2D ECHO PROTOCOL
Abnormalities detected from PLAX LV,
PLAX of LV PLAX RVOT, PLAX RVIT
1. WALL MOTION See page 61-65
2. ZOOM MITRAL VALVE
3. ZOOM AORTIC VALVE
4. COLOR MAPPING
COLOR BOX AORTIC VALVE THEN MITRAL
VALVE
CHECK FOR REGURGE
COLOR MAP WHOLE REGION OF INTEREST
INTERROGATE FOR ANY ABNORMALITIES
Direct Measurements
END-DIASTOLE - after the mitral valve closure, ecg: after the onset of the QRS
(IVSD, LVEDD, PWD, RV, RVWT, AO)
Summarized/outlined by: Ma. Carmela Paz Espero, RRT
Sources: B. Anderson Echocardiography: The Normal Examination and Echocardiographic Measurements
American Society of Echocardiography
AORTIC ROOT
END-SYSTOLE - after aortic valve closure, ecg: after T-wave
(IVSS, LVESD, PWS)
LA- measure at the level of the midpoint of SOV (see white arrow)
*measurement error- measure LA
inferiorly beneath to AO annulus.
*Source of error – fuzzy echoes (see yellow arrow)
MID SYSTOLE - maximal valve opening (LVOTD, AO ANNULUS)
*Ao annulus measure at point insertion of the right and
non coronary cusps
* LVOT diameter measure at or proximal to annulus
Summarized/outlined by: Ma. Carmela Paz Espero, RRT
Sources: B. Anderson Echocardiography: The Normal Examination and Echocardiographic Measurements
American Society of Echocardiography
Summarized/outlined by: Ma. Carmela Paz Espero, RRT
Sources: B. Anderson Echocardiography: The Normal Examination and Echocardiographic Measurements
American Society of Echocardiography
Motion Mode (M- MODE)
PSAX of LV– cursor is positioned perpendicular to the long axis of the LV just the distal
to the tips of the open MVL.
-Preferred view form-mode is PLAX view as the LV long axis and other
anatomic landmarks are best seen on this view.
EPSS- measure at the tip of the mitral valve leaflet
Summarized/outlined by: Ma. Carmela Paz Espero, RRT
Sources: B. Anderson Echocardiography: The Normal Examination and Echocardiographic Measurements
American Society of Echocardiography
AO/LA- cursor is positioned through the aorta and at the level of the SOV ensuring that
the alignment is perpendicular to the long axos of the aorta and aortic annulus
- Preferred view is the PLAX as the long axis of the aorta as well as other
anatomic landmarks are best seen from this view.
Abnormalities detected from M-mode
examination
See page 80
PSAX (LEVEL OF THE MV LEAFLET/ PAPILLARY MUSCLE/APEX)
WALL MOTION
BASE, MID, APEX
PSAX (GREAT VESSEL)
WALL MOTION Abnormalities detected from
ZOOM AO VALVE GREAT VESSEL
COLOR MAPPING
FOCUS PV AND MPA, show RPA AND LPA See page 66-67
FOCUS AORTA AND LA
FOCUS TV
INTERROGATE FOR ANY ABNORMALITIES
Direct Measurements
END-DIASTOLE - after the mitral valve closure, ecg: after the onset of the QRS
(RVOT, PV ANNULUS, MPA)
MEASURE PULMONARY VELOCITY - using PW Doppler; Baseline Up
-get PULMONARY ACCELERATION TIME (PAT)
*PULMONARY REGURGE measure using CW; Baseline Down
AND TRICUSPID REGURGE and measure using CW; Baseline Up
Summarized/outlined by: Ma. Carmela Paz Espero, RRT
Sources: B. Anderson Echocardiography: The Normal Examination and Echocardiographic Measurements
American Society of Echocardiography
APICAL Abnormalities detected
from APICAL CHAMBERS
4 CHAMBER
See page 68
WALL MOTION (show LV WALL by zooming or
increasing depth)
COLOR MAPPING (by Focusing MV and TV)
Direct Measurements
END-DIASTOLE - after the mitral valve closure, ecg: after the onset of the QRS
(TV ANNULUS , MV ANNULUS, RIGHT VENTRICLE)
END-SYSTOLE - after aortic valve closure, ecg: after T-wave
( RA-greatest Dimension)
LA VOLUME INDEX – ASE recommendation : area length method and
method of disk (more accurate)
LA VOLUME = 0.85 x Area 4 ch x Area 2ch
L (ASE recommends using the shorter of the 2 lengths)
LA VOLUME INDEX = LA VOLUME
BSA
Doppler Velocities
MITRAL VALVE AND TRICUSPID VALVE VELOCITIES - using PW; Baseline down
*MITRAL AND TRICUSPID REGURGE and measure using CW; Baseline up
MITRAL INFLOW by using PW
(E WAVE DT, IVRT, A WAVE DURATION, A DURATION)
MITRAL ANNULAR TDI by using PW
(LAT E;A AND MED E;A)
PULMONARY VENOUS VELOCITY by using PW
(SYSTOLIC, DIASTOLIC, S/D RATIO, AR VELOCITY AR DURATION)
TAPSE by using M-MODE
2 CHAMBER
WALL MOTION (show LV WALL by zooming or increasing depth)
COLOR MAPPING (by Focusing MV and TV)
3 CHAMBER
WALL MOTION (show LV WALL by zooming or increasing depth)
COLOR MAPPING (by Focusing MV and AV)
Summarized/outlined by: Ma. Carmela Paz Espero, RRT
Sources: B. Anderson Echocardiography: The Normal Examination and Echocardiographic Measurements
American Society of Echocardiography
SUBCOSTAL
TO CLEARLY DELINEATE INSTRUCT PT TO INALE AND HOLD FOR at least 5 seconds
(Enough to show the best subcostal view)
SUPINE; BENDING OF KNEES NEEDED TO RELEASE THE TENSION
COLOR MAPPING
SUPRASTERNAL
SUPINE- REMOVE THE PILLOW; HYPEREXTENSION OF NECK; NECK ON LEFT SIDE
WALL MOTION
COLOR MAPPING Abnormalities detected
from SUBCOSTAL &
SUPRASTERNNAL
See page 69
Summarized/outlined by: Ma. Carmela Paz Espero, RRT
Sources: B. Anderson Echocardiography: The Normal Examination and Echocardiographic Measurements
American Society of Echocardiography
