ECHO: Heart Valve Disease

Below is a lecture on Heart valve disease taken at UCSF. I really like this lecture because it mentions all of the heart pathologies that come into play when the valves are not working properly. There are some funny moments, and the instructor--Jonathan Zaroff M.D.-- that gives the lecture made me lol. He's serious, and he knows his stuff but at the same time, he adds a little humor during the lecture. You won't get bored, i guarantee.

SPI Certificate: Good or Bad? Guarantee or Uncertain?

So a month ago, i got a letter in the mail and this is what i got:

I feel happy that i passed but at the same time, i wonder, will this certificate guarantee me a job? Uh..not really. I may sound less optimistic here but i'm just being a realist. I realize that experience matters most in life rather than a piece of paper or diploma/certificate that tells you "you're the man" for the job. A person can know all the principals components of Ultrasound Technology but can that person really scan? The point i'm trying to make is, i hope i'm not that type of person---knows a lot, but can't do a lot. I rather be booksmart and "scan-smart" at the same time, which is why i want to scan as much as possible so i can get a job eventually.

But then you got the "haters" or the "jealous ones" that get threatened when you try to become the "master" of scanning. And what do these poeple do? They slow you down, and man...they have been distracting me since day one. Dood...relax! I'm just trying to get my career started and its not like i'm saying "i'm better than you" (although i am because i know more than you do--sorry for being cocky), its more like me trying to become successful. Dah well...what can you do right? Keep moving forward and never look back...that's my motto for this fall!

And then now, i got to take my license ECHO exam so i can be ellegible to work as an ECHO sonographer. But truth is, a lot of places are looking for experience. SMH. I got a feeling that i'll be jobless within the next two years so what i'm i going to be doing during that time? Only time will tell i guess. But one thing i'm certain with is my scanning abilities. So if any employers are reading this, you better consider picking me because i'm the type of tech that gets the job done completely. And i know a lot of experienced techs out there but they don't know WTF their doing or looking at! And that's my word!

But enough of the hostility...i know passing the SPI is a doorway opportunity to become ARDMS elligible and since i have a B.S. degree in a particular discipline, i have the upper hand. I feel content where i am now but at the same time, i'm concerned about me getting a job in the future.

ECHO Basics 101: Structures Viewed

LEFT PARASTERNAL LONG-AXIS VIEW

• Anterior right ventricular free wall
• Right ventricular cavity
• Interventricular Septum, including membranous portion
• Left ventricular cavity
• Left ventricular posterior wall
• Mitral valve and apparatus (chordae tendinae)
• Left Atrium
• Aortic valve (right and non-coronary cusps--left cusp often not visible)
• Aortic root (anterior and posterior wall)
• LVOT
• Cornoary Sinus (found on AV groove, next to Posterior MVL)
• Descending thoracic aorta
• Pericardium
• Wall Segments: Basal, Mid, and Apical

RIGHT VENTRICULAR INFLOW VIEW

• Obtained by starting in PLAX and angling anteriorly
• Right Atrium
• Right ventricle
• Tricuspid valve (Anterior and Posterior leaflets)
• Eustachian valve often seen (from IVC)

RIGHT VENTRICULAR OUTFLOW VIEW

• Obtained by starting in PLAX and angling posteriorly
• Right ventricle
• Pulmonic valve
• Main pulmonic artery

PARASTERNAL SHORT-AXIS VIEW

• Left ventricle - all wall segments: Anterior LVFW, Anterior-Lateral LVFW, Posterior-Lateral LVFW, Inferior-Posterior LVFW, Inferior LVFW, and Ventricular Septum
• Interventricular Septum - all wall segments: Anterior VS, Middle VS, Inferior VS
• Right ventricle - all wall segments: Anterior RVFW, Middle RVFW, Inferior RVFW
• Aortic valve - all three cusps: Right coronory cusp, Left coronary cusp, and non-coronary cusp
• Pulmonic valve
• Tricuspid valve (Anterior and Septal leaflets)
• Mitral valve (Anterior and posterior leaflets)
• Papillary muscles (Anterior-Lateral and Posterior-medial)
• Right atrium
• Left atrium
• Interatrial septum
• Left Atrial Appendage
• Pericardium

APICAL FOUR-CHAMBER VIEW

• Left ventricle (septal wall, apex, and lateral wall)
• Right ventricle (free wall)
• Right atrium (Chiari network)
• Left atrium (Coronary sinus - obtained by posterior angulation)
• Mitral valve (Anterior and Posterior leaftlets)
• Tricuspid valve (Anterior and Septal leaflets)
• Interatrial and interventricular septae
• Pulmonary veins

APICAL FIVE-CHAMBER VIEW

• Left ventricle
• Left atrium
• Atrioventricular valves
• Right ventricle
• Right atrium
• Aortic valve
• LVOT
• Ascending aorta

