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0PowerPoint Echocardiography
0PowerPoint Echocardiography
RV
• Conus arteriosus - RVOT
• 3 papillary muscles
LV
• 2 papillary muscles (usually)
Echocardiography
Equipment
• Transducer - microconvex or cardiac
(sector scanner)
– small footprint
– Fan-shaped beam or sector
• Higher frequency for small animals
• Lower 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
• CINe loop is helpful (3-7 sec)
Echocardiography
Preparation
• Thin coated animals – alcohol, part the
hairs, gel
• Thick coated – shave the window – at the
sternum, just behind the right elbow
• Sedation only if needed
– Acepromazine – 0.025 mg/lb (max 1 mg)
– Buprenex – 0.01-0.02 mg/kg
• Or butorphanol 0.1 mg/lb
– Mix together and give IV (handout)
– Trazadone (cat study) – lower BP
Echocardiography
Indications • Cyanosis
• Murmur, CHF • Effusions – pleural,
• Gallop Rhythm pericardial, abdominal
• Arrhythmia • Cardiomegaly
– Tachycardia • Pulmonary edema
– Bradycardia • Heartworm Disease
– Pulse deficits
• Thoracic Mass
• Muffled heart or lung
• Splenic Mass
Sounds
• Thromboembolism
• Syncope
Echocardiography
Equipment
Abbreviations – Structures
• P – pericardium
• RV – right ventricle
• IVS – intraventricular septum
• LV – left ventricle
• PPM – posterior papillary muscle
• APM – anterior papillary muscle*
1. Short Axis – Left Ventricle
dog
Abbreviations – Structures –
• P – pericardium
• RV – right ventricle
• IVS – intraventricular septum
• LV – left ventricle
• PPM – posterior papillary muscle
• APM – anterior papillary muscle
1. Short Axis – Left Ventricle
cat
Abbreviations – Structures –
• P – pericardium
• RV – right ventricle
• IVS – intraventricular septum
• LV – left ventricle
• PPM – posterior papillary muscle
• APM – anterior papillary muscle
1. Short Axis – Left Ventricle
1. Short Axis – Left Ventricle
Normal/Abnormal Features
Assess volume status
• normal – round with adequate fill in diastole
• Volume contracted – oval or small round, walls
look artifactually thickened & contraction intense
Check for pericardial effusion
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 preload and afterload can affect FS, as
well as myocardial function
1. Short Axis – Left Ventricle
Measurements - Calculated
• FS – fractional shortening
• AKA shortening fraction (SF)
– >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 LVPW
measurement
1. Short Axis – Left Ventricle
Measurements - Tips
• Don’t include PM in the LVPW 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
– Measure at top of PM as they transition to chordae
1. Short Axis – Left Ventricle
Measurements - Tips
• Measure 3-5 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 papillary muscles
No measurements here
2. Short Axis – Apex
Structures
• Pericardium
• May or may not see RV
• LV apical lumen – no papillary muscles
No measurements here
3. Short Axis – Chordae Tendinae
large dog
Structures
• Pericardium
• RV
• LV
• CH - Chordae Tendinae (posterior & anterior)
No measurements here
3. Short Axis – Chordae Tendinae
small dog
Structures
• Pericardium
• RV
• LV
• CH - Chordae Tendinae (posterior & anterior)
No measurements here
3. Short Axis – Chordae Tendinae
Structures -
• Pericardium
• RV
• LV
• CH - Chordae Tendinae (posterior & anterior)
No measurements here
3. Short Axis – Chordae Tendinae
cat
Structures -
• Pericardium
• RV
• LV
• CH - Chordae Tendinae (posterior & anterior)
No measurements here
4. Short Axis – Mitral Valve
Large Dog
Small Dog
Need to zoom in
Measurement
• EPSS – E-Point to Septal Separation
