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Basic Echocardiography
Wendy Blount, DVM
Nacogdoches TX
Echo Technique - Anatomy
Tricuspid valve
• Septal leaflet
• Parietal leaflet
Mitral valve
• Leaflets are less
distinct
Pulmonic Valve
• Right cusp
• Left cusp
• Intermediate cusp
Aortic Valve
• Right cusp
• Left cusp
• Septal cusp
Echo Technique - Anatomy
RV
• Conus arteriosus
• 3 papillary muscles
LV
• 2 papillary muscles
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
Heart Sounds
• HS1
– AV Valves close
– Beginning of systole
• HS2
– Semilunar valves close
– Beginning of diastole
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
Heart Sounds
Gallop Rhythms
– HS3?
– HS4?
– Can’t tell the difference if heart rate
is above 160-180
– Just call it a summation gallop
Echocardiography
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
Echocardiography
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
Echocardiography
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
Echocardiography
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 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 Ventricle
Abbreviations - Structures
• P – pericardium
• RV – right ventricle
• LV – left ventricle
• PPM – posterior papillary muscle
• APM – anterior papillary muscle
1. Short Axis – Left Ventricle
Measurements
• IVSTD - IntraVentricular Septum Diastole
• LVIDD - LV Inner Diameter Diastole
• LVPWD – LV Posterior Wall Diastole
• IVSTS - IntraVentricular Septum Systole
• LVIDS - LV Inner Diameter Systole
• LVPWS – LV Posterior Wall Systole
1. 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 Ventricle
Measurements - Calculated
• FS – fractional shortening
• >30% in the dog
• >40% in the cat
• >45% if MR is compensated
1. 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 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 – Apex
Structures
• Pericardium
• May or may not see RV
• LV apical lumen
No measurements here
3. Short Axis – Chordae Tendinae
Structures
• Pericardium
• RV
• LV
• CH - Chordae Tendinae (posterior & anterior)
No measurements here
4. Short Axis – Mitral Valve
Structures
• Pericardium
• RV
• RV Papillary Muscles
• LV
• MV - Mitral Valve (Posterior & Anterior)
4. 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 Valve
Structures
• RVOT – Right Ventricular Outflow Tract
• TV – Tricuspid Valve
• PV – Pulmonic Valve
• Ao – Aortic Valve
• LA – Left Atrium
5. 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 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)
•
•
•
•
•
LVIDD – 11.0 mm
LVIDS - 6.4 mm
LVPW - 3.3 mm
FS - 42%
EPSS - 0
7. Long Axis – 4 Chamber
Technique
• Get short axis LV-PM view
• Rotate 90 degrees counterclockwise
7. 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 Chamber
Video
8. Long Axis – LVOT
Technique
• Find 4 Chamber view
• Angle the “dot” toward the shoulders
• Elevate the cord end of the probe
8. 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 – LVOT
Video
Normal Dog Video