1. M-MODE ECHOCARDIOGRPHY
THE LOSS ART

2. M-MODE PHYSICS
B mode echoes from an interface that changes position will be seen as echoes moving towards and away from the transducer.
If a trace line is place on this interface and the resulting trace is made to drift across the face of a CRT screen a motion pattern is obtained.

3. M-MODE PHYSICS
The resulting display shows motion of a reflector over distance and time – a distance time graph
The change in distance (dy) over a period of time dt is represented by the slope of the reflector line of motion.
dy/dt = slope = velocity

4. M-MODE PHYSICS
If this motion pattern is obtained on moving cardiac structures then the resulting images constitute M-mode echocardiography.
M-mode echocardiography is use to evaluate the morphology of structures, movement and velocity of cardiac valves and walls and timing of cardiac events.

5. M-mode Tracing
Distance
Time

6. M-mode Evaluation
Amplitude
Velocity
Time intervals
Morphology

7. Amplitude Measurement
Distance Y2
Amplitude = Y2 –Y1 Y1
Time

8. Time Measurement
Distance
Time interval = T2 – T1 T1 T2
Time

9. Slope Measurement Slope = dy/dt = velocity dy = Y2 –Y1 dt = T2 – T1 Y2

10. M-mode at the Mitral Valve
The mitral valve has 2 leaflets – anterior and posterior.
Specific letters corresponding to systole and diastole are assigned to the m-mode tracing of the mitral valve.

11. EKG Tracing
QRS complex
T-wave
P wave
Systole
Diastole

12. M-mode at Mitral Valve
Distance
Time
Diastole
Systole

13. M-mode at the Mitral Valve
Phase of Cardiac Cycle
Assigned Letters
Diastole
d,e,f, and a
Systole
c and d

14. M-mode at Mitral Valve d e a d
Distance f c
Systole
Diastole
Time

15. M-mode at Mitral Valve d-e amplitude Diastole Distance Systole Time e

16. M-mode at Mitral Valve
Septum
EPSS
Distance e
Systole
Diastole
Time

17. M-mode at Mitral Valve e
d-e slope
Distance
Diastole
Systole d
Time

18. M-mode at Mitral Valve e
e-f slope
Distance f
Systole
Diastole
Time

19. M-mode at Mitral Valve

20. M-mode at the Mitral Valve
Amplitude
Description
Normal Value
EPSS
Measure e point to septal separation
< 5 mm
d-e
Measures the maximum excusion of the mitral valve following diastolic opening.
17 to 30 mm

21. M-mode at the Mitral Valve
Slope
Description
Normal Value
d-e
Measure rate of initial opening of the mitral valve in early diastole.
240 to 380 mm/s
e-f
Measures the rate of early closure of the mitral valve following diastolic opening.
50 to 180 mm/s

22. M-mode Findings at the MV
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation

23. M-mode Findings at the MV
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations

24. M-mode at Mitral Valve B-bump on the AC shoulder. Systole Distance
Time
Diastole
Systole

25. M-mode at Mitral Valve Premature Closure Premature Closure- closure
on or before the onset of the
QRS complex.
Distance
Time
Diastole
Systole

26. Systolic anterior motion
M-mode at Mitral Valve
Systolic anterior motion
of the AMVL
Distance
Time
Diastole
Systole

27. Systolic anterior motion
M-mode at Mitral Valve
Systolic anterior motion
of the AMVL
Distance
Time
Diastole
Systole

28. M-mode at Mitral Valve MV prolapse posterior leaflet Systole Distance
Time
Diastole
Systole

29. M-mode at Mitral Valve MV Prolapse – both leaflet Systole Distance
Time
Diastole
Systole

30. M-mode at Mitral Valve Flail posterior leaflet Systole Distance Time
Diastole
Systole

31. M-mode at Mitral Valve Aortic Regurgitation Systole Distance Time
Diastole
Systole

32. M-mode at Mitral Valve Mitral Stenosis Sinus Rhythm Systole Distance
Time
Diastole
Systole

33. M-mode at Mitral Valve Mitral Stenosis Atrial Fibrillation Systole
Distance
Time
Diastole
Systole

34. M-mode at Mitral Valve
Atrial Myxoma
Distance
Time
Diastole
Systole

35. M-mode at Mitral Valve
Vegetation
Distance
Time
Diastole
Systole

36. Mitral Regurgitation
Distance
Time
Diastole
Systole

37. Mitral Regurgitation
Distance
Time
Diastole
Systole

38. Mitral Regurgitation
Atrial Myxoma
Distance
Time
Diastole
Systole

39. Mitral Regurgitation
Atrial Myxoma
Distance
Time
Diastole
Systole

40. M-mode at Mitral Valve
Atrial Myxoma
Distance
Time
Diastole
Systole

41. Color M-mode

42. Color M-mode
Propagation Velocity, Vp

43. M- Mode
Aortic Valve

44. M-mode at the Aortic Valve
The aortic valve has 3 cusps – right coronary, left coronary and non-coronary cusps.
The cusps imaged in the PLAX view are the right coronary and the non-coronary cusps.

