Apical 4 chamber view

Module 1: How TTE images are created

Module 1: How TTE images are created - Overview

Sound and ultrasound
Definitions
The characteristics of waves
Wavelength
Frequency
Amplitude
Propagation velocity
The effects of tissue on ultrasound
Reflection
Refraction
Scatter
Attenuation
Effects of Ultrasound on Tissue
Imaging modalities: how ultrasound images are created
Generation of a 2D image
Resolution
Doppler imaging
Principles of Doppler imaging
Modes of Doppler Imaging: overview
Pulsed Wave Doppler Imaging
Spectral Display
Color Doppler Imaging
Tissue Doppler Imaging
Continuous Wave Doppler
M mode
3D Imaging
Strain
Ultrasound Transducers - Piezoelectric Crystals
Ultrasound Transducer Design
Imaging artifacts: overview
Degraded image
Missing structures
Erroneously perceived structures
Mislocated structures
Summary

Module 2: TTE probe manipulation and imaging planes

Module 2: TTE probe manipulation and imaging planes - Overview

Probe manipulation
Patient and probe positioning
Image orientation
Conventional imaging planes
Parasternal imaging
Parasternal long axis - PLAX
Parasternal long axis - RV inflow
Parasternal long axis - RV outflow
Parasternal short axis - pulmonary bifurcation
Parasternal short axis - pulmonic valve (PSAX-PV)
Parasternal short axis - aortic valve (PSAX AV)
Parasternal short axis - mitral valve (PSAX MV)
Parasternal short axis - left ventricle mid papillary (PSAX LV mid)
Parasternal short axis - left ventricle apex (PSAX LV apex)
Right parasternal long axis
Apical imaging planes
Apical 4 chamber (A4C)
Apical 5 chamber (A5C)
Apical 2 chamber (A2C)
Apical 3 chamber (A3C)
Apical 4 chamber - RV focussed
Subcostal imaging planes
Subcostal 4 chamber (SC4C)
Subcostal short axis
Subcostal inferior vena cava
Suprasternal imaging planes
Suprasternal long axis
Suprasternal short axis

Module 3: Measurements, calculations and reference values

Module 3: Measurements, calculations and reference values - Overview

Stroke Volume
Ejection Fraction: Modified Simpson's Calculation
Velocity
Gradient: the modified Bernoulli equation
Fractional Shortening
Fractional Area Change
Right Ventricular Systolic Pressure & Pulmonary Artery Systolic Pressure
Shunt Ratio
dP/dt
Pressure half time
Mitral Valve Area by Pressure Half Time
Aortic regurgitation assessment by pressure half time
Continuity equation
PISA: Proximal Isovelocity Surface Area
Regurgitant Orifice Area
Regurgitant Volume
Vena Contracta
Reference values
Chambers
Left Ventricle
Right Ventricle
Atria
Valves
Mitral Valve
Aortic Valve
Pulmonic Valve
Aorta
Coronary Sinus
Summary

Module 4: Mitral valve

Module 4: Mitral valve - Overview

Anatomy
Annulus
Aorto-mitral continuity
Leaflet structure
Leaflet function
Cords
Primary, secondary and tertiary cords
Papillary muscles
TTE views
Parasternal long axis view
Parasternal short axis view - MV
Apical 4 chamber view
Apical 5 chamber view
Apical 3 chamber view
Apical 2 chamber view
Subcostal 4 Chamber View
Subcostal short axis view - MV
Mitral regurgitation - MR
Mechanisms - MR
Mitral regurgitation with normal leaflet motion - MR
Mitral regurgitation with excessive leaflet motion - MR
Mitral regurgitation with restricted leaflet motion - MR
Grading severity - MR
Spectral doppler - MR
Flow convergence - MR
Vena contracta - MR
Mitral stenosis
Mechanisms - MS
Spectral Doppler assessment - MS
2D assessment MS
Quantification - MS
Conclusion
Suggested simulator work

