Download Introduction to Cardiac Ultrasound

Intro to Bedside Ultrasound
Cardiac Ultrasound
TEACHERS
 University of California-Irvine School of Medicine
 Nathan Molina
 Trevor Plescia
 Jack Silva
[email protected]
[email protected]
[email protected]
Aorta
Pulmonary trunk
Left ventricle
Pericardium Right ventricle
The 4 Views of Cardiac Ultrasound
PARASTERNAL LONG
PARASTERNAL SHORT
APICAL 4-CHAMBER
SUBXIPHOID (SUBCOSTAL)
Parasternal Short
Parasternal Long
Apical 4-Chamber
Right
Subxiphoid
CARDIAC ULTRASOUND TRANSDUCERS
Phased Array (P21)
Convex (C60)
• The best transducer for viewing the heart is the
phased array P21
• The convex C60 can also be used
PARASTERNAL LONG
-
-
Start with the probe just to the left of the sternum
(parasternal), in the 2 nd intercostal space
The indicator should be pointed to the patient’s left hip
This will give a view of the heart along its long axis
What is the arrow pointing to?
Left Ventricle
What is the arrow pointing to?
Right Ventricle
What is the arrow pointing to?
Interventricular
septum
What is the arrow pointing to?
Pericardium
What is the arrow pointing to?
Aortic Outflow Tract
What is the arrow pointing to?
Mitral Valve
Left Atrium
17
Mitral Valve
(Anterior Leaflet)
Mitral Valve
(Anterior Leaflet)
LEFT VENTRICULAR FUNCTION
- In parasternal long axis,
observe movement of mitral
valve
- Anterior leaflet should slap
interventricular septum
- Observe left ventricular
contraction during systole
- Deficiencies indicate poor
left ventricular function
- Avoid fluid overload
HYPERTROPHIC
CARDIOMYOPATHY
- Normal septum thickness:
0.8 – 1.2 cm
- >1.2 cm – HCM
- Each tick mark = 1 cm
- Useful for estimation
- Use calipers to make exact
measurement
ATHLETE’S HEART VS HCM
Athlete’s Heart
(Benign Enlargement)
HCM
Septum Thickness
<15 mm
>15 mm
Symmetry
Yes (for septum and LV
wall)
No (septum much
thicker)
Deconditioning
Reduction within 3
months
None
PARASTERNAL SHORT
-
Start in the parasternal long axis (indicator pointed to
patient ’s left hip)
-
Then rotate the probe 90° clockwise so that the
indicator is pointed to the patient’s right hip
PARASTERNAL SHORT
-
Once positioned, use the fanning technique to view
different structures:
Initially you will see the mitral valve, which
resembles a “fish mouth”
Fan inferiorly to see the papillary muscles and the
apex
-
-
-
You may also see the chordae tendineae
Fan superiorly, to see the aortic valve, which
resembles the “Mercedes-Benz” logo
Mitral Valve: “Fish Mouth”
Fan inferiorly to see papillary muscles
Fan superiorly to see the aortic valve
Aortic Valve: “Mercedes-Benz”
QUESTION
From the parasternal short view, how
would you manipulate the transducer
to visualize the aortic valve?
Fan superiorly
APICAL 4-CHAMBER
-
-
Start with the transducer over the patient’s Point of Maximal Impulse or PMI (4 th or 5 th intercostal space,
midclavicular or anterior axillary)
Point the indicator to the patient’s right
APICAL 4-CHAMBER
-
Fan the probe superiorly toward the base of the
heart
Assess the size of the ventricles. The right ventricle
should be approximately 2/3 the size of the left
ventricle.
The apical 4-chamber view can be hard to find on
patients in a supine position
-
-
Try the left lateral decubitus position, as it brings the
heart closer to the thoracic cage
APICAL 4-CHAMBER
Tricuspid
valve
RV
RA
LV
LA
Mitral
valve
SUBXIPHOID
-
Indicator pointed to patient’s right
SUBXIPHOID VIEW
The subxiphoid view is useful clinically for:
•
Diagnosing pericardial effusion
•
The pericardium is a high attenuating structure, and
will appear hyperechoic. Fluid will be hypoechoic.
•
Diagnosing cardiac arrest
•
FAST scan
SUBXIPHOID TRICK
 Start at liver edge and
follow subcostal margin
until heart is seen
 Aim beam at chin
Subxiphoid
Tricuspid
Valve
RV
Pericardium
LV
RA
LA
Mitral Valve
PERICARDIAL EFFUSION
-
Fluid in the pericardial sac
Increased intrapericardial pressure can disrupt
cardiac rhythm and efficiency
Cardiac tamponade
SUMMARY
 Cardiac ultrasound utilizes 4 different views:
 1) Parasternal long
 2) Parasternal short
 3) Apical 4-chamber
 4) Subxiphoid
 The indicator is pointed to the patient ’s right in all views except for parasternal long, where it is pointed to the
patient ’s left hip
SUMMARY
 Structures visible in each view
 Parasternal long: interventricular septum, left ventricle,
mitral valve, aortic valve, aortic outflow tract, and right
ventricle
 In a normal heart, the mitral valve’s anterior leaflet will
make contact with the interventricular septum
 Parasternal short: aortic valve, mitral valve, and papillary
muscles
 Apical 4-chamber: all 4 chambers of the heart
 Subxiphoid is good for assessing pericardial effusion
REFERENCES
 Atlas of Anatomy, Second Edition, By Gilroy,
MacPherson, Ross, Schuenke, Schulte, Schumacher.
Thieme Medical Publishers, 2012.
 Select images from the UCISOM Ultrasound in
Education Department