BASIC ECHOCARDIOGRAPHY

2D and M Mode

Cardioloy Div, Dept of Internal Med

Cipto M National Gen Hospital
FM-UI

The Modalities of Echo

The following modalities of echo are used clinically:
1. Conventional echo
Two-Dimensional echo (2-D echo)
Motion- mode echo (M-mode echo)
2. Doppler Echo
Continuous wave (CW) Doppler
Pulsed wave (PW) Doppler
Colour flow(CF) Doppler

All modalities follow the same principle of ultrasound

Differ in how reflected sound waves are collected and analysed

Two-Dimensional Echo
(2-D echo)
This technique is used to
"see" the actual structures
and motion of the heart
structures at work.
A 2-D echo view appears
cone-shaped on the monitor.

M-Mode echocardiography
An M- mode echocardiogram is not
a "picture" of the heart, but rather
a diagram that shows how the
positions of its structures change
during the course of the cardiac
cycle.
measurement of cardiac
dimensions and motion patterns.
Also facilitate analysis of time
relationships with other
physiological variables such as
ECG

Cardiac Window
1.Parasternal window
2. Apical window
3. Subcostal window
4. Suprasternal
window

Parasternal Long-Axis View

(PLAX)
Transducer position: left
sternal edge; 2nd 4th
intercostal space
Most echo studies begin
with this view

PLAX View
(Base of the heart to apex),
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

R
V
LV

AO
LA

PLAX View
(Base of the heart to apex),
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

15

Patternofnormalaorticflow

PLAX-

M Mode (1)

PLAX View-

M Mode (1) - Abnormal

PLAX View
(Base of the heart to apex),
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-

-DE Excursion
- EF slope
-EPSS

M Mode (2)

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)

Wallthickessofleftventricle

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.

Left ventricle - systolic function

FRACTION SHORTHENING

EJECTION FRACTION

FS = EDD ESD/EDD
EF = EDV-ESV / EDV x 100 %

PLAX View -

M Mode (3)

PLAX View -

M Mode (3) Abnormal

Decreasedcontractilityincoronary
heartdisease

Pericardialeffusion

AV Groove

Pericardial

GradingPericardial
Effusion
(1) small (echo-free space in diastole <10

mm)
(2) moderate (at least >=10 mm
posteriorly),
(3) large ( >=20 mm), or
(4) very large ( >=20 mm and compression
of the heart).

37

Parasternal Short Axis View

(PSAX)
Transducer position: left sternal
edge; 2nd 4th intercostal space
Marker dot direction: points
towards left shoulder
(900 clockwise from PLAX view)
By tilting transducer on an axis
between the left hip and right
shoulder, short axis views are
obtained at different levels, from
the aorta to the LV apex.

PSAXView
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

PSAX2DViewBasalLevel

PSAX2DViewMidLevel

PSAX2DViewApicalLevel

PSAXView
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

PSAXMModeBasalLevel

PSAXMModeViewMidLevel

PSAXViewApicalLevel

RADIAL WALL MOTION ABNORMALITIES

REGIONAL WALL MOTION

54

ApicalViews

4-chamber (A4C)
2-chamber (A2C)
5-chamber (A5C)

Apical 4-Chamber View

(AP4CH)
Transducer position:
apex
Marker dot direction:
points towards left
shoulder
The AP5 CH view is
obtained from this view
by slight anterior
angulation of the
transducer towards the
chest wall. The LVOT
can then be visualised

Left ventricle - systolic function

AREA LENGTH
4 CHAMBER VIEW
LV VOLUME SISTOLIK &
DIASTOLIK
SIMPSONS METHOD
4 CHAMBER
2 CHAMBER
LV VOLUME SISTOLIK
& DIASTOLIK

LVEFAreaLength(AL)

Apical 2-Chamber View

(AP2CH)
Transducer position: apex of
the heart
Marker dot direction: points
towards left side of neck (450
anticlockwise from AP4CH
view)
Good for assessment of
LV anterior wall
LV inferior wall

TAPSE
( Tricuspid Annular Plane Systolic
Excursion)

Apical 4-Chamber View (AP4CH)

abnormal

ApicalViews:5chamber(A4C)

SubCostal 4 Chamber
View
Transducer position:
under the xiphisternum
Marker dot position: points towards
left shoulder
The subject lies supine with head
slightly low (no pillow). With feet on
the bed, the knees are slightly
elevated
Better images are obtained with the
abdomen relaxed and during
inspiration
Interatrial septum, pericardial
effusion, desc abdominal aorta

SubcostalWindow
The short axis views

DilatedIVC

Estimation of Pulmonary Pressure

RA pressure
IVC size

Suprasternal View
Transducer position:
suprasternal notch
Marker dot direction:
points towards left jaw
The subject lies supine with
the neck hyperexrended. The
head is rotated slightly
towards the left

IT SHOULD BE EMPHASIZED THAT

IDENTIFICATION & MEASUREMENTS OF
SOME OF THE STRUCTURES LISTED
MAY NOT ALWAYS BE NECESSARY TO
PROVIDE COMPREHENSIVE &
CLINICALLY RELEVANT REPORT

Thank You