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은별 왕
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심장 (Heart) 심초음파 서울대병원내과 김용진 심장은평생몇번이나뛸까요? 1) 3 백만번 2) 3 천만번 3) 3 억번 4) 30 억번 30 억박동, 2 억리터의혈액 Cause 심장질환 6.2 12.4 11.1 16.2 뇌졸중 4.3 8.5 7.7 11.3 기타심혈관질환 2.6 5.1 6.0 8.8 심혈관질환 13.1 26.0 24.8 36.

Unipolar major depression 3. Perinatal conditions 3. Road traffic accidents 4. Diarrhoeal diseases 4. 뇌혈관질환 5. Unipolar major depression 5. COPD 6. 관상동맥질환 6. Lower respiratory infections 7. 뇌혈관질환 7.

1 심장 (Heart) 심초음파 서울대병원내과 김용진 심장은평생몇번이나뛸까요? 1) 3 백만번 2) 3 천만번 3) 3 억번 4) 30 억번 30 억박동, 2 억리터의혈액 Cause 심장질환 뇌졸중 기타심혈관질환 심혈관질환 총사망 WHO:WHF 심혈관질환의중요성 Millions (%) Millions (%) 장애의원인 1999 Disease or Injury 2020 Disease or Injury 1. Acute lower respiratory infections1. 관상동맥질환 2. HIV/AIDS 2. Unipolar major depression 3. Perinatal conditions 3. Road traffic accidents 4. Diarrhoeal diseases 4. 뇌혈관질환 5. Unipolar major depression 5. COPD 6. 관상동맥질환 6. Lower respiratory infections 7. 뇌혈관질환 7. Tuberculosis 8. Malaria 8. War 9. Traffic accidents 9. Diarrhoeal diseases 10. COPD 10. HIV 심질환의진단적검사 심도자술 (cardiac catheterization) 심장영상의어려움 Cardiac Motion 심혈관조영술 (coronary angiography) 심초음파도 (echocardiography) 핵의학영상 (nuclear imaging) 운동부하심전도 (treadmill test) 24시간심전도 (Holter monitoring) 1

2 심초음파 Ultrasound stethoscope 심초음파란무엇인가? 심초음파의실제 심초음파, 심장초음파 Echo exam Cardiac ultrasound Echocardiography Echo : 메아리 심초음파 M-mode echocardiography Two-dimensional echocardiography Doppler echocardiography Spectral Doppler pulsed wave (PW) Doppler continuous wave (CW) Doppler color Doppler Single-Element Imaging A B M-mode time 2

3 M-mode 심초음파 2D 심초음파 RV LV 2D 심초음파 Access to the Heart 2-D Imaging of 3-D Objects 3

4 Parasternal window Parasternal long-axis view Parasternal long-axis view Parasternal long-axis view Parasternal long-axis view Parasternal long-axis view 4

5 Parasternal short-axis view Parasternal short-axis view Parasternal short-axis view Parasternal short-axis view Apical view Apical 4-chamber view 5

6 Apical 4-chamber view Apical 2-chamber view Apical 5-chamber & long-axis view Subcostal view Subcostal view Suprasternal view 6

$fraction):$ 60 % :

7 좌심실기능 수축기 / 이완기좌심실직경 : 30/48 mm 좌심실구혈율 (ejection fraction): 60 % 좌심실기능 수축기 / 이완기좌심실직경 : 57/64 mm 좌심실구혈율 (ejection fraction): 21 % 좌심실수축기능 : 확장성심근증 판막기능 : 승모판협착증 국소벽운동 : 심근경색증 국소벽운동 : 심근경색증 LAD & LCX RCA 7

8 국소벽운동 : 심첨류혈전증 Doppler effect Christian Doppler, 도플러효과 (Doppler effect) 도플러심초음파 F t F r V Doppler Shift = F r F t = 2Ft (V cos / c) 8

9 Spectral Doppler Spectral Doppler 승모판역류증 Jet area(cm 2 ) Grade 1 : 4-8 Grade 2 : 8-12 Grade 3 : Grade 4 : > 16 판막기능 : 대동맥판역류증 선천성심기형 : 심방중격결손증 9

10 선천성심기형 : 심실중격결손증 Daniel Bernoulli,1782 도플러심초음파 : 혈역학적평가 Simplified Bernoulli equation 도플러심초음파 : 폐동맥수축기압 PAP systolic = 4 V TR 2 + RAP P = 4 V 2 2 V 1 V 2 도플러심초음파 : 판막질환평가 카테터 vs 도플러 10

도플러심초음파 : 혈역학적평가 Volume Stroke volume and

$fraction Pulmonary-systemic flow$ instantaneous gradient Mean gradient

transesophageal echo (TEE) 부하심초음파 ( 도부타민,

11 도플러심초음파 : 혈역학적평가 Volume Stroke volume and cardiac output Regurgitant volume and fraction Pulmonary-systemic flow ratio(qp/qs) Pressure gradients Maximal instantaneous gradient Mean gradient Valve area Stenotic valve area Regurgitant orifice area Intracardiac pressure Pulmonary artery pressure, LA pressure, LVEDP 심초음파검사의종류 경흉부심초음파 : transthoracic echo (TTE) 경식도심초음파 : transesophageal echo (TEE) 부하심초음파 ( 도부타민, 운동 ) 수술중심초음파 : intraoperative echo 심장수술마취중갑작스런혈압저하 심장수술마취중갑작스런혈압저하 Under intensive inotropics Intensive inotropics Stop inotropics Hydration 심방중격결손증시술 경식도 심장내 경식도심초음파 : 높은해상도 11

12 운동심초음파 운동심초음파 : 협심증 운동전 운동중 AP4C AP2C Recent Development Contrast Echo: LV Opacification Poor image quality Contrast echocardiography Contrast Echo: Apical HCM Contrast Echo: Apical Thrombus 12

13 2D Strain: Myocardial Function Automated Volume Measurement 3D LV Opacification 3D LV Opacification 3D Echo: Mitral Prolapse 3D Echo: Mechanical Valve 13

14 3D Echocardiography Atrial Septal Defect 3D Strain Imaging Miniaturization Miniaturization Conventional Echo Hand-held Echo Heart 14

임상병리검사과학회지 : 제 30 권저 112 호 섬근경색환자에서의 Wall Motion Abnormality 의부위와 관상동맥질환의벼교 이화의대동대문병원섬전도살 검형중 여영옥 The Comparsion of Wa1l Motion Abnorma1 Site an

임상병리검사과학회지 : 제 30 권저 112 호 섬근경색환자에서의 Wall Motion Abnormality 의부위와 관상동맥질환의벼교 이화의대동대문병원섬전도살 검형중 여영옥 The Comparsion of Wa1l Motion Abnorma1 Site an 임상병리검사과학회지 : 제 30 권저 112 호 1998. 섬근경색환자에서의 Wall Motion Abnormality 의부위와 관상동맥질환의벼교 이화의대동대문병원섬전도살 검형중 여영옥 The Comparsion of Wa1l Motion Abnorma1 Site and Coron 따 y Artery Disease in Myocardia1 Infarction