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Echocardiography

1.Display latch
2. LCD display
3. Power indicator
4. On/Off button
5. Battery
6. ECG cable connector
7. Pedoff probe connector
8.Probe locking handle
9. Probe connector
10. Monitor hinge
11. Soft menu buttons
12. Alpha-numeric keyboard
13. Functional keyboard
14. Trackball
15. Speakers
16. Rear panel connectors
17. Anti-theft cable insertion

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Tombol depan

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Scanning mode
2D-Mode overview

M-MODE

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Color MODE

PW and CW Doppler

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TVI (tissue velocity imaging) view

Cara menyimpan gambar di flashdisk

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Preparation
Positioning
Ideal : lying on his left side, with the left arm widely abducted
ICU patients unable to move
place a pillow under the patient's right side & bend
the patient's knees towards right heart closer to
the chest wall
abduct the patient's left arm widen ICS
Room
Close patients curtain privacy
Physician
use dominant hand
rest wrist on the patient's chest
Device
Gel water-based improves probe-skin contact
Probe flat-small probe enough to slip between ribs

Echo window
A. Parasternal
a. PLAX (Parasternal Long Axis)
b. PSAX (Parasternal Short Axis)
B. Apical
a. A4C (Apical 4 Chambers)
b. A5C (Apical 5 Chambers)
C. Subcostal - IVC ( inferior vena cava)

PLAX (Parasternal Long Axis)

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Probe left lateral border of the sternum just at the sterno-costal
angle
Notch angled 10-11 oclock
Between 3rd-5th ICS

3 Criteria

1. the septum must be as horizontal as possible


2. you should not visualize the apex of the left ventricle
3. you should see the aortic and mitral valves but not the tricuspid
valve

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Troubleshooting:

If you see the tricuspid valve --> angle your probe upwards (you are too
high and your ultrasound beam is aiming too anterior)
If you see the apex of the left ventricle --> rotate your probe a few degrees
clockwise (you are foreshortening the left ventricle)
If you lose the image --> come back closer to the sternum, you may be
sliding on the chest (take anchor on your wrist but don't put too much
pressure on the probe, you will slide)

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PSAX
Probe same as PLAX

Notch angled 90o away from PLAX

Criteria PSAX

1. the left ventricle should be round shaped and symetric

2. the left ventricle should be in the middle of the screen

Dibagi menjadi 3 Level:

Ao Valve level
Mitral valve
level

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Papillary
APICAL 4 muscle level
CHAMBER
Probe apex of LV

Notch 2 or 3 o'clock

Criteria:

1. The apex of the left ventricle should be close to the probe, and the lines of
the crux should be vertical and horizontal, the intersection point at the middle
of the image.

2. You should visualize the mitral and tricuspid


valves full opening and closing, and the atria.

3. Be careful not to shorten the apex of the left


ventricle, which would appear round-shaped
and hyperkinetic.

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Troubleshooting:

If the crux of the heart is tilted toward the right of the screen, you are too
medial, you should translate your probe laterally.
If the crux of the heart is tilted toward the left of the screen, you are too
lateral (less frequent), you should translate your probe medially
If you don't see the mitral and tricuspid valve of the atria, your probe is
aimed too deep. You should angle the probe up to visualize the atria.

APICAL 5 CHAMBER
Probe & notch same as A4C
Handle tilted down so that the surface of probe goes upward.

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Subcostal IVC
Probe below xiphoid

Notch 12 oclock

7 Haemodynamic States
IVC
PCWP
LVCO
Vti-SV
EF
Eyeball LV Wall Motion
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TAPSE

Cara mengukur IVC


Tempatkan probe di subcostal pada arah jam 12 tampak gambaran IVC
yang bermuara pada RA arahkan cursor sekitar 1-
2cm dari muara RA tekan M-MODE freeze
pada layar monitor pilih ivc collapsibility ukur
diameter ekspirasi dan diameter inspirasi

Cara mengukur RAP pada pasien


dengan pernafasan spontan:

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Cara mengukur CO

A. Ukur LVOT Diam :


Tempatkan probe pada posisi PLAX
tempatkan cursor pada posisi aorta tekan
freeze pada layar monitor pilih option
GENERAL DIMENSION LVOT Diam ukur
ukur diameter Aorta tekan store

B. Ukur LVOT VTi (left ventricular out flow


tract velocity time integral):
Tempatkan probe pada posisi A5C
arahkan cursor beberapa mm diatas katup
aorta tekan PW freeze pada
monitor pilih option GENERAL AORTIC
LVOT TRACE ukur besar gelombang
(minimal 2 gelombang) CO otomatis akan
terbaca di monitor

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VTI tracing

Vmax maksimum dan minimum

Mengukur kecukupan cairan dari VTI variation


Dengan mengukur VTI kita juga bisa memperkirakan kecukupan cairan.
VTI variation lebih dari 12% dianggap masih fluid responsiveness.
Atau, bisa juga dengan menghitung peak velocities (Vmax) maksimum
dan minimum. Variasi lebih dari 12% juga dianggap sebagai fluid
responsiveness.

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Cara megukur EF

a. By teich: Tempatkan probe pada posisi PLAX arahkan cursor


memotong LV tekan M-MODE freeze ukur LVIDd dan
LVIDs

By plane:

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Eye ball LV wall motion
Tempat kan probe pada posisi PLAX, PSAX, Apical lihat gerakan
dinding LV

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Mengukur TAPSE (tricuspid annular plane
systolic)
Tempatkan probe pada posisi Apical 4 chamber arahkan cursor
pada annulus tricuspid lateral tekan M-MODE pada puncak
sistole freeze pada layar monitor pilih TAPSE ukur ketinggian
gelombang seperti gambar di bawah
Nilai normal diatas 16 mm.

Cara mengitung PCWP


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