1. Basic Echocardiography Wendy Blount, DVM Nacogdoches TX Wendy Blount, DVM Nacogdoches TX

2. Echo Technique - Anatomy Tricuspid valve Septal leaflet Parietal leaflet Pulmonic Valve Right cusp Left cusp Intermediate cusp Mitral valve Leaflets are less distinct Aortic Valve Right cusp Left cusp Septal cusp

3. Echo Technique - Anatomy RV Conus arteriosus 3 papillary muscles LV 2 papillary muscles

4. Echo Technique - Physiology Ventricular filling - volume 70% passive 30% atrial contraction Diastole – time period First 1/3 - rapid passive filling from atria Second 1/3 – filling slows (diastases) Final 1/3 – atria contract

5. Echo Technique - Physiology Heart Sounds HS1 –AV Valves close –Beginning of systole HS2 –Semilunar valves close –Beginning of diastole

6. Echo Technique - Physiology Heart Sounds HS3 – protodiastolic gallop –Rapid ventricular filling –First 1/3 of diastole –stiff LV –large diastolic volume HS4 –Atrial contraction –Last 1/3 of diastole –Stiff LV or 3 rd degree heart block

7. Echo Technique - Physiology Heart Sounds Gallop Rhythms –HS3? –HS4? –Can’t tell the difference if heart rate is above 160-180 –Just call it a summation gallop

8. Echocardiography Equipment Transducer – small footprint Fan-shaped beam or sector High frequency for small animals Low frequency for large animals Machines range from 2.5-10 Mhz 5-7 mHz will work fine for most dogs and cats for echo

9. 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

10. Echocardiography Preparation Thin coated animals – alcohol, part the hairs, gel Thick coated animals – shave the window – at the sternum, just behind the elbow Sedation only if needed –Acepromazine – 0.025 mg/lb (max 1 mg) –Buprenex – 0.01-0.02 mg/kg –Mix together and give IV

11. Echocardiography Positioning for 8 standard views Right lateral recumbency Cardiac table is nice but not necessary Sonographer needs a stool or chair Placement of probe: –3rd-6 th ICS –Usually 4 th -5 th ICS –Feel the apical beat, and put your probe there –Adjust one space forward or back as needed –Rarely move the probe head – just fan and twist

12. 1. Short Axis – Left Ventricle Feel the right apical beat Point the probe marker cranially Place the probe at the apical beat Rotate and fan until papillary muscles are seen, and the same in size If you are getting a shadow, try one intercostal space forward or back

13. 1. Short Axis – Left Ventricle Abbreviations - Structures P – pericardium RV – right ventricle LV – left ventricle PPM – posterior papillary muscle APM – anterior papillary muscle

14. 1. Short Axis – Left Ventricle Measurements IVSTDIVSTD - IntraVentricular Septum Diastole LVIDD - LV Inner Diameter Diastole LVPWD – LV Posterior Wall Diastole IVSTSIVSTS - IntraVentricular Septum Systole LVIDS - LV Inner Diameter Systole LVPWS – LV Posterior Wall Systole

15. 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 prelood and afterload can affect FS, as well as myocardial function

16. 1. Short Axis – Left Ventricle Measurements - Calculated FS – fractional shortening >30% in the dog >40% in the cat >45% if MR is compensated

17. 1. Short Axis – Left Ventricle Measurements - Tips Make sure you don’t include PM in the LFPW 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

18. 1. Short Axis – Left Ventricle Measurements - Tips Measure three times –Take the average –Throw out any outliers Several sets of normals published –1-2mm outside normal may not always be significant

19. 2. Short Axis – Apex Structures Pericardium May or may not see RV LV apical lumen No measurements here

20. 3. Short Axis – Chordae Tendinae Structures Pericardium RV LV CH - Chordae Tendinae (posterior & anterior) No measurements here

21. 4. Short Axis – Mitral Valve Structures Pericardium RV RV Papillary Muscles LV MV - Mitral Valve (Posterior & Anterior)

22. 4. Short Axis – Mitral Valve Measurement EPSS – E-Point to Septal Separation –Can denote decreased LV systolic function –Less than 6 mm in large dogs –Less than 3-5 mm in small dogs and cats

23. 5. Short Axis – Aortic Valve Structures RVOT – Right Ventricular Outflow Tract TV – Tricuspid Valve PV – Pulmonic Valve Ao – Aortic Valve LA – Left Atrium

24. 5. Short Axis – Aortic Valve Measurements Ao – at largest dimension (systole) LA – at largest dimension (diastole) LA:Ao – –0.8 to 1.3 in dogs –0.8 to 1.4 in cats

25. 6. Short Axis – Pulmonary Artery Structures RA – Right Atrium Ao – Aorta (ascending) PA– Pulmonary Artery –LPA – left pulmonary artery –RPA – right pulmonary artery CaVC – Caudal Vena Cava

26. Ferret Echo Normal Values (Mean) LVIDD – 11.0 mm LVIDS - 6.4 mm LVPW - 3.3 mm FS - 42% EPSS - 0

27. 7. Long Axis – 4 Chamber Technique Get short axis LV-PM view Rotate 90 degrees counterclockwise

28. 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 PVe – Pulmonary Vein

29. 7. Long Axis – 4 Chamber Video

30. 8. Long Axis – LVOT Technique Find 4 Chamber view Angle the “dot” toward the shoulders Elevate the cord end of the probe

31. 8. Long Axis – LVOT Structures RV, TV, RA LV, PM, MV Very edge of the LA LVOT – AV (LC, SC), ascending Ao RPA – Right Pulmonary Artery

32. 8. Long Axis – LVOT Video Normal Dog Video