Two Dimensional and M-Mode Echocardiography - Boon

Two Dimensional a nd M-Mode
Echocardiography
fo r rhc
Small Animal
Practitioner
June A. Boon
BA. MS
Made Easy Series

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PRINTED IN THE UNITED STATES OF AMERICA
ISBN# 1-893441-28-8
Print number 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data

Boon, June A.
Two-dimensional and M-mode echocardiography: for the small animal practitioner/
June Boon
p. cm.
Includes bibliographical references (p. ).
ISBN 1-893441-28-8
1. Veterinary echocardiography. I. Title.
SF811 .B67 2001

636.089'61207543--dc21
2001027991
Dedication
This book is dedicated to my family- Dave, Denali, and Logan. You

make my life rich.
Preface
Over the past decade ultrasound equipment has become more
affordable allowing individuals in private practice to use it as
part of its daily diagnostic procedures. It is my hope that Two
Dimensional and M~Mode Echocardiography for the Small
Animal Practitioner will provide the guidance necessary to
obtain and assess echocardiographic images and provide a quick
checklist for the echocardiographic features of common congeni~
tal and acquired cardiac diseases. This handbook does not elabo~
rate on the diagnostic features of each cardiac disease . To under~
stand these echocardiographic features in greater detail, please
refer to the recommended reading list.

Table of Contents
Section 1 The Basics
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Some Helpful Hints. . . . ............ . . . . . . 3
Applications . . . . . . . . . . .... . . . . . . . . . . . . . 4
Cardiac Anatomy . . . . . . . . . . . . . . . . . . . . ... 5
Orientation of the Heart in the Thorax .... 6
Section 2 Obtaining the Image

and Subjective Assessment
Right Parasternal Long Axis Left Ventricular
Outflow View . . . . . . . . . . . . . . . . . . . . . . . . . 10
Technique in the Dog . . . . . . . . . . . . . . . . . . . . . . . . 10
Modifications in Technique for the Cat . . . . . . . . . . . 12
Subjective Assessment of the Left
Ventricular Outflow View in the Dog . . . . . . . . . . 13
Ventricular Outflow View in the Cat . . . . . . . . . . . 14
Right Parastemal Long Axis Four Chamber View .. 15
Technique in the Dog and Cat . . . . . . . . . . . . . . . . . 15
Subjective Assessment of the Four
Chamber View in the Dog and Cat . . . . . . . . . . . . 1 7
Right Parasternal Transverse Views . . . . . . . . . . . 18
Subjective Assessment of the
Transverse Views in the Dog and Cat . . . . . . . . . . 23
Left Parastemal Cranial Left Ventricular
Outflow View . . . . . . . . . . . . . . . . . . . . . . . . . 26
Subjective Assessment of the Left Parastemal
Cranial Ventricular Outflow View . . . . . . . . . . . . . 2 7
Left Parastemal Right Atrium and Auricle View .. 28
Subjective Assessment of the Left Parastemal Right
Atrium and the Auricle View . . . . . . . . . . . . . . . . . . 29
Left Parasternal Pulmonary Artery View ....... 30
Technique in the Dog and Cat . . . . . . . . . . . . . . . . .30
Subjective Assessment of the Left Parasternal
Pulmonary Artery View . . . . . . . . . . . . . . . . . . . . . 31
Left Parastemal Cranial Transverse Heart
Base View . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2
Technique in the Dog and Cat . . . . . . . . . . . . . . . . . 3 2
Cranial Transverse Heart Base View . . . . . . . . . . .33
Left Parasternal Apical Four Chamber View .... 34
Technique in the Dog . . . . . . . . . . . . . . . . . . . . . . . .34
Technique in the Cat . . . . . . . . . . . . . . . . . , . . . . . . .35
Subjective Assessment of the Left Parastemal
Apical Four Chamber View . . . . . . . . . . . . . . . . . .36
Left Parasternal Apical Five Chamber View .... 36
Technique in the Dog and Cat . . . . . . . . . . . . . . . . .36
Apical Five Chamber View . . . . . . . . . . . . . . . . . .38
Section 3
M-Mode Echocardiography:
A Quantitative Assessment
Principles of M-Mode Echocardiography ....... 40
M-Mode of the Left Ventricle . . . . . . . . . . . . . . . 40
Cursor Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
M-Mode of the Aorta and Left Atrium ........ 43
Cursor Placement . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
M-Mode of the Mitral Valve . . . . . . . . . . . . . . . . 45
Cursor Placement . . . . . . . . . . . . . . . . . . . . . . . . . . .4 5
Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Assessment of M-Mode Measurements . . . . . . . . 4 7
Diastolic Measurements . . . . . . . . . . . . . . . ... .. .. .4 7
Systolic Measurements . . . . . . . . . . . . . . . . . . . . . . . .48
Types of Enlargement . . . . . . . . . . . . . . . . . . . . . . . . .48
Assessment of Left Ventricular Function . . . . . . . 49
Fractional Shortening . . . . . . . . . . . . . . . . . . . . . . . .49
Section 4 Echocardiographic
Reference Values
Echocardiographic Reference Values for
Parameters in the Cat . . . . . . . . . . . . . . . . . . . 56
Echocardiographic R eference Values for
Parameters Unrelated to Body Size in the ' Dog .. 57
Echocardiographic R eference Values for
Parameters Related to Body Size in the Dog .. 58
Section 5 Common Acquired

Heart Disease
Mitral Valve Disease . . . . . . . . . . . . . . . . . . . . . . 68
Endocard~~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Hypertrophic Cardiomyopathy . . . . . . . . . . .... 71
Dilated Cardiomyopathy . . . . . . . . . . . . . . . . . . . 74
Restrictive Cardiomyopathy . . . . . . . . . . . . . . . . 76
Pericardial Effusion . . . . . . . . . . . . . . . . . . . . . . . 78
Hemangiosarcoma . . . . . . . . . . . . . . . . . . . . . . . . 80
Aortic Body T umors . . . . . . . . . . . . . . . . . . . . . . 82
Section 6 Common Congenital
Heart Diseases
Patent Ductus Arteriosus . . . . . . . . . . . . . . . . . . . 86
Subaortic Stenosis . . . . . . . . . . . . . . . . . . . . . . . . 88
Pulmonic Stenosis . . . . . . . . . . . . . . . . . . . . . . . . 91
Ventricular Septal Defect . . . . . . . . . . . . . . . . . . 94
Tricuspid Dysplasia . . . . . . . . . . . . . . . . . . . . . . . 96
Abbreviations ....................... 99
Recommended Readings ....... _... 107

Section 1
The Basics
2
Introduction
The goal of this book is to provide the technical
information to help you obtain quality echocardiographic images.
This goal is accomplished by using images, video clips (on CD
ROM), and detailed information on measurement and assessment
of echocardiographic images. Mastery of echocardiographic tech~
nique and assessment makes applying the diagnostic guidelines of
common cardiac diseases presented in this handbook easy.
Some Helpful Hints

The following icons are used in this book to indicate important
concepts:
./ This is a routine feature of the subject being discussed .
., This is a salient feature. If you remember anything about this

particular subject, this is it.
h We will use this selectively. This is a key point to understanding

this particular topic.
~ Stop. This doesn't look important but it can really make

a difference.
ti'f. Something serious, possibly life threatening, will happen if you

don't remember this, resulting in the loss of both patient
and client.
o A companion CD is available for purchase by calling

877~306~9793. The CD contains the text and figures of this
book, as well as video clips illustrating the points made in bulleted
lists for normal structures, disease features and imaging technique.
It also contains additional information on basic physics, and a self~
test section for structure identification.
3
Applications
Evaluation of
• Valvular lesions
• Chamber sizes
• Myocardial function
• Pericardial effusions
• Differentiation of congenital heart diseases
Aid in the diagnosis of
./ Acquired heart disease
Degenerative mitral valve disease
Endocarditis
Cardiomyopathies (hypertrophic, dilate'!, restrictive)
Pericardial effusions
Cardiac neoplasia
Thoracic masses
./ Congenital heart disease
Patent ductus arteriosus
Ventricular septal defects
Subaortic stenosis
Pulmonic stenosis
Tricuspid dysplasia
Combination of defects
Indications for an echocardiogram
./ When the clinical picture implies heart disease and any of the
following are present:
Coughing Cyanosis
Exercise intolerance Lethargy
Arrhythmia's Weak pulses
Pulmonary edema Murmurs
Radiographic evidence Pulmonary congestion
of heart enlargement Collapse or syncope
4
Cardiac Anatomy
From the body To the body
Figure 1-1. This diagram shows the chambers and vessels of the heart.
Flow through the heart is indicated. Notice the relationships between the
mitral valve and the aorta (the aortic wall is continuous with the septal leaflet
of the mitral valve), the pulmonary artery and the tricuspid valve (the pul-
monic valve is continuous with the septal leaflet of the tricuspid valve), and
the two semilunar valves .
5
Orientation of the
Heart in the Thorax
Figure 1-2 This lateral radiograph of a cat's thorax shows how the long axis of the
heart is aligned. This image indicates how the sound plane should be aligned on the
thorax to obtain good long axis images. Notice how much sternal contact there is,
this is why the transducer in cats is much closer to the sternum than in dogs.
6
Figure 1-3 This lateral radiograph of a dog's thorax shows how the long axis
of the heart is aligned more upright than the cat. The axis extends more from
xyphoid to shoulder, with less sternal contact than the cat.
7
8
Section 2
Obtaining the
Image and
Subjective
Assessment
9
Right Parasternal Long
Axis Left Ventricular
Outflovv Vievv
Techniq ue in the Dog 0
./ Place the dog in right lateral recumbency over a cutout in an
exam table, area of the heart over the cutout .
./ Feel for the apical impulse on the right side (point on the
thorax where you can feel the heart beat) .
• Place the transducer at that location, holding it in the following
manner (Figure 2,1):
• Crystals point toward the lumbar spine ,
• Cable of the transducer extends toward the elbows
• Reference mark directed toward the neck
• Angle of about 45 degrees between the chest wall
and the transducer
• Without changing how you are holding the transducer, move
the transducer around the thorax. Move ventral and dorsal in
that intercostal space, move forward a space and repeat. Move
back a space and repeat. Continue until you have found the
location with the best image quality regardless of whether the
imaging plane is perfect. (If you have not changed the way you
hold the transducer it will be almost a perfect long axis)
h To perfect the image:
• If the aorta is not seen, rotate the transducer so the
reference mark moves counterclockwise (towards you and the
front legs of the animal, away from the spine).
• Twist to lengthen the left ventricular chamber.
• Lift transducer up and down (decreasing or increasing the
angle between the transducer and the thorax) without changing
where it is pointing to widen the left ventricular chamber.
• Point more caudal to see more of the left ventricular chamber.
• Point more toward the thoracic spine in order to see more
of the heart base structures.
• Do not lift or drop the transducer in the process of
performing these last two movements.
10
• If these movements do not result in a good long axis outflow
image, then you must slide dorsal or ventral in the intercostal
space because it implies you are not under the heart properly.
• Follow the steps above to perfect the image again after
repositioning in the space.
Figure 2-1A This illustration shows how the right parasternal long axis left
ventricular outflow view of the heart is oriented in the thorax of a dog.
Figure 2-1 B The transducer should be held and positioned as shown in this
image in order to obtain a right parasternal long axis left ventricular outflow
view. See text for details.
11
Modifications in Technique
for the Cat 0
./ Keep the cat stretched out as much as possible (Figure 2,2) .
./ Pull the cat's front legs forward .
h Keep the back straight .
• Hold the transducer the same way as for the dog.
• Start with the transducer way up under the right leg of
the cat right next to the sternum.
• Slide caudal along the sternum with the transducer until
you see something beating.
• Conti nue to slide caudal until the beating structure is
centered on the monitor.
• Stop here and s lid e ventrally or dorsally until the heart
appears clearly on t h e monitor.
h Adjust the imaging plane as directed above in the dog.
Figure 2-2A
This illustration shows
how the right parasternal
long axis left ventricular
outflow view of the heart
is oriented in the thorax
of a cat.
Figure 2-28
The transducer should be
held and positioned as
shown in this image in
order to obtain a right
parasternal long axis left
ventricular outflow view.
See text for details.
12
Left Ventricular Outflow View
in the Dog
(Figure 2-3) 0
./ Straight interventricular septum
• Upward curvature suggests left ventricular volume overload.
• Downward curvature suggests one of the following:
Left ventricular volume contraction
Right ventricular volume overload
Septal hypertrophy
./ The aorta and left atrium are similar in size .
./ The mitral valve:
• Is thin with the same thickness from the- base of the leaflets
to their tips
• Does not prolapse (bend) back into the left atrium
./ The ventricular septum does not protrude downward in front
of the aorta .
./ The right ventricular chamber is approximately 1/3 the size of
the left ventricular chamber.
./ The right ventricular wall is approximately 1/2 the thickness
of the left ventricular free wall.
• Make sure the left ventricular wall is normal in thickness
based on M-Mode measurements.
• If the relationship of right to left wall thickness is normal
and the left wall is thick, so is the right.
Figu re 2-3 This is a normal

right parasternal long axis
left ventricular outflow view
in the dog. See the text for
features that make
this echocardiographic
image normal.
13
Left Ventricular Outflow View
in the Cat
(Figure 2-4) 0
./ The septum may bow slightly upward .
./ The left atrium may be up to 1.7 times larger than the aorta .
./ The ventricular septum may normally protrude down in front
of the aorta to a small degree (arrow).
• The width of the left ventricular outflow tract should not
change as the heart contracts .
./ Normal mitral va lve appearance
• Thin pliable leaflets
./ The right ventric ular wall is about 1/2 the thickness of the
left ventr ic ula r wall.
• Make sure the left ventricular wall is normal in t hickness
based on M -M ode m easurements.
• If the relat io n ship of right to left wall thickness is normal
and the left wall is thick, so is the right .
./ The right ventricular ch a mbe r is approxim ately 1/3 the size of
the left ventricular c h a mbe r.
Figure 2-4. The ventricular septum can extend down into the left ventricular
outflow tract (arrow) and the left atrium can be larger than the aorta in normal
feline hearts, as seen in this right parasternal long axis left ventricular outflow
view from a cat. See the text for other features that make this echocardiographic
image normal.
14
Right Parasternal Long
Axis Four Chamber Vievv
Technique in the Dog and Cat
(Figure 2~5) 0
Figure 2-5A
Th is illustration shows
how the right parasternal
long axis fou r chamber
view of the heart is
oriented in t he thorax.
Figure 2-58
held and posit ioned as
order to obtain a right
parasternal long axis four
chamber view.
See t ext for details .
./ Start with a good left ventricular outflow view.