Module 5: Aortic valve

Module 5: Aortic valve - Overview

Aortic stenosis
Anatomy
Aortic regurgitation
Aortic valve area
Introduction
The aortic valve annulus
The sinuses of valsalva
The aortic valve leaflets
The commissures
Aorto-mitral continuity
TTE views
Parasternal long axis view
Parasternal short axis - aortic valve view
Apical 5 chamber view
Apical 3 chamber view
Right parasternal long axis view
Suprasternal notch long axis view
Mechanisms
Calcific aortic stenosis
Bicuspid aortic stenosis
Rheumatic aortic stenosis
Quantification
Velocity & gradient
Dimensionless index
Grading Severity
Mechanisms
Leaflet abnormalities
Root dilation
Quantification
Jet / LVOT width
Continuous wave doppler assessment
Descending aorta flow reversal
Vena contracta
Regurgitant volume, fraction & orifice area
Left ventricular size & function
Grading severity
Summary

Module 6: Left ventricle

Module 6: Left ventricle - Overview

Wall thickness
Assessment
Fractional shortening
Ejection fraction
Anatomy
Gross anatomy
Segmental anatomy
Blood supply
TTE views
Parasternal long axis view
Parasternal short axis view - MV
Parasternal short axis view - LV midpapillary
Parasternal short axis view - LV apex
Apical 2 chamber view
Apical 3 chamber view
Apical 5 chamber view
Subcostal 4 chamber view
Subcostal short axis view - LV midpapillary
Dimensions
LV internal diameter
Chamber volume
Left ventricular mass
Systolic function
Global systolic function
Fractional area change
Tissue Doppler imaging
Strain imaging
Regional systolic function
Diastolic function
? add something on 3D
Cardiomyopathies
Ischemic cardiomyopathy
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Amyloid heart disease
Takotsubo cardiomyopathy
Conclusion
Test
Suggested simulator work
Apical 4 chamber View

Module 7: Right ventricle

Module 7: Right ventricle - Overview

Anatomy
Gross Anatomy
Inlet portion
Apical Trabecular Component
Outlet portion
Blood Supply to the Right Ventricle
TTE Views
Parasternal Long Axis View
Parasternal RV Inflow View
Parasternal Short Axis View
Apical 4 chamber view
Subcostal 4 chamber view
Assessment of the right ventricle
Dimensions
Systolic function
Right Ventricle Index of Myocardial Performance (RIMP)
Tricuspid Annular Plane Systolic Excursion (TAPSE)
Pulmonary artery systolic pressure
Fractional Area Change (FAC)
RV dP/dt
Strain imaging
Diastolic function
Grading RV diastolic function
Tricuspid Valve Inflow
Tricuspid Annular Velocity
Grading Severity
Pathology
Volume Overload
Pressure Overload
Intrinsic Disease
Conclusion
Test
Suggested Simulator Work

Module 8: Aorta

Module 8: Aorta - Overview

PLAX
Intraaortic balloon pump
Pathology (atheroma, dissection, aneurysm, coarctation, IABP)
Aortic aneurysm
Atheromatous disease
Coarctation
Aortic dissection
Anatomy
SSN LAX

Module 9: Tricuspid valve

Module 9: Tricuspid valve - Overview

Quantification
Tricuspid valve
Tricuspid regurgitation
Tricuspid stenosis
A4C
Anatomy
PLAX - RV Inflow
Mechanisms
Primary leaflet abnormality
Secondary (functional)

Module 10: Pulmonary valve

Module 10: Pulmonary valve - Overview

Anatomy
Pulmonary Valve Area
TTE Views
Parasternal Short Axis View
Congenital
Acquired
Pulmonary Regurgitation
Mechanisms
Quantification
PR jet size and Vena Contracta
EROA and Regurgitant Volume
PR Index
Pressure half time
Diastolic flow Reversal
Grading Severity
Pulmonary stenosis
Mechanisms
Quantification
Pressure gradient
RV systolic pressure
Grading severity
Conclusion

Module 11: Other structures

Module 11: Other structures - Overview

Left atrium assessment
Left atrial appendage
Pulmonary veins
Pulmonary venous flow
Right atrium assessment
SVC and IVC
Eustachian valve and crista terminalis
Coronary sinus
Atrial septum
Pericardium

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