M-MODE ECHOCARDIOGRPHY

THE LOSS ART

 M-MODE PHYSICS

B mode echoes from an interface that changes

position will be seen as echoes moving towards
and away from the transducer.

If a trace line is place on this interface and the

resulting trace is made to drift across the face of
a CRT screen a motion pattern is obtained.
 M-MODE PHYSICS

The resulting display shows motion of a reflector

over distance and time – a distance time graph

The change in distance (dy) over a period of time

dt is represented by the slope of the reflector line
of motion.

dy/dt = slope = velocity

 M-MODE PHYSICS

If this motion pattern is obtained on moving

cardiac structures then the resulting images
constitute M-mode echocardiography.

M-mode echocardiography is use to evaluate the

morphology of structures, movement and
velocity of cardiac valves and walls and timing of
cardiac events.
 M-mode Tracing

Distance

Time
 M-mode Evaluation

Amplitude

Velocity

Time intervals

Morphology
 Amplitude Measurement

Distance
Y2

Amplitude = Y2 –Y1

Y1

Time
 Time Measurement

Distance
Time interval = T2 – T1

T1 T2 Time
 Slope Measurement

Y2

dy = Y2 –Y1

Y1
Slope = dy/dt = velocity

T1 T2

dt = T2 – T1
 M-mode at the Mitral Valve

The mitral valve has 2 leaflets – anterior and

posterior.

Specific letters corresponding to systole and

diastole are assigned to the m-mode tracing
of the mitral valve.
 EKG Tracing

QRS complex
T-wave
P wave

Systole Diastole
 M-mode at Mitral Valve

Distance

Time
Diastole Systole
 M-mode at the Mitral Valve

Phase of Cardiac Cycle Assigned Letters

Diastole d,e,f, and a

Systole c and d
 M-mode at Mitral Valve

d
Distance f c

Systole
Diastole Time
 M-mode at Mitral Valve

d-e amplitude
Distance

Systole
d Diastole Time
 M-mode at Mitral Valve

Septum

EPSS
Distance

Systole
Diastole Time
 M-mode at Mitral Valve

d-e slope
Distance

Diastole

Systole
d Time
 M-mode at Mitral Valve

e-f slope
Distance f

Systole
Diastole Time
M-mode at Mitral Valve
 M-mode at the Mitral Valve

Normal
Amplitude Description
Value
EPSS Measure e point to septal < 5 mm
separation
d-e Measures the maximum 17 to 30 mm
excusion of the mitral valve
following diastolic opening.
 M-mode at the Mitral Valve

Slope Description Normal Value

d-e Measure rate of initial 240 to 380

opening of the mitral valve mm/s
in early diastole.
e-f Measures the rate of early 50 to 180 mm/s
closure of the mitral valve
following diastolic opening.
M-mode Findings at the MV

B- bump on the AC shoulder

Premature Closure of the MV

Systolic anterior motion of the AMVL

Mitral Valve Prolapse

Mitral Regurgitation
M-mode Findings at the MV

Flail PMVL

Fluttering of the AMVL

Mitral Stenosis

LA myxoma

Vegetations
 M-mode at Mitral Valve

B-bump on the
AC shoulder.
Distance

Time
Diastole Systole
 M-mode at Mitral Valve
Premature Closure

Premature Closure- closure

on or before the onset of the
Distance QRS complex.

Time
Diastole Systole
 M-mode at Mitral Valve

Systolic anterior motion

Distance of the AMVL

Time
Diastole Systole
 M-mode at Mitral Valve

Systolic anterior motion

Distance of the AMVL

Time
Diastole Systole
 M-mode at Mitral Valve

MV prolapse
Distance posterior leaflet

Time
Diastole Systole
 M-mode at Mitral Valve

MV Prolapse –
both leaflet
Distance

Time
Diastole Systole
 M-mode at Mitral Valve

Distance Flail posterior leaflet

Time
Diastole Systole
 M-mode at Mitral Valve

Aortic Regurgitation
Distance

Time
Diastole Systole
 M-mode at Mitral Valve
Mitral Stenosis

Sinus Rhythm
Distance

Time
Diastole Systole
 M-mode at Mitral Valve
Mitral Stenosis

Atrial Fibrillation
Distance

Time
Diastole Systole
 M-mode at Mitral Valve

Atrial Myxoma
Distance

Time
Diastole Systole
 M-mode at Mitral Valve

Vegetation
Distance

Time
Diastole Systole
 Mitral Regurgitation

Distance

Time
Diastole Systole
 Mitral Regurgitation

Distance

Time
Diastole Systole
 Mitral Regurgitation

Atrial Myxoma
Distance

Time
Diastole Systole
 Mitral Regurgitation

Atrial Myxoma
Distance

Time
Diastole Systole
 M-mode at Mitral Valve

Atrial Myxoma
Distance

Time
Diastole Systole
Color M-mode
Color M-mode

Propagation Velocity, Vp
M- Mode

Aortic Valve
 M-mode at the Aortic Valve

The aortic valve has 3 cusps – right coronary,

left coronary and non-coronary cusps.

The cusps imaged in the PLAX view are the

right coronary and the non-coronary cusps.
M-mode at the Aortic Valve

Non-coronary cusp

Anterior aortic root

Coronary cusp

Posterior aortic root

Left Atrium
 M-mode at the Aortic Valve

Cusp Separation
Aortic root

LA dimension
M-mode at the Aortic Valve

Measurements are made from

leading edge to leading edge.