./ Twist the transducer so the reference mark moves away from
you toward the spine.
h Do not lift or drop the transducer until the aorta has disappeared .
./ Once the atrial septum is seen, lift and drop the transducer
slightly towards and away from the dog's thorax to create a longer
wider left ventricular chamber and well defined atrial septum.
15
~ Be s ure n ot t o con fu se t h e ven a cava fo r a n e n larged right
atrium. Lifting the t r a n sducer too muc h b r in gs in the caudal
ven a cava a nd c reates t h e app ear a n ce of a la rge right atrium
(Figure 2,6A) . C o ntinuing t o lift t h e t ra n sducer a llows visuali,
zation o f b o th cava (Fig ure 2 , 6 B) .
• When the ven a cava is seen, the angle between the transducer
and ch est wall is too small.
./ Point t h e crystals toward the thor acic sp ine in order to see
m o re of the r igh t atrium.
Figure 2-6A Lifting the transducer up towards the animal's thorax from a
good right parasternal four chamber view allows part of the caudal vena ca va
to be seen This can make the right atrium appear artifactually large .
Figure 2-68 Continuing to lift the transducer upwards towards the an imal 's
thorax will bring both the caudal and cranial vena cava into view.
16
Subjective Assessment of
the Four Chamber View In the
Dog and Cat
(Figure 2- 7) 0
Figure 2-7 Th is is a normal

right parasternal four cham-
ber view of the heart. See
t he text for features that
make this ech ocardi ographic
image normal.
tI' Th~ interatrial septum is straight.

• Upward curvature suggests left atrial dilation
Lifting the transducer too much while turning into
this view can make the interatrial septum appear to
bow upward.
Lift and drop the transducer to create a straight septum.
h If it cannot be done, there is true upward curving of the septum.
• Downward curvature suggests right atrial dilation.
h If you lift the transducer while obtaining this view, the vena
cava are seen and these may make the right atrium appear to be
artifactually dilated (see Figure 2-6).
tI' The ventricular septum is straight.
• The slight upward curve as it moves away from the mitral
annulus is normal.
• Downward curvature suggests one of the following:
Right sided volume overload
Septal hypertrophy
Left-sided volume contraction
• Upward curvature suggests
Left-sided volume overload
17
./ The mitral valves are normal.
h This is probably the best imaging plane to see lesions without
artifactually creating them .
./ Right ventricular wall thickness is about half the thickness of
the left ventricular wall.
• Make sure the left ventricular wall is normal in thickness
based on M-Mode measurements.
• If the relationship of right to left wall thickness is normal
and the left wall is thick, so is the right.
h Do not assess right ventricular size in this imaging plane.
• It is easy to create a very large right ventricle with slightly
different transducer placement.
Right Parasternal
Transverse Vievvs
Technique in the Dog and Cat 0
(Figures 2-8, 2-9, 2-10, and 2-11)
./ Start with a good left ventricular outflow view.
• Pay attention to the long axis of the heart and how it is aligned
within the thorax. Imagine a line along the length of the heart.
• Very deep-chested dogs, for instance, may have a heart
that is oriented straight up and down in the thorax from
spine to sternum.
• Most dogs typically have hearts that are oriented from
shoulder to xyphoid (see Figure 1-3).
• The long axis in cats is oriented a little more along the
sternum (see Figure 1-2).
• This line is how you will fan and point the crystals as you
move from base to apex to obtain these transverse views .
./ Twist the transducer so the reference mark moves away from
the spine toward the animal's elbows .
./ Drop the transducer slightly but keep at least a 60-degree
angle between the transducer and the thorax .
./ Twist until a round left-ventricular chamber or aorta is seen.
• You have twisted enough when the left ventricle is
symmetrical and both papillary muscles are seen clearly or
18
• When the aorta in the center of the image is a complete
and closed circle or cloverleaf shape .
./ Pivot the transducer so that the crystals point from the base of
the heart to the apex a long the lo n g axis of the heart (as visualized
in step 1).
h Keep the angle between the transducer and the thorax; do
not become perpendicular to the chest wall.
Figure 2-SA This illustration shows how the right parasternal transverse view
of the left ventricle at the level of the papillary muscles is oriented in the thorax.
Figure 2-S8 The transducer should be held and positioned as shown in this
image in order to obtain this right parasternal transverse view of the left ven-
tricle. See text for details.
19
Figure 2-9A This illustration shows how the right parasternal transverse view
of the mitral valve is oriented in the thorax.
Figure 2-98 The transducer should be held and positioned as shown in this
image in order to obtain a right parasternal transverse view of the mitral valve.
20
Figure 2-10A This illustration shows how the right parasternal transverse
view of the heart base at the level of the aorta and left atrium is oriented in
the thorax.
Figure 2-1 OB The transducer should be held and positioned as shown in this
image in order to obtain a right parasternal transverse view of the aorta and left
atrium. See text for details.
21
Figure 2-11A This illustration shows how the right parasternal transverse view
of the heart base at the level of the pulmonary artery is oriented in the thorax.
Figure 2-11 B The transducer should be held and positioned as shown in this
image in order to obtain a right parasternal transverse view of the heart base at the
level of the pulmonary artery. See text for details.
22
Transverse Views in the Dog
and Cat 0
Left ventricle at the papillary muscles (Figure 2-12):
Figure 2-12 This is a normal

right parasternal transverse image
of the left ventricle. See the text
for features that make this
echocardiographic image normal.
./ Symmetrical circular left ventricular chamber

. / Papillary muscles are similar in size .
./ Ventricular septum is not flattened .
./ Uniform contraction
. / Right ventricular wall thickness about 1/2 the thickness of
the left ventricular wall thickness
h Be careful about evaluating right ventricular size on trans-
verse views since the oblique angles used often make it look
quite large.
• Double check your evaluation of size on long axis
outflow views .
. / Irregularities on the right side of the septum are normal; they
represent the trabeculae and papillary muscles of the right heart.
Left ven tricle at the chordae tendinae (Figure 2 -13) :
. / Symmetrical circular left ventricular chamber
. / Bright lines replace the muscular bundle of the papillary muscles
23
Figure 2-13 This is a normal right
parasternal transverse image of the
chordae tendinae. See the text for fea-
tures that make this echocardiographic
image normal.
Mitral valve (Figures 2-14A and 2-14B):

./ The leaflets should be normal without thick areas .
./ Artifactual lesions are easy to create in this i'maging plane .
./ The leaflets should move well.
Figure 2-14A These are normal right

parasternal transverse images of the
mitral valve. The mitral valve is open .
RV
& LV /
MV
Figure 2-14B The mitral valve

{ ~
is closed. See the text for features
that make this echocardiographic ~~
image normal.
24
Heart base~aorta and left atrium (Figure 2-15):
. / The aorta and left atrium are similar in size based upon an
imaginary line drawn through the middle of the aorta and the
main body of the left atrium.
~ Make sure all three cusps of the aortic valve are visible and
that the aorta is a closed circle when making this comparison .
./ Atrial septum is straight .
./ The left atrial wall makes a smooth transition into the left auricle.
• This is important in cats where the body of the left atrium
may appear to be normal but the auricle is enlarged as seen
by bulging at the atrial and auricular junction.
Heart base-aorta and pulmonary artery (Figure 2-16):
./ Aorta and pulmonary artery are similar in diameter.
./ The pulmonary artery remains the same width from the level of
the valves down to the bifurcation into right an? left branches .
./ The left main pulmonary artery is just barely seen .
./ The pulmonic valves move well toward the walls of the pul-
monary artery. Cineloop is often required to visualize the valve
motion well.
Figure 2-15 This is a normal right
parasternal transverse image of the
heart base at the aorta. See the text
for features that make this echocar-
diographic image normal.

right parasternal transverse image
of the heart base at the pul-
monary artery. See the text for
features that make this echocar-
25
Left Parasternal
Cranial Left Ventricular
Outflovv Vievv
(Figure 2~17)
tI' Reference mark towards the nose

tI' Crystals directed towards the spine
tI' Cable extends towards e lbow.
tI'Angle of about 30 degrees between the transducer and the
chest wall
Figure 2-17A This illus-
tration shows how the
left parasternal cranial
long axis left ventricular
outflow view of the heart
is oriented in the thorax.
Figure 2-178 The trans-

ducer should be held and
positioned as shown in
this image in order to
obtain a left parasternal
cranial long axis left
26
h Find the image as fa r c r a ni a l as yo u c a n.
h Yo u will feel the a nima l 's trice p s aga inst your h a nd .
./ Lift the tra n sducer up a nd d o wn until a n aorta is seen .
./ Twis t the tra n sducer clockwise a nd c o unte rclock w ise until t h e
aorta is a lo n g as poss ible.
h M ost of the time, when images h e re a re poor, it is b ecau se t h e
tran sducer is not positioned far enou gh aw ay fro m the st e rnum.
M ove d o rsally a n d cranial to try and improve this image.

Left Parasternal Cranial Left
Ventricular Outflow View
(Figure 2 -1 8 ) 0
./ The le ft ventric ula r o utflow tract sh o uld be clear of obs truc-
tion (no rings, e t c. ) .
./ The aortic valves a re free o f les io n s .
./ The ao rta re m a ins the sam e dia m e t e r a ll a lo n g its le n g th .
Figure 2-18 This is a normal left parasternal cranial long axis left ventricular
outflow view . See the text for features that make this echocardi ographic
image normal.
27
Left Parasternal Right
Atrium and Auricle Vievv
(Figure 2-19) 0
• Start with a good long axis left ventricular outflow view on
the left .
./ Make sure the aorta is as long as poss ib le .
./ M ake sure you are as far cranial and dorsal as you can get for
a clear image .
./ Drop the cab le slightly until the auricle comes into view.
./ Rotate in and out of the auricle to see a ll aspects.

left parasternal cranial
long axis view of the
right atrium and auricle
is oriented in the thorax.

view of the right atrium
and auricle.
28
Parasternal Right Atrium and
Auricle View
(Figure 2-20) 0
. / The auricle should be clear of soft tissue densities.
Figure 2-20 This is a normal left parasternal cranial long axis view of the right
atrium and auricle. See the text for features that make this echocardiographic
image normal.
29
Left Parasternal
Pulmonary Artery Vievv
(Figure 2-21) 0
." Start w ith a good long axis left ventricu lar outflow view.
./ M ake sure the aorta is as long as possib le .
./ M ake sure you are as far cranial and dorsal as you can get fo r
a clear image .
./ Lift the transducer slightly unti l the pu lmonary artery comes
into view.
Figure 2-21A
how the left parasternal
cranial long axis view of
the pulmonary artery is
oriented in the thorax.
Figure 2-218
order to obtain a left
parasternal view of the
pulmonary artery.
30
Parasternal Pulmonary Artery View
(Figure 2-22) 0
./ The pulmonic valve should look normal and move well towards
the walls of the pulmonary artery.
./ There should be no post-stenotic dilation.
Figure 2-22 This is a normal left parasternal cranial long axis view of the
pulmonary artery. See the text for features that make this echocardiographic
image normal.
31
Left Parasternal Cranial
Transverse Heart
Base Vievv
(Figure 2-23) 0
• From any of the cranial long axis views
./ Twist the transducer so that the reference mark is directed
towards the spine .
./ Drop the cab le down away from the chest wall so that the trans-
ducer is a lmost perpendicular to the c h est wall.
./ Fanning towards the heart base (shou lders) with the sound
beam will bring in the pulmonary a rtery and fanning caudally
should bring in the tricuspid valve and right atrium.
Figure 2-23A
cranial transverse view of
the heart is oriented in
the thorax.
Figure 2-238
order to obtain a left
parasternal transverse.
view of the heart.
32
Left Parasternal Cranial
Transverse Heart Base View
(Figure 2~2 4) 0
./ The tricu spid valve should move well and look thin in this
imaging plane .
./ The pulmonary valves should have normal conformation
a n d motion.
Figure 2-24A This is a normal left parasternal transverse image of the heart base
emphasizing the tricuspid valve. See the text for features that make this echocard io-
graphic image normal.
Figure 2-248 This is a normal left parasternal transverse image of the heart base
emphasizing the pulmonic valve. See the text for features that make this echocar-
33
Left Parasternal Apical
Four Chamber Vievv
Technique in the Dog 0
(Figure 2-25)
./ R eference mark directed toward the spine
h Point the crystals toward the neck (cable to knees) .
. / About 30 degrees between chest wall and transducer
h Keep the edges of the sound p lane equidistant t o the
scanning table .
./ Find the liver n ear the last intercostal space, close to the sternum.
Figure 2-25A
apical four chamber view
of the heart is oriented in
the thorax of the dog.
Figure 2-258
The transducer should
be held and positioned
as shown in this image
in order to obtain a left
parasternal apical four
chamber view in the
dog . See text for details.
34
./ Stay next to the sternum and slide forward until the liver
disappears and the h eart is seen.
• The h eart will typically not look good right here
./ Lift the transducer up towards the chest wall to e longate the heart
and clear up the image .
./ If the ventricle is not long, you have slid forward too far; slide
back, and keep the transducer up.
Technique in the Cat 0

(Figure 2-26)
./ Reference mark directed toward the spine
h Point the crystals toward the front legs (cable to knees).
h Almost no space between chest wall and transducer
h The transducer hugs the abdominal wall.
h Keep the edges of the sound plane equidistant to the
scanning table .
./ Find the liver near the last intercostal space, close to the sternum .
./ Stay next to the sternum and slide forward until the liver disap-
pears and the heart is seen.
• The heart will typically not look good right here
./ Lift the transducer up towards the chest wall to e longate the heart .
./ If the ventricle is not long, you have slid forward too far; slide back
and keep the transducer up.
Figure 2-26 The transducer should be held and positioned as shown in this
image in order to obtain a left parasternal apical four chamber view in the cat.
35
Left Parasternal Apical Four
Chamber View 0
(Figure 2-27)
./ Use this view for valve appearance and motion .
./ Check for prolapse and rupture of the chordae .
./ Necessary for Doppler

left parasternal apical four
chamber view of the heart.
See the text for features that
make this echocardiographic
image normal.
Left Parasternal Apical