– If increased above normal, can denote
enlarged LV, volume overload and often
poor systolic function
– Less than 6 mm in large dogs
– Less than 3-5 mm in small dogs and cats
4. Short Axis – Mitral Valve
Measurement
• EPSS – E-Point to Septal Separation
– If increased above normal, can denote
enlarged LV, volume overload and often
poor systolic function
– Less than 6 mm in large dogs
– Less than 3-5 mm in small dogs and cats
4. Short Axis – Mitral Valve
Measurement
• EPSS – E-Point to Septal Separation
– If increased above normal, can denote
enlarged LV, volume overload and often
poor systolic function
– Less than 6 mm in large dogs
– Less than 3-5 mm in small dogs and cats
4. Short Axis – Mitral Valve
Normal
MVD
RV
LV AMV
PMV
5. Short Axis – Aortic Valve
Normal Dog
Ao
Structures – “Mercedes Sign” View
LA
• RVOT – Right Ventricular Outflow Tract
• TV – Tricuspid Valve
• PV – Pulmonic Valve
• Ao – Aortic Valve
• LA – Left Atrium
5. Short Axis – Aortic Valve
Dog LA
Enlargement
Ao
Cat
obliqued
•
5. Short Axis – Aortic Valve
•
5. Short Axis – Aortic Valve
Measurements
• Aos – at largest dimension (systole)
• LAd – at largest dimension (diastole)
• LA:Ao –
– 0.8 to 1.3 in dogs
– 0.8 to 1.4 in cats
5. Short Axis – Aortic Valve
Normal
Enlarged LA
Ao
LA
5. Short Axis – Aortic Valve
Normal
Enlarged LA
Ao
LA
6. Short Axis – Pulmonary Artery
Structures
• RA – Right Atrium
• Ao – Aorta (ascending)
• MPA – Main Pulmonary Artery
– LPA – left pulmonary artery
– RPA – right pulmonary artery
• CaVC – Caudal Vena Cava*
6. Short Axis – Pulmonary Artery
PDA
PDA
Cat
PDA
•
5. Short Axis – Pulmonary Artery
•
7. Long Axis – 4 Chamber
Technique
• Get short axis “mushroom” view
• Rotate 90 degrees counterclockwise
• “Thumb to the Bum”
• Pick up the cord and point the beam to
the TL junction of the spine
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*
7. Long Axis – 4 Chamber
RV
LV
Structures
• RV – Right Ventricle
• RA – Right Atrium – difficult to view completely
• TV – Tricuspid Valve
• LV –Normal LV:RV > 3:1
Left Ventricle
• LA – Left Atrium
• MV – Mitral Valve, PM – papillary muscle
7. Long Axis – 4 Chamber
RV
LV
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
7. Long Axis – 4 Chamber
RA
Structures LA
• RV – Right Ventricle
• RA –Normal
Right LA:RA
Atrium – difficult to view completely
= 1:1
• TV – Tricuspid Valve
• LV – Left Ventricle
• LA – Left Atrium
• MV – Mitral Valve, PM – papillary muscle
7. Long Axis – 4 Chamber
IVS
1
LV
2
3
4
Structures 5
• RV – Right Ventricle
• RA – Right Atrium – difficult to view completely
• TV – Tricuspid Valve
• LV –
Normal Left =Ventricle
LV:IVS 4-6:1
• LA – Left Atrium
• MV – Mitral Valve, PM – papillary muscle
7. Long Axis – 4 Chamber
7. Long Axis – 4 Chamber
Normal Features
• LVID:RVID > 2-3:1
• RVFW < LVFW 1:2-3
• RA:LA = approximately 1:1
• LVID:IVS = 4-6:1
• FS >30% in the dog, >40% in the cat
7. Long Axis – 4 Chamber
Structures
• RV, TV, RA
• LV, PM, MV
• Very edge of the LA
• LVOT – AoV (LC, SC), ascending Ao
• RPA – Right Pulmonary Artery
8. Long Axis – LVOT
Structures
• RV, TV, RA
• LV, PM, MV
• Very edge of the LA
• LVOT – AoV (LC, SC), ascending Ao
• RPA – Right Pulmonary Artery
7. Long Axis – LVOT
8. Long Axis – LVOT
• LVIDD – 11.0 mm
• LVIDS - 6.4 mm
• LVPW - 3.3 mm
• FS - 42%
• EPSS - 0
Cat Echoes for Dummies
Summary
Vet Handouts
• Chart – cardiac safe sedation and normal echo values for
dogs (1-120 pounds)
• Oncura Echocardiography Manual
Hidden Slides
• Anatomy of the heart valves
• Indications for Echocardiogram
• Emergency Cardiac US Exams – TFAST® & VetBLUE®
Acknowledgements