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Two-Dimensional and M-Mode

Echocardiography for the Small Animal

Practitioner

June A. Boon

Two-Dimensional andM-Mode Echocardiographyfor the Small AnimalPractitioner

The Rapid Reference Series

Books in the Rapid Reference series are ideal quick references, using a concise,

practical approach to provide small animal practitioners with fast access to essen-

tial information. Designed to be used at a patient’s side, these books make it easy

to quickly diagnose and treat patients. With a spiral binding to lie flat, Rapid

Reference books are an indispensable tool for the exam room.

Other Rapid Reference Series Titles

Life-Threatening Cardiac Emergencies for the Small Animal Practitioner

By Maureen McMichael and Ryan Fries

Two-Dimensionaland M-ModeEchocardiographyfor the Small AnimalPractitioner

SECOND EDITION

June A. Boon MSInstructor and Echocardiographer

College of Veterinary Medicine and Biomedical Sciences

Colorado State University

Fort Collins, Colorado, USA

This edition first published 2017 © 2017 by John Wiley & Sons, Inc

Editorial offices: 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USAThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK9600 Garsington Road, Oxford, OX4 2DQ, UK

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The contents of this work are intended to further general scientific research, understanding, and discussion only andare not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, ortreatment by health science practitioners for any particular patient. The publisher and the author make norepresentations or warranties with respect to the accuracy or completeness of the contents of this work andspecifically disclaim all warranties, including without limitation any implied warranties of fitness for a particularpurpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and theconstant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to reviewand evaluate the information provided in the package insert or instructions for each medicine, equipment, or devicefor, among other things, any changes in the instructions or indication of usage and for added warnings andprecautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website isreferred to in this work as a citation and/or a potential source of further information does not mean that the authoror the publisher endorses the information the organization or Website may provide or recommendations it maymake. Further, readers should be aware that Internet Websites listed in this work may have changed or disappearedbetween when this work was written and when it is read. No warranty may be created or extended by anypromotional statements for this work. Neither the publisher nor the author shall be liable for any damages arisingherefrom.

Library of Congress Cataloging-in-Publication Data

Names: Boon, June A., author.Title: Two-dimensional and M-mode echocardiography for the small animal practitioner / June A. Boon.Description: Second edition. | Ames, Iowa : John Wiley & Sons Inc., 2017. | Includes bibliographical references and

index.Identifiers: LCCN 2017015710| ISBN 9781119028536 (pbk.) | ISBN 9781119028550 (Adobe PDF) | ISBN

9781119028567 (epub)Subjects: LCSH: Veterinary echocardiography. | MESH: Echocardiography–veterinary | HandbooksClassification: LCC SF811 .B663 2017 | NLM SF 811 | DDC 636.089/61207543–dc23LC record available at https://lccn.loc.gov/2017015710

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not beavailable in electronic books.

Set in 9.5/13pt Meridien by Aptara Inc., New Delhi, India

1 2017

This book is dedicated to my family – you all make my life rich.

Contents

Preface, ix

About the Companion Website, xi

1 The Basics, 1

2 Knobology for the Echocardiogram: Improving Image Quality, 7

3 Two-Dimensional Imaging Planes and Subjective Assessment, 24

4 Imaging Planes: Technique in the Dog and Cat, 51

5 M-Mode Echocardiography, 75

6 Measurement and Assessment of Two-Dimensional and M-Mode

Images, 83

7 Echocardiographic Features of Common Acquired Heart Diseases, 106

Recommended Reading, 136

Glossary, 137

Index, 139

vii

Preface

With increasing affordability, ultrasound equipment has made its way into many

private practices. Whilst entire books and sections of large books are devoted to

the study of cardiac ultrasound, this handbook is meant to be a starter resource

and a quick handy reference for fundamental echocardiographic information,

and is by no means a comprehensive resource on veterinary echocardiography.

The handbook starts with the controls on your machine, because presets do not

always work well, moves on to discussing normal imaging planes and their sub-

jective assessment, discusses how to obtain the imaging planes, then covers basic

measurements of size and function, and finally reviews the typical features of

common acquired heart disease. Videos of technique and features of disease are

utilized to help you develop the skill necessary to perform the echocardiogram

and aid in its interpretation. As with any skill set, it will require practice, patience

and more in-depth reading to develop these techniques and assessments.

ix

About the CompanionWebsite

This book is accompanied by a companion website:

www.wiley.com/go/boon/two-dimensional

The website includes:� Supplementary videos clips that demonstrate scanning techniques and disease

features.� A play icon appears in the margin whenever a relevant video clip is avail-

able on the website.� Each video corresponds to certain figures within the text, appearing beside the

video for ease of reference.� The password for the site is the last word in the caption for Figure 3.10.

xi

Chapter 1 The Basics

Echocardiographic Applications 1

Some Indications for an Echocardiogram 2

Cardiac Anatomy 2

Orientation of the Heart in the Thorax 3

How To 4

Echocardiographic Applications

� Evaluation of:◦ Valve morphology◦ Chamber sizes◦ Wall thickness◦ Myocardial function◦ Pericardial effusion

� Aid in the Diagnosis of:◦ Chronic valve disease◦ Endocarditis◦ Cardiomyopathies (hypertrophic, dilated, unclassified)◦ Pericardial effusions◦ Cardiac neoplasia◦ Pulmonary hypertension◦ Congenital heart disease

Two-Dimensional and M-Mode Echocardiography for the Small Animal Practitioner, Second Edition. June A. Boon.

© 2017 John Wiley & Sons, Inc. Published 2017 by John Wiley & Sons, Inc.

Companion Website: www.wiley.com/go/boon/two-dimensional

1

2 Two-Dimensional and M-Mode Echocardiography

Some Indications for an Echocardiogram

� Coughing� Exercise intolerance� Arrhythmia� Pulmonary edema� Pulmonary congestion� Collapse or syncope� Murmurs� Cyanosis� Lethargy� Weak pulses� Radiographic evidence of heart enlargement

Cardiac Anatomy

Figure 1.1 Heart Diagram. Diagram of the heart showing the chambers, valves and vessels

of the heart. Flow through the heart is indicated. Note the relationships between the mitral

valve and the aorta, and the pulmonary artery and the tricuspid valve. For details of

abbreviations used in the figures, see the Glossary.