An overview of transthoracic, transesophageal, and intracardiac echocardiography. Includes indications for ordering an echocardiogram, plus pictures and videos.

1. 1 xx
IN

2. 2 xx2 xx
INTRODUCTION
•Echocardiograms are one of the most
commonly performed cardiac studies
•Provide comprehensive information about
cardiac structure and function
•Aid in establishing diagnosis and guiding
treatment
•Can be ordered by all physicians, not just
cardiologists

3. 3 xx3 xx
•Hand-held ultrasound probe positioned in
specific areas (windows) to visualize heart

4. 4 xx4 xx
•Performed by inserting a small (~1/2
inch) ultrasound probe into the
esophagus

5. 5 xx5 xx
•Thin catheter (8 Fr) with ultrasound
transducer at tip, inserted directly into the RA
through femoral venous access

6. 6 xx6 xx

7. 7 xx7 xx
ULTRASOUND PHYSICS
•TEE and ICE: Higher frequency sound waves
generate high resolution images
•Waves do not travel far, but allows for
imaging of finer details
•TEE uses frequency of 7 MHz, ICE uses
5-10 MHz
•TTE: Lower frequency sound waves
generate lower resolution images
•Allows for deeper penetration of waves
through more tissue, adequate for most
situations
•TTE uses frequency of 3 MHz

8. 8 xx8 xx
TTE
TEE

9. 9 xx9 xx
•Assessment of LV function
•Most common reason an echo is ordered
•Most useful measurement is Ejection Fraction
•Difference in LV volume at end-systole and
end-diastole
•Normal range is 55%-65%
•Wall motion abnomalities (WMA) can be
described
•Hypokinesis- LV contraction is diminished
•Akinesis- no contraction
•Dyskinesis- uncoordinated contraction
http://www.youtube.com/watch?v=amCLvflTUCI
Normal LV function PLAX
http://www.youtube.com/watch?v=V0kepFF4AEs
Normal LV function APICAL4

10. 10 xx
Hozumi T et al. Heart 2003;89:1163-1168
©2003 by BMJ Publishing Group Ltd and British Cardiovascular Society
WMA

11. 11 xx11 xx
•Murmurs
•Abnormal heart sounds caused by
abnormal blood flow through the heart
•Valvular heart disease
•Increased flow across normal valve
•Shunts due to congenital or acquired
defects
•Tumors
http://www.medicanalife.com/watch_video.php?v=f88e591176322f2
Myxoma

12. 12 xx12 xx
•Aortic Valve Disease
•Aortic Stenosis
•Assess valve opening and mobility of
cusps
•Note presence of calcium or
thickening
•Measure velocity of blood flow across
valve
•Calculate valve area
•Aortic Regurgitation
•Assessed using Doppler
http://www.echojournal.org/video/16/Aortic-Valve
Normal AO valve
http://www.youtube.com/watch?v=MJoEyHxoi5Y
Aortic stenosis, 2D and 3D

13. 13 xx13 xx
CONTINUOUS WAVE DOPPLER

14. 14 xx14 xx
•Mitral Valve Disease
•Mitral Regurgitation
•Assess closure of valve leaflets
•Assess with Doppler
•Mitral Stenosis
•Caused by rheumatic heart disease
•Check for abnormal thickening and
opening of leaflets
http://www.youtube.com/watch?v=yN8z01DAgVY
Mitral valve PSAX
http://www.youtube.com/watch?v=amCLvflTUCI
Mitral valve PLAX

15. 15 xx15 xx
•Atrial Fibrillation
•Can be related to valvular disease, CAD,
diastolic dysfunction, or cardiomyopathy
•Echos can assess any underlying
problems and guide treatment
•Best to control rate before study
•Patients with major structural
abnormalities, significant LV systolic
dysfunction, or LA diameter >4.5 cm are
less likely to maintain SR after CV
http://www.youtube.com/watch?v=XgJoO_f7xZg
AF

16. 16 xx16 xx
•Stroke/TIA
•Up to 20% of CVA’s may be caused by
cardiac emboli
•TTE rarely shows a direct source of emboli
(such as thrombus, vegetations, or tumors)
•Shows abnormalities which predispose a
patient to embolization (such as MV
disease, PFO, or LV aneurysm)
•TEE is an effective screening tool to detect
LAA thrombus before CV of AF and AF
ablation procedures

17. 17 xx17 xx

18. 18 xx18 xx

19. 19 xx19 xx

20. 20 xx20 xx
•Infective Endocarditis
•Bacterial infection of heart valves
•Established bacteria is called a vegetation
•Damaged and abnormal valves are at higher
risk
•Acute (staph) versus subacute (strep)
•Symptoms: fever, murmur, emboli, stroke
•IV drug abuse can increase risk of bacterial
endocarditis
•Can also be used in setting of suspected
device system infection
http://www.youtube.com/watch?v=RN9jzqg2z98
Mitral Vegetation

21. 21 xx21 xx
•Assessment of Artificial Valves
•Can be used for tissue and mechanical
valves
•Check for regurgitation and leaking of
blood around valve annulus
•Check velocity of blood flow through the
valve

22. 22 xx22 xx
MISCELLANEOUS
•Assessment of ASD/VSD/PFO
•Pericarditis/Pericardial Effusion/Cardiac
Tampanade
http://www.youtube.com/watch?v=KoMBYodwXpY&feature=results_m
ain&playnext=1&list=PL7E09221BF7CC64C9
•Suspected Aortic Dissection
http://www.youtube.com/watch?v=p2WPALg2W7Q VSD
http://www.youtube.com/watch?v=nD8DrZCPFBI&feature=related
Dissection in ascending aorta

23. 23 xx23 xx
MISCELLANEOUS
•Visualization of interatrial septum for
transseptal procedures- ICE

24. 24 xx24 xx
SUMMARY
•Echocardiography is a valuable tool in the
diagnosis and
management of cardiac patients
•Consider the indication and chose
echocardiography method accordingly
•An echo study needs to be performed by
skilled technologists and physicians for
accurate results

25. 25 xx25 xx
VIDEOS
http://www.youtube.com/watch?v=B3un6pFV8So (normal echo)
http://www.youtube.com/watch?v=N61stug0oBM&feature=related
(AS, LVH, Rt side dilatation, PPM, MR, AI)
http://www.youtube.com/watch?v=mlsbfqZljSE&feature=related (LV
thrombus)
http://www.youtube.com/watch?v=izDZnG4T8bc (bubble study)
http://folk.ntnu.no/stoylen/strainrate/Ultrasound/ Ultrasound Review
ARTICLES
http://www.eplabdigest.com/article/4148 ICE Overview