PowerPoint - Echocardiography 1

Basic EchocardiographyBasic Echocardiography

Wendy Blount, DVMNacogdoches TXWendy Blount, DVMNacogdoches TX

Echo Technique - AnatomyEcho Technique - Anatomy

Tricuspid valve• Septal leaflet• Parietal leaflet

Pulmonic Valve• Right cusp• Left cusp• Intermediate cusp

Mitral valve• Leaflets are less

distinct

Aortic Valve• Right cusp• Left cusp• Septal cusp

Echo Technique - AnatomyEcho Technique - Anatomy

RV• Conus arteriosus• 3 papillary muscles

LV• 2 papillary muscles

EchocardiographyEchocardiography

Equipment• Transducer – small footprint• Fan-shaped beam or sector• High frequency for small animals• Low frequency for large animals• Machines range from 2.5-10 Mhz• 5-7 MHz will work fine for most

dogs and cats for echo


Equipment• Double window with simultaneous

B and M modes (video)

• Can do measurements on B-mode or M-mode

• Need a cursor which can measure mm, or cm marks on the images

• Ability to capture images is important


Preparation• Thin coated animals – alcohol, part the

hairs, gel• Thick coated animals – shave the

window – at the sternum, just behind the elbow

• Sedation only if needed– Acepromazine – 0.025 mg/lb (max 1 mg)– Buprenex – 0.01-0.02 mg/kg– Mix together and give IV (handout)


Positioning for 8 standard views• Right lateral recumbency• Cardiac table is nice but not necessary• Sonographer needs a stool or chair• Placement of probe:

– Feel the apical beat, and put your probe there (probe marker cranial)

– Imagine the longitudinal axis of the heart, probe at 90o (short axis views)

– Adjust 1 intercostal space Cr or Cd PRN– Rarely move the probe head – just fan and

twist (video)

1. Short Axis – Left Ventricle1. Short Axis – Left Ventricle

• Fan from base to apex, until you have just passed the mitral valve, and the LV papillary muscles appear (mushroom view)

• Rotate until PM are the same size• If you are getting a rib shadow, try one

intercostal space cranial or caudal• Fan cranial and caudal to center the heart on

the screen


Abbreviations - Structures• P – pericardium• RV – right ventricle• IVS – intraventricular septum• LV – left ventricle• PPM – posterior papillary muscle• APM – anterior papillary muscle


Measurements• IVSTdIVSTd - IntraVentricular Septum Diastole• LVIDd - LV Inner Diameter Diastole• LVPWd – LV Posterior Wall Diastole• IVSTsIVSTs - IntraVentricular Septum Systole• LVIDs - LV Inner Diameter Systole• LVPWs – LV Posterior Wall Systole


Measurements• IVSTdIVSTd = IVSd IVSd = VSdVSd• LVIDd = LVd = LVLd• LVPWd = LVFWd = LVWd • IVSTsIVSTs = IVSs IVSs = VSsVSs• LVIDs = LVs = LVLs• LVPWs = LVFWs = LVWs


Measurements - Calculated• FS – fractional shortening

(LVIDd – LVIDs)

LVIDd– Assumes perpendicular to myocardium– Assumes contractility is uniform in the LV– Extremes in preload and afterload can affect FS, as

well as myocardial function


Measurements - Calculated• FS – fractional shortening• AKA shortening fraction (SF)

– >30% in the dog– >40% in the cat– >45% if MR is compensated


Measurements - Tips• Make sure you don’t include PM in the LVPW

measurement– If you do, your LVPW will be artifactually thicker– Clue – check for this if LVPW is much thicker than IVS

• Make sure you are not too far apical– If you are, your LVID will be artifactually small– And LVPW will be artifactually thick


Measurements - Tips• Measure three times

– Take the average– Throw out any outliers

• Several sets of normals published– 1-2mm outside normal may not always be

significant

2. Short Axis – Apex2. Short Axis – Apex

Structures• Pericardium• May or may not see RV• LV apical lumen

No measurements here

3. Short Axis – Chordae Tendinae3. Short Axis – Chordae Tendinae

Structures• Pericardium• RV• LV • CH - Chordae Tendinae (posterior & anterior)

No measurements here

4. Short Axis – Mitral Valve4. Short Axis – Mitral Valve

Structures• Pericardium• RV• RV Papillary Muscles• LV • MV - Mitral Valve (Posterior & Anterior)

4. Short Axis – Mitral Valve4. Short Axis – Mitral Valve

Measurement• EPSS – E-Point to Septal Separation

– Can denote decreased LV systolic function– Less than 6 mm in large dogs– Less than 3-5 mm in small dogs and cats

5. Short Axis – Aortic Valve5. Short Axis – Aortic Valve

Structures• RVOT – Right Ventricular Outflow Tract• TV – Tricuspid Valve• PV – Pulmonic Valve• Ao – Aortic Valve• LA – Left Atrium

5. Short Axis – Aortic Valve5. Short Axis – Aortic Valve

Measurements• Ao – at largest dimension (systole)• LA – at largest dimension (diastole)• LA:Ao –

– 0.8 to 1.3 in dogs– 0.8 to 1.4 in cats

6. Short Axis – Pulmonary Artery6. Short Axis – Pulmonary Artery

Structures• RA – Right Atrium• Ao – Aorta (ascending)• PA– Pulmonary Artery

– LPA – left pulmonary artery– RPA – right pulmonary artery

• CaVC – Caudal Vena Cava

7. Long Axis – 4 Chamber7. Long Axis – 4 Chamber

Technique• Get short axis “mushroom” view• Rotate 90 degrees counterclockwise


Structures• RV – Right Ventricle• RA – Right Atrium – difficult to view completely• TV – Tricuspid Valve• LV – Left Ventricle• LA – Left Atrium• MV – Mitral Valve, PM – papillary muscle


Video

8. Long Axis – LVOT8. Long Axis – LVOT

Technique• Find 4 Chamber view• Angle the “dot” toward the shoulders• Elevate the cord end of the probe


Structures• RV, TV, RA• LV, PM, MV• Very edge of the LA• LVOT – AV (LC, SC), ascending Ao• RPA – Right Pulmonary Artery


Video

Normal Dog Video

Dog RV Measurement ValuesDog RV Measurement Values

• RVWd – less than LVWd• RVIDd – 1/3 or less of LVIDd

(handout)

Cat Echo Normal ValuesCat Echo Normal Values

• IVSTd – 3-6 mm• LVIDd – 10-21 mm• LVPWd – 3-6 mm• IVSTs - 4-9• LVIDs – 4-11 mm• LVPWs – 4-10 mm• Aos – 6-12 mm• LAd – 7-15 mm

• FS - >40%• EPSS - 0-3 mm• EF - >70%• LA:Ao – 0.8-1.4• RVIDd - 3-7 mm• RVWd - <3 mm

(form)

Ferret Echo Normal Values (Mean)Ferret Echo Normal Values (Mean)

• LVIDD – 11.0 mm• LVIDS - 6.4 mm• LVPW - 3.3 mm• FS - 42%• EPSS - 0

PowerPoint - Echocardiography 1

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