Clinical Echocardiography

The Echocardiography section offers a detailed exploration of this fundamental diagnostic modality used across the spectrum of cardiovascular conditions. This resource provides a thorough understanding of both the fundamental techniques and the advanced applications of echocardiography. Each topic is complemented by self-assessment cases to enhance the learning process.

Echocardiography

Physics of ultrasound

Basic sound and ultrasound physics Unlike light waves, which can propagate through vacuum, sound waves can only propagate through a

Echocardiography

The ultrasound transducer

The ultrasound transducer & piezoelectric crystals The ultrasound transducer generates ultrasound (ultrasonic) waves. The transducer is held with one hand

Echocardiography

Technical aspects of the ultrasound image

Generating the ultrasound image The ultrasound transducer generates short bursts (pulses) of ultrasound waves. Reflected ultrasound waves are analyzed by

Echocardiography

Two-dimensional (2D) echocardiography

Echocardiography in 2D Two-dimensional (2D) ultrasound is the most commonly used modality in echocardiography. The two dimensions presented are width

Echocardiography

Optimization of the ultrasound image

Principles of image optimization in echocardiography In order to obtain optimal ultrasound images, it is necessary to adjust several parameters

Echocardiography

M-mode (motion mode) echocardiography

M-mode echocardiography M-mode was previously the dominating modality in echocardiography. Although it has now largely been replaced by 2D echocardiography,

Echocardiography

Doppler effect and Doppler echocardiography

The Doppler effect When sound waves hit objects some of the sound waves are reflected back to the sound source.

Echocardiography

Pulsed Wave Doppler

Pulsed Wave Doppler The pulsed wave Doppler (PW Doppler) sends short pulses of ultrasound and analyzes reflected sound waves between

Echocardiography

Continuous Wave Doppler (CW Doppler)

Continuous Wave Doppler In continuous wave Doppler (CW Doppler), ultrasound waves are continuously emitted from the transducer and the reflections

Echocardiography

Color Doppler

Color Doppler Velocities recorded in a sample volume of the pulsed wave Doppler can be presented with a color. A

Echocardiography

Tissue Doppler (Tissue Velocity Imaging)

Tissue Doppler (Tissue Velocity Imaging) Previous chapters on Doppler imaging have all focused on measurements of blood flow. However, the

Echocardiography

Artifacts in ultrasound imaging

Ultrasound artifacts The following artifacts are common in ultrasound imaging: The ultrasound image displays non-existing structures. The ultrasound image does

Echocardiography

Hemodynamic principles and calculations

Calculation of hemodynamic parameters by ultrasound Hemodynamics is the study of blood flow dynamics. The physical laws that govern blood

Echocardiography

The Bernoulli principle and estimation of pressure gradients

The Bernoulli principle and pressure gradients using Doppler measurements Continuous wave Doppler and pulsed wave Doppler can measure the velocity

Echocardiography

The Continuity Equation (The Principle of Continuity)

The Continuity Equation: What Goes In Must Come Out As previously discussed, stroke volume is usually calculated by measuring area

Echocardiography

Stroke Volume, VTI (Velocity Time Integral) & Cardiac Output

Principles of flows and volumes in the heart If the flow in a cylinder is constant, then flow (Q) is

Echocardiography

Proximal Isovelocity Surface Area (PISA)

Hemodynamic calculations with PISA (Proximal Isovelocity Surface Area) PISA (Proximal Isovelocity Surface Area) is a phenomenon that occurs when liquid

Principles and Preparations for Echocardiographic Examinations

The echocardiographic examination The use of echocardiography has increased dramatically during the past few decades. Advances in echocardiography have been

Echocardiography

Performing Echocardiographic Examinations

Principles of echocardiographic examinations In small children, it is possible to perform the entire transthoracic echocardiography (TTE) with the child

Figure 1. Echocardiographic windows to obtain images.

Echocardiography

Standard Transthoracic Echocardiogram: Complete Imaging Protocol

The standard transthoracic echocardiographic examination This chapter presents a sequential series of images that comprise a complete standard echocardiographic examination.

Left Ventricular Function

Left ventricular function and its echocardiographic assessment Cardiac function depends on a large number of parameters, including atrial function, valvular

Figure 1. Layers of the left ventricular wall, pericardium and ventricular cavity.

Echocardiography

Myocardial Mechanics: Structure and Function of Myocardial Fibers

Structure and contractile function of myocardial fibers The left ventricular wall can be subdivided into several layers. These layers are

Figure 1. Left ventricular pressure-volume relationship during a single cardiac cycle.

Echocardiography

Ventricular Pressure-Volume Relationship: Preload, Afterload, Stroke Volume, Wall Stress & Frank-Starling’s law

Ventricular Pressure-Volume Relationship Left ventricular pressure-volume relationship can be described by a loop diagram with volume depicted on the x-axis

Figure 1. Calculation of stroke volume in LVOT.

Echocardiography

Assessing left ventricular systolic function

Methods for assessing systolic function (contractile function) Several echocardiographic measurements are available to assess left ventricular systolic function. These methods

Echocardiography

Left ventricular mass and volume (size)

Size and mass of the left ventricle Left ventricular mass is a flawed proxy for ventricular systolic function and load.

Echocardiography

Ejection fraction (EF): Physiology, Measurement & Clinical Evaluation

Ventricular ejection fraction (EF) For several decades, ejection fraction (EF) has been the dominating method for assessing left ventricular systolic

$Figure 1. Calculation of fractional shortening.$

Echocardiography

Fractional shortening for estimation of ejection fraction

Fractional shortening (FS) for estimating systolic function Fractional shortening (FS) is calculated by measuring the percentage change in left ventricular

Figure 1A-2C. Orientation of myocardial muscle fibers result in longitudinal, radial and circumferential shortening (contraction).

