ADULT
ECHOCARDIOGRAPHY
COURSE
Harry H. Holdorf PhD, MPA, RDMS (Ab, OB/Gyn,
BR), RVT (VT), LRT(AS), N.P.
INTRODUCTION
Table of Contents
Objectives
Adult Echocardiography
T of C
1.
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12.
13.
Abbreviations
Anatomy and Hemodynamics
Cardiac Physiology
Technique and Patient Care
The aortic valve
The pulmonic valve
The mitral valve
The tricuspid valve
Valvular heart disease
Coronary Anatomy
Prosthetic valves
Cardiomyopathies
Diastolic Dysfunction
Table of contents cont…
14. The pericardium
15. Hypertensive Heart Disease
16. Ischemic Heart Disease
17. Adult Congenital Heart Disease
18. Foreign Bodies, Masses, and
Myxomas
19. EKG-Electrocardiogram
20. Lectures on Adult
Echocardiography
21. Final Exam prep 1
22. Final Exam prep 2
23. Final Exam
Objectives
Interact appropriately with the patient, physicians and staff.
Identify the pertinent clinical questions and the goal of the
examination.
Recognize significant clinical information and historical facts
from the patient and the medical records, which may impact
the diagnostic examination.
Review data from current and previous examinations to
produce a written/oral summary of technical findings,
including relevant interval changes, for the reporting
physician’s reference.
Select the correct transducer type and frequency for
examination(s) being performed.
Adjust instrument controls including examination presets,
scale size, focal zone(s), overall gain, time gain
compensation, and frame rate to optimize image quality.
Demonstrate knowledge and understanding of Doppler
ultrasound principles, spectral analysis, and color flow
imaging relevant to and in the AE specialty.
Demonstrate knowledge and understanding of anatomy,
physiology, pathology and pathophysiology relevant to and in
the AE specialty.
Demonstrate the ability to perform sonographic examinations
of the appropriate organs and areas of interest according to
professional and employing institution protocols relevant to
and in the AE specialty.
Recognize, identify and document the abnormal sonographic
patterns
of
disease
processes,
pathology,
and
pathophysiology of the organs and areas of interest.
Modify the scanning protocol based on the sonographic
findings and the differential diagnosis relevant to and in the
AE specialty.
Perform related measurements from sonographic images or
data.
Utilize appropriate examination recording devices to obtain
pertinent documentation of examination findings.
Lecture one
ABBREVIATIONS
Abbreviations
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AR
Ao
AoV
ASD
ASH
AV
BBB
BP
BPM
BSA
CHF
CI
CM
CO
Aortic Regurgitation (AI)
Aorta
Aortic valve
Atrial Septal Defect
Asymmetric Septal Hypertrophy
Atrioventrical
Bundle Branch Block
Blood Pressure
Beats Per Minute
Body Surface Area
Congestive Heart Failure
Cardiac Index
Cardiomyopathy
Cardiac Output
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COPD Chronic Obstructive Pulmonary Disease
CPI Cardiovascular Principles and Instrumentation
CS Coronary Sinus
CVA Cerebral Vascular Accident
CW Continuous Wave Doppler
DA Ductus Arteriosus
DM Diastolic Murmur
DOE Dyspnea and Exertion
ed End Diastolic
EF Ejection Fraction
ECG Electorcardiogram (EKG)
FO Foramen Ovale
HCM Hypertrophic Cardiomyopathy
HOCM Hypertrophic Obstructive Cardiomyopathy
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IHSS Idiopathic Hypertrophic Subaortic Stenosis
IVC Inferior Vena Cava
L
Liter
LA Left Atrium
LAD Left Anterior Descending Coronary Artery
LAX Long Axis View
LSB Left Sternal Border
LV Left Ventricle
LVEDP Left Ventricular End Diastolic Pressure
LVET Left ventricular Ejection Time
LVH Left Ventricular Hypertrophy
LVOT Left Ventricular Outflow Tract
MHz Megahertz
MAC Mitral Annular Calcification
MI Myocardial Infarction
ml Milliliter
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mm Hg Millimeters of Mercury
MR Mitral Regurgitation
MS Mitral Stenosis
MV Mitral Valve
MVA Mitral Valve Area
