{"id":63144,"date":"2024-04-04T16:41:57","date_gmt":"2024-04-04T11:11:57","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=63144"},"modified":"2024-04-04T19:24:58","modified_gmt":"2024-04-04T13:54:58","slug":"basics-of-echocardiography","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/basics-of-echocardiography\/","title":{"rendered":"Basics of Echocardiography"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/qNOw4C3fKdA?si=ZYVITNxF95LlJX--\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><br \/>\n<strong>Transcript of the video:<\/strong> Echocardiography is now not restricted to the echocardiographic laboratory.\u00a0It is used in the emergency department, at bedside, in the intensive care unit as well\u00a0as in the operating room.\u00a0Hence a basic knowledge is needed for all physicians and paramedics.\u00a0During echocardiography, a transducer transmits the ultrasound beam towards the heart.\u00a0Echoes received by the transducer from various structures of the heart are analysed by the\u00a0echocardiograph and a graphical representation<br \/>\ndisplayed on the monitor.<\/p>\n<p>Location of the transducer is at the top of the image sector.\u00a0Structures nearer to the transducer are shown at the top of the image and those away from the transducer at the bottom of the image.\u00a0<span style=\"font-size: revert; color: initial;\">The image shown here is an animated 2 dimensional <\/span><span style=\"font-size: revert; color: initial;\">echocardiogram.<\/span><\/p>\n<p>This one is an older mode known as time-motion mode or M-Mode echocardiogram.\u00a0Unlike the previous 2 dimensional imaging, this is a single dimensional imaging.\u00a0Movement of the structures along a single<br \/>\nscan line are depicted as a horizontal graph.\u00a0Though it is the oldest mode of echocardiography,<br \/>\nit is still being used for taking measurements\u00a0of the left ventricle.<\/p>\n<p>Doppler echocardiography uses the Doppler principle and targets the moving red blood\u00a0cells.\u00a0The velocity at each point is depicted as a spectral tracing.\u00a0In Pulsed Doppler, intermittent pulses are sent, and echoes received.\u00a0In Continuous wave Doppler, the signals are sent and received continuously.<\/p>\n<p>Flow away from the transducer is depicted below the baseline and those towards the transducer\u00a0are depicted above the baseline.\u00a0When the velocity is beyond the limit of the Doppler mode used, the upper part is cut off\u00a0as can be seen above the baseline in this case.<\/p>\n<p>The remaining part is shown below the baseline.\u00a0This is known as aliasing and wrap around.\u00a0The direction of flow is difficult to interpret then.\u00a0In such situations, continuous wave Doppler<br \/>\nwith higher velocity range is used.<\/p>\n<p>An intermediate option is HPRF or high pulse repetition Doppler.\u00a0Disadvantage of continuous wave is that it cannot pinpoint the exact location of the\u00a0high velocity signal as it is continuously transmitting and receiving echo signal.\u00a0Displaying Doppler flow information on a two dimensional image is known as colour flow\u00a0mapping or color Doppler imaging.<\/p>\n<p>Here one image is two dimensional another has colour flow information in a sector.\u00a0Blue colour represents flow away from the transducer and red colour flow towards the\u00a0transducer.\u00a0It has nothing to do with the colour of the blood like oxygenated or deoxygenated.<\/p>\n<p>While conventional Doppler images the velocity of blood, same principle applied to the myocardium\u00a0is known as tissue Doppler imaging.\u00a0Tissue Doppler information overlayed on two dimensional image is known as colour kinesis,\u00a0which can be seen in the inset at the top of this image.<\/p>\n<p>Tracing in the lower part is tissue Doppler imaging from the medial mitral annulus.\u00a0The images shown so far were from transthoracic echocardiography.<\/p>\n<p>Another mode is transesophageal echocardiography in which the echo probe at the tip of an endoscope like device is introduced into the esophagus.\u00a0As the esophagus is just posterior to the heart, image quality is excellent.\u00a0Shorter distance permits the use of higher frequency transducers which give better image\u00a0resolution.\u00a0Higher frequency transducers have only low depth penetration and are not suitable for\u00a0transthoracic echocardiography.<\/p>\n<p>The four common locations at which the echocardiographic transducer is placed for imaging are the parasternal,\u00a0apical, subcostal, and suprasternal.\u00a0Parasternal views are often obtained first, followed by apical, subcostal, and suprasternal.\u00a0A good knowledge of the anatomy of the heart is needed for interpretation of images from\u00a0each view.<\/p>\n<p>This becomes more difficult in complex congenital heart diseases where the cardiac chamber positions\u00a0and size may vary.