ECHOCARDIOGRAPHY

(ECHO)
TABLE OF CONTENTS

01 DEFINITION
OF TERMS
CLINICAL
03
APPLICATIONS
ECHO
02
TECHNIQUES
RECENT
04 ADVANCES
 INTRODUCTION

an understanding of the basic principles of ultrasound imaging and

Doppler echocardiography is essential both during data acquisition
and for correct interpretation of the ultrasound information.
01

DEFINITION
OF TERMS
Sound waves are mechanical vibrations
that induce alternate refraction and
compression of any physical medium
through which they pass

ULTRASOUND WAVES
 ULTRASOUND WAVES

FREQUENCY VELOCITY PROPAGATION

• The number of ultrasound 01 02 The speed that a sound wave
waves in a 1-second interval. moves through the body
• Simply means cycles per
second.

WAVELENGTH
AMPLITUDE 04 03 • The distance from peak to
Height of the ultrasound peak of an ultrasound wave.
wave or “loudness”
measured in decibels (dB) • Wavelength can be calculated
by dividing the frequency ( f in
Hz) by the propagation
velocity (c in m/s).
ULTRASOUND TISSUE INTERACTION

ACOUSTIC IMPEDANCE
A characteristic of each tissue
defined by tissue density (r)
and propagation of velocity (c)
ULTRASOUND TISSUE INTERACTION

REFLECTION REFRACTION
Return of ultrasound signal Deflection of ultrasound waves
to the transducer from a from a straight path because of
smooth tissue boundary differences in acoustic impedance

SCATTERING ATTENUATION
Radiation of ultrasound in Loss in signal strength due to
multiple directions from a small absorption of ultrasound energy
structure, such as blood cells by tissues
 TRANSDUCERS
Ultrasound transducers use a piezoelectric crystal to alternately transmit and receive ultrasound signals

BASIC CHARACTERISTICS OF A TRANSDUCER:

● Transmission frequency (from 2.5 MHz for transthoracic to 20 MHz for intravascular
ultrasound)

● Bandwidth (range of frequencies in the transmitted ultrasound pulse)

● Pulse repetition frequency (the number of transmission-receive cycles per second)

● Focal depth (depends on beam shape and focusing)

● Aperture (size of the transducer face or “footprint”)

● Power output
02

ECHO
TECHNIQUES
 A 2D echocardiographic image is

01
generated from the data obtained by
electronically “sweeping” the
ultrasound beam across the
tomographic plane.

For each scan line, short pulses (or

02
bursts of ultrasound) are emitted at a
PRF determined by the time needed for
ultrasound to travel to and from the

2D DIMENSIONAL
maximum image depth.
For cardiac applications, a high frame

03
rate (≥30 frames per second) is desirable
for accurate display of cardiac motion.
This frame rate allows 33 ms per frame or
128 scan lines per 2D image at a
displayed depth of 20 cm
 M-mode data are shown on the video

01 monitor either “scrolling” or

“sweeping” across the screen at 50 to
100 mm/s.

M-mode recordings allow identification

of very rapid intracardiac motion
02 because the sampling rate is about
1800 times per second compared to a
2D frame rate of 30 frames per second
M-MODE Other examples of rapid intracardiac

03
motion best demonstrated with M-mode
imaging include the high-frequency
fluttering of the anterior mitral leaflet in
patients with aortic regurgitation and
the rapid oscillating motion of valvular
vegetations.
Septal wall

Mitral leaflet
 Doppler echocardiography is based on the
01 change in frequency of the backscattered
signal from small moving structures (e.g., red
blood cells) intercepted by the ultrasound
beam

A stationary target, if much smaller than the

02 wavelength, will scatter ultrasound in all

directions, with the frequency of the
scattered signal being the same as the
DOPPLER transmitted frequency when observed from
any direction
ULTRASOUND
03
A moving target, however, will backscatter
ultrasound to the transducer so that the
frequency observed when the target is
moving toward the transducer is higher and
the frequency observed when the target is
moving away from the transducer is lower
than the original transmitted frequency.
 01
CW Doppler uses two ultrasound
crystals; one continuously transmits
and one continuously receives the
ultrasound signal.

The major advantage of CW Doppler is

02 that very high-frequency shifts
(velocities) can be measured accurately
because sampling is continuous.
CONTINUOUS-
WAVE DOPPLER
03
The potential disadvantage of CW
Doppler is that signals from the entire
length of the ultrasound beam are
recorded simultaneously.
 Pulsed Doppler echocardiography allows
sampling of blood flow velocities from a

01 specific intracardiac depth. A pulse of

ultrasound is transmitted, and then, after a
time interval determined by the depth of
interest, the transducer briefly “samples” the
backscattered signals.

