Echocardiograp

hy
Examination
Rudy A.Taruli MD
Husada Hospital
Jakarta
2005

History

A mode Echo
M mode Echo
B mode Echo ( 2D )
Doppler Echo ( PW & CW, PRF )
Contrast Echo
Color Doppler Echo ( CFI )
Tissue Doppler
Harmonic Imaging
Digital Echo, 3 D / 4 D Echo

Transducer
Interrogation
Transthoracic Echo (TTE)
Transesophageal Echo (TEE)
Intraoperative Echo
Intracardiac Echo
Epicardiac Echo
Intravascular Echo (IVUS)

Using B mode, M mode,

Color doppler & Doppler
We can evaluate :
ANATOMY, FUNCTION &
HEMODYNAMIC
Contrast echo still useful (perfusion)
Stress echo (myocardial viability)

How to Perform
Echo
examination

Three components
1.
2.
3.

Operator
Instrument
Patient

Operator :
1.

Cognitive skill ( knowledge of physical

principle, normal/pathologic cardiac
anatomy, cardiac auscultation, ECG, fluid
dynamic and normal blood flow etc)

2. Technical skill ( operation of USG

equipment and all controls, position
of transducer, perform complete
standard examination quantitative
analysis etc )

Training requirement :
a. Level I : 3
b. Level II : 3
c. Level III : 6

months, 150 exam.

months, 150 exam.
months, 450 exam.

Instrument :
Should equipped with the basic
requirement of M-mode, 2D sector
scanning, Doppler, color flow imaging
Frequency of at least 2,0 2,5 Mhz
(adult), 3,0 5,0 Mhz (pediatric),
harmonic imaging
Controlled gray scale, gain, depth of
field (zoom), filter, color flow gain
and filter

Patient :
Gives full information, patients
position,
Hemodynamic status, ECG, limiting
factors (obese, emphysematous

Important !
Spatial Orientation & Hand eye
coordination

How to perform ?

Instrument preparation ( + ID)

Informed patient
Left lateral decubitus
2 D Echo + Color Flow mapping (overview)
M Mode (Aorta-LA, MV, LV cavity,
calculation, PV)
Still frame (systolic-diastolic), PSLAX &
PSSAX
Doppler Echo (MV / LV inflow, AV / LVOT,
TV,PV)

 Semiquantitative,

quantitative
measurements (Regurgitation,
Stenosis, intracardiac
pressures, cardiac output,
Qp/Qs)
Good image, good printer
Reports

B-mode (2 D Echo)

M mode
Echo

Adult normal values

Aortic root
: 20 37 mm
Ao cusp separation : 15 26 mm
Left atrial
: 19 40 mm
LV end diast
: 37 56 mm
LV end syst
: 20 38 mm
IVS (diast)
:
6 11 mm
PW (diast)
:
6 - 11 mm
Fract shortening
: 28 41 %
Eject Fr. (EF)
: 50 74 %

LVH

LVH

HCM

Thrombus

Ball thrombus

EbsteinAnomaly

Doppler Echo
Mode : pulse wave, continuous
wave
Application : for valvular heart
disease, congenital heart disease,
quantitation of volume flow,
assessment of ventricular
performance

Color Flow
Imaging
For valvular congenital
heart disease,
hemodynamic assessment

AR

Car.bulb

TEE

TEE, Cor.Art

Contrast Echo

Tissue Doppler

REFERENCES
1.Feigenbaum, H. : Echocardiography, Lea & Febiger, Philadelphia, 4th
Ed, 1986
2. Oh JK, Seward JB, Tajik JA : The Echo Mannual, Lippincott Williams &
Wilkins, Philadelphia, 2nd Ed, 1999
3. Kisslo J, Adams D, Mark DB : Basic Doppler Echocardiography,
Clinics
in Diagnostic Ultrasound vol. 17, Churchill Livingstone, NY 1986
4. Kerut EK, Mcllwain EF, Plotnick GD : Handbook of Echo Doppler Interpretation, Futura Publishing Co Inc. Armonk NY, 1996
5. Harry JM : Cardiac Doppler Hemodynamic Workbook, Iowa Heart
Institute, 1997
6. Weidenbach M. et al : Computer based Training in Two Dimensional
Echocardiography using an Echocardiography Simulator, J Am Soc
Echocardiogr, 2005, 4, 362 366
7. Omoto R. : Color Atlas of Real Time Two Dimensional Doppler Echo
cardography, Shindan To Chiryo Co Ltd. Tokyo, 2nd Ed, 1987
8. Nanda, NC : Textbook + Atlas of Color Doppler Echocardiography,