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Echocardiography > 400 question knowledge > Flashcards

400 question knowledge Flashcards

1
Q

Normal IVRT

A

70-100

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2
Q

Normal E/A ratio

A

1

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3
Q

Normal E wave decel time

A

160-250

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4
Q

Increase frame rate by…

A

decreasing depth, reducing sector angle, decrease line density.

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5
Q

Continuity equation is based on

A

Law of Conservation of Mass

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6
Q

Near Field Zone Length formula

A

Transducer diameter squared / wavelength x 4

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7
Q

Attenuation is greater at _____ frequencies due to _____ wavelength.

A
  1. Higher

2. Shorter

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8
Q

Attenuation is greatest in ____, and next greatest in ____

A
  1. Air

2. Bone

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9
Q

Half Intensity depth

A

Depth at which energy is reduced by half.
Measure of attenuation.
6cm/frequency

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10
Q

Calculate PRF

A

77,000/depth in cm

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11
Q

3 ways to increase lateral resolution:

A
  1. Increase transducer diameter.
  2. Increase frequency.
  3. Focusing.
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12
Q

Increasing frequency will ______ axial resolution.

A

Increase

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13
Q

Duty Factor

A

Pulse Duration/PRP

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14
Q

Persistence

A

Process of keeping prior frames on the console. Smooths the image.

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15
Q

Nyquist Limit

A

PRF/2

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16
Q

You can increase the aliasing velocity by…

A

Increasing the frequency of the beam.

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17
Q

Where does mirror artifact occur?

A

Occurs deeper than the structure.

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18
Q

Sound travels faster in a medium with ________ density and ______ stiffness.

A
  1. Low

2. High

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19
Q

Doppler Shift Equation

A

Fd= (2 x Fo x V x cos theta) / C

Fd= Doppler Shift (Hz)
Fo= Frequency (Hz)
V= velocity (m/s)
C= speed of sound in medium (1540m/s)
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20
Q

Attenuation Coefficient

A

Frequency/2

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21
Q

How do you find the attenuation?

A

Attenuation = attenuation coefficient x depth

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22
Q

Impedance

A

Impedance = density x propagation speed

Measured in rayls

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23
Q

With respect to amplitude, intensity is…

A

Amplitude squared

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24
Q

Volumetric flow rate decreases with… (3 things)

A
  1. Decreased pressure gradient
  2. Decreased vessel radius
  3. Increased viscosity
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25
Q

The Bernoulli Equation employs what law?

A

Law of conservation of ENERGY.

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26
Q

Severe MR jet area cut off

A

> = 40%

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27
Q

Severe MR jet to LA area ratio

A

> = 4

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28
Q

Severe MR vena contracta

A

Diameter of >= 0.7 cm

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29
Q

Severe MR ERO

A

> = 0.4 cm squared

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30
Q

Pulmonary vein sign of severe MR

A

Systolic flow reversal

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31
Q

3 ways to increase lateral resolution:

A
  1. Increase transducer diameter.
  2. Increase frequency.
  3. Focusing.
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32
Q

Increasing frequency will ______ axial resolution.

A

Increase

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33
Q

Duty Factor

A

Pulse Duration/PRP

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34
Q

Persistence

A

Process of keeping prior frames on the console. Smooths the image.

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35
Q

Nyquist Limit

A

PRF/2

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36
Q

You can increase the aliasing velocity by…

A

Increasing the frequency of the beam.

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37
Q

Acute severe MR jet will have this shape…

A

V

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38
Q

AVA via continuity equation

A

A1V1=A2V2

AVA = (LVOT area x LVOT velocity)/Ao velocity

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39
Q

AREA=

A

0.785 x Dsquared

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40
Q

Gorlin equation will ______ AVA, compared to continuity

A

Underestimate

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41
Q

Formula for peak flow rate from PISA

A

2 (pi) (r squared) x aliasing velocity (cm/s)

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42
Q

ERO formula

A

[2 (pi) (r squared) x aliasing velocity (cm/s)] / regurgitant velocity

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43
Q

MR ERO cut offs

A

mild < 0.2, mod 0.2-0.4, severe >0.4

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44
Q

When given angle of inlet, how do you account for that in peak flow calculations with PISA?

