M-MODE ECHOCARDIOGRPHY THE LOSS ART. M-MODE PHYSICS B mode echoes from an interface that changes...

M-MODE ECHOCARDIOGRPHY

THE LOSS ART

M-MODE PHYSICS

B mode echoes from an interface that changes position will be seen as echoes moving towards and away from the transducer.

If a trace line is place on this interface and the resulting trace is made to drift across the face of a CRT screen a motion pattern is obtained.

M-MODE PHYSICS

The resulting display shows motion of a reflector over distance and time – a distance time graph

The change in distance (dy) over a period of time dt is represented by the slope of the reflector line of motion.

dy/dt = slope = velocity

M-MODE PHYSICS

If this motion pattern is obtained on moving cardiac structures then the resulting images constitute M-mode echocardiography.

M-mode echocardiography is use to evaluate the morphology of structures, movement and velocity of cardiac valves and walls and timing of cardiac events.

Distance

Time

M-mode Tracing

M-mode Evaluation

Amplitude

Velocity

Time intervals

Morphology

Amplitude = Y2 –Y1

Y1

Y2

Amplitude Measurement

Distance

Time

Time interval = T2 – T1

T2T1

Time Measurement

Distance

Time

dy = Y2 –Y1

Y1

Y2

Slope Measurement

T1 T2

dt = T2 – T1

Slope = dy/dt = velocity

M-mode at the Mitral Valve

The mitral valve has 2 leaflets – anterior and posterior.

Specific letters corresponding to systole and diastole are assigned to the m-mode tracing of the mitral valve.

EKG Tracing

T-wave

QRS complex

P wave

Systole Diastole

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

Phase of Cardiac Cycle Assigned Letters

Diastole d,e,f, and a

Systole c and d

M-mode at the Mitral Valve

Systole

M-mode at Mitral Valve

Diastole

dc

a

f

e

d

Time

Distance

Systole

M-mode at Mitral Valve

Diastole

e

d Time

Distanced-e amplitude

Systole

M-mode at Mitral Valve

Diastole

Septum

e

Time

DistanceEPSS

Systole

M-mode at Mitral Valve

Diastole

e

d Time

Distanced-e slope

Systole

M-mode at Mitral Valve

Diastole

f

e

Time

Distancee-f slope

M-mode at Mitral Valve

M-mode at the Mitral Valve

Amplitude DescriptionNormal Value

EPSS Measure e point to septal separation

< 5 mm

d-e Measures the maximum excusion of the mitral valve following diastolic opening.

17 to 30 mm

M-mode at the Mitral Valve

Slope Description Normal Value

d-e Measure rate of initial opening of the mitral valve in early diastole.

240 to 380 mm/s

e-f Measures the rate of early closure of the mitral valve following diastolic opening.

50 to 180 mm/s

M-mode Findings at the MV

B- bump on the AC shoulder

Premature Closure of the MV

Systolic anterior motion of the AMVL

Mitral Valve Prolapse

Mitral Regurgitation

M-mode Findings at the MV

Flail PMVL

Fluttering of the AMVL

Mitral Stenosis

LA myxoma

Vegetations

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

B-bump on theAC shoulder.

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

Premature Closure

Premature Closure- closureon or before the onset of theQRS complex.

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

Systolic anterior motion of the AMVL

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

Systolic anterior motion of the AMVL

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

MV prolapse posterior leaflet

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

MV Prolapse – both leaflet

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

Flail posterior leaflet

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

Aortic Regurgitation

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

Sinus Rhythm

Mitral Stenosis

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

Atrial Fibrillation

Mitral Stenosis

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

Atrial Myxoma

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

Vegetation

Distance

SystoleDiastole

Time

Mitral Regurgitation

Distance

SystoleDiastole

Time

Mitral Regurgitation

Distance

Systole

Mitral Regurgitation

Diastole

Time

Atrial Myxoma

Distance

SystoleDiastole

Time

Atrial Myxoma

Mitral Regurgitation

Distance

Systole

M-mode at Mitral Valve

Diastole

Time

Atrial Myxoma

Color M-mode

Color M-mode

Propagation Velocity, Vp

M- Mode

Aortic Valve

M-mode at the Aortic Valve

The aortic valve has 3 cusps – right coronary, left coronary and non-coronary cusps.

The cusps imaged in the PLAX view are the right coronary and the non-coronary cusps.

M-mode at the Aortic Valve

Coronary cusp

Non-coronary cusp

Anterior aortic root

Posterior aortic root

Left Atrium

M-mode at the Aortic Valve

LA dimension

Cusp SeparationAortic root

M-mode at the Aortic Valve

LA dimension

Cusp SeparationAortic root Measurements are made from leading edge to leading edge.

