M-MODE ECHOCARDIOGRPHY
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Transcript of M-MODE ECHOCARDIOGRPHY
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M-MODE ECHOCARDIOGRPHY
THE LOST ART
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M-MODE PHYSICS
B mode echoes from an interface that changes position will be seen as echoes moving towards and away from the transducer.
If a trace line is place on this interface and the resulting trace is made to drift across the face of a CRT screen a motion pattern is obtained.
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M-MODE PHYSICS
The resulting display shows motion of a reflector over distance and time – a distance time graph
The change in distance (dy) over a period of time dt is represented by the slope of the reflector line of motion.
dy/dt = slope = velocity
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M-MODE PHYSICS
If this motion pattern is obtained on moving cardiac structures then the resulting images constitute M-mode echocardiography.
M-mode echocardiography is use to evaluate the morphology of structures, movement and velocity of cardiac valves and walls and timing of cardiac events.
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Distance
Time
M-mode Tracing
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M-mode Evaluation
Amplitude
Velocity
Time intervals
Morphology
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Amplitude = Y2 –Y1
Y1
Y2
Amplitude Measurement
Distance
Time
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Time interval = T2 – T1
T2T1
Time Measurement
Distance
Time
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dy = Y2 –Y1
Y1
Y2
Slope Measurement
T1 T2
dt = T2 – T1
Slope = dy/dt = velocity
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M-mode at the Mitral Valve
The mitral valve has 2 leaflets – anterior and posterior.
Specific letters corresponding to systole and diastole are assigned to the m-mode tracing of the mitral valve.
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EKG Tracing
T-wave
QRS complex
P wave
Systole Diastole
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
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Phase of Cardiac Cycle Assigned Letters
Diastole d,e,f, and a
Systole c and d
M-mode at the Mitral Valve
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Systole
M-mode at Mitral Valve
Diastole
dc
a
f
e
d
Time
Distance
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Systole
M-mode at Mitral Valve
Diastole
e
d Time
Distanced-e amplitude
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Systole
M-mode at Mitral Valve
Diastole
Septum
e
Time
DistanceEPSS
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Systole
M-mode at Mitral Valve
Diastole
e
d Time
Distanced-e slope
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Systole
M-mode at Mitral Valve
Diastole
f
e
Time
Distancee-f slope
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M-mode at Mitral Valve
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M-mode at the Mitral Valve
Amplitude DescriptionNormal Value
EPSS Measure e point to septal separation
< 5 mm
d-e Measures the maximum excusion of the mitral valve following diastolic opening.
17 to 30 mm
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M-mode at the Mitral Valve
Slope Description Normal Value
d-e Measure rate of initial opening of the mitral valve in early diastole.
240 to 380 mm/s
e-f Measures the rate of early closure of the mitral valve following diastolic opening.
50 to 180 mm/s
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M-mode Findings at the MV
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
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M-mode Findings at the MV
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
B-bump on theAC shoulder.
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Premature Closure
Premature Closure- closureon or before the onset of theQRS complex.
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Systolic anterior motion of the AMVL
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Systolic anterior motion of the AMVL
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
MV prolapse posterior leaflet
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
MV Prolapse – both leaflet
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Flail posterior leaflet
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Aortic Regurgitation
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Sinus Rhythm
Mitral Stenosis
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Atrial Fibrillation
Mitral Stenosis
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Atrial Myxoma
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Vegetation
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Distance
SystoleDiastole
Time
Mitral Regurgitation
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Distance
SystoleDiastole
Time
Mitral Regurgitation
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Distance
Systole
Mitral Regurgitation
Diastole
Time
Atrial Myxoma
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Distance
SystoleDiastole
Time
Atrial Myxoma
Mitral Regurgitation
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Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Atrial Myxoma
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Color M-mode
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Color M-mode
Propagation Velocity, Vp
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M- Mode
Aortic Valve
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M-mode at the Aortic Valve
The aortic valve has 3 cusps – right coronary, left coronary and non-coronary cusps.
The cusps imaged in the PLAX view are the right coronary and the non-coronary cusps.
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M-mode at the Aortic Valve
Coronary cusp
Non-coronary cusp
Anterior aortic root
Posterior aortic root
Left Atrium
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M-mode at the Aortic Valve
LA dimension
Cusp SeparationAortic root
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M-mode at the Aortic Valve
LA dimension
Cusp SeparationAortic root Measurements are made from leading edge to leading edge.
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M-mode at the Aortic Valve
Dilated LA
Dilated aortic root
Decreased excursion
Premature opening
Premature closing
Exaggerated anterior motion of Aortic Root
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M-mode at the Aortic Valve
Reduced anterior motion of Aortic Root
Thickening
Calcification
Vegetations
Bicuspid valve
Prosthetic valve
Aortic Regurgitation
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M-mode at the Aortic Valve
Premature Opening
Opening of the AV before the onset of the QRS complex
Seen in Elevated LV-EDP
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M-mode at the Aortic Valve
Premature Closure
Closure of the AV before the onset of the T wave
Seen in IHSS
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M-mode at the Aortic Valve
Bicuspid Valve
Eccentric closure line
Seen when there is a Bicuspid aortic valve
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M-mode at the Aortic Valve
Decreased Cusp Separation
Seen in Aortic Stenosis
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M-mode at the Aortic Valve
Seen in aortic sclerosis
Thickened, calcified aorticvalve leaflet.