A

You change formula to be:

[2 (pi) (r squared)] x [angle of inlet/180] x aliasing velocity

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45
Q

ERO (using PISA)

A

ERO = peak flow rate / peak inflow velocity

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46
Q

Regurgitant Volume (using PISA)

A

Reg Vol = ERO x MR VTI

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47
Q

ERO (when given volumes and VTI’s)

A

ERO = Regurgitant volume / regurgitant VTI

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48
Q

AI ERO cut offs

A

mild < 0.1, mod 0.1-0.29, Severe > 0.3

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49
Q

Regurgitant Fraction

A

Reg Fraction = Regurgitant Volume / total flow

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50
Q

Pulmonary Hypertension severity

A

Mild mPAP 25-40
Mod mPAP 41-55
Severe mPAP >55

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51
Q

Stroke Volume

A

SV = LVOT area x LVOT VTI

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52
Q

Sinus Venosus ASD is associated with…

A

anomalous return of Right upper pulmonary vein into the Right Atrium

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53
Q

Primum ASD is associated with…

A

Cleft anterior leaflet of the mitral valve.

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54
Q

Normal Pressure Half Time in prosthetic valve

A

65-80ms

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55
Q

Prosthetic Valve AI with PHT < 200ms is c/w

A

Severe AI

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56
Q

Elevated E:A ratio is c/w

A

elevated LA pressures.

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57
Q

Best view to evaluate paravalvular leak in mechanical MVR

A

PLAX

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58
Q

Most common benign tumor in the heart is…

A

Papillary Fibroelastoma

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59
Q

Most common metastatic malignant tumor of the heart is…

A

melanoma

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60
Q

Most common primary malignant tumor of heart is…

A

rhabdomyoma

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61
Q

Features of Tetralogy of Fallot

A
  1. VSD
  2. RVOT obstruction / pulmonary stenosis
  3. Overriding Aorta
  4. RVH
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62
Q

Pentalogy of Fallot

A

Tet plus an ASD

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63
Q

Most common location for accessory pathway in Ebstein’s anomaly is…

A

Right Lateral.

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64
Q

In pLAX, a defect in the basal anteroseptum is c/w

A

Outlet Muscular VSD

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65
Q

In pLAX, a defect in the mid anteroseptum is c/w

A

Travecular VSD

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66
Q

In SAX @ level of aortic valve, a defect in the area around the valve/LVOT from 9o’clock to 12 o’clock would be a …

A

Membranous VSD

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67
Q

In SAX @ level of aortic valve, a defect in the area around the valve/LVOT from 12:00 to 3:00 would be a …

A

Outlet Muscular VSD

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68
Q

In SAX @ level of MV, a mid septal defect would be a…

A

Inlet Muscular VSD

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69
Q

In SAX @ level of MV, a anteroseptal defect would be a …

A

Trabecular VSD

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70
Q

In SAX @ level of pap muscles a septal defect would be a

A

Trabecular VSD

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71
Q

In Apical 4, a basal inferoseptal defect would be a …

A

Inlet VSD

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72
Q

In Apical 4 a mid to distal Inferoseptal defect would be a…

A

Trabecular VSD

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73
Q

In Apical 5 a basal anteroseptal defect would be a …

A

Membranous VSD

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74
Q

In Apical 5 a mid anteroseptal defect would be a

A

Trabecular VSD

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75
Q

Outlet VSD are associated with…

A

Severe progressive AI, should be surgically corrected.

