Dr.

Lusiani, SpPD

 Born in Jakarta, November, 14th 1978

 1997-2003 : Faculty of Medicine , University of
Indonesia
 2005 – 2010 : Internal Medicine, Faculty of
Medicine , University of Indonesia
 2010 – present : Staff of Cardiology Division of
Internal Medicine, FKUI-RSCM
WORKSHOP HANDS ON ECHOCARDIOGRAPHY
12th HOPECARDIS

2D AND M MODE
ECHOCARDIOGRAPHY
EXAMINATION

LUSIANI
Cardiology Division, Internal Medicine Department
FKUI-RSCM
 Objective
 understand basic principles of 2-D and M-mode
echocardiography
 understand normal and abnormal findings in 2-D
and M-mode echocardiography
Parasternal Long Axis (PLAX) View
PLAX View
(Base of the heart to apex), 2nd to 4th intercostals space, left sternal edge
1. 2D : MV, LVOT, Basal and the mid part of the interventricular septum (IVS), LV, RV,
LA, Pericardium
2. M-Mode Study
 Position 1 – line placed across the AV : Tracing valve, Aortic root diameter,
Left atrium diameter
 Position 2 – line placed perpendicular at the tips of the MV leaflets : DE
excursion, EF slopes, EPSS
 Position 3 – line placed beyond the tips of the MV in the left and right
ventricular cavities
 A tracing of LV dimension cavity
 Intra Ventricular Septum (IVS) and Posterior Wall (PW)
 Right Ventricular (RV)
 Other examination, eg. Pericardial, pleura
3. Colour Doppler Mode : MV, AV
PLAX View
(Base of the heart to apex), 2nd to 4th intercostals space, left sternal edge
1. 2D : MV, LVOT, Basal and the mid part of the interventricular septum (IVS), LV, RV,
LA, Pericardium
2. M-Mode Study
 Position 1 – line placed across the AV : Tracing valve, Aortic root diameter,
Left atrium diameter
 Position 2 – line placed perpendicular at the tips of the MV leaflets : DE
excursion, EF slopes, EPSS
 Position 3 – line placed beyond the tips of the MV in the left and right
ventricular cavities
 A tracing of LV dimension cavity
 Intra Ventricular Septum (IVS) and Posterior Wall (PW)
 Right Ventricular (RV)
 Other examination, eg. Pericardial, pleura
3. Colour Doppler Mode : MV, AV
PLAX View-2D
PLAX View-2D - Abnormal
PLAX View
(Base of the heart to apex), 2nd to 4th intercostals space, left sternal edge
1. 2D : MV, LVOT, Basal and the mid part of the interventricular septum (IVS), LV, RV,
LA, Pericardium
2. M-Mode Study
 Position 1 – line placed across the AV : Tracing valve, Aortic root diameter,
Left atrium diameter
 Position 2 – line placed perpendicular at the tips of the MV leaflets : DE
excursion, EF slopes, EPSS
 Position 3 – line placed beyond the tips of the MV in the left and right
ventricular cavities
 A tracing of LV dimension cavity
 Intra Ventricular Septum (IVS) and Posterior Wall (PW)
 Right Ventricular (RV)
 Other examination, eg. Pericardial, pleura
3. Colour Doppler Mode : MV, AV
PLAX- M Mode (1)
Pattern of normal aortic
flow
PLAX View- M Mode (1) - Abnormal
PLAX View
(Base of the heart to apex), 2nd to 4th intercostals space, left sternal edge
1. 2D : MV, LVOT, Basal and the mid part of the interventricular septum (IVS), LV, RV,
LA, Pericardium
2. M-Mode Study
 Position 1 – line placed across the AV : Tracing valve, Aortic root diameter,
Left atrium diameter
 Position 2 – line placed perpendicular at the tips of the MV leaflets : DE
excursion, EF slopes, EPSS
 Position 3 – line placed beyond the tips of the MV in the left and right
ventricular cavities
 A tracing of LV dimension cavity
 Intra Ventricular Septum (IVS) and Posterior Wall (PW)
 Right Ventricular (RV)
 Other examination, eg. Pericardial, pleura
3. Colour Doppler Mode : MV, AV
PLAX View- M Mode (2)

-DE Excursion
- EF slope
-EPSS
PLAX View - M Mode (2) - Abnormal
PLAX View
(Base of the heart to apex), 2nd to 4th intercostals space, left sternal edge
1. 2D : MV, LVOT, Basal and the mid part of the interventricular septum (IVS), LV, RV,
LA, Pericardium
2. M-Mode Study
 Position 1 – line placed across the AV : Tracing valve, Aortic root diameter,
Left atrium diameter
 Position 2 – line placed perpendicular at the tips of the MV leaflets : DE
excursion, EF slopes, EPSS
 Position 3 – line placed beyond the tips of the MV in the left and right
ventricular cavities
 A tracing of LV dimension cavity
 Intra Ventricular Septum (IVS) and Posterior Wall (PW)
 Right Ventricular (RV)
 Other examination, eg. Pericardial, pleura
3. Colour Doppler Mode : MV, AV
PLAX View - M Mode (3)
 Wall thickess of left
ventricle

LVEDD is at the end of diastole (R wave of ECG). The normal range is 3.5-5.6 cm.

