The Focused Echocardiographic

Examination

Sharon Kay PhDMSc (Perfusion)MSc (echocardiography)BSc (Med)

Echocardiography

v echocardiography describes the use of ultrasound in to assess the heart

v due to diagnostic potential, echo is widely used as common cardiac investigation

v safe, non-invasive, cost effective, most frequently used imaging procedure in the diagnosis of heart disease

v 2D echo

v Spectral Doppler

v Colour Doppler

5 things to look for

v S - Size

v M - Movement

v A - Artefacts

v C - Consistency

v C - Conclusion

v Subcostal long axis

v Subcostal long axis

v RV Dilated v LV Dilated

v Subcostal Short

v Subcostal IVC

• Normal • Dilated

Subcostal Aorta

v Parasternal long axis

v Parasternal short axis - LV

Parasternal short axis - Valves

Apical 4 chamber

Apical 5 chamber

Apical 2 chamber

Apical long axis

Suprasternal – aortic arch

Diastology - What does it all Mean??

• Diastology• Normal• Normal for age, without LA dilatation• Impaired relaxation with normal filling pressures• Impaired relaxation with elevated filling pressures

• Decrease in LV compliance• Pseudo normalization - Moderate• Reversible restrictive - Marked• Irreversible restrictive – Severe• Constrictive

E>A

PV a reversal

Inflow swing

Chambers

• Size• All 4 chambers remodel in size depending

on pathology present• eg: PHT / Aortic incompetence

Chambers

• Movement - Function• Fractional shortening – the squeeze of

the Ventricle• Global – Cardiomyopathy –

• ETOH• Athletes –

• Segmental – AMI / IHD / Tako Tsubo

Wall thickness

• Size• (or thinness)• Hypertrophy – hypertension systemic or

pulmonary• Deposits – sarcoid / amyloid / HOCM

v LVEF

• Mildly reduced

v AMI

Inferolateral MI

Pericardial effusion

v Haematoma

Pulmonary hypertension

Cardiomyopathy

• Hypertensive • HOCM

Chambers

• The atria• Size ( LA – dilated ? why)

• Diastolic dysfunction ?• IAS – hypermobile / aneurysmal / PFO /

Not just filling pressure …… Movement• Masses • Thrombus / SEC / myxoma / Artifact

Masses

LA myxoma

Valves

v Regurgitation

v SIZE of chamber and jet

v Mitral regurgitation

Valves

v Stenosis - Movementv Artifactv Are the leaflets mobile –

Consistently mobile to the other similar valvevLunar valves and AV valve

Aortic stenosis

Mitral stenosis

CASE study

AV

Extra systolic

5 things SMACC

v S - Size

v M - Movement

v A - Artefacts

v C - Consistency

v C - Conclusion