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Cardiac anatomy
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Echocardiography-why do we need it?
Overview
• 90% of echo requests are for LV function assessment– Qualitative and quantitative
• Remainder for valvular and structural problems
Function• The Heart is a PUMP & forms part of the
Cardiovascular system
•Right and left side of the heart•Work in synchrony
Basic Anatomy of the Heart
Chambers
• Right Atrium (RA)
• Right Ventricle (RV)– Filling Chambers
• Left Atrium (LA)
• Left Ventricle (LV)– Pumping chambers
Vessels
• Vessels:– Aorta (Ao)– Pulmonary artery– Inferior & Superior
Vena Cava (IVC & SVC)
– Pulmonary Veins (PV)
Valves
• Atrioventrucular
• Semilunar
Valves
• The function of the cardiac valves is to prevent retrograde flow of blood through the heart
Septum
• Interventricular septum (IVS)
• Interatrial septum (IAS)
Left Ventricular Walls
Coronary Arteries
Left Anterior Descending ArteryCircumflex ArteryRight Circumflex Artery
The Cardiac Cycle
• Ventricular filling – DIASTOLE
– AV valves are opened
– SV are closed
•
• Ventricular emptying– SYSTOLE
– AV valves are closed
– SV are opened
The Heart in DIASTOLE
The Heart in SYSTOLE
Two-Dimensional Echocardiography (2D)
• Access to the heart can be very difficult
• Windows available:– Parasternal– Apical– Subcostal– Suprasternal– Transoesophageal
Parasternal Long Axis
• Right Ventricular Wall
• Right Ventricle
• Interventricular Septum
• Left Ventricle
• Posterior Wall
• Mitral Valve
• Papillary Muscles
• Chordae Tendinae
• Left Atrium
• Aortic Valve
• Ascending Aorta
Parasternal Short Axis (Aortic Valve Level)
• Right Ventricle
• Left Atrium
• Tricuspid Valve
• Pulmonic Valve
• Pulmonary Artery
• Aortic Valve
• Right Atrium
Parasternal Short Axis (Mitral Valve Level)
• Right Ventricular Wall
• Right Ventricle
• Interventricular Septum
• Left Ventricle
• Mitral Valve
• Posterior Wall
• Pericardium
Parasternal Short Axis (Papillary Level)
• Right Ventricular Wall
• Right Ventricle
• Interventricular Septum
• Left Ventricle
• Papillary Muscles
• Posterior Wall
Apical Four Chamber
• Left Ventricular Apex• Interventricular Septum• Right Ventricle• Interatrial Septum• Left Ventricle• Lateral Wall• Mitral Valve• Tricuspid Valve• Papillary Muscles• Chordae Tendinae• Left Atrium• Right Atrium • Pulmonary Veins
Apical Five Chamber
• Left Ventricular Apex• Interventricular Septum• Right Ventricle• Interatrial Septum• Left Ventricle• Lateral Wall• Mitral Valve• Tricuspid Valve• Aortic Valve• LV Outflow Tract• Left Atrium• Right Atrium • Pulmonary Veins
Apical Two Chamber
• Left Ventricular Apex
• Left Ventricle• Inferior Wall• Anterior Wall• Mitral Valve• Left Atrium • Pulmonary Veins
Apical Long Axis
• Left Ventricular Apex
• Left Ventricle• Inferior Wall• Anterior Wall• Mitral Valve• Left Atrium • AO
SUBCOSTAL
SUPRASTERNAL
Hands on!!!!!
• M-Mode is obtained by placing a cursor through structures of interest in the Heart
• Only structures transected by this line are imaged and they are plotted against time to form a tracing
M-Mode echocardiography
• A graph against time of the position of the reflecting structures of the heart relative to the marker is produced
• The M-Mode, or Time Motion, makes accurate measurements of dimensions and velocity of motion
M-Mode echocardiography
• PLAX or PSAX
M-Mode AO/LA
• PLAX or PSAX
M-Mode MITRAL VALVE
• PLAX or PSAX
M-Mode LEFT VENTRICLE
Hands on!!!!!
• To assess blood flow VELOCITY and DIRECTION• PWD is used when the exact location of the blood
flow sampled needs to be known• CWD is used when we need to determine the peak
velocity of blood flow through a particular valve
DOPPLER
• Blood flow from the LA to the LV• Diastole• Displayed above the baseline
FLOW PATTERNSMITRAL VALVE FLOW
• Blood ejected from the LV into the Ao • Systole• Displayed below the baseline
FLOW PATTERNSAORTIC VALVE FLOW
• Blood flow from the RA to the RV• Diastole• Displayed above the baseline
FLOW PATTERNSTRICUSPID VALVE FLOW
• Blood ejected from the RV into the PA • Systole• Displayed below the baseline
FLOW PATTERNSPULMONARY VALVE FLOW
• To assign colors to flow direction and show the entire area of any flow, normal or abnormal, within the Heart
• Quick visual search of flow anomalies.• Standard practice is “BART”
COLOR FLOW DOPPLERin Echocardiography
AORTIC INSUFFICIENCY
MITRAL STENOSIS/INSUFFICIENCY
Hands on!!!!!
PATHOLOGIESPATHOLOGIES
Ultrasound in Cardiac Assessments
Ultrasound in Cardiac Assessments
• Valve Disease
• Cardiomyopathy
• Endocarditis
• Prosthetic Heart valve assessment
• Pericardial effusion
• Systemic Hypertension
• Pulmonary Hypetension
• Ischemic Heart Disease
• Septal Defects
• Tumours
Mitral ValveMitral Valve
• Disease of the Mitral Valve– Mitral Stenosis– Mitral Regurgitation– Mitral Valve Prolapse
Mitral StenosisMitral Stenosis
Mitral RegurgitationMitral Regurgitation
Aortic ValveAortic Valve
• Disease– Aortic Stenosis
– Aortic Regurgitation
– Bicuspid Valve
Aortic RegurgitationAortic Regurgitation
Tricuspid ValveTricuspid Valve
• Disease– Stenosis– Regurgitation
Tricuspid RegurgitationTricuspid Regurgitation
PulmonaryValvePulmonaryValve
• Disease– Stenosis– Regurgitation