ECHOCARDIOGRAPHY

BY MANDE SAMUELBDUE 2014-2016

ECUREI

indications

• symptoms, signs or previous tests that indicate possible structuralheart disease● heart murmurs when associated with symptoms or when structuralheart disease is suspected, and the follow-up of those with knownsignificant valvular stenosis or regurgitation● prosthetic valves (except asymptomatic patients with mechanical valves

or those in whom no further intervention would be undertaken)● suspected or proven infective endocarditis● known or suspected ischaemic heart disease (e.g. diagnostic stress

echo,assessment following myocardial infarction)● known or suspected cardiomyopathy

indications

• ● suspected pericarditis or pericardial effusion, and follow-up of patients

• with known moderate or large pericardial effusions (or small effusions

• if there has been a clinical change)• ● suspected or possible cardiac masses (and follow-up of

patients• following surgical excision of a cardiac mass)• ● pulmonary disease (with cardiac involvement)• ● pulmonary hypertension

indications

● thromboembolism● neurological disorders (with cardiac involvement)● arrhythmias (with suspected/possible structural heart

disease)● syncope (with suspected/possible structural heart disease)● hypertension (if left ventricular hypertrophy

(LVH)/dysfunction or aortic coarctation are suspected)● aortic disease (e.g. monitoring of aortic root dimensions in

Marfan syndrome)● known or suspected congenital heart disease.

Standard windows and views1) Left parasternal window Parasternal long axis view (Parasternal right

ventricular (RV) inflow view)

(Parasternal RV outflow view)

Parasternal short axis view2) (Right parasternal

window)3) Apical window

Apical 4-chamber view Apical 5-chamber view Apical 2-chamber view Apical 3-chamber (long axis)

view4) Subcostal window Subcostal long axis view Subcostal short axis view5) Suprasternal window Aorta view.

Left parasternal window

• The left parasternal window is located to the left of the sternum, usually in the third or fourth intercostal space.

• From the left parasternal window a number of views can be obtained.

Parasternal long axis view

• To obtain the view with the probe in the left parasternal window, rotate the probe so that the probe’s ‘reference point’ (sometimes a ‘dot’) is pointing towards the patient’s right shoulder.

Parasternal long axis view

In this view:

● Use 2-D M-mode to: Assess structure and mobility of the aortic valve. The right and non-

coronary cusps are visible and normally have a central closure line – an eccentric closure line suggests bicuspid aortic valve.

• measure the aortic root dimensions and inspect the ascending aorta;do not forget to look at the descending aorta as it runs behind the left atrium (LA) – this is a useful landmark for assessing a pericardial/pleural effusion

• assess structure and mobility of the mitral valve – in this view, the A2 and P2 segments are visible

• measure LA dimensions

• measure LV dimensions and assess function (anteroseptum andposterior (also known as inferolateral) wall)• measure RV dimensions and assess function• assess the pericardium and check for any pericardial (or pleural)

effusion.● Use colour Doppler to:• assess the aortic valve for stenosis or regurgitation• examine mitral valve inflow and check for regurgitation• check for flow acceleration in the left ventricular outflow tract

(LVOT) in association with septal hypertrophy• check the integrity of the interventricular septum (IVS).