猫超声心动提示与技巧翻译feline cardiomyopathy echo diagnosis tips and tricks

EchocardiographyinEchocardiographyinTipsandDr.GerhardDiplomateACVIM(cardiology)DiplomateECVIM-CA(InternalWhytoperformanEchoinWhytoperformanEchoinaSymptomssuggestiveofMurmur心杂音Galloprhythm奔马律Dyspnea呼吸困难Arrhythmia••••Screening/BreedingElevatedNT-proBNP(>100Tip1:howtoperformanTip1:howtoperformanechoina第1招：怎样给猫做超声心动呢•Catsshouldbegentlyrestrainedinlateralrecumbency(asdogs)猫需要温柔的侧卧保定（同犬一样Exception:catswithdyspnea→→trytodoonlyaquick••••lookforLAsizelookforpleuraleffusion•Use7Mhztransducer(orhigherTip2:Sedation第2招：给猫FelineSedationProtocolsasymptomaticTip2:Sedation第2招：给猫FelineSedationProtocolsasymptomaticcatneedingMidazolam0.2mg/kg+hydromorphone0.1mg/kgIMinthesamesyringe咪达唑仑0.2mg/kg+氢吗啡酮Acepromazine0.05-0.1mg/kg+0.1mg/kgSQorHydromorphone0.05mg/kg+midazolam0.1mg/kgCatwithcongestiveheartButorphanol0.2mg/kg+midazolam0.2oracepromazine0.05mg/kgifveryuncooperative)IM(furosemidebeforeultrasoundifdyspneic)segef02WhyareCatHeartSoundsSoDifficulttoWhyareCatHeartSoundsSoDifficulttoCharacterize?WhyareCatHeartSoundsSoDifficulttoCharacterize?WhyareCatHeartSoundsSoDifficulttoCharacterize?Gallopheartsoundscanbehardto•WhyareCatHeartSoundsSoDifficulttoCharacterize?WhyareCatHeartSoundsSoDifficulttoCharacterize?GallopheartsoundscanbehardtoMurmursincatsallsoundthe••WhyareCatHeartSoundsSoDifficulttoCharacterize?GallopWhyareCatHeartSoundsSoDifficulttoCharacterize?GallopheartsoundscanbehardtoMurmursincatsallsoundtheMurmursareoften•••WhyareCatHeartSoundsSoDifficulttoCharacterize?GallopWhyareCatHeartSoundsSoDifficulttoCharacterize?GallopheartsoundscanbehardtoMurmursincatsallsoundtheMurmursareoften•••WhyareCatHeartSoundsSoWhyareCatHeartSoundsSoDifficulttoCharacterize?WhyareCatHeartSoundsSoDifficulttoCharacterize?WhyareCatHeartSoundsSoDifficulttoCharacterize?Catsaresmall;thevalveareasareclose•ThepositionoftheheartinthethoraxchangesManycatshaveaveryrapidheartrateSomecatspurrandsomecatsare•••WhyareCatHeartSoundsSoDifficulttoCharacterize?CatsWhyareCatHeartSoundsSoDifficulttoCharacterize?Catsaresmall;thevalveareasareclose•ThepositionoftheheartinthethoraxchangesManycatshaveaveryrapidheartrateSomecatspurrandsomecatsare•••WhyareCatHeartSoundsSoDifficulttoCharacterize?CatsareWhyareCatHeartSoundsSoDifficulttoCharacterize?Catsaresmall;thevalveareasareclose•ThepositionoftheheartinthethoraxchangesManycatshaveaveryrapidheartrateSomecatspurrandsomecatsare•••Heartmurmurs心杂Heartmurmurs心杂Thetwomostcommoncardiacmurmursinadultcatsare:成年猫最常见的2种心杂音为SAM:systolicanteriormotionDRVOTOdynamicrightventricularoutflowtractobstruction右心室流出通道阻塞•••Heartmurmurs心杂ThetwoHeartmurmurs心杂Thetwomostcommoncardiacmurmursinadultcatsare:成年猫最常见的2种心杂音为SAM:systolicanteriormotionDRVOTOdynamicrightventricularoutflowtractobstruction右心室流出通道阻塞•••Theneglectedarea:ventralthoraxovertheTip3:MurmursinTip3:Murmursincatsareoften→→soifyouheardamurmurandcan‘tfinditon→→trytoelevatetheheart•••••••barklikea„tease“thecatblowatthe….butbecarfullTip4:howtodetectTip4:howtodetectSAMSystolicanteriormotionofmitralvalveSAM=二尖瓣的收缩期向前运动reasonformurmurinHCMSAMcausesdynamicobstructionofLV-outflowtractdynamicSAM导致左心室流出通道动态性阻塞→→动态心杂fastHR心率快→→slowmurmur心率慢→→杂音SAMSAMDynamicLVOT动态右心室流出通道DynamicLVOT动态右心室流出通道阻 