ECHOCARDIOGRAPHY

AND ITS APPLICATION

Presented by
POONAM VISHWAKARMA
Ph.D Scholar
Department of Veterinary Medicine

SUBMITTED TO:
DR. M.L. SATYANARAYANA
PROFESSOR & HEAD
DEPT OF VETERINARY PATHOLOGY
VETERINARY COLLEGE BENGALURU-24

CARDIAC ULTRASOUND/ CARDIAC ECHO/ ECHO

Ultrasound waves sent from chest wall

ECHOCARDIOGRAPHY

Used since many years (1980s)

Is an noninvasive method to evaluate Cardiac

Anatomy and Function clinically

No known side effects, even with frequent and
repeat testing.
Real-time test, portable, low cost
Echocardiography includes

2-Dimensional echocardiography
Motion-mode echocardiography

Doppler echocardiography

2-D Echocardiography
Real-time echocardiography
Cross-sectional echocardiography
Sector scanning
Used to qualitatively assess:

Heart
Pericardial space
Cardiac chamber size
Wall thickness
Global and regional systolic function
Valvular and vascular structures.

Advantages
:
Provides anatomically correct and easily understood
view
Identification of masses, valves, great vessels & wall
motion abnormalities.
Allows superior evaluation of Rt. Ventricle, Rt. Atrium
& Lt. Atrium compared to M-mode
More sensitive & specific for diagnosis of Pericardial
effusion & Cardiac temponade than M-mode
Congenital cardiac disorder

TWO-DIMENSIONAL IMAGING

2-D Echocardiography Contd

Disadvantages
Interfaces between various tissue densities

e.g. fluid & muscles

Accurate end-systolic & end-diastolic chamber and wall
dimension are difficult to determine as multiple cardiac
cycles are not seen on oscilloscope simultaneously
2-D echocardiography limited value in case of valvular
dysfunction, where the valve appears structurally
This is a major problem in equine cardiology where
valvular regurgitation is commonly associated with
minimal or no gross valvular lesions

M-mode echocardiography
Displays

signals caused by echogenic tissues at

known depth
X-axis: time
Y-axis: varying intensities/ brightness

Provides quantitative information in Systole & Diastole

Motion-mode
Quantitating single dimensions of wall and chambers
Estimate chamber volumes
LV mass

Brightness

One-dimensional Imaging (M-mode)

Time

M-mode Echocardiography Contd...

Advantages
Measurement of chamber dimension, wall thickness &

valvular motion
Multiple cardiac cycles are viewed simultaneously

Disadvantages
Anatomic relationships between chambers & vessels

may be difficult to define

Discrete lesion may not be visualized, as the ultrasound
beam is localized to a small region of the heart

Simultaneous recording of motion mode (M-mode) and two dimensional

echocardiograms. The arrows on the right image indicates the position of the
ultrasound beam from which the M-mode recording was made. LVW = left
ventricular wall, LV = left ventricle, LA = left atrium, RV = right ventricle

Doppler Echocardiography
Measures

the direction & velocity of RBCs

moving through the heart & great vessels
Functional information regarding intra cardiac
haemodynamics
Systolic and diastolic flow
Blood velocity and volumes
Severity of valvular lesions
Location and severity of shunts
Assessment of diastolic function

Advantages
Quantitative information regarding pressure gradient
across stenotic valves
Shunting lesions can be documented and quantitated
even if they are too small to be seen with 2-D
echocardiography
Overestimation of blood velocity will not occur

The Doppler principle was defined by Christian

Andreas Doppler

Doppler Echocardiography Contd...

Disadvantage
Parallel alignment with blood flow is
necessary during the interrogation

Doppler - Spectral
PULSE

CONTINUOUS

Stress Echo
Before and during stress test
Detection of myocardial ischemia and

viability
Assess the efficacy of coronary
revascularization
and
anti-anginal
medications

Transesophageal Echo
Miniature ultrasound probe at the end of

endoscopes
Two-dimensional , M-mode , Doppler
Superior quality images
Left atrial appendage, pulmonary valve,
mitral valve
Semi-invasive

Three-dimensional echocardiography

3 D echo boxdeveloped by the European Association of

Echocardiography offers a complete review of Three Dimensional
Echocardiography
Using an ultrasound probe with an array of transducers and an
appropriate processing system
Enables detailed anatomical assessment of cardiac pathology,
particularly valvular defects and cardiomyopathies
The ability to slice the virtual heart in infinite planes in an
anatomically appropriate manner and to reconstruct Three-dimensional
images of anatomic structures make 3D echocardiography unique for
the understanding of the congenitally malformed heart
Real Time 3-Dimensional echocardiography can be used to guide the
location of bioptomes during right ventricular endomyocardial biopsies

The following cardiac and vascular structures are

generally be evaluated as part of a comprehensive
transthoracic echocardiography(TTE) report:
1) Left Ventricle
2) Left Atrium
3) Right Atrium
4) Right Ventricle
5) Aortic Valve
6) Mitral Valve
7) Tricuspid Valve
8) Pulmonic Valve
9) Pericardium
10) Aorta
11) Pulmonary Artery
12) Inferior Vena Cava and Pulmonary Veins

ECHOCARDIOGRAPHIC INDICATION
Used

for diagnosis of congenital or acquired

cardiac diseases
Animal without cardiac murmur but with
cyanosis
Large breed dogs with acquired murmur
Animal with CHF
Animal with cardiac arrhythmias
Animal with pericardial disease
Animal with suspected endocarditis

EQUIPMENTS USED

EQUIPMENT/MACHI

Sector transducer.
TRANSDUCER with
frequency of 3.5MHz to
7.5MHz
Low frequency for large
breed dogs
High frequency for cats,
puppies & small breed dogs
TRANSDUCER with dual
capability of M-mode & 2Dimension