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76
Q

Another name for an Outlet VSD is…

A

Supracristal VSD

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77
Q

The only ASD that can be closed percutaneously is…

A

Secundum

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78
Q

Largest Secundum that can be closed by a device…

A

40mm

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79
Q

Secundum ASD’s are associated with…

A

Mitral Valve Prolapse

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80
Q

Primum ASD’s are associated with…

A

AV valve abnormalities (cleft MV most commonly)
Left Axis Deviation
LVOT obstruction

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81
Q

Unroofed CS is associated with…

A

Persistent Left SVC.

82
Q

Indications for VSD closure:

A
  1. Qp/Qs > or = 2
  2. clinical evidence of LV volume overload
  3. h/o IE
83
Q

Pulmonary Vein tracing S1 wave is determined by…

A

atrial relaxation

84
Q

D wave deceleration time in pulmonary vein tracings should be…

A

170-260ms

85
Q

Reduced D wave decel time (pulmonary veins) means…

A

High left atrial pressures

86
Q

Prolonged D wave decel time (pulmonary veins) means…

A

Mitral stenosis

87
Q

Normal E wave propagation velocity by color M mode inside the LV is

A

> 50cm/s

88
Q

Increased tau is c/w

A

LV diastolic dysfunction, stiffness, slow relaxation

89
Q

Ventricular Asynchrony is measured by…

A

Time delay between ventricles measured as delay from Q wave to flow at PA or Ao, then take difference between ventricles.

90
Q

Features of Partial AV Canal Defect

A
  1. Primum ASD
  2. Cleft MV
  3. Widened antero-septal tricuspid commisure
91
Q

Features of Complete AV Canal Defect

A
  1. Primum ASD
  2. Cleft MV
  3. Widened antero-septal tricuspid commisure
  4. Inlet VSD
92
Q

