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MD3001 > Intro to Echocardiography > Flashcards

Intro to Echocardiography Flashcards

1
Q

What is an echocardiography ?

A

the use of ultrasound to examine the heart (non invasive)

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2
Q

Which specialties make most use of echocardiographs ?

A

Cardiology, anaesthesia, resuscitation, and paediatric cardiology.

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3
Q

What is the first exam of choice for evaluating cardiac structure and function in most clinical conditions.

A

Echocardiography

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4
Q

What is the most widely used cardiovascular imaging modality ?

A

Echocardiography

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5
Q

What are some of the pros associated with echocardiography ?

A
  • Quick
  • Least trouble/danger and distress to the patient (lack of ionizing radiation)
  • Provides speedy clinically relevant data at comparatively low cost
  • Portable
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6
Q

What information does echocardiography give on the heart ?

A

Information on cardiac structure, containing the size and shape of cardiac chambers, as well as the function and morphology of cardiac valves concomitant with systolic and diastolic function and intra cardiac haemodynamics.

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7
Q

Identify and describe the main types of transducers.

A

1) LINEAR ARRAY TRANSDUCERS
- High frequency, low penetration
- Only for superficial structures (muscles, tendons, vessels, nerves)

2) CURVED ARRAY TRANSDUCERS
- Low frequency, high penetration
- For general abdomen, obstetrical, and endoluminal scanning

3) PHASED ARRAY TRANSDUCERS
- For transthoracic echo
- E.g. between the ribs

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8
Q

What are the main aspects to look out for when manipulating an ultrasound probe ?

A
  • Pressure
  • Alignment (movement)
  • Rotation
  • Tilting (fanning)
  • Orientation of the probe (all US probes have an orientation marker, directed to cephaled side when longitudinal scan and to the right when transverse scan, which is usually represented by a groove or a ridge on one side of the transducer and corresponds to a green dot (or a logo) on the monitor.
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9
Q

Define imaging window.

A

Anatomic position on the patient’s body where an ultrasound transducer is placed to visualize specific structures.

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10
Q

Identify the different cardiac windows used in Transthoracic Ecchocardiography (TTE).

A
  1. Parasternal (long axis, short axis at aortic valve, mitral valve, and papillary muscle levels)
  2. Apical (A4C and A5C views)
  3. Subcostal
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11
Q

Describe how to orientate the transducer when using the long axis of the parasternal window.

A

LONG AXIS

  • Placed in the 3rd/4th IC space (orientation marker points to the R shoulder of the patient, at 10 o’clock)
  • Depth 12-16 cm (for assessment of a pericardial and pleural effusion, use depth of 20-24 cm)
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12
Q

Describe how to orientate the transducer when using the short axis of the parasternal window (at the aortic valve level).

A

SHORT AXIS (AORTIC VALVE LEVEL)

  • From the parasternal long axis view, rotate the transducer by 90 degrees clockwise (orientation marker points to the L shoulder of the patient, at 2 o’clock)
  • Tilt transducer face slightly upwards towards the patient’s R shoulder
  • Depth 12-16 cm
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13
Q

Describe how to orientate the transducer when using the short axis of the parasternal window (at the mitral valve level).

A

SHORT AXIS (MITRAL VALVE LEVEL)

  • From the parasternal long axis view, rotate the transducer by 90 degrees clockwise (orientation marker points to the L shoulder of the patient, at 2 o’clock)
  • Transducer perpendicular to chest wall
  • Depth 12-16 cm
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14
Q

Describe how to orientate the transducer when using the short axis of the parasternal window (at the papillary muscle level).

A
  • From the parasternal long axis view, rotate the transducer by 90 degrees clockwise (orientation marker points to the L shoulder of the patient, at 2 o’clock)
  • Tilt the transducer’s face slightly downward towards the patient’s left flank
  • Depth 12-16 cm
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15
Q

What structures are visible using the long axis of the parasternal window ? What may you assess them for using echocardiography ?

A
  • RV (size and function)
  • LV (size and function)
  • Ascending aorta (size)
  • Aortic valve (motion, opening, and calcification)
  • Mitral valve (motion, opening, and calcification)
  • Pericardium (pericardial fluidity)
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16
Q

What structures are visible using the short axis (aortic valve level) of the parasternal window ? What may you assess them for using echocardiography ?

A
  • Aortic valve (opening and calcification)
  • Tricuspid valve (motion and regurgitation)
  • Pulmonary valve (motion and regurgitation)
  • RA (better assessed in apical C4 view)
  • LA (better assessed in apical C4 view)
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17
Q

What structures are visible using the short axis (mitral valve level) of the parasternal window ? What may you assess them for using echocardiography ?

A
  • RV (size and function)
  • Inter-ventricular septum (systolic and diastolic shape)
  • LV (size and function)
  • Mitral valve (opening and calcification)
  • Pericardium (pericardial fluidity)
18
Q

What structures are visible using the short axis (papillary muscle level) of the parasternal window ? What may you assess them for using echocardiography ?

A
  • RV (size and function)
  • Inter-ventricular septum (systolic and diastolic shape)
  • LV (size and function)
  • Inferior wall (thickening and motion)
  • Anterior wall (thickening and motion)
  • Pericardium (pericardial fluidity)
19
Q

Define the M-mode in echocardiography.