MVP Mitral Valve Prolapse
O2
Oxygen
OS Opening Snap
PA Pulmonary Artery
PDA Patient Ductus Arteriosus
PE Pericardial Effusion
PEP Pre-Ejection Period
PHTN Pulmonary Hypertension
PR Pulmonic Regurgitation
PS Pulmonic Stenosis
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PV Pulmonary Valve (or vein)
PVC Premature Ventricular Contraction
PVD Peripheral Vascular Disease
PW Pulsed Wave Doppler
Q
Flow
RA Right Atrium
RAP Right Arterial Pressure
RCA Right Coronary Artery
RUSBRight Upper Sternal Border
RV Right Ventricle
RVH Right Ventricular Hypertrophy
RVOTRight Ventricular Outflow Tract
RVSPRight Ventricular Systolic Pressure
SA Sinoatrial
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SAM Systolic Anterior Motion
SAX Short Axis View
SBE Subacute Bacterial Endocarditis
SBP Systolic Blood Pressure
SV Stroke Volume
SVC Superior Vena Cava
TGV Transposition of the Great Vessels
TR Tricuspid Regurgitation
TS
Tricuspid Stenosis
TV
Tricuspid Valve
UA Umbilical Artery
UV Umbilical Vein
VSD Ventricular Septal Defect
WPW Wolf-Parkinson-White Syndrome
Aortic Regurgitation AR
Aorta
Aortic Valve
ASD
Asymmetric Septal Hypertrophy
Atrioventricular AV
Bundle Branch Block BBB
Blood Pressure
Beats per minute
Body surface area
In simple terms Body Surface Area is the area covered by one’s skin
the largest organ of the body
1.It is often a clinical measure used by physicians
2. to calculate the drug dosages and for administration of intravenous fluids
Congestive heart failure
Cardiac Index
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A large person has a higher cardiac output
than a small person. The cardiac index
represents cardiac output that has been
adjusted to a person's size.
Dividing cardiac output by the person's body
surface area, or BSA, will provide the
cardiac index.
Cardiac output correlates better with body
surface area than weight. Cardiac output
that is expressed per square meter of body
surface area is termed cardiac index.
Cardiomyopathy
Cardiac Output
Chronic Obstructive
Pulmonary Disease (COPD)
Cardiovascular Principles
and Instrumentation
Coronary Sinus
Cerebral Vascular Accident
Continuous Wave Doppler
Ductus Arteriosus
Diastolic Murmur
Dyspnea and Exertion
End Diastolic
Ejection Fraction
Electrocardiogram (EKG)
Foramen Ovale
PFO
Hypertrophic Cardiomyopathy
Hypertrophic Obstructive
Cardiomyopathy
Idiopathic Hypertrophic
Subaortic Stenosis
Inferior Vena Cava
Liter = heart pumps 5-7 liters
of blood per minute
Left Atrium
Left Anterior Descending
Coronary Artery
Long Axis View
Left Sternal Border
Left Ventricle
Left Ventricular End
Diastolic Pressure
• Left Ventricular end-diastolic
pressure (LVEDP):
• The pressure in the Left ventricle
at the end of diastole, (usually
measured in the left ventricle) as
an approximation of the enddiastolic volume, or preload.
Left Ventricular Ejection
Time
The time for the ejection of blood
from the left ventricle, beginning
with aortic valve opening and
ending with aortic valve closure.
Left Ventricular Hypertrophy
Left Ventricular Outflow
Tract
Megahertz
Mitral Annular Calcification
Myocardial Infarction
Milliliter
Millimeters of Mercury
Mitral Regurgitation
Mitral Stenosis
Mitral Valve
Mitral valve area
• Aortic Annulus Size
cm
Mitral Annulus Size
cm
Aortic VTI
Mitral VTI
1.8-2.3
3.0-3.5
18-25 cm
10-13 cm
Mitral Valve Prolapse
MVP: Mitral valve prolapse is a condition in
which the two valve flaps of the mitral
valve do not close smoothly or
evenly. Mitral valve prolapse is also known
as click-murmur syndrome, Barlow's
syndrome or floppy valve syndrome.
When the heart contracts, part of one or
both flaps collapse backward into the left
atrium. In some cases, the prolapsed valve
lets a small amount of blood leak
backward through the valve, which may
cause a heart murmur.
Oxygen
Opening snap
Pulmonary Artery
Patient Ductus Arteriosus
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Patent ductus arteriosus (PDA) is a condition in which
the ductus arteriosus does not close.