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M-mode at the Aortic Valve
Seen in Mitral Stenosis
Reduced anterior motion of aortic root
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M-mode at the Aortic Valve
Exaggerated anterior motion of aortic root
Seen in Mitral Regurgitation
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Aortic Regurgitation
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Aortic Regurgitation
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Aortic Regurgitation
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M - Mode
Left Ventricle
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M-mode at Left Ventricle
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M-mode at Left Ventricle
Thickening of the IVS and LVPW
Movement of the IVS and LVPW
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• RVWd
• RVIDd
M-mode Measurement
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• IVSd
• IVS excursion
• IVSs
M-mode Measurement
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• LVIDd
• LVIDd index
• LVIDs
• LVIDs index
M-mode Measurement
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• LVPWd
• LVPW excursion
• LVPW max excursion velocity
• LVPWs
M-mode Measurement
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M-mode at Left Ventricle
RVWT
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M-mode at Left Ventricle
RVIDd
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M-mode at Left Ventricle
IVSd
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M-mode at Left Ventricle
LVIDd
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M-mode at Left Ventricle
LVPWd
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M-mode at Left Ventricle
IVS excursion
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M-mode at Left Ventricle
IVSs
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M-mode at Left Ventricle
LVIDs
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M-mode at Left Ventricle
LVPWs
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M-mode at Left Ventricle
LVPW excursion
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M-mode at Left Ventricle
LVPW max velocity= slope
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M-mode at Left Ventricle
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• FS
• EF
• LV mass
• RWT
M-mode LV Calculation
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• % IVS thickening
• % LVPW thickening
• IVS/LVPW ratio
M-mode LV Calculation
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M-mode LV Calculation
FS = LVIDd – LVIDs LVIDd
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M-mode LV Calculation
EF = LVIDd3 – LVIDs3
LVIDd3
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M-mode LV Calculation
RWT = IVSd + LVPWd LVIDd
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M-mode LV Calculation
IVS % thickening = (IVSs – IVSd) x 100 IVSd
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M-mode LV Calculation
LVPW % thickening = (LVPWs – LVPWd) x 100 LVPWd
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M-mode LV Calculation
LV Mass = 1.04 {(LVIDd + IVSd + LVPWd)3 – (LVIDd)3} x 0.8 + 0.6g
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Increase LVW thickness
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Increased WallThickness
Symmetrical
ConcentricHypertrophy
Asymmetrical
InfiltrativeDiseases
ConcentricRemodeling
HypertrophicCardiomyopathy
Increased Wall ThicknessIncrease LVW thickness
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LV Hypertrophy - Hypertension
Pressure Overload
Concentric LVH
Increase Wall thicknessNormal Mss
Increase Wall thicknessIncreased Mass
Remodeling
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Increase Wall thickness
Normal LV Mass Increased LV Mass
Measure LV Mass
Concentric Remodeling Concentric Hypertrophy
LV Hypertrophy - Hypertension
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Increase Wall thickness
Increased LV Mass
Concentric Hypertrophy
LV Hypertrophy – Aortic Stenosis
Pressure Overload
LVH
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Eccentric LV Hypertrophy
Increased LV size withSpherical shape
Normal LV Mass Increased LV Mass
Measure LV Mass
No LV hypertrophy Eccentric Hypertrophy
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Measurement Assessment
Concentric Hypertrophy
Concentric
Remodeling
Eccentric Hypertrophy
Wall Thickness Increased Increased Normal
Relative Wall Thickness
Increased Increased Normal - Decreased
LV Chamber size Normal Normal Increased
LV Chamber shape Elliptical Elliptical Spherical
LV mass Increased Normal Increased
LV Hypertrophy
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Paradoxical Septal Motion
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•RV hypertrophy
•RV dilatation
•LBBB
•Post Cardiac Surgery
Paradoxical Septal Motion
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Ischemia
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Ischemia
Normal Wall thickness
No systolic thickening
Reduced Motion
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Post Infarct
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Post Infarct
Thin echogenic wall
No systolic thickening
Reduced Motion
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Pericardial Effusion
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Pericardial Effusion
Infection
Postviral pericarditis
Bacterial
Tuberculosis
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Pericardial Effusion
Malignant
Metastatic disease – lymphoma & melanoma
Direct extension – lung and breast
Primary cardiac malignancy
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Pericardial Effusion
Inflammatory
Post MI (Dressler’s Syndrome)
Uremia
Collagen vascular disease
Post cardiac surgery
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Pericardial Effusion
Intracardiac-Pericardial communication
Blunt or penetrating chest trauma
Post catheter procedures
LV rupture (post MI)
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Pericardial Thickening
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Pericardial Thickening
Constrictive pericarditis
Occurs following
Surgery
Radiation therapy
Repeated episodes of pericarditis