Five Chamber Vievv
(Figures 2-28 and 2-29)
./ Start with a good ap ical four chamber v iew.
./ Lift the transducer even more toward the chest wall. It may be
parallel with the scan table at this point
./ Do not rotate or redirect the transducer.
h Make sure the edges of the sound plane are still equidistant
from the scan table.
36
left parasternal apical
five chamber view of the
heart is oriented in the
thorax of the dog .

t his image in order to
apical five chamber view
in the dog.

apical five chamber view
in the cat.
37
Left Parasternal Apical Five
Chamber View 0
(Figure 2-30)
.,/ Use this view for valve appearance and motion .
.,/ Check for prolapse and rupture of the chordae
.,/ Check for post-stenotic aortic dilation
.,/ Necessary for Doppler
Figure 2-30. This is a normal left parasternal apical five chamber view of the
heart. See the text for features that make this echocardiographic image normal.
38
Section 3
M-Mode
Echocardiography:
A Quantitative
Assessment
39
Principles of M-Mode
Echocardiography
h One single sound beam is selected over the real time image .
./' This is selected with the cursor on your ultrasound image .
./' The structures under the cursor are seen on the M-Mode image .
./' The M-Mode diagram has depth on the y-axis and time on
the x-axis .
./' The M-Mode scro lls across the screen showing the cardiac
structures as they change during diastole and systole .
./' An appropriate M-Mode is frozen for measuring .
./' Freeze an image with clearly defined structural boundaries.
M-Mode of the Left

Ventricle
Cursor Placement 0
./' The c ursor may be placed over long- or short-axis images .
• The long-axis image should be the right parasternal left ven-
tricular outflow view (Figure 3-1).
h It should be optimized for length and width, a clear
aorta, and well-moving mitral va lves.
Figure 3-1 When the long

axis is used for an M-Mode of
the left ventricle, the cursor
should be placed over the
largest part of the left ventricu-
lar chamber, perpendicular to
the septum and free wall,
between the mitral valves and
the papillary muscle, on a left
40
h The wall and the septum are parallel to each other when
left ventricular size is optimized.
h If the image is too tipped (apex up) to position the cur-
sor perpendicular to the wall and septum, move forward
one intercostal space and dorsally in that space. Then point
the crysta ls more cauda lly.
./ Place the cursor perpendicular to the septum and free wall
at the largest ventricular dimension between the tips of the
mitral valve and the papillary muscles.
~ Make s ure you are not placing the cursor over the thinner
part of the septum within the left ventricular outflow tract .
• The short-axis image should be the right parasternal trans-
verse view at the level of the chordae tendinae (Figure 3-2) .
./ Fan the sound beam between the mitral valves and papillary
muscles in order to find the chordae .
./ Make sure the image is symmetrical.
h Make sure the transverse p lane is the smallest one you can
obtain at the level of the chordae, and that the RV is clearly seen.
h If there is no RV, the transducer is too close to the apex.
Follow directions under Key #3 above.
h Place the c ursor through the middle of the left ventricular
chamber making two similar halves-mirror images of each other.
Figure 3-2 When the transverse view is used for an M-Mode of the left ventri-
cle, the cursor should be placed so that it creates two halves which are mirror
images of each other, at the level of the chordae tendinae.
41
Measurements
(Figure 3-3)
Diastolic
./ These should be made at the onset of the QRS complex, if
you have an ECG .
./ Otherwise measure at the largest left ventricular dimension
just before the wall and septum contract .
./ When there is filling secondary to the atrial contraction,
measure just before this point.
Figure 3-3 The arrows show where measurements are taken on left ventricular
M-Modes. See the text for details.
Systolic
./ These are made at the smallest left ventricular chamber size .
• Measure both diastolic and systolic indices in the following
manner:
• Septum-from the top of the septum to the bottom of the
septum, including the lines that define its boundaries
• Left ventricular chamber-from the bottom of the septum
to the top of the wall. Do not include the lines defining the
septal and wall boundaries.
• Left ventricu lar wall-from the top of the wall to the top
of the pericardial sac. Include the line defining the wall and
chamber boundary.
42
M-Mode of the Aorta and
Left Atrium
Cursor Placement 0
./ These images may be obtained from right parasternal long~ or
short~axis images .
./ From the long~axis left ventricular outflow view (Figure 3A)

• Place the cursor perpendicular to the walls of the aorta
over the valve cusps.
• This should place the cursor automatically through the
body of the left atrium .
• Make sure the left ventricular chamber is as long and
wide as possible.
• The wall and the septum are parallel to each other if the
chamber is as long as it can be.
• Make sure the mitral valves move well and are clearly
seen.
Figure 3-4 When the long axis is
used for an M-Mode of the aorta
and left atrium, the cursor should
be placed over the aortic valves,
perpendicular to the aortic walls,
through the largest portion of the
left atrium, on a left ventricular
outflow view.
• Often you must scan so as to move the image to the left

side of the monitor to align the cursor properly.
• Point the crystals toward the thoracic spine without
dropping or lifting the transducer itself.
• Twist the transducer to lengthen the heart again if necessary.
./ From the short~axis view (Figure 3~5)
• Place the cursor perpendicular to the walls of the aorta
through the aortic valve.
h Be sure the aorta is a closed circle, a ll 3 cusps are
visible, and the left atrium and auricle are clearly seen.
43
• Do not have any pulmonary artery in the image.
• The cursor should be aligned through the body of the left
atrium, not the auricle.
• The image may have to be oriented toward the left side of
the monitor for this to work.
Figure 3-5 When the transverse

view is used for an M-Mode of the
aorta and left atrium, the cursor
should be placed so that it divides the
aorta in half when all three cusps are
seen and goes through the main body
of the left atrial chamber.
Measurements
(Figure 3-6)
./ Aorta-measured at the end of diastole
• These measurements are made to coincide with the onset
of the QRS complex.
• If an ECG is not available, measure at the lowest point of
aortic wall motion .
./ Measure from the top of the anterior (top) aortic wall to the
top of the posterior (bottom) aortic wall.
./ The line representing the top of the aorta is included in the
measurement but the bottom line is not .
./ Left atrium
• These measurements are made at the largest left atrial
chamber size when the aortic walls are at their highest point .
./ Measure from the top of the posterior aortic wall to the top of
the pericardium.
• The line representing the bottom of the aorta is included
in this measurement.
• If a left atrial wall is seen, ignore it and measure down to
the top of the pericardium.
44
Figure 3-6 The arrows show where measurements are ta~n on aortic - left
atrial M-Modes. See the text for details.
M-Mode of the
Mitral Valve
Cursor Placement 0
./ This image may be made from either the right parasternal
long axis or short axis views .
./ From the long axis (Figure 3-7)
• Find the best long axis left ventricular outflow view.
• Make sure the mitral valves move well and that the aortic
valves are also seen.
Figure 3-7 When the long axis is

used for an M-Mode of the mitral
valve, the cursor should be placed
over the tips of the mitral valves on
a left ventricular outflow view.
45
• Place the cursor over the tips of the mitral valve leaflets.
• The cursor shou ld be fairly perpendicular to the septum
and n o t diagonal through the left ventricular chamber.
./ From the sh ort axis (Figure 3~8)
• Find the transverse view where both leaflets are seen (the
fish mouth view).
• Make sure the image is symmetrical.
• Place the cursor through the middle of the chamber across
the middle of the mitral valves.
Figure 3-8 When the transverse view is used for an M-Mode of the mitral valve,
the cursor should be placed so that it divides the mitral valve into equal halves.
Measurement
./ At slower h eart rates, the mitral valve sh ould h ave an "M"
configuration (Figure 3~9)
• The first peak of the M represents rapid ventricular filling
a nd is called the E point.
• The a trium h as been filling throughout ventricular systo le
a nd, at the beginning of diastole, the pressure gradient from
left atrium to left ventricle cau ses the mitral valves to
passively but rapidly open towards the septum and free wall.
• After the initial filling phase, pressures equilibrate
somewhat and flow decreases. The mitral valves move toward a
partially closed position.
• The atria l contraction toward the end of diastole causes
the valve to actively open toward the septum and free wall again.
46
• This creates the second peak of the "M" and is referred to
as the A point .
./ The only consistent measurement of mitral valves is the E
Point to Septal Separation (EPSS) .
. / Measure from the top of the E point to the septum (Figure 3-9) .
./ Do not include the line defining the bottom of the septum in
the measurement.
Figure 3-9 The arrows

show where the meas-
urement is taken on the
mitral valve M-Mode.
See the text for details.
Assessment of M-Mode
Measu rements
Diastolic Measurements
h Used to assess chamber sizes
• L a rger diastolic measurements reflect increased volume within
that chamber or vessel.
• Smaller measurements reflect reduced volumes .
h Used to assess wall and septal thicknesses
• Increased diastolic wall or septal measurements reflect hypertrophy
(real or pseudo, see discussion later)
• Decreased diastolic wall or septal measure mens reflect a lack
of hypertophy
47
Systolic Measurements
h Used to assess function
• Increases in wall or septal thicknesses during systole do not
necessarily mean hypertrophy; it could simply be due to
increased function .
• Increased systolic left ventricular chamber size reflects decreased
function of the heart not necessarily increased volume.
Types of Enlargement
Concentric
• Hypertrophy with normal or reduced diastolic left ventricular
chamber size
• Increased septal and/or free wall thickness with no increase in
chamber size '
Causes of concentric hypertrophy
h This may be idiopathic hypertrophy
./ Hypertrophic cardiomyopathy
h It may be secondary to increased workload (afterload) on
the heart .
./ Subaortic stenosis
./ Systemic hypertension
h It may be "psuedo" hypertrophy
./ Volume contraction decreases chamber size and makes the
walls appear thick when they are simply not as stretched as
they normally would be (like in the bladder).
• Dehydration
• Hemorrhage
• Addison's disease
• Pulmonic stenosis (decreased flow into the left heart)
• Pulmonary hypertension (decreased flow into the left heart)
Eccentric
./ Hypertrophy of the septum and wall with increased diastolic left
ventricular chamber size, secondary to increased volume in the heart
Causes of eccentric hypertrophy
./ Valvular insufficiencies
• Mitral
• Aortic
48
./ Shunts
• Patent ductus arteriosus (PDA)
• Ventricular septal defect (VSD)
./ Miscellaneous
• Chronic anemia
• Systemic hypertension (later stages)
./ Dilated cardiomyopathy (typically no increased wall thicknesses)
Assessment of Left
Ventricular Function
Fractional Shortening
• This is an index of overall cardiac function. '
h Many things affect it, but these three things are important
to consider: preload, afterload, and finally contractility itself.
./ Preload
• Increased preload stretches the myocardial fibers.
• This allows the muscle fibers to slide over each other to a
greater extent (Frank Starling) and fractional shortening
increases (Figures 3-10 and 3-11) .
h Therefore, hearts with increased preload and no myocardial
dysfunction should always have elevated fractional shortenings.
h How high should it go?
./ No matter how dilated a heart becomes, if the intrinsic
ability of the muscle to contract is not compromised, it
will shorten down to normal systolic dimensions .
./ So both an elevated fractional shortening and normal
systolic dimensions for that dog's body size should be seen
in the presence of increased volume and normal muscle.
• Decreased preload decreases the amount of stretch on the
muscle myofibers.
• This diminishes their ability to slide over each other and
fractional shortening is decreased (Figures 3-10 and 3-12).
• Therefore, poor fractional shortening may simply be due
to poor preload, not poor contractility.
• Check the diastolic dimension of the left ventricle ro
assess preload.
49
Effects of preload
on muscle function
1 1
Normal Preload
1 1
Increased Preload
11 _ _- Decreased Preload
Figure 3-10 These lines represent the thick and thin filaments of a muscle cell.
The vertical lines in the middle of each diagram represent how far the filaments
slide over each other during contraction and represent systolic length.
A) Under normal preload conditions, the filaments slide over each other towards
the center of the cell and a normal amount of shortening (fractional shortening)
is achieved .
B) When preload is increased the fibers start out in a less overlapped state, dur-
ing contraction they still shorten down to the normal systolic length and as a
result the degree of shortening (fractional shortening) is increased .
C) When preload is decreased, the fibers start out in a more overlapped state.
During systole they slide towards the normal systolic length but the degree of
shortening (fractional shortening) is reduced as a result of starting out at a
shorter length.
50
na I SI S
: M-mode
Calculiltlons
Figure 3-11 Increased preload, as measured from increased diastolic dimen-

sions, increases the stretch on the muscle fibers, allowing greater change in
fiber length with contraction and results in elevated fractional shortening
(59.0%) when the muscle is normal.
aln Menu
nal Sl5.
: H-mode
CalculatIons
Figure 3-12 Decreased preload, as measured from diastolic dimensions on this