45. M-mode at the Aortic Valve
Non-coronary cusp
Anterior aortic root
Coronary cusp
Posterior aortic root
Left Atrium

46. M-mode at the Aortic Valve
Cusp Separation
Aortic root
LA dimension

47. M-mode at the Aortic Valve
Aortic root
Measurements are made from leading edge to leading edge.
Cusp Separation
LA dimension

48. M-mode at the Aortic Valve
Dilated LA
Dilated aortic root
Decreased excursion
Premature opening
Premature closing
Exaggerated anterior motion of Aortic Root

49. M-mode at the Aortic Valve
Reduced anterior motion of Aortic Root
Thickening
Calcification
Vegetations
Bicuspid valve
Prosthetic valve
Aortic Regurgitation

50. M-mode at the Aortic Valve
Premature Opening
Opening of the AV before the onset of the QRS complex
Seen in Elevated LV-EDP

51. M-mode at the Aortic Valve
Premature Closure
Closure of the AV before
the onset of the T wave
Seen in IHSS

52. M-mode at the Aortic Valve
Bicuspid Valve
Eccentric closure line
Seen when there is a Bicuspid aortic valve

53. M-mode at the Aortic Valve
Decreased Cusp Separation
Seen in Aortic Stenosis

54. M-mode at the Aortic Valve
Thickened, calcified aortic
valve leaflet.
Seen in aortic sclerosis

55. M-mode at the Aortic Valve
Seen in Mitral Stenosis
Reduced anterior
motion of aortic root

56. M-mode at the Aortic Valve
Seen in Mitral Regurgitation
Exaggerated anterior
motion of aortic root

57. Aortic Regurgitation

58. Aortic Regurgitation

59. Aortic Regurgitation

60. M - Mode
Left Ventricle

61. M-mode at Left Ventricle

62. M-mode at Left Ventricle
Thickening of the IVS and LVPW
Movement of the IVS and LVPW

63. M-mode Measurement
RVWd
RVIDd

64. M-mode Measurement
IVSd
IVS excursion
IVSs

65. M-mode Measurement
LVIDd
LVIDd index
LVIDs
LVIDs index

66. M-mode Measurement LVPWd LVPW excursion LVPW max excursion velocity
LVPWs

67. M-mode at Left Ventricle
RVWT

68. M-mode at Left Ventricle
RVIDd

69. M-mode at Left Ventricle
IVSd

70. M-mode at Left Ventricle
LVIDd

71. M-mode at Left Ventricle
LVPWd

72. M-mode at Left Ventricle
IVS excursion

73. M-mode at Left Ventricle
IVSs

74. M-mode at Left Ventricle
LVIDs

75. M-mode at Left Ventricle
LVPWs

76. M-mode at Left Ventricle
LVPW excursion

77. M-mode at Left Ventricle
LVPW max velocity
= slope

78. M-mode at Left Ventricle

79. M-mode LV Calculation FS EF
LV mass
RWT

80. M-mode LV Calculation % IVS thickening % LVPW thickening
IVS/LVPW ratio

81. M-mode LV Calculation
FS = LVIDd – LVIDs
LVIDd

82. M-mode LV Calculation
EF = LVIDd3 – LVIDs3
LVIDd3

83. M-mode LV Calculation
RWT = IVSd + LVPWd
LVIDd

84. M-mode LV Calculation
IVS % thickening = (IVSs – IVSd) x 100
IVSd

85. M-mode LV Calculation
LVPW % thickening = (LVPWs – LVPWd) x 100
LVPWd

86. M-mode LV Calculation
LV Mass = 1.04 {(LVIDd + IVSd + LVPWd)3 – (LVIDd)3} x g

87. Increase LVW thickness

88. Increase LVW thickness Increased Wall Thickness
Symmetrical
Asymmetrical
Hypertrophic
Cardiomyopathy
Concentric
Hypertrophy
Concentric
Remodeling
Infiltrative
Diseases

89. Increase Wall thickness Increase Wall thickness
LV Hypertrophy - Hypertension
Pressure Overload
Concentric LVH
Increase Wall thickness
Increased Mass
Remodeling
Increase Wall thickness
Normal Mss

90. Increase Wall thickness Concentric Remodeling Concentric Hypertrophy
LV Hypertrophy - Hypertension
Increase Wall thickness
Measure LV Mass
Normal LV Mass
Increased LV Mass
Concentric Remodeling
Concentric Hypertrophy

91. Increase Wall thickness Concentric Hypertrophy
LV Hypertrophy – Aortic Stenosis
Pressure Overload
LVH
Increase Wall thickness
Increased LV Mass
Concentric Hypertrophy

92. Eccentric LV Hypertrophy
Increased LV size with
Spherical shape
Measure LV Mass
Normal LV Mass
Increased LV Mass
No LV hypertrophy
Eccentric Hypertrophy

93. Measurement Assessment Concentric Hypertrophy Eccentric Hypertrophy
LV Hypertrophy
Measurement Assessment
Concentric Hypertrophy
Concentric
Remodeling
Eccentric Hypertrophy
Wall Thickness
Increased
Normal
Relative Wall Thickness
Normal - Decreased
LV Chamber size
LV Chamber shape
Elliptical
Spherical
LV mass

94. Paradoxical Septal Motion

95. Paradoxical Septal Motion
RV hypertrophy
RV dilatation
LBBB
Post Cardiac Surgery

96. Ischemia

97. Ischemia
Normal Wall thickness
No systolic thickening
Reduced Motion

98. Post Infarct

99. Post Infarct
Thin echogenic wall
No systolic thickening
Reduced Motion

100. Pericardial Effusion

101. Pericardial Effusion Infection Postviral pericarditis Bacterial
Tuberculosis

102. Pericardial Effusion Malignant
Metastatic disease – lymphoma & melanoma
Direct extension – lung and breast
Primary cardiac malignancy

103. Pericardial Effusion Inflammatory Post MI (Dressler’s Syndrome) Uremia
Collagen vascular disease
Post cardiac surgery

104. Intracardiac-Pericardial communication
Pericardial Effusion
Intracardiac-Pericardial communication
Blunt or penetrating chest trauma
Post catheter procedures
LV rupture (post MI)

105. Pericardial Thickening

106. Pericardial Thickening
Constrictive pericarditis
Occurs following
Surgery
Radiation therapy
Repeated episodes of pericarditis