basic echocardiography wendy blount, dvm nacogdoches tx wendy blount, dvm nacogdoches tx

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Basic Echocardiography Wendy Blount, DVM Nacogdoches TX

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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

Echo Technique - Physiology

Echo Technique - Physiology

Ventricular filling - volume• 70% passive• 30% atrial contraction

Diastole – time period• First 1/3 - rapid passive filling from atria• Second 1/3 – filling slows (diastases)• Final 1/3 – atria contract

Echo Technique - Physiology

Echo Technique - Physiology

Heart Sounds• HS1

– AV Valves close– Beginning of systole

• HS2– Semilunar valves close– Beginning of diastole

Echo Technique - Physiology

Echo Technique - Physiology

Heart Sounds• HS3 – protodiastolic gallop

– Rapid ventricular filling– First 1/3 of diastole– stiff LV– large diastolic volume

• HS4– Atrial contraction– Last 1/3 of diastole– Stiff LV or 3rd degree heart block

Echo Technique - Physiology

Echo Technique - Physiology

Heart SoundsGallop Rhythms

– HS3?– HS4?– Can’t tell the difference if heart rate

is above 160-180– Just call it a summation gallop

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

EchocardiographyEchocardiography

Equipment• Double window with simultaneous

B and M modes• 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

EchocardiographyEchocardiography

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

EchocardiographyEchocardiography

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

– 3rd-6th ICS– Usually 4th-5th ICS– Feel the apical beat, and put your probe

there– Adjust one space forward or back as needed– Rarely move the probe head – just fan and

twist

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

• Feel the right apical beat• Point the probe marker cranially• Place the probe at the apical beat• Rotate and fan until papillary muscles

are seen, and the same in size• If you are getting a shadow, try one

intercostal space forward or back

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

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

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

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

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

Measurements - Calculated• FS – fractional shortening

(LVIDD – LVIDS)

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

well as myocardial function

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

Measurements - Calculated• FS – fractional shortening• >30% in the dog• >40% in the cat• >45% if MR is compensated

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

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

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

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

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

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

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

Technique• Get short axis LV-PM view• Rotate 90 degrees counterclockwise

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

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• PVe – Pulmonary Vein

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

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

8. Long Axis – LVOT8. Long Axis – LVOT

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

8. Long Axis – LVOT8. Long Axis – LVOT

Video

Normal Dog Video