M-Mode, reduces fiber length and the degree of change in fiber length as the
muscle contracts, resulting in diminished fractional shortening (20 .6%) even if
the muscle is normal. Abnormal wall and septal motion in this image are often
seen with decreased preload.
51
.,/ Afterload (Figure 3-13)
h Increased afterload without chronic training diminishes
the ability to contract (think of pressing a free weight you are not
used to) even if the muscle is normal (Figure 3-14) .
.,/ Therefore fractional shortening is depressed.
h Decreased afterload makes it easier for the muscle
to contract .
.,/ Therefore fractional shortening is increased .
.,/ Contractility
.,/ This is the intrinsic contractile property of the muscle fibers.
h When fractional shortening is decreased and increased
afterload and decreased preload are ruled out as causes of poor
function, then contractility can be blamed (Figure 3-14).
h Volume overloaded hearts with normal contractility
should have elevated fractional shortening because of the
increased preload (see Figure 3-11).
Effects of afterload
on muscle function
--.-
_, r,.
Normal Afterload Increased Afterload
~ . .
Decreased Afterload
Figure 3-13 Afterload, the load the heart has to contract against, affects
the degree of muscle shortening. In this illustration, lifting weights you are
trained for, allows muscle to shorten normally. Increasing the amount of
weight, however, without training, prevents the muscle from shortening ade-
quately, even though your muscle is normal. Decreasing afterload makes it
easier for the muscle to work.
52
~ Volume overloaded hearts with normal fractional shorten-
ing (as opposed to increased) and increased systolic dimensions have
some degree of myocardial failure (Figure 3-15).
Figure 3-14 When preload is normal or increased, and blood pressure is nor-
mal, a decreased fractional shortening is consistent with the diagnosis of
myocardial dysfunction . If blood pressure is elevated however, it may be the
cause of poor fractional shortening.
Figure 3-15 Normal fractional shortening, and increased systolic dimensions

in hearts with increased preload, implies some degree of myocardial failure.
The diastolic dimension is increased on this M-Mode. Blood pressure should
be checked to rule out the effects of high afterload on this heart.
53
54
Section 4
Echoca rd iog ra ph ic
Reference Values
55
Reference Values in
the Cat
The reference ranges in this table are not significantly correlated
to body weight in the cat. Most normal cats shou ld have
echocardiographic values that fall within these parameters.
Parameter 95% Cl
Ao (mm) 6.0 - 12.1
LVET (msec) 100 - 180
LA (mm) 7.0-17.0
EPSS (mm) 0 .0 - 2.0
LVd (mm) 10.8-21.4
LVs (mm) 4.0 - 11.2
% FS 40 - 67
VSd (mm) 3.0 - 6 .0
VSs (mm) 4.0 - 9.0
LVWd (mm) 2.5 - 6.0
LVWs (mm) 4.3 - 9.8
LNAo .88 - 1.79
Data from:
Sisson D, Helinski C, et ai , Plasma tau ri ne concentrations and M-Mode echocar-
diographic measures in healthy cats and cats with dilated cardiomyopathy. J Vet
Int Med 1991 ;5:232-238.
Jacobs G, Knight D, M-Mode echocardiographic measurements in non-anes-
thetized healthy cats: effects of body weight, heart rate, and other variables.
Am J Vet Res 1985;46: 1705-1711.
56
Reference Values for
Parameters Unrelated to
Body Size in the Dog
Parameters of function, ratios, and EPSS are independent of
body size and weight. Most dogs, r egard less of s ize, should fall
within these 95% confidence inte rvals.
Parameter 95% Cl
LVET (msec) 161 - 195
PEP (msec) 20 - 94
PEP/LVET .1 - .54
LA/AO .83 - 1.13
EPSS (mm) .30-7.7
% FS 33 - 46
VSd/LVd .22 - .34
HR 49 - 146
Data from:
Boon J, Wingfield W, Miller C. Echocardiographic indices in the normal dog. Vet
Rad 1983;24:214-221.
Boon J. Manual of Veterinary Echocardiography, Williams & Wilkins, Philadelphia,
1998.
57
Echocardiographic
Reference Values for
Parameters Related to
Body Size in the Dog
All parameters of chamber size and wall thicknesses are dependent
upon the animal's weight. Using the following tables look up weight
along the left hand column; follow the row along to the right to see
the range of normal size or thickness for that weight. Parameters are
listed across the top. These represent 95% confidence intervals; real-
ize that 5% of individuals will fall outside of these reference ranges.
58
ECHOCARDIOGRAPHIC VALUES IN THE DOG (mm)
LVW -d
~ Lbs VS - d LV - d VS-s LV -s LVW -s AO LA
0.5 1 4.4 - 6.8 -7.7 - 4.2 3.5 - 5.4 6.7 - 9.4 -8.7 - 1.6 6.1 - 8.5 -11.3 - 2.6 -14.2-1.2
0.9 2 4.7 - 6.9 -1.2-10.7 3.7 - 5.5 7.1 - 9.6 -4.2 - 6.1 6.4 - 8.7 -6.7 - 7.2 -8.4 - 7.1
1.4 3 4.9-7.1 2.7 - 14.5 3.9 - 5.6 7.4 - 9.8 -1.5-8.8 6.7 - 8.9 -4.0 - 9.9 -5.0 - 10.5
1.8 4 5.1 - 7.2 5.4 - 17.2 4.0 - 5.7 7.7-10.0 0.3 - 10.7 6.9 - 9.1 -2 .1 - 11.8 -2.6 - 12.9
2.3 5 5.3 - 7.3 7.5 - 19.3 4.2 - 5.8 7.9-10.2 1.8 - 12.1 7.1 - 9.2 -0.6 - 13.3 -0.7 - 14.8
2.7 6 5.4 - 7.4 9.2-21.0 4.3 - 5.9 8.2 - 10.3 3.0 - 13.3 7.3 - 9.3 0.6 - 14.5 0.9-16.3
3.2 7 5.6 - 7.4 10.7 - 22.5 4.4 - 6.0 8.4 - 10.5 4.0 - 14.3 7.5 - 9.4 1.7 - 15.5 2.2 - 17.6
3.6 8 5.7 - 7.5 11.9 - 23.7 4.5 - 6.0 8.6 - 10.6 4.9 - 15.2 7.7 - 9.6 2.6 - 16.4 3.3-18.7
4.1 9 5.8 - 7.6 13.0 - 24.8 4.6-6.1 8.8 - 10.8 5.6 - 15.9 7.8 - 9.7 3.3-17.2 4.3-19.7
4.5 10 6.0 - 7.7 14.0 - 25.8 4.7 - 6.2 9.0 - 10.9 6.3 - 16.6 8.0 - 9.8 4 .1 - 17.9 5.2 - 20.6
5.0 11 6.1 - 7.8 14.9 - 26.7 4.9 - 6.2 9.2 - 11.1 6.9-17.2 8.1 - 9.9 4 .7-18.5 6.0-21.4
5.5 12 6.2 - 7.8 15.7-27.5 5.0 - 6.3 9.4 - 11.2 7.5 - 17.8 8.3 - 10.0 5.3-19.1 6.7-22.1
5.9 13 6.3 - 7.9 16.5 - 28.3 5.0 - 6.4 9.5 - 11.3 8.0 - 18.3 8.4-10.1 5.8 - 19.6 7.4 - 22.8
6.4 14 6.4 - 8.0 17.2-29.0 5.1 - 6.4 9.7-11,.4 8.5 - 18.8 8.6 - 10.2 6.3 - 20.1 8.0 - 23.4
6.8 15 6.6 - 8.1 17.8-29.6 5.2 - 6.5 9.9 - 11.5 9.0 - 19.3 8.7-10.3 6.8 - 20.6 8.6 - 24.0
7.3 16 6.7 - 8.1 18.5 - 30.2 5.3 - 6.5 10.0 - 11.7 9.4 - 19.7 8.8 - 10.4 7.2 - 21.0 9.1 - 24.5
7.7 17 6.8 - 8.2 19.0 - 30.8 5.4 - 6.6 10.2 - 11.8 9.8 - 20.1
, 9.0 - 10.4 7.6-21.4 9.7 - 25.0
8.2 18 6.9 - 8.3 19.6-31.3 5.5 - 6.6 10.3-11.9 10.2 - 20.4 9.1 - 10.5 8.0-21.8 10.1 - 25.5
8.6 19 7.0 - 8.3 20.1 - 31.8 5.6 - 6.7 10.5-12.0 10.5 - 20.8 9.2 - 10.6 8.4 - 22.2 10.6 - 26.0
9.1 20 7.1 - 8.4 20.6 - 32.3 5.7 - 6.7 10.6 - 12.1 10.9-21.1 9.4-10.7 8.7 - 22.5 11.0 - 26.4
9.5 21 7.2 - 8.5 21.0-32.8 5.7 - 6.8 10.8 - 12.2 11.2 - 21.4 9.5 - 10.8 9.0 - 22.8 11.5 - 26.8
10.0 22 7.3 - 8.5 21.5 - 33.2 5.8 - 6.9 10.9-12.3 11.5-21.7 9.6-10.9 9.3 - 23.1 11.8-27.2
10.5 23 7.4 - 8.6 21.9 - 33.6 5.9 - 6.9 11.1 - 12.4 11.8 - 22.0 9.7-11.0 9.6 - 23.4 12.2 - 27.6
10.9 24 7.5-8.7 22.3 - 34.0 6.0 - 7.0 11.2 - 12.5 12.1 - 22.3 9.8-11.0 9.9 - 23.7 12.6-27.9
11.4 25 7.6-8.7 22.7 - 34.4 6.1-7 .0 11.3 - 12.6 12.3 - 22.6 9.9 - 11.1 10.2 - 24.0 12.9 - 28.3
V1
\0
0\
o

Kg Lb5 VS - d LV - d LVW -d VS -5 LV -5 LVW -5 AO LA
11.8 26 7 .6 - 8.8 23.0-34.8 6 .1-7 .1 11 .5-12 .7 12.6-22.8 10.0 - 11 .2 10.5-24.2 13.3 - 28.6
12.3 27 7 .7 - 8.8 23.4-35 .1 6 .2-7 .1 11.6-12.9 12.8-23.1 10.1 - 11 .3 10.7 - 24.5 13.6 - 28.9
12.7 28 7 .8-8.9 23 .7-35 .5 6.3-7.2 11 .7-13 .0 13.1-23.3 10.3-11.4 11.0 - 24.7 13.9 - 29.2
13.2 2 9 7 .9 - 9.0 24.1-35.8 6.3-7.2 11 .9-13 .1 13.3-23.5 10.4-11.5 11.2 - 25.0 14.2 - 29.5
13.6 30 8.0 - 9.0 24.4 - 36.1 6.4 - 7.3 12.0 - 13.2 13.5 - 23 .8 10.5 - 11.5 11 .4 - 25.2 14.5 - 29.8
14.1 31 8.1 - 9.1 24.7-36.4 6.5-7.3 12.1-13.3 13.7-24.0 10.6 - 11 .6 11.6 - 25.4 14.8-30.1
14.5 32 8 .1 - 9.2 25.0 - 36.7 6 .5 -7.4 12.2 -13.4 13.9 - 24.2 10.7 - 11.7 11.9 - 25.6 15.0 - 30.3
15.0 33 8.2 - 9.2 25.3 - 37.0 6.6 - 7.4 12.4 - 13.5 14.1 - 24.4 10.8 - 11 .8 12.1 - 25.8 15.3 - 30.6
15.5 34 8 .3 - 9.3 25.6 - 37 .3 6.7 - 7 .5 12.5 - 13.6 14.3 - 24.6 10.8 - 11.9 12.3 - 26.0 15.5 - 30.8
15.9 35 8 .4 - 9.3 25.9 - 37.6 6.7 - 7 .5 12.6-13.7 14.5 - 24.8 10.9 - 11.9 12.5 - 26.2 15.8 - 31 .1
16.4 36 8.5 - 9.4 26.1 - 37.8 6.8 - 7.6 12.7-13.8 14.7 - 24.9 11.0 - 12.0 12.7 - 26.4 16.0 - 31.3
16.8 37 8 .5 - 9.5 26.4 - 38.1 6.8 - 7.6 12.8 - 13.9 14.9-25.1 11.1 - 12.1 12.8 - 26.6 16.2 - 31.6
17.3 38 8.6 - 9.5 26.6 - 38.3 6.9 - 7.7 12.9 - 13.9 15.1 - 25.3 11.2 - 12.2 13.0 - 26.7 16.5 - 31.8
17.7 39 8.7 - 9.6 26.9 - 38.6 7.0 - 7 .7 13.0 - 14.0 15.2 - 25.5 11 .3 - 12.3 13.2 - 26.9 16.7 - 32.0
18.2 40 8.7 - 9.6 27 .1 - 38.8 7.0 - 7 .8 13.1 - 14.1 15.4 - 25.6 11.4 - 12.3 13.4-27 .1 16.9 - 32.2
18.6 41 8.8 - 9.7 27 .4 - 39.1 7.1 - 7 .8 13.2 - 14.2 15.6 - 25.8 11.5 - 12.4 13.5 - 27.2 17.1 - 32.4
19.1 42 8 .9 - 9.8 27 .6 - 39.3 7.1 -7 .9 13.3 - 14.3 15.7 - 25 .9 11 .6-12.5 13.7 - 27.4 17.3 - 32.6
19.5 43 8 .9 - 9.8 27 .8 - 39.5 7.2 - 7 .9 13.4 - 14.4 15.9 - 26.1 11 .6-12.6 13.8 - 27 .6 17.5 - 32.8
20.0 44 9 .0 - 9.9 28.0 - 39.7 7 .2 - 8 .0 13.5 - 14.5 16.0 - 26.l 11 .7-12.6 14.0 - 27 .7 17.7 - 33.0
20.5 45 9.1 - 10.0 28.2 - 39.9 7.3 - 8.0 13.6 - 14.6 16.2 - 26.4 11.8-12.7 14.2 - 27.9 17.9 - 33.2
20.9 46 9.1 - 10.0 28.4 - 40.1 7.3 - 8.1 13.7 - 14.7 16.3 - 26.5 11.9-12.8 14.3 - 28.0 18.1 - 33.4
21.4 47 9.2-10.1 28.6 - 40.3 7.4 - 8 .1 13.8 - 14.8 16.5-26.7 11 .9-12.9 14.4 - 28.2 18.3 - 33 .6
21.8 48 9 .2-10.1 28.8 - 40.5 7 .4 - 8 .2 13.9 - 14.9 16.6 - 26.8 12.0 - 13.0 14.6 - 28.3 18.5 - 33.7
22.3 49 9.3 - 10.2 29.0 - 40.7 7 .5 - 8 .2 14.0 - 15.0 16.7 - 26.9 12.1 - 13.1 14.7 - 28.4 18.6 - 33.9
22 .7 50 9.4 - 10.3 29.2 - 40.9 7 .5 - 8 .3 14.1 -15.1 16.9 - 27 .1 12.2 - 13.1 14.9 - 28.6 18.8 - 34.1
Kg Lbs vs - d LV - d LVW -d vs -s LV -s LVW -s AO LA
23.2 is,-
I
9.4 - 10.3 29.4 - 41.1 7.6 - 8.4 14.2 - 1:5.2 17.0 - 27.2 12.2 - 13.2 15.0 - 28.7~ 19.0 - 34.2
23.6 i 52 9.5 -10.4 29.6 - 41.3 7.6 - 8.4 14.3 -15.3 17.1 - 27.3 12.3 -13.3 15.1 - 28.8 19.1 - 34.4
24.153 9.5-10.5 29.8-41.5 7.7-8.5 14.4-15.4 17.3-27.5 12.4-13.4 15.2-29.0 19.3 - 34.6
24.554 9.6-10.5 30.0-41 .6 7.7-8.5 14.5-15.5 17.4-27.6 1'2.4-13 .5 15.4-29.1 19.4-34.7
25.0 55 9.6 -10.6 30.1 - 41.8 7.8 - 8.6 14.6 -15.6 17.5 - 27.7 12.5 -13 .5 15.5 - 29.2 19.6 - 34.9
25.5 56 9.7 -10.7 30.3 - 42.0 7.8 - 8.6 14.6 -15.7 17.6 - 27.8 12.6 -13.6 15.6 - 29.3 19.8 - 35.0
25.9 57 9.7 -10.7 30.5 - 42.1 7.8 - 8.7 14.7 -15.8 17.7 - 27.9 12.6 -13.7 15.7 - 29.4 19.9-35.2
26.4 58 9.8 - 10.8 30.6 - 42.3 7.9 - 8.7 14.8 -15.9 17.8-28.0 12.7-13.8 15.8 - 29.6 20.1 - 35.3
26.8 59 9.8 - 10.9 30.8 - 42.5 7.9 - 8.8 14.9 - 16.0 18.0 - 28.1 12.8 - 13.9 16.0 - 29.7 20.2 - 35.5
27.3 60 9.9 - 10.9 30.9 - 42.6 8.0 - 8.8 15.0 - 16.1 18.1 - 28.3 12.8 - 13.9 16.1 - 29.8 20.3 - 35.6
27.7 61 9.9 - 11.0 31.1 - 42.8 8.0 - 8 .9 15.0 - 16.2 18.2 - 28.4 12.9 - 14.0 16.2 - 29.9 20.5 - 35.7
28.2 62 10.0 - 11 .0 31.3-42.9 8.0 - 8 .9 15.1 - 16.3 18.3 - 28.5 13.0-14.1 16.3 - 30.0 20.6 - 35.9
28.6 63 10.0 - 11.1 31.4-43.1 8.1 - 9.0 15.2 - 16.4 18.4 - 28.6 13.0-14.2 16.4 - 30.1 20.7 - 36.0
29.1 64 10.1 - 11.2 31.6 - 43.2 8.1 - 9.1 15.3 - 16.5 18.5 - 28.7 13.1 - 14.3 16.5 - 30.2 20.9 - 36.2
29.5 65 10.1 - 11.2 31.7 - 43.4 8.2 - 9.1 15.4 - 16.6 18.6 - 28.8 13.1 - 14.3 16.6 - 30.3 21.0 - 36.3
30.0 66 10.2 - 11 .3 31.8-43.5 8.2 - 9.2 15.4 - 16.7 18.7 - 28.9 13.2-14.4 16.7 - 30.4 21.1 - 36.4
30.5 67 10.2 - 11.4 I 32.0 - 43.7 8.2 - 9.2 15.5 - 16.8 18.8 - 29.0 13.3 - 14.5 16.8 - 30.5 21.3-36.5
30.9 68 10.3 - 11.4 32.1 - 43.8 8.3 - 9.3 15.6 - 16.9 18.9 - 29.1 13.3-14.6 16.9 - 30.6 21.4 - 36.7
31.4 69 10.3 - 11.5 ! 32.3 - 43.9 8.3 - 9.3 15.7 - 17.0 19.0 - 29.2 13.4-14.7 17.0-30.7 21.5 - 36.8
31 .8 70 10.4 - 11.6 32.4 - 44.1 8.3 - 9.4 15.7 - 17.1 19.1 - 29.3 13.4-14.7 17.1 - 30.8 21.6-36.9
32.3 71 10.4 - 11.6 32.5 - 44.2 8.4 - 9.4 15.8 - 17.2 19.2 - 29.4 13.5 - 14.8 17.2-30.9 21.7 - 37.0
32.7 72 10.4 - 11.7 32.7 - 44.4 8.4 - 9.5 15.9 - 17.3 19.3 - 29.5 13.6 - 14.9 17.3 - 31.0 21.9-37.1
33.2 73 10.5 - 11.8 32.8 - 44.5 8 .4 - 9.5 15.9 - 17.4 19.3-29.5 13.6 - 15.0 17.4 - 31.1 22.0 - 37.3
33.6 74 10.5 - 11.8 I 32.9 - 44.6 8.5 - 9.6 I 16.0-17.5 19.4 - 29.6 I 13.7 - 15.1 17.5-31.2 22.1 - 37.4
34.1 75 10.6 - 11.9 33.0 - 44.7 8.5 - 9.6 16.1 - 17.6 19.5 - 29.7 13.7 - 15.1 17.6-31.3 22.2 - 37.5
01
0'\
N

