Two Dimensional Measurements

2D Measurements are performed in addition to M-mode of:

• MV

  • measure excursion and slope

• Aov cusp separation

• Ao root diameter

2D measurements are done in:

• PLAX

  • some will do in PSAX

• obtain clear image and freeze

• scroll between systole and diastole for measurements

  • use EKG as guide

Diastolic Measurements:

• Occur when LV is at max dimension → QRS complex

• RV

• IVS

• LVID_d

• Posterior wall

Systolic Measurements:

• When LV is at max squeeze → T wave

• LVID_s

• LA

2D advantages:

• easier to perform and visualize

• often more accurate

  • good for off axis images

  • chordae confusion is decreased

Other 2D uses:

• Ejection Fraction (EF)

• Easily “eye-balled”

  • all views should be carefully examined before determining EF

  • quad screen used

• Now using advanced 3D software to quantify

Ejection Fraction (EF)

• (stroke volume/LVEDV) x 100

• estimated % of blood filling LV in diastole that is ejected by LV in systole per beat

• norm: 55-60%

  • 100% is cavity obliteration and abnormal

• indicates how well muscle squeezes

2D Optimization:

• Persistence

  • keep low 0-1

• Focal zone

  • PLAX

    • keep at or below posterior wall

  • Apicals

    • keep 1st at A-V valves or mid atria

    • use 2nd focal zone at apex

• Sector width

  • narrow for apical and PSAX mid-apex

2D Optimization:

• LGC’s

  • lateral gain control

  • enhances the edge of image

  • keep in ‘smiley face’ if multiple controls

  • most machines now have this in a touch screen

• Tissue harmonics

  • turn off in subcostal view