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Echocardiography
Selwyn Wong
Middlemore Hospital
Echocardiography Basics
Ultrasound waves sent from chest wall
Echocardiography Basics
Two-dimensional imaging
Echocardiography Basics
Echocardiography Basics
Echocardiography Basics
Echocardiography Basics
One-dimensional imaging (M-mode)
Echocardiography Basics
One-dimensional imaging (M-mode)
Echocardiography Basics
Doppler - Spectral
Pulse Continuous
Normal
End-diastole
3.5-5.7cm
End-systole
2.1-4.0cm
Left ventricle - size
Normal
End-diastole
3.5-5.7cm
End-systole
2.1-4.0cm
Left ventricle - wall thickness
IVS and PW
0.6 -1.1cm
Left ventricle - systolic function
Fractional Shortening (FS)
FS = EDD-ESD / EDD
Left ventricle - systolic function
Fractional Shortening (FS)
FS = EDD-ESD / EDD
Left ventricle - systolic function
Left ventricle - systolic function
Diameter
Normal 2.0-4.0cm
Mild 4.0-5.0cm
Moderate 5.0-6.0cm
Severe >6.0cm
Left atrium - size
Area
Normal <20cm2
Mild 20-30cm2
Moderate 30-40cm2
Severe >40cm2
Left atrium - thrombus
Cardiac Valves
Morphology
Valve dysfunction
aetiology
quantification
consequences
serial evaluation
Valve regurgitation - quantification
Consequences
AR - LV Response
Chronic AR - decompensated LV
LVEF<55%, LVESD>55mm, LVESV 60ml/m2
Part One
A patient with aortic regurgitation has the following haemodynamic
measurements:
cardiac output (CO) 7.5 L/minute
heart rate (HR) 75/minute
left ventricular end-diastolic volume (LVEDV) 200 mL
left ventricular end-systolic volume (LVESV) 50 mL
The regurgitant fraction is defined as the ratio of the regurgitant volume
to the total volume flowing through the valve with each beat.
IVC size
Part One
The severity of pulmonary hypertension can be determined using
continuous wave Doppler measurements of the velocity of tricuspid
regurgitation. This method uses the Bernoulli equation which states that
P = 4v2 (where P = instantaneous pressure gradient and v =
velocity across the valve). There is tricuspid regurgitation with a peak
velocity of 4 metres/second and a mean velocity of 3.5 metres/second.
Assuming right atrial pressure is 5 mmHg, the best estimate of the peak
right ventricular systolic pressure ( 2 mmHg) is:
A. 50 mmHg.
B. 55 mmHg.
C. 60 mmHg.
D. 65 mmHg.
E. 70 mmHg.
Cardiac Tamponade
Cardiac Tamponade
Cardiac Tamponade
Part One
A 65-year-old woman presents with a one-week history of progressive
dyspnoea. On admission, there are signs of shock, a systolic murmur
and an elevated jugular venous pressure. The ECG shows sinus
tachycardia but no other abnormality. An antero-posterior chest X-ray
shows cardiomegaly. The serum troponin I level is 0.5 mg/L [<0.1]. A
computed tomography (CT) scan is shown below.
NYHA 3-4
EF < 35%
QRS duration > 120 msec
Echocardiography