Tip5:howtoTip5:howtodetect“DR第5招：如何诊断“DRDRVOTO:dynamicrightventricularoutflowtractobstructionDRVOTO:右心室流出通道阻塞othername:DIPS(dynamicinfundibularsystolicnarrowingofRVoutflowusuallybengin,dynamiccauses:hyperdynamiccirculatorysituations-anemia,hyperthyroidism,inflammationrarelywithHCMMechanismsofDynamicRVOTMechanismsofDynamicRVOTNormalDRVOTO=DSPSorDIPSSystolicnarrowingofRV右心室漏斗部心缩DynamicrightventricularoutflowDynamicrightventricularoutflowtractColorDopplerturbulentFlowinRVoutflowPWorCW-late-systolicpeakincreasedvelocity>速度增加>“DRVOTO”:UsetheLA/AOviewtoseetheRVOT“DRVOTO”:“DRVOTO”:UsetheLA/AOviewtoseetheRVOT“DRVOTO”:利用左心室/主动脉切面看右心室流出通道“DRVOTO”:UsetheLA/AOviewtoseetheRVOT“DRVOTO”:“DRVOTO”:UsetheLA/AOviewtoseetheRVOT“DRVOTO”:利用左心室/主动脉切面看右心室流出通道“DRVOTO“DRVOTOCW-Doppler“DRVOTO”:DynamicRVOTRVOTVelocityDynamicRVOTRVOTVelocity>2.0右心室血流流出速度2.0PrimaryMyocardial原发性心肌PrimaryMyocardial原发性心肌PrimaryMyocardial原发性心肌PrimaryMyocardial原发性心肌PrimaryMyocardial原发性心肌PrimaryMyocardial原发性心肌PrimaryMyocardial原发性心肌PrimaryMyocardial原发性心肌PrimaryMyocardial原发性心肌PrimaryMyocardial原发性心肌LVWall,VentricularHCM,HOCMLVWall,VentricularHCM,HOCM肥厚阻塞性心6–10Normal正限制性3-5.0(5.5)DCM(Thin扩张性心肌病（壁薄Burnout燃尽性1.5-3.5LVWallThickness,左心室厚度Tip5thinkaboutTip5thinkaboutyourdifferentialsforleftventricularhypertrophy 甲 SystemicTip6:HCMTip:Tip6:HCMTip:asHCMmaybeuseECHO2D-measurements(notM-Papillary-muscleFocalGeneralized(concentric)HCM–•ConcentricLVHCM–•ConcentricLVAsymmetricseptalDilatedLA左心房扩SmallLVIntracardiac•••••HCMFormsHCMHCMFormsHCM表现形WhyEchoisdifferentfrom PM-Diastole收缩WhyEchoisdifferentfrom PM-Diastole收缩 M-Diastole收 M-Systole舒张 [.71Autopsy尸 HCMEchoFeatures••••LVHCMEchoFeatures••••LVwallthickness≧6Greyzone:5.0(5.5)-6.05.0(5.5)6.0normalsystolicnormaltomildlydecreased••±LAdiastolicimpairmentwithdelayedrelaxationpatternordecreasedTVI-E-wave舒张受损，伴有延迟舒张模式或降低的组织速度超声E+/-HCMwithSAMofthemitralvalve•Tip7:Tip7:Tip:measurein2D,freezeyourimageandscrollthroughcardiac技巧：用二维超声测量，冻结图像并缓慢移动光标查看心动周Measurements测量结Measurements测量结ScrollthroughyourEcho-loop,measureatseveraldifferentTip8:Tip8:PapillaryPapillarymusclesenlargementoftenthefirstabnormalitynotedsubjectivejudgment:normal,mild,moderate,lookforendsystolicchambermildormoderatepapillarymusclehypertrophy:calledequivocal–recheckafter3–6monthPapillarymuscle•Papillarymuscle•SeveralwaystomeasurepapillarymusclesMethodsnotyetclinicallyoftenLackofclearcut-off••PapillarymusclePapillarymusclePPMarea后乳区uppernormalcut-offvalueforsumofPPMPapillarymusclePapillarymusclehypertrophy:PPMPPMuppernormalcut-offvalueforlenghtofPPMPapillarymusclehypertrophy:Papillarymusclehypertrophy:PPMPPMuppernormalcut-offvalueforwidthofPPMLeftventricularexcludesystemicLeftventricularexcludesystemichypertensionhyperthyroidismScreeningformalecats>2公猫2femalecats:3-4Ifcatsareexaminedearlier,theyshouldbeTip9:Tip9:falseFalsetendonsaresometimescalled„moderatorHowever,moderatorbandsonlyexistin假腱有时被称为“隔缘肉柱”，但是“隔缘肉柱”只存在于Tip9Tip9falsetendons假FalsetendonsarefoundinmanyOnlyoccasionallytheycauseTheycancausearestrictivepatternàdiastolicdysfunctionFalsetendonsmaynotberecognizedàandmaketheLVwalllookthick.SoquiteoftencatsareoverdiagnosedwithHCMduetofalsetendons“moderatorbandCM“moderatorbandCMCorrecttermsforfiberscrossingRV:moderatorband;LV:false•Pitfalls警Pitfalls警FalsetendonsmaymimicFalsetendonsFalsetendons假FalsetendonsFalsetendons假“falsetendonsCM“falsetendonsCMImportanttoslowtheEcholoop,orfreezetheimageandscrollthroughit!•Tip10:FreezeTip10:Freeze第10AsHRisoftenveryfastin因为猫的心跳一般很快Remembertousethe„Freeze“ButtonandscrollthroughtheimagesYoucanalsousethisbutton,iftheseesomethinginteresting,butcatmoves→→theloopisprobablyinthemachinesmemoryOrifyourEchomachinehasit:usethe„slowplay“functionforstoredloops••••Tip11:mitralinflowTip11:mitralinflowUsetheECGtoidentifythewaves利用心电图来确定••comesinearlydiastole–aftertheT-ontheE波出现在心舒期早期心电图上的TA-wavecomesaftertheP-waveontheECG•Tip12:fusedTip12:fusedE-andA-RememberthatwithhighHeartratesEandA-wavesoftenfuse!••Tip13:DiseaseTip13:DiseaseVentriclegivesthediseasetheAtriashowtheclinicalimportanceoftheTherearenoestablishedvaluestogroupthecatsintodifferentseveritystages:somecardiologistsonlyusewalldiameterothersincludeLAsize•••••HCMStagingLMU<<GreyzoneHCMStagingLMU<<Greyzone(weightdependant根据体重5.0–<6.0–<6.5–<6.0–1.5–>7.0>6.0>Fianal最后一TryFianal最后一TrytoexerciseyourEchoskillsfirstinOnceyougetyourviewsconsistently→→trya一旦你获得的图像稳定→→尝试对猫进行AndExercise,Exercise•••RestrictiveRestrictiveRCMRCMissecondmostcommonRCMRCMissecondmostcommonformofcardiomyopathyincatsfeature:diastolicproblemcausedbystiffnessofmyocardialventricularwallsnotthickened心室壁不增normalcontractilitybutbothatriaenlarged!但两个心房扩Restrictivecardiomyopathy限制性心肌MyokardialRestrictivecardiomyopathy限制性心肌MyokardialRCMRCMEndomyocardialFibrosisRestrictiveBothatriaVentriclesneitherRestrictiveBothatriaVentriclesneitherhypertrophied,norDiagnosisconfirmedbytissueDopplerimagingifnotavailable:Mitral-inflowRCMECHOFeatures••••NormalLVwallnormalsystolicRCMECHOFeatures••••NormalLVwallnormalsystolicbiatrialRestrictivefillingpatternofmitralinflow(E:A>2,shortdecelerationtime)二尖瓣流入限制性充盈表现（E:A>2，减速时间短RestrictiveTVIpattern(E-wave<2.5限制性组织速度图谱(E-2.5Largefibroticbridgingbandorscarofthe±MildLVhypertrophy,severeLA•••DopplerEchocardiography多普勒心DopplerEchocardiography多普勒心Trans-mitralInflowPatternsTissueDoppler••AVCAorticValveTissueDoppler••AVCAorticValveClosure主动脉瓣MVOMitralValveOpeningRestriktiveversusunclassifedRestriktiveversusunclassifedrestrictivecardiomyopathyshowssmallE-WavesinTDIRestrictiveRestrictiveRestrictiveRestrictiv