The ductus arteriosus is a blood vessel that allows blood
to go around the baby's lungs before birth. Soon after the
infant is born and the lungs fill with air, the ductus
arteriosus is no longer needed. It usually closes in a
couple of days after birth. If the vessel doesn't close, it is
referred to as a PDA.
PDA leads to abnormal blood flow between the aorta and
pulmonary artery, two major blood vessels that carry
blood from the heart.
Pericardial Effusion
Pre-Ejection Period
The period between
ventricular contraction
the semilunar valves
blood ejection into
commences.
when the
occurs and
open and
the aorta
Pulmonary Hypertension
Pulmonic Regurgitation
Pulmonic Stenosis
Pulmonary Valve (or vein)
Premature Ventricular
Contraction
Peripheral Vascular Disease
Pulsed Wave Doppler
Flow (Q)
Right Atrium
Right Atrial Pressure
Right Coronary Artery
Right Upper Sternal Border
Right Ventricle
Right Ventricular Hypertrophy
Right Ventricular Outflow
Tract
Right Ventricular Systolic
Pressure
Sinoatrial
Systolic Anterior Motion
(SAM)
• Systolic anterior motion (SAM) of the
mitral valve (MV) can be a lifethreatening condition. The SAM can
result in severe left ventricular outflow
tract obstruction and/or mitral
regurgitation and is associated with an
up to 20% risk of sudden death.
• Systolic anterior motion (SAM)
describes the dynamic movement of the
mitral valve (MV) during systole
anteriorly towards the left ventricular
outflow tract (LVOT).
Short Axis View
Bicuspid Aortic Valve
Subacute Bacterial
Endocarditis
• Subacute Bacterial Endocarditis (SBE)
is a bacterial infection that produces
growths on the endocardium (the cells
lining the inside of the heart). Subacute
bacterial endocarditis usually (but not
always) is caused by a type of bacteria;
it occurs on damaged valves, and, if
untreated, can become fatal within six
weeks to a year.
Systolic Blood Pressure
Stroke Volume
Superior Vena Cava
Transposition of the Great
Vessels
Tricuspid Regurgitation
Tricuspid Stenosis
Tricuspid Valve
Umbilical Artery
• The umbilical vein is
a vein present during fetal
development that
carries oxygenated blood from
the placenta to the growing fetus.
Umbilical Vein
Ventricular Septal Defect
Wolf-Parkinson-White
Syndrome
• WPW is caused by the presence of an
abnormal accessory electrical
conduction pathway between
the atria and the ventricles.
• Electrical signals traveling down this
abnormal pathway (known as
the bundle of Kent) may stimulate the
ventricles to contract prematurely,
resulting in a unique type
of supraventricular tachycardia referred
to as an atrioventricular reciprocating
tachycardia.
Most cardiac output is reduced because of:
Restrictive physiology (Hypertrophy of the ventricles)
In the typical 4 chamber view, why can an inter-atrial septum
appear so fat?
AMYLOID DEPOSITS
• Color flow Doppler can
demonstrate…
– Normal tricuspid regurgitation
– Moderate tricuspid
regurgitation
– Mild tricuspid regurgitation
– Hint: Moderate regurgitation
on Doppler takes up more
than one-half of the chamber
Prosthetic mitral valves
• Tilting disk
• Ball and cage
• St. Jude
The ball and cage is not put in
anymore. (Makes too much noise)
They last for 30-40 years, though.
Wire on the image?
Probably a pace-maker wire
Q: One of the best features
of the ball and cage
prosthetic valve is:
A.
B.
C.
D.
A.
Durability
Low gradient
No need for blood thinners
Low chance of infection
• Sometimes, the degree of mitral
regurg is indeterminate because
of:
• Noise
• Artifact
• Reverberation
• An asymptomatic 36 y/o male
has which common associated
defect?
• ASD
Expect to see a wide variety of Pathology
Dilated CM
Carcinoid
Amyloid CM
Ao Dissection
Tetralogy of Fallot
Ischemic CM
Apical HCM
Effusions
Ebstein’s
Marfan
2 HOCM
Flail MV
VSD
Non Compacted LV
Pseudoaneurysm
MV vege (TEE)
Stress Cases
Pulmonary HTN
Bicuspid Ao
LA myxoma (TEE)
PDA
MVR – Ball/cage
RV Vol. overload
Sub Ao Membrane
Cleft MV
Finished with lecture one
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