intro to echocardiography

Question 1

LO?

Answer 1

Understand the basics of Echocardiography.
Understand the different cardiac windows used in echocardiography and relate the images seen to the underlying cardiac anatomy and physiology.
Have a basic understanding of the use of Echocardiography in assessment in the context of the Cardiology Clinic.
Have a basic understanding of the role of Echocardiography in Point of Care Ultrasound.

Question 2

what is the first exam of choice for evaluating heart structure?

Answer 2

echocardiograpghy

Question 3

what are the advantages of echocardiography?

Answer 3

• low cost
• low distress to patients
• provides a detailed picture of the hearts structure
• highly available
• no ionising radiation

Question 4

what are the disadvantages of echocardiography?

Answer 4

• highly user dependant
• it is only 2D imaging

Question 5

how do they work?

Answer 5

sound waves bounce of different parts of the heart ‘echos’ which will appear as pictures on the sonograpghers computer.

Question 6

what is an echocardiography?

Answer 6

‘- echo’ is the use of ultrasound to examine the heart.
- non invase diagnostic procedure

Question 7

how quickly can an echo be done and does it distress patients?

Answer 7

Compared with other imaging techniques,echocardiographymay be done quickly, with the least trouble and distress to the patient, and provides speedy clinically relevant data at comparatively low cost.

Question 8

what type of info does echocardiograogh give?

Answer 8

-cardiac structure
- containing the size and shape of cardiac chambers
- function and morphology of the cardiac valves
- systolic and diastolic function and intra cardiac haemodynamics.

Question 9

main type of echo?

Answer 9

Trans-thoracic echocardiography (TTE)

Question 10

advanced types of echo?

Answer 10

• Trans-oesophageal echocardiography
• Stress echocardiography
• Contrast echocardiography
• 3D echocardiography

Question 11

what is echogenicity?

Answer 11

Echogenicity of the tissue refers tothe ability to reflect or transmit ultrasound waves in the context of surrounding tissues

Question 12

what is:
1) hyper echoic
2) hypo echoic
3) anechoic

Answer 12

1) white on screen (bone and air)
2) gray on screen (soft tissue)
3) black on the screen (fluid and blood)

Question 13

what type of probe do we use in echo?

Answer 13

phased array probe

Question 14

what are the main types of probe?

Answer 14

• linear array probe
• curved array probe
• phased array probe

Question 15

linear array probes?

Answer 15

• images of flat superficial surfaces
• high frequency sound will not penetrate deep into tissue, so high frequency probes (like this one) will only be used for superficial structures.

Question 16

curved array probes?

Answer 16

• end-liminal scanning
• general abdomen and obstetrical scanning
• the images for this one will always have a curved superficial surface

Question 17

phased array probe?

Answer 17

• every element in the array will participate in the formation of each transmitted pulse
• the sound beams are steered at varying angles from one side of the transducer to the other = producing a sector image format.
• thi probe is smaller and can scan in areas where acoustic access is limited, like between the ribs.

Question 18

describe probe and image orientation?

Answer 18

• must be properly orientated to accurately identify the structures
• probe orientation marker should be on the right side of the patient
• therefore the orientation marker on the left side of the monitor will show the cephalad end during a longitudinal scan or the right side during a transverse scan.

Question 19

what is the typical frequency range for an adult echo?

Answer 19

1-5 MHz

Question 20

location of the 4 valves?

Question 21

what is an imaging window?

Answer 21

An imaging window refers to an anatomic position on the patient’s body where an ultrasound transducer is placed to visualize specific structures.

Question 22

what are the imaging windows for echo?

Answer 22

For Transthoracic Ecchocardiography (TTE) there are three standard imaging windows.
1. Parasternal. (long and short axis)
2. Apical.
3. Subcostal.

Question 23

what are the 4 probe manipulation manoeuvres?

Answer 23

• pressure
• allighnmnet
• rotation
• tiliting

Question 24

parasternal long axis?

Answer 24

• transducer is placed in 3rd-4th intercostal space
• orientation marker should be put towards the patients right shoulder
• depth 12-16cm
• for assessment of a pericardial and pleural effusion use a depth of 20-24cm

Question 25

what is the m mode?

Answer 25

The m-mode is designed to document and analyze tissue motion. This mode is particularly important in studying cardiac valve and wall motion and in documenting foetal heart rate and activity.

Question 26

parasternal short axis- mitral valve level?

Answer 26

- from the parasternal long axis view, rotate the transducer 90 degrees clockwise - transducer orientation marker is pointing towards the patients left shoulder - transducer is perpendicular to the chest wall - depth is 12-16cm

Question 27

apical four - chamber (A4C) view?

Answer 27

- the transducer is placed on the apical impulse - tilt the face of the transducer up until the ultrasound beam cuts through the long axis of the heart - transducer orientation marker is at 3 o'clock - -depth is 14-18cm

Question 28

apical five chamber (A5C)

Answer 28

- from the apical 4 chamber view, tilt the face of the transducer slightly upward until the aortic valve appears - transducer orientation marker is at 3 o'clock - depth 14-18cm

Question 29

subcostal 4 chambers

Answer 29

- patient is supine - transducer is placed 2-3 cm below the xyphoid process - direct the transducer towards the patients chin/left shoulder - transducer orientation marker is at 3 o'clock - hold the transducer palm down to facilitate cephalic angulation of the ultrasound beam - depth is 16-24 cm

Question 30

subcostal inferno vena cava?

Answer 30

- from subcostal four chamber view, rotate the transducer 9- degrees counter clockwise always keeping the right atrium on the screen - transducer orientation marker is at 12 o'clock - depth 16-24 cm - it is important to see the IVC merging into the RA, this will confirm that you are not visulaing the aorta.

Question 31

basic echo in resuscitation?

Answer 31

in normal echo we use multiple views and techniques ut in resuscitation we are only using it to answer yes or no questions.

Question 32

what are you looking for in basic echo in resuscitation?

Answer 32

What are we looking for? 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)

Question 33

transoesophageal echo?

Answer 33

 If it's 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 transesophageal echocardiogram can be performed. this goes down the throat so have to take this into consideration for the patient.