Echocardiographic examination

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TECHmED.sk

New examination
Left ventricle
LV diastolic function
Right ventricle
RV pressure
Kinetics and effusion
Atria and IVC
Aorta
AV
MV
TV
PV
Summary
Values
Views

Echocardiographic examination

TECHmED.sk

New
LV
LV diastole
RV
RV pressure
Kinetics
Atria
Aorta
AV
MV
TV
PV
Summary
Values
Views

Right ventricular pressure and overload

Vmax TR (Peak tricuspid regurgitation systolic jet velocity) CW doppler Apical 4 chamber (A4C). Tricuspid valve CW doppler

Vmax TR

Peak tricuspidal regurgitation velocity

RAP (Right atrial pressure), IVC, IVC sniff SC (subcostal view) long axis inferior vena cava IVC.

RAP

Right atrial pressure

Vmax TR (Peak tricuspid regurgitation systolic jet velocity) CW doppler RAP (Right atrial pressure), IVC, IVC sniff

RVSP(SPAP)

Right ventricular systolic pressure

PR earlyD Vmax PR (Pulmonary regurgitation at early diastole) PSAX (level great vessels) focus on PV, CW doppler

PRearlyD(Vmax PR)

Pulmonary regurgitation at early diastole

PR earlyD Vmax PR (Pulmonary regurgitation at early diastole) RAP (Right atrial pressure), IVC, IVC sniff

mPAP

Mean pulmonar arterial pressure

PR lateD (Pulmonary regurgitation et late diastole) PSAX (level great vessels) focus on PV, CW doppler

PRlateD

Pulmonary regurgitation et late diastole

PR lateD (Pulmonary regurgitation et late diastole) RAP (Right atrial pressure), IVC, IVC sniff

PADP

Pulmonary artery diastolic pressure

RVOT prox PLAX (Right ventricular outflow tract dimension at proximal Parasternal long axis (PLAX)

RVOTprox(PLAX)

Right ventricular outflow tract dimension at proximal (PLAX)

Basal right left ventricle ratio A4C (Apical 4 chamber) RV focused

Basal RV/LV >1

Basal right/left ventricle ratio >1

D septum during systole (Right ventricular pressure overload) PSAX (parasternal short axis) level of MV (mitral valve)

D septum in systole

Right ventricular pressure overload

D septum during diastole (Right ventricular volume overload) PSAX (parasternal short axis) level of MV (mitral valve)

D septum in diastole

Right ventricular volume overload

IVC diameter (Inferior vena cava diameter) SC (subcostal view) long axis inferior vena cava IVC.

IVCdiameter

Inferior vena cava diameter

IVC collaps (Inferior vena cava collapsibility) SC (subcostal view) long axis inferior vena cava IVC.

IVCcollaps

Inferior vena cava collapsibility

PAAT (Pulmonary artery acceleration time) PW doppler PSAX (parasternal short axis), PW doppler of RVOT

PAAT

Pulmonary artery acceleration time

maxPG TR (Tricuspid regurgitation maximal pressure gradient) CW doppler Apical 4 chamber (A4C). Tricuspid valve CW doppler

maxPG TR

Tricuspid regurgitation maximal pressure gradient

PAAT (Pulmonary artery acceleration time) PW doppler Vmax TR (Peak tricuspid regurgitation systolic jet velocity) CW doppler

60/60 sign

60/60 Echo sign

McConnell's sign (Mid wall hypokinesia and apical hyperkinesia) A4C (Apical 4 chamber) RV focused

McConnell's sign

Mid wall hypokinesia and apical hyperkinesia

Trombus RV (Right heart mobile trombus) A4C (Apical 4 chamber) RV focused

Trombus RV

Right heart mobile trombus

TAPSE (Tricuspid annular plane systolic excursion) A4C (Apical 4 chamber) RV focused. M mode TAPSE

TAPSE

Tricuspid annular plane systolic excursion

S´ wave pulsed TDI (Peak systolic velocity of the tricuspid annulus by Pulsed TDI) A4C (Apical 4 chamber), PW doppler, lateral tricuspid annulus

S´wavepulsedTDI

Peak systolic velocity of the tricuspid annulus by Pulsed TDI

References:

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

Recommendations for the Evaluation of LV Diastolic Function by Echocardiography: An Update from the ASE and EACVI (2016)

Recommendations on the use of echocardiography in adult hypertension: a report from the EACVI and the ASE (2015)

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: ASE, EACVI, ESC, CSE (2010)

Guidelines for the diagnosis and management of acute pulmonary embolism ESC, ERS (2019)

Echocardiography in aortic diseases: EAE recommendations for clinical practice (2010)

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

ESSENTIAL ECHOCARDIOGRAPHY A Companion to Braunwald’s Heart Disease

Coronary Artery Territories (Echocardiography Illustrated Book 4)

RV pressure

Vmax TR
m/s

Peak tricuspidal regurgitation velocity

RAP
mmHg

Right atrial pressure
3, 8, 15mmHg (IVCdiameter + IVCcollaps)

RVSP(SPAP)
mmHg

Right ventricular systolic pressure
RVSP = 4 x Vmax TR2 + RAP

PRearlyD(Vmax PR)
m/s

Pulmonary regurgitation at early diastole

mPAP
mmHg

Mean pulmonar arterial pressure
mPAP = 4 x (PRearlyD)2 + RAP

PRlateD
m/s

Pulmonary regurgitation et late diastole

PADP
mmHg

Pulmonary artery diastolic pressure
PADP = 4 x (PRlateD)2 + RAP

Pressure overload

RVOTprox(PLAX) >30mm

Right ventricular outflow tract at proximal (PLAX)

Basal RV/LV >1

Basal right/left ventricle ratio >1

D septum

D septum in systole (Right ventricular pressure overload)
D septum in diastole (Right ventricular volume overload)

IVCdiameter >2,1cm

Inferior vena cava diameter

IVCcollaps <50%

Inferior vena cava collapsibility

PAAT
ms

Pulmonary artery acceleration time

maxPG TR
mmHg

Tricuspid regurgitation maximal pressure gradient

60/60 sign

60/60 Echo sign
PAAT ≤60ms and maxPG TR ≤60mmHg

McConnell's sign

Mid wall hypokinesia and apical hyperkinesia

Trombus RV

Right heart mobile trombus

TAPSE <16mm

Tricuspid annular plane systolic excursion

S’wavepulsedTDI<9,5cm/s

Peak systolic velocity tricuspid annulus (Pulsed TDI)

Vmax TR (Peak tricuspid regurgitation systolic jet velocity) CW doppler Apical 4 chamber (A4C). Tricuspid valve CW doppler

Vmax TR

Peak tricuspidal regurgitation velocity

  • It´s used to calculate: RVSP(SPAP)
  • A4C (RV focused).
  • Systole (ECG: R wave - The end of T wave).
  • CW doppler.
    • Place the cursor between tricuspid leaflet tips.
    • Color doppler (helps with blood flow identification).