APICAL TWO-CHAMBER VIEW

• Left ventricle (Anterior wall, Inferior wall, and apex)
• Left atrium
• Left Atrial Appendage
• Coronary sinus
• Mitral valve (Anterior and Posterior leaflets)

APICAL LONG-AXIS VIEW

• Left ventricle (septum, posterior wall, apex)
• Left atrium
• Aortic valve
• Ascending aorta
• Mitral valve and apparatus
• Right ventricle (small portion)

SUBCOSTAL FOUR-CHAMBER VIEW

• Left ventricle (septal wall, lateral wall)
• Right ventricle (free wall)
• Left atrium
• Right atrium
• Atrioventricular valves
• Interatrial septum
• Interventricular septum
• 5-Chamber view can be obtained by angling the probe upward
• Useful for confirming septal defects with Doppler

SUBCOSTAL SHORT-AXIS VIEW

• Left ventricle - short axis
• Right ventricle
• Tricuspid valve
• Pulmonic valve
• Right ventricular outflow tract
• Main pulmonary artery

SUBCOSTAL INFERIOR VENA CAVA VIEW

• Inferior vena cava
• Hepatic veins
• Right atrium
• Caudate of liver
• Ligamentum venosum
• Eustachian valve
• Chiari Network
• Useful for collapsing IVC when patient sniffs

SUPRASTERNAL VIEW/NOTCH

• Ascending aorta
• Aortic arch
• Descending aorta
• Brachiocephalic or innominate artery
• Left common carotid artery
• Left subclavian artery
• Right pulmonary artery
• useful in detecting Aortic coarctation

ECHO Basics 101: Heart Anatomy

The heart is a cone-shaped, hollow, fibromuscular organ located in the middle mediastinum between the lungs and pleurae. The organ is surrounded by pericardium (which appears echogenic in US) that is made up of fibrous tissue and serosal components. Its purpose is to reduce friction with each cardiac movement; allow freedom of movement of the heart; contains the heart within the mediastinum; and acts as a barrier to infection (i.e. endocarditis). The weight of the heart varies in males (280-340g) and in females (230-280g), and can be calculated by multiplying 0.45% and 0.40% of total body weight in males and females, respectively.

The heart is divided into four chambers: right atrium, left atrium, right ventricle, and left ventricle. The two most important valves are the semilunar (AoV, PV), and atrioventricular (MV, TV). The left side of the heart is usually thicker and contains a great deal of pressure than the right side. However, volume pumped by both sides is equal to ensure normal circulation of flow. The right side supplies the pulmonary circulation with a lower oxygen saturation of about 75%, and receives blood from SVC and IVC that enters to the right atrium. The right side of the heart contains the TV which closes during right ventricular systole and contained blood in right ventricle is propelled out of RVOT through the semilunar PV to the lungs or pulmonary circuit. In contrast, the left side of the heart has a systolic pressure of about 120 mmHg with a high oxygen saturation of 95-100%, and receives blood from the lungs through the pulmonary veins that enters in the back of the left atrium. The left side of the heart contains the MV which opens during left atrial systole and closes during ventricular systole, in which blood is propelled out of the LV through the outflow tract and into the AO.

In ECHO, or Transthoracic Exam, a number of specific protocols are induced and the structures can be viewed from various positions and windows. The shots obtained are the following:

1. Left Parasternal Long-Axis View (PLAX or PSLA)
2. Left Parasternal Right Ventricular Inflow View (RVIT)
3. Left Parasternal Right Ventricular Outflow View (RVOT)
4. Parasternal Short-Axis View (SAX or PSSA)
5. Apical Four-Chamber View (A4C)
6. Apical Five-Chamber View (A5C)
7. Apical Two-Chamber View (A2C)
8. Apical Long-Axis View or Apical Three-Chamber View (A3C)
9. Subcostal Four-Chamber View
10. Subcostal Short-Axis View
11. Subsubcostal Inferior Vena Cava View
12. Suprasternal View/Notch

ECHO Exam

its that time again....starting on Oct through end Dec, i will be studying for my ECHO license exam so i can obtain my certificate as a licensed ECHO sonographer. Am i excited? Well, i'm kind of nervous but happy at the same time, but all i'm thinking about is starting my career as an Ultrasound ECHO Technologist. I have applied to several clinics / hospitals and i'm telling you...it "really" drains the shit out of you! There are times when i get frustrated because all these places are looking for 1-3 years experience. WTF?!? Just hire me already, i'm ready and i won't let you down! Oh well, i guess that's just how it is and all i got to do now is keep fighting and looking.

Hopefully, when i pass my ECHO exam, i'll be ready to scan the patients and i'll know what to expect with the procedures. So wish me luck...whoever is reading this.