Kg Lbs VS - d LV - d LVW -d VS -s LV -s LVW -s AO LA
34.5 76 10.6 - 12.0 T 33.2 - 44.9 8.5 - 9.7 16.2 - 17.7 19.6 - 29.8 113.8 - 15.2 17.6 - 31.4 22.3 - 37.6
I
35.0 77 10.6-12.0 : 33.3-45.0 8.6-9.7 16.2-17.7 19.7-29.9 113.8-15.3 17.7-31.4 22.4-37.7
35.5 78 10.7-12.1 33.4-45.1 8.6-9.8 16.3-17.8 19.8-30.0 113.9-15.4 17.8-31.5 22.5-37.8
35.9 79 10.7-12.1 33.5-45.2 8.6-9.8 16.4-17.9 19.9-30.1 1!3.9-15.4 17.9 - 31.6 22.6-37.9
36.4 80 10.8-12.2 33.6-45.3 8.7-9.9 16.4-18.0 19.9-30.1 114.0-15.5 18.0-31.7 22.7-38.0
36.8 81 10.8 - 12.3 33.8 - 45.5 8.7 - 10.0 16.5 - 18.1 20.0 - 30.2 114.0 - 15.6 18.1 - 31.8 22.8 - 38.1
37.3 82 10.9 - 12.3 33.9 - 45.6 8.7 - 10.0 16.6 - 18.2 20.1 - 30.3 114.1 - 15.7 18.1 - 31.9 23.0 - 38.3
37.7 83 10.9 - 12.4 34.0 - 45.7 8.8 - 10.1 16.6 - 18.3 20.2 - 30.4 114.2 - 15.8 18.2 - 32.0 23.1 - 38.4
38.2 84 10.9 - 12.5 34.1 - 45.8 8.8 - 10.1 16.7 - 18.4 20.2 - 30.5 114.2 - 15.8 18.3 - 32.0 23.2 - 38.5
38.6 85 11.0 - 12.5 34.2 - 45.9 8.8 - 10.2 ! 16.8 - 18.5 20.3 - 30.5 114.3 - 15.9 18.4 - 32 .1 i 23.2 - 38.6
39.1 86 11.0 - 12.6 34.3 - 46.0 8.9 - 10.2 16.8 - 18.6 20.4 - 30.6 114 .3 - 16.0 18.5 - 32 .2 23 .3 - 38.7
39.5 87 11.0 - 12.6 I 34.4 - 46.1 8.9-10.3 16.9 - 18.7 20.5 - 30.7 14.4 - 16.1 18.5 - 32.3 23.4 - 38.8
40.0 88 11.1 - 12.7 34.5 - 46.3 8.9-10.3 17.0 - 18.8 20.5 - 30.8 14.4 - 16.1 18.6 - 32 .4 23.5 - 38.9
40.5 89 11.1 - 12.8 34.6 - 46.4 9.0 - 10.4 17.0 - 18.9 20.6 - 30.8 114.5 - 16.2 18.7 - 32.4 23.6 - 39.0
40.9 90 11.2 - 12.8 34.7 - 46.5 9.0 - 10.4 17.1 - 19.0 20.7 - 30.9 114.5 - 16.3 18.8 - 32.5 23.7 - 39.0
41.4 91 11 .2 - 12.9 I 34.8 - 46.6 9.0 - 10.5 17.2 - 19.0 20.8 - 31.0 114.6 - 16.4 18.8 - 32.6 23.8 - 39.1
41.8 92 I 11.2-13.0 34.9 - 46.7 9.1 - 10.5 17.2 - 19.1 20.8 - 31.1 14.6 - 16.4 18.9-32.7 23.9 - 39.2
42.3 93 11 .3 - 13.0 35.0 - 46.8 9.1 - 10.6 17.3-19.2 20.9-31.1 14.7 - 16.5 19.0-32.7 24.0 - 39.3
42.7 94 I 11.3 - 13.1 35.1 - 46.9 9.1 - 10.6 I 17.4 - 19.3 21.0-31.2 14.7 - 16.6 19.0 - 32.8 24.1 - 39.4
43.2 95 11 .3 - 13.1 35.2 - 47.0 9.2-10.7 17.4 - 19.4 21.0-31.3 14.8 - 16.7 19.1 - 32.9 24.2 - 39.5
43.6 96 i 11.4-13.2 35.3-47.1 9.2-10.7 17.5 - 19.5 21.1 - 31.4 14.8 - 16.7 19.2-32.9 24.3 - 39.6
44.1 97 11.4-13.3 35.4 - 47.2 9.2 - 10.8 17.5 - 19.6 21.2-31.4 14.9 - 16.8 19.2 - 33.0 24.3 - 39.7
44.5 98 11.5-13.3 35.5 - 47.3 9.2 - 10.8 17.6 - 19.7 21.2-31.5 114.9 - 16.9 19.3-33.1 24.4 - 39.8
45.0 99 I 11.5-13.4 35.6 - 47.4 9.3 - 10.9 17.7 - 19.8 21.3-31.6 115.0 - 16.9 19.4 - 33.2 24.5 - 39.9
45.5 100 11.5 - 13.4 35.7 - 47.5 9.3 - 10.9 I 17.7 - 19.8 21.4-31.6 115.0 - 17.0 19.4 - 33.2 24.6 - 40.0
LV - d LVW -d
~ Lbs VS - d VS-s LV -s LVW -s AO LA
45.9 101 11.6 - 13.5 35.8 - 47.6 9.3 - 11.0 17.8 - 19.9 21.4 - 31.7 15.1 - 17.1 19.5-33.3 24.7 - 40.0
46.4 102 11.6 - 13.6 35.9 - 47.7 9.4 - 11.0 17.8 - 20.0 21.5-31.8 15.1 - 17.2 19.6 - 33.4 24.8 - 40.1
46.8 103 11.6 - 13.6 36.0 - 47.8 9.4 - 11.1 17.9-20.1 21.6-31.8 15.2 - 17.2 19.6 - 33.4 24.8 - 40.2
47.3 104 11.7-13.7 36.1 - 47.9 9.4 - 11.1 18.0 - 20.2 21.6-31.9 15.2 - 17.3 19.7 - 33.5 24.9 - 40.3
47.7 105 11.7 -13.7 36.2 - 47.9 9.5 - 11.2 18.0 - 20.3 21.7-32.0 15.2 - 17.4 19.8 - 33.6 25.0 - 40.4
48.2 106 11.7 - 13.8 36.3 - 48.0 9.5 - 11.2 18.1 - 20.4 21.7 - 32.0 15.3 - 17.5 19.8 - 33.6 25.1 - 40.5
48.6 107 11.8 - 13.9 36.3 - 48.1 9.5 - 11.3 18.2 - 20.5 21.8-32.1 15.3-17.5 19.9 - 33.7 25.1 - 40.5
49.1 108 11.8 - 13.9 36.4 - 48.2 9.5 - 11.3 18.2 - 20.5 21.9-32.1 15.4-17.6 19.9 - 33.8 25.2 - 40.6
49.5 109 11.9-14.0 36.5 - 48.3 9.6 - 11.4 18.3 - 20.6 21.9 - 32.2 15.4-17.7 20.0 - 33.8 25.3 - 40.7
50.0 110 11.9-14.0 36.6 - 48.4 9.6 - 11.4 18.3 - 20.7 22.0 - 32.3 15.5-17.7 20.1 - 33.9 25.4 - 40.8
50.5 111 11.9-14.1 36.7 - 48.5 9.6 - 11.5 18.4 - 20.8 22.0 - 32.3 15.5-17.8 20.1 - 34.0 25.4 - 40.9
50.9 112 12.0 - 14.1 36.8 - 48.6 9.7 - 11.5 18.5 - 20.9 22.1 - 32.4 15.6 - 17.9 20.2 - 34.0 25.5 - 40.9
51.4 113 12.0-14.2 36.8 - 48.7 9.7-11.5 18.5-21.0 22.1 - 32.4 15.6 - 18.0 20.2 - 34.1 25.6-41.0
51.8 114 12.0 - 14.3 36.9 - 48.7 9.7-11.6 18.6 - 21.1 22.2 - 32.5 15.7 - 18.0 20.3 - 34.1 25.7-41.1
52.3 115 12.1 - 14.3 37.0 - 48.8 9.7-11.6 18.6 - 21.1 22.2 - 32.6 15.7 - 18.1 20.3 - 34.2 25.7 - 41.2
52.7 116 12.1 - 14.4 37.1-48.9 9.8 - 11.7 18.7 - 21.2 22.3 - 32.6 15.8 - 18.2 20.4 - 34.3 25.8-41.3
53.2 117 12.1 - 14.4 37.2 - 49.0 9.8-11.7 18.7 - 21.3 22.4 - 32.7 15.8 - 18.2 20.4 - 34.3 25.9 - 41.3
53.6 118 12.2-14.5 37.2 - 49.1 9.8 - 11.8 18.8 - 21.4 22.4 - 32.1 15.8 - 18.3 20.5 - 34.4 25.9 - 41.4
54.1 119 12.2-14.5 37.3 - 49.2 9.8 - 11.8 18.9-21.5 22.5 - 32.8 15.9 - 18.4 20.6 - 34.4 26.0 - 41.5
54.5 120 12.2-14.6 37.4 - 49.2 9.9 - 11.9 18.9-21.6 22.5 - 32.9 15.9 - 18.4 20.6 - 34.5 26.1 - 41.6
55.0 121 12.3 - 14.7 37.5 - 49.3 9.9 - 11.9 19.0-21.6 22.6 - 32.9 16.0 - 18.5 20.7 - 34.6 26.1 - 41.6
55.5 122 12.3-14.7 37.5 - 49.4 9.9 - 12.0 19.0 - 21.7 22.6 - 33.0 16.0 - 18.6 20.7 - 34.6 26.2-41.7
55.9 123 12.3-14.8 37.6 - 49.5 10.0 - 12.0 19.1 - 21.8 22.7 - 33.0 16.1 - 18.7 20.8 - 34.7 26.3-41.8
56.4 124 12.4 - 14.8 37.7 - 49.6 10.0 - 12.1 19.1 - 21.9 22.7 - 33.1 16.1 - 18.7 20.8 - 34.7 26.3-41.8
56.8 125 12.4-14.9 37.8 - 49.6 10.0 - 12.1 19.2 - 22.0 22.8 - 33.1 16.2 - 18.8 20.9 - 34.8 26.4-41.9
0"1
w
0'\
~

