Hello welcome everybody, this is Dr. Bolad, board certified physician in Cardiology,
Interventional Cardiology and Internal Medicine. I am here to help you with all the information
you need for your heart health and informing you about all the latest treatments in cardiology.
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Ultrasound scan of the heart also known as echocardiogram, is a very common and
routine cardiac test that is performed regularly on patients with heart disease.
It evaluates the heart anatomy and heart function. There are two types of echocardiography,
the first is done by putting a transducer on the chest wall over the heart
this is known as trans-thoracic echocardiography. The second type is done by sedating the patient
and passing an ultrasound transducer down the esophagus to the back of the heart
for clear evaluation of the cardiac structures and function. This is known as trans-esophagial
echocardiography. Today I will be talking to you about the trans-thoracic echocardiography,
the modalities that we perform by putting the ultrasound transducer probe on the chest wall
over the heart and it is often used as a first-line cardiac imaging modality
owing to its wide availability and non-invasiveness and lack of radiation exposure.
Using this technique we obtain two-dimensional echo information generally known as 2D echo,
in addition to Doppler blood flow information generally known as Doppler echo. I will
concentrate on the two-dimensional echo in this video. In performing the procedure the patient is
brought to the echo laboratory and placed on an examination table in the supine position.
The echo transducer is then applied to the chest wall over the heart and the transducer is moved
to different positions on the chest to acquire different pictures of the heart from different
locations. Most labs follow the recommendations of the American Society of Echocardiography
with respect to image display with the transducer position depicted at the top of the screen, with
the heart anatomy more distant from the transducer and shown at the lower region of the display, with
the lateral or the left structures to the right of the screen and the medial or the right structures
to the left of the screen. I will now talk about the different ultrasound transducer positions
that we routinely use during echocardiography. The first position is what we label as parasternal
long axis view. The ultrasound transducer is placed in the third or fourth left intercostal
space. This is the image that we first get. As seen in this video and as i point with the arrow
the aortic valve is in the center of the screen with the right and posterior cusps shown then you
can see immediately to the right of the valve a slight dilatation known as the sinuses of Valsalva
and more to the right of it is the aorta, which is displayed as a tubular structure. I then zoom out
and you can still see the aortic valve and the aorta and in addition you see the left atrium,
the mitral valve with the anterior mitral valve leaflet and the posterior mitral
valve leaflet. On the top of screen you see the right ventricle and you can see the septal wall
of the left ventricle and the inferior lateral wall of the left ventricle
Then I rotate my transducer 90 degrees and I get what we call as a parasternal
short axis view. This is how it looks like.
In the center of the screen you see the aortic valve. The normal aortic valve has three leaflets,
you can see the right cusp here, the posterior cusp here and the left cusp here. Just above that
you see the pulmonary valve and on the left of the screen you see the right ventricle and the
tricuspid valve and the right atrium and above and to the right the pulmonary artery. Then I tilt my
probe to concentrate on the mitral valve. In this view I see the right ventricle, the left ventricle
which looks like a circle in this short axis view and the mitral leaflets with the anterior leaflet,
the posterior leaflet displayed in the middle of the circle.
Then I angle my transducer slightly to the left ventricle at the level of the papillary muscles
with the left ventricle still looking circular in this view. At this time I need to focus on getting
a good assessment of the right side of the heart and I tilt my echo transducer to the right side
and here I can see the posterior leaflet of the tricuspid valve, the anterior leaflet,
the anterior wall of the right ventricle and the inferior wall of the right ventricle and here is
the right atrium. Then I move my transducer to the apex of the heart to get what we call the apical
4 chamber views. This is how it looks like with the left side of the heart displayed on the right
side of the screen and the right side of the heart displayed on the left side of the screen.
You can see here the left atrium, the mitral valve, the left ventricle,
the right ventricle and the right atrium. In this view I then zoom into individual chambers
to assess them and perform measurements . Here I concentrate on the left ventricle and assess
its walls and you can also see clearly the anterior leaflet of the mitral valve and
the posterior leaflet of the mitral valve. I then tilt my probe slightly to change the angle and be
able to assess the aortic valve. I then tilt my transducer to get the apical 2 chamber views
in which only the left ventricle and the left atrium are displayed. Then I tilt
my probe to see the apical 3 chamber view as can be seen here with the left atrium,
the anterior mitral valve leaflet, the posterior mitral valve leaflet, the aortic valve and
the left ventricle with its different walls. From here I move my probe to the lower part
of the chest and perform the subcostal views, I first get a view of the inferior vena cava
to assess whether it is dilated or not as can be seen here. I then tilt my probe to view the heart
from this subcostal position. You can see here the inter-atrial septum, the tricuspid valve,
the right atrium, the right ventricle, the left ventricle and the left atrium
During my echo examination I get information about the size of the heart chambers about the
regioanl abnormalities of the heart chambers and information about the heart valves. In addition,
I use Doppler ultrasound imaging to evaluate the flow of blood through the heart valves.
I also perform tissue Doppler imaging specialty evaluate excursion of the tissue at the tricuspid
valve and the mitral valve levels. I will talk about the echo Doppler evaluations and
the tissue Doppler imaging in another video. If you have any question about what I presented
you today or any cardiology question in general, then subscribe to my channel
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this is Dr. Bolad helping you with your heart health, thanks for watching and talk to you soon.
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