Basic Echo

Part I: Steps of ECHO Exam

Prepared by Dr. Elsayed Farag, MD

Approach To Easy ECHO Exam

Patient.

Operator (? Analyzer).

Report.

Managing Doctor.

Echocardiographic examination protocol

Requirements:-

· Patient.

·Operator.

· Machine & Transducer.

Back ground Bases of exam.

Approach Sites.

Modes Used.

Sequences of Adult Doppler echo exam

Steps Sequences during Performing Doppler Echo    exam.

Report.

I. Approach Sites:

(A) Standard Approaches:

-   Parastenal: (Long axis, Short axis at different levels )

- Apical: (Ap 4ch, Ap 5ch, Ap 2ch)

-  Subcostal:

(B) Other Approaches (when needed)

-   Rt parasternal.

-   Suprasternal.                             

-   TEE.

II. Modes used for Examination:

-   2Ds

-  M-mode

-  Doppler (CFM, PW & CW,Tissue Dopp)

III.Sequences of Adult doppler echocardiographic examination

Assess Machine.

Assure Patient.

Hold & Manipulation Transducerand Perform whole Echo examination

Steps Sequences during Performing Doppler Echo exam.

Writing the report at end of examination

Assess Machine:

• Check (Date,keys, transducer).

• dentify patient name at beginning (picture & video recording).

Assure Patient:

• Clinical evaluation, (auscultation).  

• Special positioning.

Hold Transducer:

• Holeded with thump on mark. 

• Put on para-sternal  area .

Steps during Performing Echo exam.

Displayed views on screen

Begin with Long Axis View.

With transducer in the same site Rotate transducer & proceed to Short Axis View at different levels.

Then change the transducer position to the Apical Approach and obtain Apical Views.

Notification (or Remomerization) of obtained. morphology & dimensions during examination.

For each echo view use all accessible specific modes. (2Ds, M-mode, PWD, CWD & CFM)

For each specific mode (2Ds, M-mode, PWD, CWD & CFM) 5-8 cardiac cycle should be spent for to judge the anatomy; physiology and pathology (more cycle examination is needed in abnormal vague pathology).

(1) displayed views on screen

Put Transducer on para-sternal area & observe the displayed views on screen:

a)     Non displaying of any cardiac structure: 

     change to subcostal approach & check for:-

             - Dextrocardia.

             - Machine & transducer problem.

            - Patient problem (Emphysema).

b)Appearance of any cardiac structure
            modify the displayed view by transducer adjustment, gain sitting & proceed for completion of examination.

2) Begin Begin with Long Axis view and study
the displayed 2Ds, M-mode, PWD, CFM   of   all   the   structure.

(3) With transducer in same site proceed to short Axis at its different levels (GR.VS, MV, LV and   apex) and study the displayed 2Ds, M-mode, PWD, CWD, CFM of different structures.

(4) Then change the transducer position to the apical approachand study the apical 4ch, 5ch and 2ch views (displayed 2Ds, PWD, CWD & CFM).

(5) Notification (or Remomerization) of pathology and measurement during examination.

LONG AXIS VIEW

Pericardium (Anterior pericardium)			Upper 1/3 or 2/5
Rt. Ventricular Anterior Wall
Rt. Ventricular Cavity ® RV Out Flow
Intervintrecular septum ® Anterior A.R
Right1/4	Middle 1/4	Left 2/4	Lower 2/3 or 3/5
® LVOT	LVC	Lower 2/3 or 3/5
® AML	LVC ± Ch.
® MVO	LVC
® PML	LVC ± Ch
® base of PML	LVPW (± pm)
Pericardium (Posterior pericardium

 

SHORT AXIS VIEW

A- Short Axis Level of Great Vessels : (AV, PV, PA, )

Aortic valve (central).

RVOT (above).

PV & PA (right).

RA & TV (left).

LA (below).

IAS between LA & RA.

B- Short Axis at Level of MV

- Pericardium all around.

RV (wall & cavity).

Septum (basal septum).

LVcavity & wall with MV inside.

C- Short Axis at Level papillary Muscle.

 - pericardium all around.

 - RV (Wall & cavity) anteriorly and to LT.

 - LV Septum (mid septum).

 - LV cavity and wall with 2 papillary mus.            (projection) at level of 4 & 7 o’clock.

D- Short Axis at Level of Apex:

- Pericardium all around.

- LV apex (wall & cavity).

APICAL FOUR CHAMPER VIEW

Apical 4 chamber view

Structure from apex to base:

·Pericardium all around

·Apex at Top

·IVS ® central cardiac body ® IAS (Dividing the view into left 3/5 or 2/3 and Right 2/5 or 1/3).

·Left 3/5 or 2/3: LV(Lateral wall & cavity), MV(Leaflets & opening), ® LA(cavity & wall with openings of pulm. veins).

·Rt 2/5 or 1/3: RV(Lat wall & cavity), TV(Ant & Sept. leflets & opening) ® RA (cavity & wall).

APICAL FIVE CHAMPER VIEW

 

Apical 5 CH view

Part of Pericardium

Apical 2/3 - 3/5 :

(structure from apex to base and Lt. to Rt.)

·Apex at Top

·LV-post wall ® base of PML ® LA wall

·LVC ® MO & LVOT

·IVS (anterior septum)

·RVC

 

Apical 5 CH view (Continue)

Basal 1/3 - 2/5 :

(structure from apex to base and Lt. to Rt.)

·PML ® post. LA wall.

·MVO ® LA cavity.

·AML ® post AR.

·LVOT ® Aortic valve.

·IVS ® Ant. AR

 

 

 

SUBCOSTAL VIEW

Subcostal View

•     Sit-us (relation of IVC & AO to vertebrae).•     Connections (Atria with ventricles & ventricles with great arteries)

•   IAS.

•  IVS.

• Valves.

• Chambers.

• Pericardium.

 

 

SUPRA-STERNAL View

 

S  Suprasternal View

• Ascending Aorta.

• Aortic Arch.

•  Branches of Aortic Arch.

• Upper part of Descending Aorta.

• Pulmonary Artery and branches.

DiDiagnostic for:

•  PDA

• Ao.Co arctation.

• Ao. Aneurysm (& dissection).

• Others.