LV - d LVW -d VS -s LV -s AO
~ Lbs VS - d LVW -s LA
57.3 126 12.4-14.9 37.8 - 49 .7 10.0-12.2 19.3-22.1 22 .8 - 33.2 16.2 - 18.9 20.9 - 34.8 26.5 - 42.0
57.7 127 12.5 - 15.0 37.9 - 49.8 10.1 - 12.2 19.3-22.1 22 .9 - 33.2 1,6 .2 - 18.9 21 .0 - 34.9 26.5 - 42.1
58.2 128 12.5 - 15.1 38.0 - 49.9 10.1 - 12.3 19.4 - 22 .2 22.9 - 33.3 16.3 - 19.0 21 .0 - 35.0 26.6 - 42.1
58.6 129 12.5 - 15.1 38.0 - 49 .9 10.1 - 12.3 19.4 - 22 .3 23.0 - 33.3 16.3 - 19.1 21 .1 - 35.0 26.6 - 42.2
59.1 130 12.6 - 15.2 38.1 - 50.0 10.1 - 12.3 19.5 - 22.4 23.0 - 33.4 16.4 - 19.1 21.1 - 35.1 26.7 - 42.3
59.5 131 12 .6 - 15.2 38.2 - 50.1 10.2-12 .4 19.5 - 22.5 23.1 - 33.5 16.4 - 19.2 21 .2 - 35.1 26.8 - 42.3
60.0 132 12.6 - 15.3 38.3 - 50.2 10.2 - 12.4 19.6 - 22.6 23.1 - 33.5 16.5 - 19.3 21 .2 - 35.2 26.8 - 42.4
60.5 133 12.7 - 15.3 38.3 - 50.2 10.2 - 12.5 19.7 - 22 .6 23 .2 - 33.6 16.5 - 19.3 21.2 - 35.2 26.9 -42 .5
60.9 134 12.7 - 15.4 38.4 - 50.3 10.3 - 12.5 19.7 - 22 .7 23.2 - 33.6 16.6-19.4 21.3 - 35.3 26.9 - 42.5
61.4 135 12.7 - 15.4 38.5 - 50.4 10.3 - 12.6 19.8 - 22.8 23.2 - 33.7 16.6 - 19.5 21.3 - 35.3 27 .0 - 42.6
61.8 136 12.7 - 15.5 38.5 - 50.5 10.3 - 12.6 19.8 - 22.9 23.3 - 33.7 16.6 - 19.5 21.4 - 35.4 27 .1-42.7
62.3 137 12.8 - 15.6 38.6 - 50.5 10.3 - 12.7 19.9 - 23.0 23.3 - 33.8 16.7 - 19.6 21. 4 - 35.4 27.1-42 .7
62.7 138 12.8 - 15.6 38.7 - 50.6 10.4 - 12.7 19.9 - 2.3 .0 23.4 - 33.8 16.7 - 19.7 21.5 - 35.5 27.2 - 42.8
63 .2 139 12.8-15.7 38.7 - 50.7 10.4 - 12.8 20.0 - 23 .1 23 .4 - 33.9 16.8 - 19.7 21.5 - 35.5 27.2 - 42.9
63 .6 140 12.9-15 .7 38.8 - 50.8 10.4 - 12.8 20.0 - 23 .2 23 .5 - 33.9 16.8 - 19.8 21.6 - 35.6 27.3 - 42.9
64.1 141 12.9 - 15.8 38.8 - 50.8 10.4 - 12.8 20.1 - 23 .3 23 .5 - 34.0 16.8 - 19.9 21 .6-35.7 27.3 - 43 .0
64.5 142 12.9 - 15.8 38.9 - 50.9 10.5 - 12.9 20.1 - 23 .4 23 .6 - 34.0 16.9 - 19.9 21.6 - 35.7 27.4 - 43 .1
65.0 143 13.0 - 15.9 39.0 - 51.0 10.5 - 12.9 20.2 - 23.4 23 .6 - 34.1 16.9 - 20.0 21 .7 - 35.8 27.4 - 43.1
65 .5 144 13.0 - 15.9 39.0 - 51 .0 10.5-13.0 20.3 - 23.5 23 .6 - 34.1 17.0 - 20.1 21 .7 - 35.8 27.5 - 43.2
65.9 145 13.0 - 16.0 39.1 - 51 .1 10.5 - 13.0 20.3 - 23.6 23.7 - 34.2 17 .0 - 20.1 21 .8 - 35.9 27 .6 - 43 .2
66.4 146 13.1 - 16.0 39.2 - 51.2 10.6-13 .1 20.4 - 23.7 23.7 - 34.2 17.1 - 20.2 21 .8 - 35.9 27 .6 - 43 .3
66.8 147 13.1 - 16.1 39.2 - 51.2 10.6 - 13.1 20.4 - 23.8 23.8 - 34.3 17 .1 - 20.3 21 .9 - 36.0 27 .7 - 43.4
67.3 148 13.1 - 16.1 39.3 - 51.3 10.6 - 13.2 20.5 - 23.8 23 .8 - 34.3 17.1 - 20.3 21 .9 - 36.0 27.7 - 43.4
67.7 149 13.2-16.2 39.3 - 51.4 10.6 - 13.2 20.5 - 23.9 23 .8 - 34.3 17.2 - 20.4 21 .9-36.1 27.8 - 43.5
68.2 150 13.2 - 16.3 39.4 - 51.4 10.7 - 13.2 20.6 - 24.0 23 .9 - 34.4 17.2 - 20.5 22.0 - 36.1 27 .8 - 43.6
Kg Lbs vs - d LV - d LVW -d vs -s LV -s LVW -s Aa LA
68.6 151 13.2 - 16.3 39.4 - 51.5 10.7 - 13.3 20.6 - 24.1 23 .9 - 34.4 17.3 - 20.5 22.0 - 36.2 27.9 - 43.6
69.1 152 13.2 - 16.4 39.5 - 51.6 10.7 - 13.3 20.7 - 24.1 24.0 - 34.5 17.3 - 20.6 22.1 - 36.2 27 .9 - 43 .7
69.5 153 13.3 - 16.4 39.6 - 51.6 10.7 - 13.4 20.7 - 24.2 24.0 - 34.5 17.3 - 20.6 22.1 - 36.3 28.0 - 43.7
70.0 154 13.3 - 16.5 39.6 - 51 .7 10.8 - 13.4 20.8 - 24.3 24.0 - 34.6 17.4 - 20.7 22.1 - 36.3 28.0 - 43.8
70.5 155 13.3 - 16.5 39.7 - 51.8 10.8 - 13.5 20.8 - 24.4 24.1 - 34.6 17.4 - 20.8 22.2 - 36.3 28.1 - 43 .9
70.9 156 13.4 - 16.6 ! 39.7-51.8 10.8 - 13.5 I 20.9 - 24.5 24.1 - 34.7 ! 17.5 - 20.8 22.2 - 36.4 I 28.1-43 .9
71.4 157 13.4 - 16.6 39.8 - 51.9 I 10.8 - 13.5 20.9 - 24.5 24.2 - 34.7 17.5 - 20.9 22.2 - 36.4 28.2 - 44.0
71.8 158 13.4 - 16.7 39.8 - 52.0 10.9 - 13.6 21.0 - 24.6 24.2 - 34.8 17.6 - 21.0 22 .3 - 36.5 28.2 - 44.0
72.3 159 13.5 - 16.7 ! 39.9 - 52.0 i 10.9 - 13.6 21.0 - 24.7 24.2 - 34.8 17.6 - 21.0 22.3 - 36.5 28.3 - 44.1
72.7 i 160 13.5 - 16.8 I 40.0 - 52.1 10.9-13.7 21.1-24.8 24.3 - 34.9 17.6 - 21.1 22.4 - 36.6 28.3 - 44.2
73.2 161 13 .5 - 16.8 40.0 - 52.2 ' 10.9-13.7 21 .1-24.8 24.3 - 34.9 17.7-21.2 22.4 - 36.6 28.3 - 44.2
73.6 162 13.6 - 16.9 40.1 - 52.2 11.0-13.8 21.2-24.9 24.3 - 34.9 17.7-21.2 22 .4 - 36.7 28.4 - 44.3
74.1 163 13.6 - 16.9 I 40.1 - 52 .3 11.0-13.8 21.3-25.0 24.4 - 35.0 17.8 - 21.3 22.5 - 36.7 28.4 - 44.3
74.5 164 13.6-17.0 40.2 - 52.3 I 11.0 - 13.8 21.3-25.1 24.4 - 35.0 17.8-21.3 22 .5 - 36.8 28.5 - 44.4
75.0 165 13.6 - 17.0 40.2 - 52.4 I 11.0-13.9 21.4-25.1 24.4 - 35.1 17.8-21.4 22.5 - 36.8 28.5 - 44.4
75.5 166 13.7 - 17.1 40.3 - 52.5 11.1 - 13.9 21.4 - 25.2 24.5 - 35.1 17.9 - 21.5 22.6 - 36.9 28.6 - 44.5
75.9 167 13.7 - 17.1 40.3 - 52.5 11.1-14.0 21.5-25.3 24.5 - 35.2 17.9-21 .5 22.6 - 36.9 28.6 - 44.6
76.4 168 13.7-17.2 40.4 - 52.6 11.1-14.0 21 .5-25.4 24.6 - 35.2 18.0-21.6 22.6 - 37.0 28.7 - 44.6
76.8 169 13.8 - 17.2 40.4 - 52.6 11.1 - 14.1 21.6 - 25.4 24.6 - 35.2 18.0 - 21.7 22.7 - 37.0 28.7 - 44.7
77.3 170 13.8-17.3 40.5 - 52.7 11 .2-14.1 21.6-25.5 24.6 - 35.3 18.0-21 .7 22.7 - 37.0 28.8 - 44.7
77.7 171 13.8 - 17.3 40.5 - 52.8 11.2-14.1 21.7 - 25.6 24.7 - 35.3 18.1 - 21.8 22.7 - 37.1 28.8 - 44.8
78.2 172 13.8 - 17.4 40.6 - 52 .8 11.2-14.2 21 .7 - 25.7 24.7 - 35.4 18.1 - 21.8 22.8 - 37.1 28.8 - 44.8
78.6 173 13.9 - 17.4 40.6 - 52.9 11.2-14.2 21.8 - 25.7 24.7 - 35.4 18.1 - 21.9 22.8 - 37.2 28.9 - 44.9
79.1 174 13.9 - 17.5 40.7 - 52.9 ! 11.3-14.3 21.8-25 .8 24.8 - 35.5 18.2 - 22.0 22 .8 - 37.2 28.9 - 45.0
79.5 175 13.9 - 17.5 40.7 - 53 .0 11 .3 - 14.3 21.9 - 25.9 24.8 - 35.5 18.2 - 22.0 22 .9 - 37.3 29.0 - 45.0
0'\
U'1
,.•
0"1
0"1