LVESD is at the end of systole, which occurs at the peak downward motion
of the IVS (which usually slightly precedes the peak upward motion of the
LVPW) and coincides with the T wave on the ECG. The normal range is 2.0-
4.0cm.
PLAX View - M Mode (3) - Abnormal
Decreased contractility in
coronary heart disease
Pericardial effusion

AV Groove
Pericardial effusion
Parasternal Short Axis (PSAX) View
PSAX View
Transducer placed at the 2nd to 4th intercostals space, left sternal edge and rotating the
transducer to 90o, heart is seen cut in transverse section
1. Two – dimensional
 The aortic valve level1). Valves : AV, TV, PV, PA, LA, RA, IAS, RVOT
 The mitral valve (basal) level
 The LV papillary muscle (mid) level
 The LV apex (apical) level : LV hypertrophy, LV dilatation, LV wall scars, The
presence of thrombus, Apical aneurysm.
 Anatomical and pathophysiologic motion of the LV wall.
2. M-Mode Study
 Line placed perpendicular di the centre of LV papillary muscle (mid)
 A tracing of LV dimension cavity
 InterVentricular Septum (IVS) and Posterior Wall (PW)
 Right Ventricular (RV)
 Other examination, eg. Pericardial
3. Colour Doppler Mode
 The aortic valve level AV, TV, PV, PA, IAS
PSAX View
Transducer placed at the 2nd to 4th intercostals space, left sternal edge and rotating the
transducer to 90o, heart is seen cut in transverse section
1. Two – dimensional
 The aortic valve level1). Valves : AV, TV, PV, PA, LA, RA, IAS, RVOT
 The mitral valve (basal) level
 The LV papillary muscle (mid) level
 The LV apex (apical) level : LV hypertrophy, LV dilatation, LV wall scars, The
presence of thrombus, Apical aneurysm.
 Anatomical and pathophysiologic motion of the LV wall.
2. M-Mode Study
 Line placed perpendicular di the centre of LV papillary muscle (mid)
 A tracing of LV dimension cavity
 InterVentricular Septum (IVS) and Posterior Wall (PW)
 Right Ventricular (RV)
 Other examination, eg. Pericardial
3. Colour Doppler Mode
 The aortic valve level AV, TV, PV, PA, IAS
PSAX 2D View – Aortic
Level
PSAX 2D View - Aortic Level
Abnormal

kalsifikasi
PSAX 2D View - Basal Level
PSAX M Mode - Basal Level
PSAX 2D View – Mid Level
PSAX M Mode View – Mid Level
PSAX 2D View – Apical Level
PSAX View – Apical Level
PSAX View
Transducer placed at the 2nd to 4th intercostals space, left sternal edge and rotating the
transducer to 90o, heart is seen cut in transverse section
1. Two – dimensional
 The aortic valve level1). Valves : AV, TV, PV, PA, LA, RA, IAS, RVOT
 The mitral valve (basal) level
 The LV papillary muscle (mid) level
 The LV apex (apical) level : LV hypertrophy, LV dilatation, LV wall scars, The
presence of thrombus, Apical aneurysm.
 Anatomical and pathophysiologic motion of the LV wall.
2. M-Mode Study
 Line placed perpendicular di the centre of LV papillary muscle (mid)
 A tracing of LV dimension cavity
 InterVentricular Septum (IVS) and Posterior Wall (PW)
 Right Ventricular (RV)
 Other examination, eg. Pericardial
3. Colour Doppler Mode
 The aortic valve level AV, TV, PV, PA, IAS
Apical View
Apical Views

 4-chamber (A4C)

 2-chamber (A2C)

 5-chamber (A5C)
Apical Views: 4-chamber (A4C)
o Two – dimensional study of LV,RV, IVS, LA, RA,  End-diastolic volume (EDV)
IAS, MV, TV
 LV mass
LV Systolic Function Study  Methods for LV volumes (ESV, EDV)
 Determinants of LV Performance
 Biplane method of discs (modified
 Contractility (inotropic state of myocardium) Simpson’s rule)
 Preload  Single plane area-length
 Afterload  “Quick” method (regression equation)
 Global LV Systolic Function  Technical considerations
 Measurements  Image maximization
 Ejection phase indices  Selection of precise time in cardiac cycle
 Non-ejection phase indices
for measurements
 Potential Problems
 Indirect methods (simple confirmatory
methods)
 What to measure o M-Mode
 Ejection fraction (EF)
 Fractional shortening (% FS) o Colour Doppler Mode
 Velocity of circumferential fiber
shortening (Vcf)
 End-systolic volume (ESV)
 TAPSE
( Tricuspid Annular Plane Systolic Excursion)
LVEF– Area Length (AL)
Apical Views: 2-chamber (A2C)
 2-D method of Simpson

 In this method, acquire A4C or A2C views,

making sure that the endocardial borders are
visualised well.
 Freeze the image and scroll backward and
forward to identify a frame at end diastole.
This can be timed using the appearance of
the ventricle - identifying a frame where the
ventricle appears to have the largest volume;
or with the ECG trace, where the peak of the
R wave corresponds to end-diastole.
Calculation of LV volume in end-diastole
Tracing of endocardium in end-systole completed
Calculation of volume in end-systole

The machine will then calculate the ejection fraction by using

the formula:

Ejection fraction = (LVEDV - LVESV)/LVEDV

Report of ejection fraction generated
Apical Views: 5-chamber (A4C)
Subcostal Window
 The four – chamber view
 The short axis views
Subcostal Window

 The four – chamber view

Subcostal Window
 The short axis views
Dilated IVC
TERIMAKASIH