\u00a0First view to be obtained is often the parasternal long axis view.\u00a0This view images the heart from the base to apex long axis view.<\/p>\n<p>Transducer is placed in the left parasternal region and fine adjustments in angulation\u00a0are made till a view similar to that in the left panel is obtained.\u00a0Exact position and angulation will vary between individuals.<\/p>\n<p>Usual structures imaged in this view are the right ventricular free wall and outflow region,\u00a0interventricular septum, aorta, and aortic valve, left ventricular outflow tract, anterior\u00a0and posterior mitral leaflets, left ventricular cavity, posterior wall of left ventricle and\u00a0left atrium.<\/p>\n<p>Colour Doppler imaging is used to image the flow directions and abnormal flows if any.\u00a0Here is an animated view from the parasternal long axis.<\/p>\n<p>Opening and closing movements of the aortic and mitral valves are visible.\u00a0Contraction of each region of the left ventricle is also inspected closely for any abnormalities\u00a0of regional wall motion.<\/p>\n<p>Parasternal short axis view is obtained by rotating the transducer almost at right angle\u00a0in the same location so that the echo beam is perpendicular to the base apex axis of\u00a0the heart.<\/p>\n<p>Three cuts are usually obtained in this view.\u00a0The aorta, right ventricular outflow tract and pulmonary artery up to its bifurcation\u00a0is imaged in the upward angulation shown in the left panel.\u00a0Colour flow shows the flow in pulmonary artery.\u00a0Slight downward angulation of the transducer from this view gives the left ventricular\u00a0cross section with mitral valve cross section within.\u00a0Right ventricular cavity is elliptical in<br \/>\nthis view and left ventricular cavity is circular.\u00a0Wall motion of the left ventricle can be assessed in this view also.\u00a0Planimetry of mitral valve area can be obtained in parasternal short axis view in case of\u00a0mitral stenosis.<\/p>\n<p>Apical views are obtained by keeping the transducer directly over the apex beat.\u00a0Apical four chamber, two chamber and three chamber views can be obtained by rotating\u00a0the transducer.\u00a0Apical four chamber view is illustrated here.\u00a0Apical four chamber view shows all four cardiac chambers, mitral and tricuspid valves, and\u00a0the septa.\u00a0But as the echo beam is parallel to the interatrial septum, false echo drop outs can occur in\u00a0the interatrial septum.<\/p>\n<p>Apical five chamber view including the proximal aorta can be obtained by slight tilting of\u00a0the transducer from this view.\u00a0Subcostal view is obtained from below the xiphisternum in the epigastrium.\u00a0Transducer rotation is needed to get subcostal four chamber and short axis views.\u00a0Interatrial septum is best imaged in this view.<\/p>\n<p>Assessment of the inferior vena cava for checking the hydration status is also feasible from\u00a0this view.\u00a0Subcostal view is a favourite view of pediatric echocardiographers.<\/p>\n<p>Suprasternal view is useful in imaging arch of the aorta and nearby regions of ascending\u00a0and descending aorta.\u00a0Coarctation of aorta and patent ductus arteriosus can be imaged in this view.\u00a0The image shows the blue coloured descending aortic flow on colour Doppler.\u00a0Gradient of coarctation can be assessed in<br \/>\nthis view.<\/p>\n<p>Apart from these standard views, other modified views may also be used in certain circumstances.\u00a0A right parasternal view may be used when the heart is enlarged, to assess the tricuspid\u00a0regurgitation jet.\u00a0Dilated ascending aorta will also be visible in a right parasternal view.<\/p>\n<p>An annotated video of normal colour Doppler echocardiogram illustrating various views\u00a0and an M-Mode tracing is shown here.<\/p>\n<p>[Initially there is two dimensional view from parasternal long axis view followed by colour\u00a0Doppler and M-Mode.\u00a0Parasternal short axis view, apical four chamber view and suprasternal view follows.]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Transcript of the video: Echocardiography is now not restricted to the echocardiographic laboratory.\u00a0It is used in the emergency department, at bedside, in the intensive care unit as well\u00a0as in the operating room.\u00a0Hence a basic knowledge is needed for all physicians and paramedics.\u00a0During echocardiography, a transducer transmits the ultrasound beam towards the heart.\u00a0Echoes received by the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":63145,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[9],"tags":[],"class_list":["post-63144","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Basics of Echocardiography - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/basics-of-echocardiography\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Basics of Echocardiography - All About 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