LV - d LVW -d VS-s LV -s LVW -s
~ Lbs VS - d AO LA
80.0 176 14.0 - 17.6 i 40.8-53 .1 11.3 - 14.4 i 21.9 - 26.0 24.8 - 35.5 18.3 - 22.1 22 .9 - 37.3 29.0 - 45.1
80.5 177 14.0 - 17.6 40.8-53.1 i 11 .3 - 14.4 22 .0 - 26.0 24.9 - 35.6 18.3-22.1 22.9 - 37.4 29.0 - 45.1
80.9 178 14.0 - 17.7 40.9 - 53 .2 11.3 - 14.4 ! 22.0 - 26.1 24.9 - 35.6 18.3 - 22.2 23.0 - 37.4 29.1 - 45.2
81.4 179 14.0 - 17.8 ! 40.9 - 53.2 I
11 .4 - 14.5 I 22.1 - 26.2 24.9 - 35.7 18.4 - 22 .3 23 .0 - 37.4 29.1 - 45.2
81 .8 180 14.1 - 17.8 41.0 - 53.3 11.4-14.5 22.1 - 26.3 25 .0 - 35.7 18.4 - 22 .3 23 .0 - 37.5 29.2 - 45.3
82.3 181 14.1 - 17.9 ! 41 .0-53 .4 11.4-14.6 i 22.2 - 26.3 25.0 - 35.7 18.5 - 22.4 23 .1 - 37.5 29.2 - 45.3
82 .7 182 14.1 - 17.9 41.1 - 53.4 I 11 .4 - 14.6 I 22.2 - 26.4 25.0 - 35.8 18.5 - 22.5 23.1 - 37.6 29.2 - 45.4
83 .2 183 14.2 - 18.0 41.1 - 53.5 11 .5-14.6 22 .3 - 26.5 25 .0 - 35.8 18.5 - 22 .5 23 .1 - 37.6 29.3 - 45.4
83 .6 184 14.2 - 18.0 ! 41.2-53.5 I 11 .5-14.7 ! 22.3 - 26.6 25 .1 - 35.9 18.6 - 22 .6 23 .2 - 37.7 29.3 - 45.5
84.1 185 14.2 - 18.1 41.2 - 53.6 11 .5-14.7 ! 22.4 - 26.6 25.1 - 35.9 18.6 - 22 .6 23.2 - 37.7 29.4 - 45.5
84.5 186 14.2 - 18.1 ! 41.2 - 53.6 11.5 -1 4.8 22 .4 - 26.7 25.1 - 35.9 18.7 - 22 .7 23 .2 - 37.7 29.4 - 45.6
85.0 187 14.3 - 18.2 41.3-53.7 ! 11 .6-14.8 ! 22.5 - 26.8 25 .2 - 36.0 18.7 - 22 .8 23 .2 - 37.8 29.4 - 45.6
85.5 188 14.3 - 18.2 41.3-53.7 11 .6 - 14.8 I 22 .5 - 26.8 25.2 - 36.0 18.7 - 22.8 23.3 - 37.8 29.5 - 45.7
I
85.9 189 14.3 - 18.2 41.4 - 53.8 11 .6 - 14.9 22 .6 - 26.9 25.2 - 36.1 18.8 - 22 .9 23 .3 - 37.9 29.5 - 45.8
86.4 190 14.4 - 18.3 41.4 - 53.9 11 .6 - 14.9 22 .6 - 27.0 25.3 - 36.1 18.8 - 22 .9 23.3 - 37.9 29.6 - 45.8
86.8 191 14.4 - 18.3 !i 41.5-53.9 I
i 11.6-15.0 ! 22 .7-27.1 25.3 - 36.1 18.8 - 23.0 23.4 - 37 .9 29.6 - 45.9
87.3 192 14.4 - 18.4 41.5 - 54.0 11.7-15.0 ! 22 .7 - 27.1 25.3 - 36.2 18.9-23.1 23 .4 - 38.0 29.6 - 45.9
87 .7 193 14.4 - 18.4 I 41.6 - 54.0 11.7 - 15.1 22.8 - 27 .2 25.3 - 36.2 18.9 - 23.1 23.4 - 38.0 29.7 - 46.0
88.2 194 14.5 - 18.5 41.6 - 54.1 i 11 .7 - 15.1 i 22 .8 - 27 .3 25.4 - 36.3 19.0 - 23.2 23.4 - 38.1 29.7 - 46.0
88.6 195 14.5-18.5 ! 41 .6-54.1 11 .7-15.1 I 22 .8 - 27 .3 25.4 - 36.3 19.0 - 23.2 23.5 - 38.1 29.7-46.1
89.1 196 14.5 - 18.6 41 .7 - 54.2 i 11.8 - 15.2 22.9 - 27 .4 25 .4 - 36.3 19.0 - 23 .3 23.5 - 38.2 29.8 - 46.1
89.5 197 14.6 - 18.6 I 41 .7 - 54.2 I 11.8-15.2 22 .9 - 27.5 25 .5 - 36.4 19.1 - 23 .4 23.5 - 38.2 29.8 - 46.2
90.0 198 14.6 - 18.7 41.8-54.3 11.8-15.3 i 23.0 - 27.6 25 .5 - 36.4 19.1 - 23 .4 23.5 - 38.2 29.8 - 46.2
I
90.5 199 14.6 - 18.7 iI 41.8 - 54.3 11.8 - 15.3 I 23 .0 - 27.6 25 .5 - 36.5 19.1 - 23 .5 23.6 - 38.3 29.9 - 46.3
90.9 200 14.6 - 18.8 ii 41 .8 - 54.4 11 .9 - 15.3 23 .1 - 27.7 25.5 - 36.5 19.2 - 23.5 23.6 - 38.3 29.9 - 46.3
Boon J., Manual of Veterinary Echocardiog raphy, Williams & Wilkins, Philadel ph ia, PA 1998.
Gon~a l ves
A.C., Orto n E.C. , Boon J.A., Sal ma n M .D., Linear, loga rithmic, and polynomia l models of M-Mode echocard iograph ic measurements in dogs.
AJVR 63(7):p. 994-999 . 2002 .
Section 5
Common
Acquired Heart
Diseases
67
Mitral Valve Disease
Features 0
./ Mitral valve lesions (Figures S~l and S~2)
./ Left ventricular dilation (Figures S~ 1 and 5 ~ 2)
./ Left atrial dilation (Figures 5~ 1, 5~2, and 5~3)
• Dilation usually corellates with the degree of
valvular insufficiency when ventricular function is normal.
./ Increased wall and septal motion
./ Normal EPSS
./ Possible leaflet prolapse
• Leaflet(s) buckle back into the left atrium (see Figure S~ 1)
• May be due to stretch or rupture (Figure SA)
./ Function
h Elevated
h Increased preload results in elevated fractional shortening
if the muscle has not become dysfunctional (Figure 5~5)
h Therefore normal or low fractional shortening equals
myocardial dysfunction (see Figure 3~15).
Figure 5-1 (left) Upward curvature of the ventricular septum seen w ith dilation
of the left ventricle, dilation of the left atrium, and thickened mitral valve
leaflets are seen in t his long axis left ventricular outflow view of the heart.
Figure 5-2 (right) Upward bowing of both the atrial and ventricular septums,
representing dilation of the left side of the heart and mitral va lve lesions are
seen in this long axis four chamber view of the heart.
68
Figure 5-3 This transverse
image of the heart base shows
a dilated left atrial chamber.
Figure 5-4 A mitral valve

leaflet that is pointing back
into the left atrial chamber
(arrow) suggests a ruptured
chordae, on this long axis four
chamber view of the heart.
Figure 5-5 Dynamic

wall and septal
motion with elevated
fractional shortening
is seen in hearts with
increased volume and
no myocardial failure.
69
Endocarditis
Features 0
./ Valvular lesions (Figure 5-6)
• Small to medium lesions cannot be differentiated from
degenerative lesions.
• Large irregular lesions are highly suspicious for endocarditis.
h Aortic valve lesions should alway be suspect for endocarditis .
./ Left ventricu lar dilation
./ Diastolic mitral valve flutter if there is aortic insufficiency
(Figure 5-7).
Figure 5-6 Large aortic valve

lesions (arrow) are suggestive of
endocarditis on this long axis left
Figure 5-7 Diastolic mitral valve flutter (saw tooth type of motion) (arrow) is
seen with aortic insufficiency.
70
Hypertrophic
Cardiomyopathy
Features 0
./ Concentric left ventricular hypertrophy (Figures 5-8 and 5-9)
• This may be symmetric or asymmetric
• Left atrium may be normal or dilated (Figures 5-8, 5-9, and 5-10).
h A large LA with LV hypertrophy implies diastolic dysfunction .
./ Septum u sually impinges down into the LV outflow tract
(Figures 5-8, 5-9, a nd 5-10) .
Figure 5-8 (left) This long axis outflow view of a heart with hypertrophic car-
diomyopathy shows severe symmetrical hypertrophy, left ventricular outflow
obstruction, and a normal left atrial chamber.
Figure 5-9 (right) There is asymmetric hypertrophy involving the ventricular
septum, mild narrowing of the left ventricular outflow tract, and a normal left
atrium in this heart with mild hypertrophic cardiomyopathy. This is a long axis
left ventricular outflow view of the heart.
Figure 5-10 Significant left atrial

enlargement is seen on this long
axis left ventricular outflow view in
this severely hypertrophied heart
with hypertrophic cardiomyopathy.
71
./ Systolic Anterior Motion (SAM) with moderate to severe obstruc-
tion to o u tflow (Figure 5-11)
./ Syst o lic aortic valve closure with moderate t o severe dynamic
obstruction ( Figure 5-12)
./ Function usually elevated until end-stage (Figures 5-13 and 5-14)
./ Thrombus possible within the left atrium and auricle (Figure 5-15).
Figure 5-11 Systolic anterior motion (SAM) (arrow) is seen secondary to high flow
velocities creating a venturi effect in a narrowed left ventricular outflow tract.
Figure 5-12 Systolic closure of the aortic valve (arrow) is seen secondary to
dynamic obstruction to outflow and a reduction in flow through the valve.
72
Figure 5-13 Function in
hearts with hypertrophic
cardiomyopathy is
typically excellent.
Figure 5-14 Myocardial

failure is seen more in
diminished systolic thick-
ening of the wall and
septum as opposed to a
reduction in fractional
shortening.
Figure 5-15 A thrombus

is seen in the left auricular
appendage on this trans-
verse image of the heart
base at the level of the
aorta and left atrium.
73
Dilated Cardiomyopathy
Features 0
./ Dilated left ventricle (Figure 5~16)
h Dilation not a lways present (especially in Boxers)
./ Dilated left atrium (see Figure 5~16)
./ Thrombus possible in atrium, auricle, or ventricle (rare in dogs)
(Figure 5~17)
h Poor fractional shortening (Figures 5~18 a nd 5~19)
h R educed fractional sh ortening occurs before dilation
h N ormal to thin wall and septum
./ Increased E peak to septal separation (EPSS) (Figure 5~20)
./ Reduced aortic wall m ot ion
Figure 5-16 Dilation of

the left side of the heart
is evident by bowing of
the ventricular and atrial
septums towards the
right side of the heart on
this long axis four cham-
ber view of the heart.
Figure 5-17 Thrombus

formation is extremely
rare in the dog. Here
smoke like echoes, repre-
senting sluggish blood
flow, are visible within
the left ventricular cham-
ber of a dog with dilated
cardiomyopathy. This is a
transverse image of the
left ventricle.
74
Figure 5-18 Poor
fractional shortening is a
feature of dilated
cardiomyopathy.
Figure 5-19 There can

be differences in the
amount the free wall
and ventricular septum
thickening in hearts with
dilated cardiomyopathy.
Here the free wall is
virtually noncontractile.
Figure 5-20 The EPSS

(E point to septal sepa-
ration) becomes larger
as ejection fraction
decreases in hearts with
dilated cardiomyopathy.
75
Restrictive
Cardiomyopathy
Features 0
h Normal to mildly dilated left ventricle (Figures 5-21 and 5-22)
h Very dilated left atrium (Figures 5-21,5-22, and 5-23)
./ Possible right atrial dilation as well
h Normal to mildly hypertrophied wall and septum
./ Normal to mildly depressed fractional shortening
./ Irregular endocardial surface (see Figure 5-21)
./ Not a lways visib le
./ Fibrosis within the myocardium and endocardium ""-
./ Not always seen
./ Bright echoes within the myocardium
./ Thrombus or smoke within the left atrium is common
(see Figure 5-23).
Figure 5-21 The endocardial surface may be irregular and the myocard ium can
vary in thickness in hearts with restrictive cardiomyopathy. Left atrial dilation is a
consistent feature of this disease. This is a long axis left ventricular outflow view.
76
Figure 5-22 The only abnormal two dimensional feature in restrictive car-
diomyopathy may be an enlarged left atrial chamber. The left ventricle in this
long axis left ventricular outflow view appears normal. The arrow is pointing at
smoke-like echoes.
Figure 5-23 Smoke-like echoes (arrows), representing sluggish blood flow, is

a common finding within the left atrial chambers of hearts with restrictive
cardiomyopathy. This is a transverse view of the aorta and left atrium. The
left atrium is dilated.
77
Pericardial Effusion
Features 0
./ Fluid around the heart appears as a black space (Figure 5-24).
h Fluid generally is not present much beyond the junction of
the atrium and ventricle (Figure 5 -25).
h M ay be idiopathic
h Searching for masses is easiest when fluid is present.
~ Always look before tapping, if only for a few moments.
• Many masses are missed after fluid is tapped from
the sac .
./ Pericardial tamponade (Figure 5-26)
h Right atrial and ventricu lar wall collapse
h Does not have to be a massive effusion
Figure 5-24 Pericardial effusion is seen as a black fluid filled space between the
heart and the pericardial sac (arrows) . There is pleural effusion seen outside the
pericardial sac in this transverse left ventricular image of the left ventricle.
78
Figure 5-25 Pericardial fluid (arrow) is not seen around the heart base. It stops
just beyond the junction of the left atrial wall and left ventricular wall on this
long axis four chamber view of the heart.
Figure 5-26 Right atrial collapse (arrow) and right ventricular collapse are
echocardiographic signs of cardiac tamponade. This is a modified left apical four
chamber view of the heart, but tamponade can be appreciated on right
parasternal long axis views as well.
79
Hemangiosarcoma
Features 0
.,/ Pericardial effusion if the turnor has bled into the sac
h Mass seen most commonly at right atrial appendage (Figures
5~27 and 5~28).
h Best seen from left~sided cranial views
.,/ Masses may be seen anywhere in the right ventricular wall or
right atrium (Figure 5~29) .
.,/ Uncommonly seen within the left side of the heart.
h M asses seen o utside the right auricle on left sided views may
be aortic body tumors or hemangiosarcoma (see Figure 5 ~ 2 7).
h Without effusion, many masses are missed.
~ Stand the animal up and image while standing on both sides in
order to see from a different angle when effusion is present. Masses
may be seen that are missed while the animal is in lateral recumbency.
Figure 5-27 Masses may be seen outside the auricular appendage (arrow).
These are most often hemangiosarcoma, but could potentially be aortic body
tumors. This is a left parasternal cranial long axis image of the right atrium
and auricle.
80
Figure 5-28 This mass (arrow) occupies the right atrial appendage in this left
cranial long axis image of the right atrium and auricle.
Figure 5-29 This mass involves the right atrial wall as well as occupying the right
atrial appendage. This is a modified left parasternal transverse view of the heart.
81
Aortic Body Tumors
Features 0
./ Usually no effusion
h Masses typically seen around the aorta on transverse views
(Figures 5-30) .
./ Seen between the right and left atrium
./ Seen at the pulmonary artery bifurcation
~ Usually not seen on the right side of transvere images
between the pu lmonary artery and aorta
h Masses seen outside the right auricle on left sided views may
be aortic body tumors or hemangiosarcoma (see Figure 5-27) .
./ Large masses may compress the atria or great vessels qlUsing
signs of heart failure .
./ Difficult to assess whether they are in or out of the chambers
(Figure 5-31)
Figure 5-30 Aortic body tumo rs (arrow) are usually found on the left sid e of
transverse views of the heart base between the aorta and atrial chambers or
pulmonary artery.
82
Figure 5-31 Heart base tumors (arrows) may become quite large. They often
appear to be within the chambers of the heart, but it is difficult to determine
how involved the cardiac chambers are. This is a right parasternal four chamber
view of the heart.
83
84
Section 6
Common
Congenital Heart
Diseases
85
Patent Ductus Arteriosus
Features 0
./ Dilated left ventricle (Figure 6~ 1)
./ Degree of dilation depends upon the size of the shunt .
./ Dilated left atrium (see Figure 6-1)
./ Dilated pulmonary artery (Figure 6-2)
./ May or may not have left ventricular hypertrophy
./ Function gen erally within the normal range
./ Despite being volume overloaded, function is not elevated
(Figure 6-3)
h Does n ot necessarily imply permanently poor
myocardial function
t'lp Right ventricle and atrium are normal.
./ Signs of pulmonary hypertens io n develop as pressures elevate .
./ The ductus itself is rarely seen without color flow Doppler.
Figure 6-1 Features of patent ductus arteriosus include dilated left atrial and ven-
tricular chambers. This is a long axis left ventricular outflow view of the heart.
86
Figure 6-2 The pulmonary artery is dilated in patent ductus arteriosus as
shunted blood enters this vessel. The diameter of the pulmonary artery is
greater than the diameter of the aorta. The left and right pulmonary artery
segments are also dilated on this transverse image of the heart base.
Figure 6-3 Fractional shortening is usually not elevated in hearts with patent
ductus arteriosus despite the increased preload .
87
Subaortic Stenosis
Features 0
./ Concentric left ventricular hypertrophy
./ Obstruction typically visible
./ Subvalvular ring (Figure 6-4)
./ Dynamic muscular obstruction (Figure 6-5)
./ Both may be present (Figure 6-6)
h May not be seen in very mild aortic stenosis
h Uncommon to have valvular stenosis but leaflets may be fused .
./ Can h ave hypop lastic annulus (Fig ure 6-7)
Figure 6-4' subaortic