LA dimension
M-mode at the Aortic Valve

Dilated LA
Dilated aortic root
Decreased excursion
Premature opening
Premature closing
Exaggerated anterior motion of Aortic Root
M-mode at the Aortic Valve

Reduced anterior motion of Aortic Root

Thickening
Calcification
Vegetations
Bicuspid valve
Prosthetic valve
Aortic Regurgitation
M-mode at the Aortic Valve
Premature Opening

Opening of the AV before the

onset of the QRS complex

Seen in Elevated LV-EDP

M-mode at the Aortic Valve
Premature Closure

Closure of the AV before

the onset of the T wave

Seen in IHSS
M-mode at the Aortic Valve
Bicuspid Valve

Eccentric closure line

Seen when there is a

Bicuspid aortic valve
M-mode at the Aortic Valve

Decreased Cusp Separation

Seen in Aortic Stenosis

M-mode at the Aortic Valve

Thickened, calcified aortic

valve leaflet.

Seen in aortic sclerosis

M-mode at the Aortic Valve

Seen in Mitral Stenosis

Reduced anterior
motion of aortic root
M-mode at the Aortic Valve

Seen in Mitral Regurgitation

Exaggerated anterior
motion of aortic root
Aortic Regurgitation
Aortic Regurgitation
Aortic Regurgitation
M - Mode

Left Ventricle
M-mode at Left Ventricle
M-mode at Left Ventricle

Thickening of the IVS and LVPW

Movement of the IVS and LVPW

M-mode Measurement

• RVWd

• RVIDd
M-mode Measurement

• IVSd

• IVS excursion

• IVSs
M-mode Measurement

• LVIDd

• LVIDd index

• LVIDs

• LVIDs index
M-mode Measurement

• LVPWd

• LVPW excursion

• LVPW max excursion velocity

• LVPWs
M-mode at Left Ventricle

RVWT
M-mode at Left Ventricle

RVIDd
M-mode at Left Ventricle

IVSd
M-mode at Left Ventricle

LVIDd
M-mode at Left Ventricle

LVPWd
M-mode at Left Ventricle

IVS excursion
M-mode at Left Ventricle

IVSs
M-mode at Left Ventricle

LVIDs
M-mode at Left Ventricle

LVPWs
M-mode at Left Ventricle

LVPW excursion
M-mode at Left Ventricle

LVPW max velocity

= slope
M-mode at Left Ventricle
M-mode LV Calculation

• FS

• EF

• LV mass

• RWT
M-mode LV Calculation

• % IVS thickening

• % LVPW thickening

• IVS/LVPW ratio
M-mode LV Calculation

FS = LVIDd – LVIDs
LVIDd
M-mode LV Calculation

EF = LVIDd3 – LVIDs3
LVIDd3
M-mode LV Calculation

RWT = IVSd + LVPWd

LVIDd
 M-mode LV Calculation

IVS % thickening = (IVSs – IVSd) x 100

IVSd
 M-mode LV Calculation

LVPW % thickening = (LVPWs – LVPWd) x 100

LVPWd
 M-mode LV Calculation

LV Mass = 1.04 {(LVIDd + IVSd + LVPWd)3 – (LVIDd)3} x 0.8 + 0.6g

Increase LVW thickness
 IncreasedLVW
Increase Wallthickness
Thickness
Increased Wall
Thickness

Symmetrical Asymmetrical

Concentric Concentric Hypertrophic

Hypertrophy Remodeling Cardiomyopathy

Infiltrative
Diseases
LV Hypertrophy - Hypertension

Pressure Overload

Increase Wall thickness

Concentric LVH
Increased Mass

Remodeling

Increase Wall thickness

Normal Mss
 LV Hypertrophy - Hypertension

Increase Wall thickness

Measure LV Mass

Normal LV Mass Increased LV Mass

Concentric Remodeling Concentric Hypertrophy

LV Hypertrophy – Aortic Stenosis

Pressure Overload

LVH

Increase Wall thickness

Increased LV Mass

Concentric Hypertrophy
 Eccentric LV Hypertrophy

Increased LV size with

Spherical shape

Measure LV Mass

Normal LV Mass Increased LV Mass

No LV hypertrophy Eccentric Hypertrophy

 LV Hypertrophy

Measurement Concentric Concentric Eccentric

Assessment Hypertrophy Remodeling Hypertrophy

Wall Thickness Increased Increased Normal

Relative Wall Increased Increased Normal - Decreased

Thickness

LV Chamber size Normal Normal Increased

LV Chamber shape Elliptical Elliptical Spherical

LV mass Increased Normal Increased

Paradoxical Septal Motion
Paradoxical Septal Motion

•RV hypertrophy

•RV dilatation

•LBBB

•Post Cardiac Surgery

Ischemia
 Ischemia

Normal Wall thickness

No systolic thickening

Reduced Motion
Post Infarct
Post Infarct

Thin echogenic wall

No systolic thickening

Reduced Motion
Pericardial Effusion
Pericardial Effusion

Infection

Postviral pericarditis

Bacterial

Tuberculosis
 Pericardial Effusion

Malignant

Metastatic disease – lymphoma &

melanoma

Direct extension – lung and breast

Primary cardiac malignancy

 Pericardial Effusion

Inflammatory

Post MI (Dressler’s Syndrome)

Uremia

Collagen vascular disease

Post cardiac surgery

 Pericardial Effusion

Intracardiac-Pericardial communication

Blunt or penetrating chest trauma

Post catheter procedures

LV rupture (post MI)

Pericardial Thickening
Pericardial Thickening

Constrictive pericarditis

Occurs following

Surgery

Radiation therapy

Repeated episodes of pericarditis