M-mode at the Aortic Valve

Dilated LA

Dilated aortic root

Decreased excursion

Premature opening

Premature closing

Exaggerated anterior motion of Aortic Root

M-mode at the Aortic Valve

Reduced anterior motion of Aortic Root

Thickening

Calcification

Vegetations

Bicuspid valve

Prosthetic valve

Aortic Regurgitation

M-mode at the Aortic Valve

Premature Opening

Opening of the AV before the onset of the QRS complex

Seen in Elevated LV-EDP

M-mode at the Aortic Valve

Premature Closure

Closure of the AV before the onset of the T wave

Seen in IHSS

M-mode at the Aortic Valve

Bicuspid Valve

Eccentric closure line

Seen when there is a Bicuspid aortic valve

M-mode at the Aortic Valve

Decreased Cusp Separation

Seen in Aortic Stenosis

M-mode at the Aortic Valve

Seen in aortic sclerosis

Thickened, calcified aorticvalve leaflet.

M-mode at the Aortic Valve

Seen in Mitral Stenosis

Reduced anterior motion of aortic root

M-mode at the Aortic Valve

Exaggerated anterior motion of aortic root

Seen in Mitral Regurgitation

Aortic Regurgitation

Aortic Regurgitation

Aortic Regurgitation

M - Mode

Left Ventricle

M-mode at Left Ventricle

M-mode at Left Ventricle

Thickening of the IVS and LVPW

Movement of the IVS and LVPW

• RVWd

• RVIDd

M-mode Measurement

• IVSd

• IVS excursion

• IVSs

M-mode Measurement

• LVIDd

• LVIDd index

• LVIDs

• LVIDs index

M-mode Measurement

• LVPWd

• LVPW excursion

• LVPW max excursion velocity

• LVPWs

M-mode Measurement

M-mode at Left Ventricle

RVWT

M-mode at Left Ventricle

RVIDd

M-mode at Left Ventricle

IVSd

M-mode at Left Ventricle

LVIDd

M-mode at Left Ventricle

LVPWd

M-mode at Left Ventricle

IVS excursion

M-mode at Left Ventricle

IVSs

M-mode at Left Ventricle

LVIDs

M-mode at Left Ventricle

LVPWs

M-mode at Left Ventricle

LVPW excursion

M-mode at Left Ventricle

LVPW max velocity= slope

M-mode at Left Ventricle

• FS

• EF

• LV mass

• RWT

M-mode LV Calculation

• % IVS thickening

• % LVPW thickening

• IVS/LVPW ratio

M-mode LV Calculation

M-mode LV Calculation

FS = LVIDd – LVIDs LVIDd

M-mode LV Calculation

EF = LVIDd3 – LVIDs3

LVIDd3

M-mode LV Calculation

RWT = IVSd + LVPWd LVIDd 

M-mode LV Calculation

IVS % thickening = (IVSs – IVSd) x 100 IVSd

M-mode LV Calculation

LVPW % thickening = (LVPWs – LVPWd) x 100 LVPWd

M-mode LV Calculation

LV Mass = 1.04 {(LVIDd + IVSd + LVPWd)3 – (LVIDd)3} x 0.8 + 0.6g

Increase LVW thickness

Increased WallThickness

Symmetrical

ConcentricHypertrophy

Asymmetrical

InfiltrativeDiseases

ConcentricRemodeling

HypertrophicCardiomyopathy

Increased Wall ThicknessIncrease LVW thickness

LV Hypertrophy - Hypertension

Pressure Overload

Concentric LVH

Increase Wall thicknessNormal Mss

Increase Wall thicknessIncreased Mass

Remodeling

Increase Wall thickness

Normal LV Mass Increased LV Mass

Measure LV Mass

Concentric Remodeling Concentric Hypertrophy

LV Hypertrophy - Hypertension

Increase Wall thickness

Increased LV Mass

Concentric Hypertrophy

LV Hypertrophy – Aortic Stenosis

Pressure Overload

LVH

Eccentric LV Hypertrophy

Increased LV size withSpherical shape

Normal LV Mass Increased LV Mass

Measure LV Mass

No LV hypertrophy Eccentric Hypertrophy

Measurement Assessment

Concentric Hypertrophy

Concentric

Remodeling

Eccentric Hypertrophy

Wall Thickness Increased Increased Normal

Relative Wall Thickness

Increased Increased Normal - Decreased

LV Chamber size Normal Normal Increased

LV Chamber shape Elliptical Elliptical Spherical

LV mass Increased Normal Increased

LV Hypertrophy

Paradoxical Septal Motion

•RV hypertrophy

•RV dilatation

•LBBB

•Post Cardiac Surgery

Paradoxical Septal Motion

Ischemia

Ischemia

Normal Wall thickness

No systolic thickening

Reduced Motion

Post Infarct

Post Infarct

Thin echogenic wall

No systolic thickening

Reduced Motion

Pericardial Effusion

Pericardial Effusion

Infection

Postviral pericarditis

Bacterial

Tuberculosis

Pericardial Effusion

Malignant

Metastatic disease – lymphoma & melanoma

Direct extension – lung and breast

Primary cardiac malignancy

Pericardial Effusion

Inflammatory

Post MI (Dressler’s Syndrome)

Uremia

Collagen vascular disease

Post cardiac surgery

Pericardial Effusion

Intracardiac-Pericardial communication

Blunt or penetrating chest trauma

Post catheter procedures

LV rupture (post MI)

Pericardial Thickening

Pericardial Thickening

Constrictive pericarditis

Occurs following

Surgery

Radiation therapy

Repeated episodes of pericarditis