Echocardiography in HEART DISEASE By Bolatov Aidos

WHY Echocardiography? Echocardiography remains the most commonly used and comprehensive cardiac imaging modality and is generally considered the first test of choice for assessing cardiac structure and function in most clinical situations. Quickly with minimal patient inconvenience or discomfort provides immediate clinically relevant information provides detailed data on cardiac structure, including the size and shape of cardiac chambers, as well as the morphology and function of cardiac valves noninvasive assessment of systolic and diastolic function and intracardiac hemodynamics

Echocardiography transthoracic echocardiography (TTE) transesophageal echocardiography (TEE)

PRINCIPLESOFULTRASOUND ANDINSTRUMENTATION

DOPPLERIMAGING In addition to generating images of cardiac structures, ultrasound can be used to interrogate the velocity of blood flow through the heart and to quantify movement of the cardiac chambers the frequency of any waveform emitted from a moving object will be perceived as higher than or lower than the actual frequency, depending on whether the object is moving toward or away from the observer

DOPPLERIMAGING

Color flow Doppler

Flow velocity profiles and spectral Doppler representations.

Standard adult transthoracic echocardiography imaging planes

TEE

MYOCARDIALINFARCTION Normal wall contractility (normokinesis) is seen as wall thickening caused by the contraction of individual myocardial fibers during systole. On echocardiography the radial distance between the epicardial and endocardial borders normally increases by at least 20% during systole. Myocardial ischemia, Focal hypokinesis decreased systolic thickening occurs within seconds of the onset of myocardial ischemia, before chest pain and changes on the ECG

MechanicalComplicationsafterMyocardialInfarction infarction and consequent rupture of a papillary muscle Mitral regurgitation (MR) discrete areas of echo dropout with interventricular flow coursing through, as demonstrated by color Doppler Ventricular Septal Defect Pseudoaneurysm (PsA) of the basal inferior wall. Hemopericardium caused by free wall rupture Pseudoaneurysm

VALVULAR HEART DISEASE: Mitral Valve the left atrium via the mitral annulus and to the left ventricle through the mitral chordae and papillary muscles

Mitral Stenosis In patients with rheumatic mitral stenosis develop: The commissural fusion chordal thickening and fusion leaflet thickening calcification

Mitral Regurgitation type I leaflet motion is normal and the most common abnormalities are leaflet perforation, alteration in coaptation because of bulky vegetation, or annular dilation secondary to chronic atrial fibrillation type II at least one leaflet overrides the most superior plane of the annulus, that is, mitral prolapse or flail on the basis of either intrinsic valvular abnormality or rupture of either the chordae or papillary muscles type III A leaflet motion is restricted during both systole and diastole, most commonly because of rheumatic disease type III B motion is limited in systole because of pathologic tethering on the basis of LV systolic dysfunction and remodeling, so- called functional MR