stenosis may manifest
itself as a fibrous band of
tissue (arrow) within the
left ventricular outflow
tract. This is a long axis
left ventricular outflow
view of the heart.
Figure 6-5 Hypertrophy

of the infundibular portion
of the septum (arrow)
creates a dynamic form of
subvalvular aortic stenosis.
This is a long axis left ven-
tricular outflow view of
the heart.
88
Figure 6-6 The dynamic component of subvalvular obstruction (arrow)
narrows the outflow tract during systole on this long axis left ventricular outflow
view. There is also a small fibrous band of tissue extending from the'hypertrophied
septum into the outflow tract.
Figure 6-7 Post-stenotic

dilation (arrow) is seen in
this left parasternal long
axis view of the heart.
This image also shows a
hypoplastic aortic annulus .
. / SAM if dynamic obstruction is moderate to severe (Figure 6-8)

. / Systolic closure if obstru ction is moderate to severe (Figure 6-9)
./ Fibrosis may be present (Figure 6-10)
./ Mitra l valve flutter if aortic insufficiency is moderate to severe
(see Figure 5-7)
• This results in an increased EPSS
. / Post-stenotic dilation (see Figure 6-7)
• Best seen on left cranial long axis views
h Hypertrophy may not correlate w ith severity of obstru ction
89
Figure 6-8 Systolic anterior motion (SAM) of the mitral valve (arrow) is seen
secondary to increased flow velocities within the left ventricular outflow tract.
SAM is mild in this image.
Figure 6-9 Systolic closure of the aortic valve (arrows) is seen secondary to
reduced flow through the aortic valve as the obstruction to outflow increases
early in ejection . Here, there is very limited opening of the valves .
Figure 6-10 Bright dense white echoes

represent fibrosis w ithin the myocardium.
Here, fibrosis is seen in one papillary
muscle (arrow) on this transverse view of
the left ventricle.
90
Pulmonic Stenosis
Features 0
./ Usually va lvular
./ Lea flets may be fused or dysplastic (Figure 6-11)
h The leaflets will dome if they are fused (Figure 6-12)
./ Lea flets thick and stiff if dysplastic
Figure 6-11 These pulmonic valves are fused (arrow). This cannot be appreciat-
ed on a still image and is a diagnosis that must be made from real time motion
of the valve (see video on the CD). The pulmonary artery dilates beyond the level
of the valves representing the post stenotic dilation on this transverse image at
the heart base.
Figure 6-12 Doming of the pulmonic valves (arrow) means that the valve is fused
and does not open completely. The tips of the cusps point toward the center of
the artery during systole. This is a modified transverse image of the heart base.
91
./ They m ay b e b o th fu sed a n d dysp last ic
./ The a nnulus m ay be normal or s m a ller in size (hypop lastic)
( F ig ure 6-13 ) .
h Dila tio n occurs beyond t h e level of the valves = post
s t e n otic d ilat io n (Figu res 6 -13 a nd 6- 14) .
Figure 6-13 This transverse image, at the pulmonary artery level, shows a
hypoplastic pulmonic annulus (arrow) and a dramatic post stenotic dilation
involving a large portion of the left main pulmonary artery.
Figure 6-14 There may be no obvious narrowing or abnormality of the pul-

monic valves on still images. Here just the post stenotic dilation is seen on th is
transverse view of the heart base.
92
./Right ventricu lar hypertrophy (Figure 6-15)
./No paradoxical septal motion unless a volume overload is present .
./ Tricuspid or pulmonic insufficiency is usually
present if this is seen.
h The left side of the heart is small if stenosis is moderate to severe .
./ Secondary to decreased preload
./ Creates a concentric hypertrophy pattern in the left
ventricle = pseudo-hypertrophy.
Figure 6-15 Right ventricular hypertrophy (arrow) is seen secondary to the

pressure overload created by obstruction to right ventricular outflow. This is a
right parasternal four chamber view of the heart.
93
Ventricular Septal Defect
Features 0
./ Left ventricular, left atrial, and pulmonary artery dilation
(Figure 6~16)
h May not be dilated with hemodynamically insignificant shunts .
./ Right ventricular dilation
h May not be present if blood flows directly into the
pulmonary artery
./ Function normal or high
h Most defects are seen at the junction of the septum and the
aorta on long axis images (see Figure 6~16).
~ Do not use the four chamber view.
h May not actually see small defects .
./ Often the membranous portion of the septum does
appear to be abnormal (Figure 6~ 17) .
./ Defect seen below the tricuspid valve at about 12:00 o'clock
on transverse views (Figure 6~18).
Fi gure 6-1 6 Ventricular septal defects (arrow) are usually seen on left ventricu-
lar outflow views at the junction of the ventricular septum and the aorta.
94
Figure 6-17 Sometimes the hole of a ventricular septal defect is not appreciated
well, but the junction between the septum and aorta is not smooth (arrow).
Figure 6-18 Most ventricular septal defects are seen at about 12 :00 o'clock
(arrow) on the transverse view of the heart base between the aorta and
tricuspid valves.
95
Tricuspid Dysplasia
Features 0
./ Abnormal tricuspid valve apparatus
. / Septal leaflet is usually tethered to the septum with short
chordae (Figure 6-19)
./ The anterior leaflet is usually longer than normal.
./ The papillary muscles may be abnormal (Figure 6-20).
h Use more than one view to diagnose.
~ Do not use only the right parastemal left ventricular outflow view.
./ The severity of tricuspid insufficiency is variable .
./ Right ventricular dilation if insufficiency is significant
./ Paradoxical septal motion if insufficiency is significant
(Figures 6-21 and 6-22)
./ The right atrium appears large regardless of the degree of
insufficiency because of more apical closure of the leaflets.
h Pulmonary artery size is normal.
Figure 6-19 Usually the septal leaflet of the tricuspid valve (arrow) is tethered
to the septum and displays restricted motion in hearts with tricuspid dysplasia.
96
Figure 6-20 Papillary
muscles (small arrow) are
often abnormal in addition to
the restricted septal leaflet
motion (large arrow) in tricus-
pid dysplasia. This is a long
axis four chamber view.
Figure 6-21 Paradoxical

septal mution secondary
to the right ventricular
volume overload is seen
on transverse images as a
flattened septum with a
more triangular shaped
left ventricular chamber.
Figure 6-22 Paradoxical

motion, on M-Mode
images, is seen as the
septum moves down-
ward during diastole,
with upward correction
during systole.
97
98
Abbreviations
A A peak of the mitral valve
AMY anterior mitral valve
AO aorta
AOV aortic valve
CAVC caudal vena cava
CRVC cranial vena cava
CT chordae tendinae
d diastole
E E peak of the mitral valve
EPSS E point to septal separation
FS fractional shortening
IAS interatrial septum
LA left atrium
LAU left auricular appendage
LMPA left main pulmonary artery
LV left ventricle
LVET left ventricular ejection time
LVW left ventricular wall
MV mitral valve
PA pulmonary artery
PE pericardial effusion
PEP pre-ejection period
PL pleural effusion
PM papillary muscle
PMV posterior mitral valve
PV pulmonic valve
RA right atrium
RAU right auricular appendage
RMPA right main pulmonary artery
RV right ventricle
s systole
SAM systolic anterior motion
se spontaneous contrast
TV tricuspid valve
VC vena cava
vs ventricular septum
99
100
We hope you enjoy this
Made Easy Series volume for the
Small Animal Practitioner.
If you would like more information on
other Made Easy Series
products please call 877-306-9793
or visit our online store at
www. veterinarywire.com
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Teton NewMedia
P.O. Box 4833, Jackson, WY 83001
101
Recommended Readings
The list below consists mostly of textbooks that provide a good base of knowledge for
endeavors into the field of ech ocardiograph y, its techniques, and its diagnostics.
Further reading of joumal articles is recommended to remain current on information
relating to echocardiography and specific cardiac diseases.
Berne RM, Levy MN. Cardiovascular Physiology, 8th edition. Mosby, St. Louis,
MO 2001.
Boon, JA. Manual of Veterinary Echocardiography, Williams and Wilkins,
Philadelphia, PA, 1998.
Darke P, Bonagura JD, Kelly DF. Calor Atlas of Veterinary Cardiology. Mosby-
Wolfe, London, England, 1996.
Heart Disease, 6th ed ition. Editors: Braunwald E, Zipes DP, Libby P. WB Saunders ,
Philadelphia, PA 2001.
Kirk's Cu rrent Veterinary Therapy Xll, Small Animal Practice. ~ection 9:
Cardiopulmonary Disorders pages 773-930. Editor: Bonagura JD. WB Saunders,
Kirk's Current Veterinary Therapy Xlll, Small Animal Practice. Section 9:
Cardiopulmonary Disorders pages 709-830. Editor: Bonagura JD . WB Saunders,
Kittleson MD, Kienle RD. Small Animal Cardiovascu lar Medicine. M osby, St
Louis, MO 1998.
Kittleson MD. Left ventricular function a nd failure. Part I. Camp Small Anim
1994; 16: 287-308.
Kittleson MD. Left ventricular function a nd failure. Part Il. Camp Small Anim
1994; 16: 1001-1017.
Manual of Canine and Feline Cardiology, Jrd ed ition. Editors: Tilley LP, Goodwin
JK. WB Saunders, Philadelphia, PA, 200 1.
Principles a nd Practice of Echocardiography, 2nd ed ition. Editor: Weyman AE.
Lea & Febiger, Philadelphia, PA 1994.
T extbook of Canine and Fe line Cardiology. Editors: Fox PR, Sisson D, M o ise N S.
WB Saunders, Philadelphia, PA 1999.
Thomas WP, Gaber CE, Jacobs GJ, et al. R eco mmendations for standards in
transthoracic two-dimensional ech ocardiograph y in the dog and cat.] Vet Int Med
1993, 7:247-252.
107

Two Dimensional and M-Mode Echocardiography - Boon

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Two Dimensional a nd M-Mode

Made Easy Series

Copyright © 2002 Teton NewMedia

PRINTED IN THE UNITED STATES OF AMERICA

Library of Congress Cataloging-in-Publication Data

SF811 .B67 2001

This book is dedicated to my family- Dave, Denali, and Logan. You

affordable allowing individuals in private practice to use it as

part of its daily diagnostic procedures. It is my hope that Two

Dimensional and M~Mode Echocardiography for the Small

Animal Practitioner will provide the guidance necessary to

obtain and assess echocardiographic images and provide a quick

checklist for the echocardiographic features of common congeni~

rate on the diagnostic features of each cardiac disease . To under~

stand these echocardiographic features in greater detail, please

refer to the recommended reading list.

Section 2 Obtaining the Image

Section 5 Common Acquired

Recommended Readings ....... _... 107

information to help you obtain quality echocardiographic images.

This goal is accomplished by using images, video clips (on CD

ROM), and detailed information on measurement and assessment

of echocardiographic images. Mastery of echocardiographic tech~

nique and assessment makes applying the diagnostic guidelines of

common cardiac diseases presented in this handbook easy.

Some Helpful Hints

./ This is a routine feature of the subject being discussed .

., This is a salient feature. If you remember anything about this

h We will use this selectively. This is a key point to understanding

~ Stop. This doesn't look important but it can really make

ti'f. Something serious, possibly life threatening, will happen if you

o A companion CD is available for purchase by calling

Figu re 2-3 This is a normal

./ Start with a good left ventricular outflow view.

Figure 2-7 Th is is a normal

tI' Th~ interatrial septum is straight.

Figure 2-12 This is a normal

./ Symmetrical circular left ventricular chamber

Mitral valve (Figures 2-14A and 2-14B):

Figure 2-14A These are normal right

Figure 2-14B The mitral valve

Figure 2-16 This is a normal

tI' Reference mark towards the nose

Figure 2-178 The trans-

Subjective Assessment of the

Figure 2-19A This illus-

Figure 2-198 The trans-

Technique in the Cat 0

Figure 2-27 This is a normal

Left Parasternal Apical

Figure 2-288 The trans-

Figure 2-29 The trans-

M-Mode of the Left

Figure 3-1 When the long

./ From the long~axis left ventricular outflow view (Figure 3A)

• Often you must scan so as to move the image to the left

Figure 3-5 When the transverse

Figure 3-7 When the long axis is

Figure 3-9 The arrows

Figure 3-11 Increased preload, as measured from increased diastolic dimen-

Figure 3-12 Decreased preload, as measured from diastolic dimensions on this

Normal Afterload Increased Afterload

Figure 3-15 Normal fractional shortening, and increased systolic dimensions

ECHOCARDIOGRAPHIC VALUES IN THE DOG (mm)