The pulsed Doppler interrogation line

02 and sample volume are displayed on the
2D image, with the transducer switched
to Doppler only during data recording.

PULSE DOPPLER
03
Variations of the pulsed Doppler
principle are used to generate color
Doppler flow images and tissue Doppler
recordings
 Color Doppler uses the pulsed Doppler
01 principle to generate a 2D image or
“map” of blood flow velocity
superimposed on the 2D real-time image

02
However, rather than one sample volume
depth along the ultrasound beam,
multiple sample volumes are evaluated
COLOR DOPPLER along each sampling line

FLOW
03
Color Doppler is most useful for
visualization of spatial flow patterns; for
this purpose, examiner preference
determines the most appropriate color
scale.
03

CLINICAL
APPLICATIONS
 Transabdominal ultrasound provides a

01 panoramic view of the abdomen and pelvis and

is noninvasive, whereas TVU provides a more
limited pelvic view and requires insertion of a
probe into the vagina.

02
The image generated by transvaginal
ultrasound provides a better view of the uterus
and adnexa during early pregnancy. The

TRANSABDOMINAL &
transabdominal study requires a full bladder for
optimal visualization of pelvic structures.

TRANSVAGINAL Transabdominal ultrasound cannot reliably

ULTRASOUND 03 diagnose pregnancies that are < 6 weeks'

gestation. Transvaginal ultrasound, by
contrast, can detect pregnancies earlier, at
approximately 4 ½ to 5 weeks' gestation.
Prompt diagnosis made possible by TVU can,
therefore, result in earlier treatment.
 01 Transthoracic echocardiography is one
of the most commonly performed
cardiac investigations.

TRANSTHORACIC
02
The echocardiographic examination is
ECHOCARDIOGRAM performed by a physician or by a trained
cardiac sonographer under the
supervision of a qualified physician.
 Offers the advantage of improved image
01 quality compared to transthoracic
images, particularly of posterior
structures, such as the pulmonary veins,
left atrium (LA), and mitral valve

02
Image quality is improved both because of
the decreased distance between the
transducer and the structures of interest
and because of the absence of
TRANSESOPHAGEAL intervening lung or bone tissue.

ECHOCARDIOGRAPHY
03
However, TEE imaging is more risky than
transthoracic imaging because of the
insertion of the probe in the esophagus
and the need for conscious sedation in
most patients.
04

RECENT
ADVANCES
 The physics of 3D imaging are very

01
similar to those of 2D imaging, and
issues like beam width, resolution,
and frame rate affect both
approaches

Often 3D imaging focuses on a

3D DIMENSIONAL 02
particular structure of interest, such
as a prolapsing mitral valve or an
atrial septal defect. A systemic 3D
study has not yet become routine.
 Contrast echocardiography refers to the
injection into the bloodstream of an agent that

01 results in increased echogenicity of the blood

or myocardium on ultrasound imaging,
producing opacification of the cardiac
chambers or an increase in echo density of the
myocardium.

Contrast echocardiography has four

02 proposed diagnostic applications:
• Detection of intracardiac shunts
• Enhancement of Doppler signals

CONTRAST
• LV opacification
• Myocardial perfusion
ECHOCARDIOGRAPHY
03
Use of pharmacologic contrast requires a
physician order, is restricted to studies
where improved endocardial definition is
necessary, and should be avoided in high-
risk patients.
 01
Intracardiac echocardiography uses a
catheter-like ultrasound probe that is
passed into the right heart chambers
from the femoral vein

Intracardiac echocardiography is primarily

02 utilized for monitoring invasive
procedures, although the diagnostic
potential of this modality has not been
INTRACARDIAC fully evaluated.

ECHOCARDIOGRAPHY
03 The major limitations of intracardiac
echocardiography are cost and the risks
of an invasive procedure.
 01
The term “point-of-care”
echocardiography refers to the bedside
use of small, lightweight ultrasound
systems.

02 Point-of-care ultrasound may be a useful

tool in patient triage, in screening
populations, and in medical education

POINT-OF-CARE Accurate use of these imaging devices

ECHOCARDIOGRAPHY
03
requires appropriate training and
experience in cardiac ultrasound. The
greatest limitation of these instruments is
a missed diagnosis due to an
inexperienced operator or suboptimal
image quality
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