relaxation) Wall thickness (LVH)

Slide 23 :

LV volume and Ejection Fraction (EF)

Slide 24 :

LV Dimensions and Ejection Fraction (EF)

Slide 25 :

Segmental Model: LV 3 Levels ? 17 segments Basal Level – MV annulus to papillary muscle tips Mid Level – Pap muscle tips to base of pap muscle Apical Level – Base of pap muscle to apex

Slide 26 :

17 Segment Model

Slide 27 :

Coronary artery distribution

Slide 28 :

What are Regional Wall Motion Abnormalities? Normal - > 40% increase in systolic wall thickness Hypokinesis - < 40% increase in systolic wall thickness Akinesis – negligible systolic thickening Dyskinesis – Outward systolic expansion Aneurysmal – Diastolic deformation with associated outward systolic expansion

Slide 29 :

LAD territory WMA

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Slide 33 :

Anuerysmal apex

Slide 34 :

LV diastolic function Indicates LV relaxation and compliance Diastolic dysfunction occurs early in the disease process Four key echocardiographic measurements to assess diastole Mitral inflow velocity profile Pulmonary vein inflow profile Mitral annular velocity or E’ Left atrial size / volume

Slide 35 :

????Increasing LA pressure???? ????Increasing LV edp ???? Mitral Inflow

Slide 36 :

Mitral annular velocity Measures velocity of myocardium at MV annulus Represented as E’ E/E’ correlates well with LV filling pressure

Slide 37 :

Diastolic Dysfunction ? Diastolic Heart Failure Diastolic dysfunction refers to abnormal mechanical relaxation (diastolic) properties of the ventricle Diastolic Heart Failure is distinguished by the presence of heart failure symptoms

Slide 38 :

Systolic and Diastolic Heart Failure in the Community Bursi et al 2006 JAMA 2006;296:2209-2216 556 patients with HF symptoms 55% had preserved EF (= 50%) at time of HF diagnosis Owan et al 2006 N Engl J Med 2006; 355:251-9 - Prevalence of HF with preserved EF increased over 15yrs, while rate of death remained unchanged

Slide 39 :

And the rest … Right ventricle Size and function Atria Size Valves Structure and function Regurgitation Great Vessels / Pericardium

Slide 40 :

Post Cardiac Surgery or Procedure – follow up Post CABG / PCI / remodelling - LV / RV function

Slide 41 :

Post Cardiac Surgery or Procedure – follow up Prosthetic valves - provides a baseline of prosthetic valvular function - anatomic, functional and haemodynamic data

Slide 42 :

Post Cardiac Surgery or Procedure – follow up Post PFO closure – check integrity of device

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