Cardiology 101 > Echocardiogram > Flashcards

Echocardiogram Flashcards

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1
Q
A

Parasternal Long Axis view

(PLAX)

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2
Q
A

Parasternal Long Axis (PLAX) view

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3
Q

how to best get the parasternal long axis (PLAX) view?

A

lie patient on left side, stretch left arm behind head

cardiac probe notch towards right shoulder, at 4th intercostal space

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4
Q

what are you expected to visualise from a parasternal long axis view

A
  • RV outflow tract
  • Aortic valve -> aorta
  • Mitral valve
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5
Q

what are you expected to visualise from parasternal long axis view (actual echo image)

A
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6
Q

what to assess in the parasternal long axis view?

A
  1. aortic valve:
    - use colour doppler to assess for stenosis/ regurgitation
  2. mitral valve:
    - use colour doppler to assess for stenosis/ regurgitation
  3. LA/LV/Ascending aorta dimensions
  4. RV outflow tract
  5. Pericardial effusion
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7
Q
A

PLAX inflow view to visualise RV, RA, tricuspid valve

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8
Q

what view are you trying to obtain?

A

PLAX inflow view

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9
Q

probe position to obtain PLAX inflow view?

A

cardiac probe at 4th ICS, notch pointed towards right shoulder

tilted medially towards patient

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10
Q

what structures are you trying to visualise on PLAX inflow view?

A

helps evaluate tricuspid valve function (look for TR)

ideally won’t see LV at all

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11
Q
A

PLAX outflow view

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12
Q

how to obtain PLAX outflow view?

A

first obtain PLAX view

then tilt probe laterally, facing towards collarbone

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13
Q

what structures are you trying to visualise on the PLAX outflow view

A
  • mainly to assess pulmonary valve
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14
Q
A

PLAX outflow view
mainly to assess pulmonary valve

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15
Q
A

Parasternal short axis view

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16
Q

how to obtain parasternal short axis view?

A

from parasternal long axis view, rotate cardiac probe clockwise such that notch points towards patient’s left shoulder

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17
Q

what do you expect to see in the parasternal short axis (PSAX) view?

A
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18
Q

how many different views are there in the PSAX view?

A
  1. Aortic valve level
  2. Mitral valve level
  3. Papillary muscle level
  4. Apex level
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19
Q

How to get this PSAX aortic valve level?

A

notch towards left shoulder.

fan transducer medially

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20
Q

what to assess for at PSAX view aortic valve level

A
  • mainly to assess aortic valve appearance and function

aortic valve should be a circle in the middle of the image like a Mercedes Benz

  • can also assess for tricuspid regurgitation as TV on the left of the image, and pulmonary regurgitation on the right
  • can also check for PFO/ASD by checking for doppler flow across the intertribal septum
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21
Q
A

PSAX Aortic Valve level view

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22
Q

how to get PSAX mitral valve view from the PSAX aortic valve view?

A

angle transducer from medial towards the centre/lateral

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23
Q
A

PSAX mitral valve level

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24
Q

what can you assess for on PSAX mitral valve level

A

assess for RWMA in the LV walls

assess mitral valve appearance (thickening), and function (with colour doppler)

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25
how to assess for RWMA on the PSAX mitral valve level images?
26
PSAX papillary muscle level
27
how to get to PSAX papillary muscle level?
Parasternal short axis view: notch towards left shoulder. fan probe towards lateral aspect/feet
28
what to assess for in the PSAX papillary muscle level?
mainly RWMA
29
Blue colour territory?
LAD
30
yellow colour territory?
RCA
31
green colour territory?
LCx
32
Where to look for RWMA if LAD MI?
- PSAX view: anterior (top 1/3) - PLAX view: involving the inter ventricular septum - Apical 4 chamber view: Anterior
33
where to look for RWMA if RCA affected?
inferior segments
34
where to look for RWMA if Lcx affected?
lateral segments
35
What segments are affected when looking at RWMA at PSAX level?
North = Anterior South = Inferior East = Lateral West = Septal
36
name the 3 coronary cusps at the aortic valve
top: right coronary cusp right: left coronary cusp left: non coronary cusp
37
What view is this
Apical 4 chamber view
38
How to obtain apical four chamber view
Probe at the apex of the heart and pointed towards left shoulder
39
What are the main structures seen on apical four chamber?
40
What is the circular structure on the right?
Descending aorta
41
On apical 4 chamber view, what are the usual relative sizes of the Rv:LV
Rv usually 2/3 size of LV
42
What is the circular structure on the right?
Descending aorta
43
What pathology to assess for in apical 4 chamber view
- tricuspid/ mitral regurg with colour Doppler - ASD/VSD - can look for pericardial effusion
44
What view is this
Apical five chamber view
45
How to obtain apical five chamber view
From apical four chamber view, tilt probe slightly up to bring LVOT and aortic valve into view
46
What are you trying to look at in the apical five chamber view?
Mainly the aortic valve structure and function - use colour Doppler to assess for regurgitation
47
What view is this
Apical three chamber view Aka Apical long axis view (bc similar structures seen as PLAX)
48
What will you visualise on apical three chamber view ?
Essentially similar to PLAX, Can see mitral and aortic valve And can see RWMA on inferior septal and inferior lateral walls of the LV
49
How to get apical 3 chamber view
4 chamber view then rotate probe slowly anticlockwise With notch pointing towards right shoulder
50
What is this view
Apical 2 chamber view
51
How to obtain apical 2 chamber view
Start from apical four chamber view Rotate anticlockwise about 60 degrees Aiming to get LV LA and mitral valve
52
Benefits of apical two chamber view
- whole inferior wall from base to apex (good to look for RWMA) - nice view of mitral valve
53
what view is this?
subcostal
54
how to obtain subcostal view
- supine position - notch towards left shoulder - increase depth - usually better when pt takes breath in and holds/
55
what to assess for in subcostal view?
- look for pericardial effusion - look at interatrial and inter ventricular septum for PFO/VSD
56
how to get subcostal IVC view
subcostal view, rotate anti clockwise
57
How to obtain suprasternal view of the aorta
patient lying with neck hyperextended probe onto suprasternal notch with notch to left shoulder
58
suprasternal view of aorta
59
what are you able to visualise on the suprasternal view of the aorta
visualise aorta - can look for dissection - can look for patent ductus arteriosus
60
what is the circular structure in the middle?
right branch of the pulmonary artery
61
How to assess Left ventricular appearance on TTE
- looking at size and ventricular wall thickness - Simpson's biplane method to assess LV volume - PLAX to measure LV ventricular wall thickness (ie hypertrophy)
62
how to assess for LV function on TTE?
- EF (Can be measured, or eye balled)
63
how to measure stroke volume on TTE?
stroke volume (ml) = cross sectional area of LVOT (cm2) x stroke distance (cm) > measure using pulsed wave doppler of the LVOT
64
main view to look at RWMA in ED?
PSAX
65
What to be concerned about?
D shaped septum on PSAX Think about PE
66
what are some echo signs of acute PE?
- PSAX: D shaped septum - apical 4 chamber view: RV free wall hypokinetic - might see thrombus in pulmonary artery or in transit through right heart
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