A
  • Designed to document and analyze tissue motion

- Important for studying cardiac valve and wall motion and in documenting foetal heart rate and activity

20
Q

Describe how to orientate the transducer when using the Apical 4 chamber (A4C) window

A

-Transducer placed on apical pulse
-Tilt face of transducer up until the ultrasound beam cuts through the long axis of the heart
(transducer marker is at 3 pm)
-Depth: 14-18 cm

21
Q

Describe how to orientate the transducer when using the Apical 5 chamber (A5C) window

A
  • From the apical 4 chamber view, tilt the face of the transducer slightly upwards until the aortic valve appears (orientation marker at 3 o’clock)
  • Depth: 14-18 cm
22
Q

What structures are visible in the Apical 4 Chamber View ? What may you assess them for using echocardiography ?

A 
RV (size and function)
LV (size and function)
RA (size) 
LA (size) 
Mitral valve (motion and regurgitation) 
Tricuspid valve (motion and regurgitation)
23
Q

What structures are visible in the Apical 5 Chamber View ? What may you assess them for using echocardiography ?

A 
RV (foreshortened in this view) 
LV (foreshortened in this view) 
RA (foreshortened in this view) 
LA (foreshortened in this view) 
Aortic valve (motion and regurgitation)
24
Q

Draw what you would see on an A4C and A5C view.

A

Refer to slide on page 8 in lecture.

25
Q

Draw what you would see on a parasternal, long axis view.

A

Refer to slide on page 6 in lecture.

26
Q

Draw what you would see on a parasternal, short axis view (at aortic valve, mitral valve, and papillary muscle levels respectively).

A

Refer to slides on pages 7 and 8 in lectures.

27
Q

Describe how to orientate the transducer when using the subcostal four chamber window.

A
  • Patient is supine
  • Transducer placed 2-3 cm below xyphoid process
  • Direct transducer towards patient’s chin/left shoulder (orientation marker at 3 o’clock)
  • Hold transducer palm down to facilitate cephalad angulation of the US beam
  • Depth 16-24 cm
28
Q

Describe how to orientate the transducer when using the subcostal IVC window.

A
  • From subcostal four chamber view, rotate transducer 90 degrees counter-clockwise, always keeping RA on the screen (transducer orientation marker at 12 o’clock)
  • Depth 16-24 cm
  • Important that you see IVC merging into RA (confirms that you are not vizualising the aorta)
29
Q

What structures are visible in the Subcostal Four Chamber View ? What may you assess them for using echocardiography ?

A 
RV (size and function)
LV (size and function)
RA (better assessed from A4C view) 
LA (better assessed from A4C view) 
Mitral valve (motion and regurgitation) 
Tricuspid valve (motion and regurgitation) 
Pericardium (pericardial fluidity)
30
Q

What structures are visible in the Subcostal IVC View ? What may you assess them for using echocardiography ?

A

IVC (size and respiratory variations)

31
Q

Draw what you would see on a subcostal 4 chamber view.

A

Refer to slide on page 9 in lecture.

32
Q

Draw what you would see on a subcostal IVC view.

A

Refer to slide on page 9 in lecture.

33
Q

Why may we use echocardiography in Point of Care US ?

A

Aims to answer focused clinical yes/no questions.
1) Resuscitation: In the shocked, dyspnoeic, or arrested patient it looks for (or rules out):
• Pericardial effusion (with or without signs of tamponade)
• An enlarged RV (with or without hypokinesis and paradoxical septal motion)
• LV size, in conjunction with IVC (eg small LV suggests hypovolaemia)
• LV systolic function (rough estimate only)

34
Q

Describe the main features of Marfan’s Syndrome.

A
  • Common disorder of connective tissue that can affect the Eyes, Skeleton, Lungs, Heart and Blood Vessels
  • The effects of Marfan syndrome varies between individuals, some people only being mildly affected while it may be fatal for others
  • Associated with cardiovascular complications.
35
Q

Identify the possible CV complications of Marfan’s Syndrome.

A
  • Dilatation of ascending and sometimes descending aorta
  • Incompetence of aortic and mitral valves (if severe, can cause aortic, and mitral regurgitation respectively)
  • Aneurysm and dissection of aorta.
36
Q

How would an aortic dilatation be assessed ?

A

Through a Sinus of Valsalva Echocardiogram

37
Q

Describe optimal management for Marfan’s Syndrome.

A

• echocardiogram
• additional imaging if required (TOE, MRI, CT)
• b blockers/ACEI
• Surgical referral if aortic root at sinus of valsalva exceeds
-5.5 cm or
-5% growth per year (2 mm in adults)

38
Q

Why may neonatal echocardiography be performed ?

A

For detection of duct dependent congenital heart disease

39
Q

What is the step to take if it is difficult to get a clear picture of a patient’s heart with a standard echocardiogram or if there is reason to see the heart and valves in more detail ?

A

Transoesophageal echocardiogram

40
Q

When is a Transoesophageal echocardiogram used ?

A

When it is difficult to get a clear picture of a patient’s heart with a standard echocardiogram or if there is reason to see the heart and valves in more detail.

MD3001 (75 decks)

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