Echocardiographic Examination
Patient Preparation:
Sedation or light tranquilization- in uncooperative patients
Wetting of hair with alcohol at 4 th to 5th intercostal space, then apply

coupling gel
Shaving of animal with long hair coat
Sedation is not usually required in dogs, but is often necessary in cat
to facilitate positioning

Positioning:
Lateral recumbency
Standing recumbency- if necessary
Sternal recumbency- cats

A CLINICIAN PERFORMING
SCANNING

Transducer locations

Right Parasternal location - between right 3rd & 6th Intercostal

space between sternum & Costochondral junction

 Left cranial parasternal location between left 3rd & 4th inter
costal space between sternum & costchondral junction
Left caudal (apical) parasternal location between left 5th & 7th
inter costal space (close to sternum)

2-D Echocardiographic View

chest
wall
RV

LV

A
o
LA

LV/RV

M
V

LA/Ao

Schematic diagram of the heart in the right parasternal long axis plane, demonstrating the
placement of the cursor for M-mode measurements.
LV and RV wall and lumen measurement are made with the cursor in the LV/RV position.
Mitral valve( MV) measurement are made with the cursor in the MV position,
Ao and LA measurements are made in the LA/Ao position.

ABBREVATIONS USED
RV- Right ventricle
LV- Left ventricle
RA- Right atrium
LA- Left atrium
CH- Chordae tendinae
PM- Papillary muscle
RVO- Right ventricular outflow tract
LVO- Left ventricular outflow tract
PMV- Posterior (parietal) mitral valve cusp
AMV- Anterior (septal) mitral valve cusp
PPM- Posteromedial (dorsal) papillary muscle.
APM- Anterolateral (ventral) papillary muscle.
PV- Pulmonary valve
TV- Tricuspid valve
NC- Non coronary or septal cusp (aortic valve)
Lau- Left auricle
RAu- Right auricle

Long-axis view taken from the right parasternal transducer location

Heart viewed from the right side
& the orientation of the ultrasound
beam transecting the heart

Echocardiographic
image
corresponding to the imaging plane

Long-axis four-chambered view

Long-axis view taken from the right parasternal transducer location

Long-axis view of the LV outflow tract

RV

RA

AO

LV
LC

LAu

Long-axis view obtained from left caudal (apical)

location
Heart viewed from left side with
transducer & echo beam
orientations

Echocardiographic image
corresponding to the imaging
plane

Long-axis two-chamber view of the left atrium & ventricle

LV
AMV

PMV
LA

LAu

Long-axis view of the left ventricular overflow region

RVO

LV

A0
LA

Four- chambered view

APM

VS

LV

RV

RA

LA

AS

Short axis view

By

rotating the transducer 90o

clockwise from long axis view, the
beam plane is oriented
perpendicular to the long axis of the
heart

series of views obtained

Right parasternal short axis view

probe

Figure showing how sector beam transects heart from the position
at different levels, from apex to base.

D
C

E
B

RV- Right ventricle

LV- Left ventricle
CH- Chordae tendinae
PM- Papillary muscle
LVO- Left ventricular outflow
tract
PMV- Posterior (parietal) mitral
valve cusp
RVO- Right ventricular outflow
tract
AMV- Anterior (septal) mitral
valve cusp
PPM- Posteromedial (dorsal)
papillary muscle.
APM- Anterolateral (ventral)
papillary muscle.
PV- Pulmonary valve
TV- Tricuspid valve
RA- Right atrium
LA- Left atrium
NC- Non coronary or septal cusp
(aortic valve)
Lau- Left auricle

Short axis views obtained from the right parasternal location. The diagram
in
the centre illustrates the beam orientation used to obtain images at five
levels of the LV . The corresponding images are shown clockwise from the
bottom. (A) Apical level. (B) Papillary muscle level. (C) Chordal level.
(D) Mitral valve Level (diastole). (E) Aortic valve level (diastole).

M-mode echocardiography

M-mode echocardiographic tracing at the level of the mitral

valve in a Doberman pinscher with dilated cardiomyopathy. The
mitral valve A point is increased relative to the E point as a result
of increased end-diastolic pressure and low transvavular flow.

M-mode echocardiographic tracing at level of the mitral valve in a male domestic shorthair
cat with hypertrophic cardiomyopathy
Systolic anterior motion of the mitral valve is present, & is characterised by movement of
the mitral valve leaflets toward the intraventricular septum shortly after the onset of
systole. Systolic anterior motion may contribute to dyanamic outflow obstruction

M-mode echocardiographic tracing at level of the chordae tendinae in a male labrador

retreiver with dilated cardiomyopathy. The RV & LV internal dimensions are increased in
both systole (s) and diastole (d) owing to volume overload. Intraventricular septal (IVS) &
left ventricular posterior wall (LVPW) thickening are reduced. And shortening fraction is
severely decreased. Minimal precardial effusion is also present

PATHOLOGICAL
CONDITION

2-D image revealing a greatly dilated left atrial appendage with a

large left atrial thrombus. The LV and pleural effusion are also
evident.

left atrial (LA) enlargement

blood clot in
the left
atrium

Blood Clot In The Left Atrium

thrombi

Thrombi In Left Atrial

Right Ventricular Enlargement

Right Ventricle Enlargement

Heartworm

Hydatid Cyst In Left Ventricle

CONCLUSION
Echocardiography

provides an opportunity to
investigate Cardio Vascular diseases in small
animal patients.
Imaging test cannot substitute for history taking
and physical examination.
Echocardiographic findings, in conjunction with
the physical examination, thoracic radiograph,
electrocardiograph, blood pressure measurement
and blood tests, enable accurate diagnosis &
proper management of animals with cardiac
disease

U
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