Echocardiography

Strain, strain rate and speckle tracking: Myocardial deformation

Myocardial deformation: strain, strain rate, speckle tracking As previously discussed, the left ventricular wall can be subdivided into three layers:

Echocardiography

Left Ventricular Segments for Echocardiography and Cardiac Imaging

Standardized myocardial segmentation for echocardiography and cardiac imaging Cardiovascular imaging modalities have developed rapidly in the past few decades. The

ECG

The Coronary Arteries

Coronary arteries and arterial territories The two main coronary arteries emanate from the aortic bulb (Figure 1): The right coronary

Echocardiography

Regional Myocardial Contractile Function: Wall Motion Abnormalities

Echocardiographic assessment of regional contractile function Systolic ventricular function is one of the strongest predictors of total and cardiovascular mortality.

Myocardial motion during systole and diastole.

Echocardiography

Left ventricular diastolic function

Diastolic function and echocardiographic assessment The importance of systolic function can be understood on an intuitive basis. Consider the fact

Relaxation of the left ventricle

Myocardial relaxation and left ventricular diastolic function Diastolic function is determined by the efficiency of myocardial relaxation. The degree and

Figure 1. Measurement of mitral inflow velocities.

Echocardiography

Assessment of diastolic function by echocardiography

Echocardiographic assessment of left ventricular diastolic function Methods for evaluating left ventricular diastolic function have evolved considerably in the past

Echocardiography in cardiomyopathies: an overview

Definition and types of cardiomyopathies Cardiomyopathy implies that the myocardium is structurally and functionally altered, and the pathological changes are

Figure 1. Types of left ventricular hypertrophy. Left ventricular volume is reduced in concentric hypertrophy. Eccentric hypertrophy results in increased ventricular volume.

Echocardiography

Hypertrophic Cardiomyopathy (HCM) & Hypertrophic Obstructive Cardiomyopathy (HOCM)

Hypertrophic cardiomyopathy (HCM): from pathophysiology to echocardiography Hypertrophic cardiomyopathy is a genetic disorder that causes left ventricular hypertrophy under normal

Dilated Cardiomyopathy (DCM): Definition, Types, Diagnostics & Treatment

Dilated cardiomyopathy (DCM) Dilated cardiomyopathy (DCM) is defined as dilation of one or both ventricles. Dilation of the left ventricle

Figure 1. Epsilon wave and TAD on the electrocardiogram.

Echocardiography

Arrhythmogenic Right Ventricular Cardiomyopathy / Dysplasia (ARVC, ARVD)

Arrhythmogenic Right Ventricular Cardiomyopathy / Dysplasia (ARVC, ARVD) Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is considered a genetic cardiomyopathy that predominantly

Tachycardia induced cardiomyopathy

Cardiomyopathy caused by tachycardia A prolonged tachycardia can cause cardiomyopathy with left ventricular dilation. This type of cardiomyopathy, referred to

Tricuspid stenosis

Tricuspid valve stenosis Tricuspid stenosis is a rare condition that may be caused by rheumatic valvular disease, congenital heart disease,

Echocardiography

Tricuspid regurgitation (TR/TI)

Tricuspid regurgitation The tricuspid valve separates the right ventricle and the right atrium. It normally consists of three leaflets (anterior,

Pulmonary stenosis

Pulmonary (pulmonic) stenosis Pulmonary stenosis is virtually always a consequence of congenital heart disease. The stenosis can be fixed or

Pulmonary regurgitation

Pulmonary (pulmonic) regurgitation Pulmonary regurgitation is also called pulmonic regurgitation. The majority of all adults exhibit a small pulmonary regurgitation, which

Echocardiography

Mitral valve stenosis

The mitral valve The mitral valve separates the left atrium and the left ventricle. The valve is attached to the

Echocardiography

Mitral regurgitation

Mitral regurgitation Causes of mitral regurgitation The most common cause of mitral regurgitation in high-income countries is age-related degeneration of

Figure 1. The aortic valve visualized in PSAX (parasternal shortaxis view).

Echocardiography

Aortic stenosis

Aortic stenosis The aortic valve area is normally 3.0 to 4.0 cm2. Aortic stenosis is a progressive disease that leads

Echocardiography

Aortic regurgitation

Aortic regurgitation Aortic regurgitation implies that the aortic valve leaks during diastole, such that blood regurgitates back from the aorta

Echocardiography

Congenital heart disease & GUCH (Grown Up Congenital Heart disease)

Echocardiography in Congenital Heart Disease (CHD) and Grown Up Congenital Heart (GUCH) disease Survival in congenital heart disease (CHD) has

Walls of the left ventricle and coronary artery supply.

Echocardiography

Cardiac thromboembolism: cardiac sources of embolism

Cardiac thromboembolism Thromboembolism is a leading cause of death worldwide (1). Emboli originating in the atria, left atrial appendage (LAA),

Endocarditis: definitions, causes, diagnosis, echocardiography & treatment

Endocarditis Endocarditis implies that a bacterial infection engages the heart valves and this is a serious condition. The focus of

Online medical education

Learn more.

We are dedicated to empowering clinicians with the most current, in-depth knowledge in cardiovascular medicine. Our platform offers a unique blend of expert insights, e-books, revision resources, and practical tools, designed to enhance your clinical practice and patient care. Join our community of dedicated healthcare professionals and elevate your practice evidence-based cardiovascular medicine.