Cutoffs for SEVERE MR pneumonic

A

4,4,5,6,7

Jet Area, ERO, Reg Fx, Reg Vol, VC

93
Q

Jet Area cutoff Severe MR

A

Jet Area > 40%

94
Q

ERO cutoff Severe MR

A

ERO > or = 0.4 cm squared

95
Q

Regurgitant Fraction cutoff Severe MR

A

Reg Fx > or = 50%

96
Q

Regurgitant Volume cutoff Severe MR

A

Reg Vol > or = 60 cc/bt

97
Q

Vena Contracta cutoff Severe MR

A

VC > or = 0.7 cm

98
Q

Cutoffs for Mild MR pneumonic

A

2,2,3,3,3,

Jet Area, ERO, Reg Fx, Reg Vol, VC

99
Q

Jet Area cutoff Mild MR

A

Jet Area < 20%

100
Q

ERO cutoff Mild MR

A

ERO < 0.2 cm squared

101
Q

Regurgitant Fraction cutoff Mild MR

A

Reg Fx < 30%

102
Q

Regugitant Volume cutoff Mild MR

A

Reg Vol < 30 cc/bt

103
Q

Vena Contracta cutoff Mild MR

A

VC < 0.3 cm

104
Q

Pressure Half Time in AI, mild/mod/severe

A

mild AI PHT > 500ms
mod AI PHT < 300ms
sev AI PHT < 193 ms

105
Q

Regurgitant Fraction formula

A

RF = Reg Vol / stroke volume or foward flow volume

106
Q

ERO formula

A

ERO = Regurgitant volume / VTI of regurgitant jet

107
Q

Jet Area cutoff Severe AI

A

Jet Area > or = 65%

108
Q

ERO cutoff Severe AI

A

> or = 0.3 cm

109
Q

Regurgitant fraction cutoff Severe AI

A

Reg Fx > or = 50%

110
Q

Regurgitant Volume cutoff Severe AI

A

Reg Vol > 60 cc/bt

111
Q

Vena Contract cutoff Severe AI

A

VC > or = 0.6 cm

112
Q

Mild AI cutoffs in order of pneumonic

A

25, 0.1, 30, 30, 0.3

113
Q

Jet Area cutoff mild AI

A

< 25%

114
Q

ERO cutoff mild AI

A

< 0.1 cm squared

115
Q

Regurgitant Fraction cutoff mild AI

A

Reg Fx < 30%

116
Q

Regurgitant Volume cutoff mild AI

A

Reg Vol < 30 cc/bt

117
Q

VC cutoff mild AI

A

0.3 cm

118
Q

severe AI cutoff in order of pneumonic

A

65, 0.3, 50, 60, 0.6

119
Q

Fractional Shortening formula

A

(EDV-ESV)/EDV

120
Q

VCF (velocity of circumferential shortening) formula

A

VCF = Fractional Shortening / Ejection Time

121
Q

Wall stress formula

A

WS = (end systolic pressure x radius)/wall thickness

122
Q

In pulmonary venous flow tracing, S1 is related to

A

Left Atrial relaxation

123
Q

In pulmonary venous flow tracing, S2 is related to

A

RV ejection and mitral annular descent.

124
Q

Tachycardia ______ LV relaxation.

A

Improves

125
Q

In abnormal LV relaxation, LA pressures are normally _____, and LVEDP is normally __________

A
  1. normal

2. High

126
Q

Incidence of PFO in normal population

A

25%

127
Q

With Pulmonary A-V fistulae, as in hepato-pulmonary syndrome, or P-AVMs bubbles appear in the Left Heart in…

A

3-5 beats.

128
Q

Restrictive Pattern E/A ratio

A

E/A > 2

129
Q

Restrictive Pattern Decel Time

A

Decel time < 150 ms

130
Q

Restrictive Pattern IVRT

A

IVRT < 70 ms

131
Q

Axial Resolution formula

A

Axial Resolution = Spatial Pulse Length / 2

132
Q

Spatial Pulse Length =

A

SPL = # cycles x wavelength

133
Q

Wall Motion Score Index codes

A 
Normal = 1
Hypo = 2
Akinesis = 3
Dyskinesis = 4
Aneurysmal = 5
134
Q

WMSI of ____ is c/w severe LV dysfunction

A

> or = 2

135
Q

Intensity =

A

Intensity = Power / Area

136
Q

Power =

A

Power = Amplitude squared

137
Q

Turbulent Flow is proportional to…(3 things)

A
  1. Denisty
  2. Vessel Diameter
  3. Velocity
138
Q

Turbulent Flow is inversely proportional to (1 thing)

A

Viscosity (Less viscous -> more turbulent)

139
Q

L-TGA can be associated with (3 things)

A
  1. VSD
  2. PS
  3. Heart Block
140
Q

Dimensionless Index Severe AS

A

< 0.25

141
Q

Formula of dimensionless index in AS

A

DI = LVOT velocity / AV velocity

142
Q

Austin Flint murmur

A

Diastolic rumble at the apex, assoc. with AI hitting anterior leaflet of MV. Causes fluttering of the anterior leaflet of the MV.

143
Q

Normal LA volume

A

22ml +/- 6

144
Q

Mild LA dilation

A

29-33 ml

145
Q

Moderate LA dilation

A

34-39 ml

146
Q

Severe LA enlargement

A

> 40 ml

147
Q

Ideal thickness of matching layer

A

Wavelength/4

148
Q

V pacing and LBBB create this wall motion abnormality.

A

Apical septal abnormality.

149
Q

Near field length formula

A

Near Field Length =

Transducer diameter squared (mm) x frequency (MHz) / 6

150
Q

Percentage of chronic A fib pts with clot in LAA

A

10-15%

151
Q

Things that cause diastolic MR

A

Long PR

152
Q

Restrictive pattern

  1. IVRT
  2. E wave (high or low V)
  3. A wave (high or low V)
  4. Decel time
A
  1. IVRT is short.
  2. E wave is high/tall
  3. A wave is low/small
  4. Decel time is short
153
Q

What is bandwidth.

A

The range of frequencies a transducer can operate over.

154
Q

Center frequency

A

The frequency in the middle of the bandwidth. So bandwidth from 2-4 MHz? Center freq = 3

155
Q

Fractional Bandwidth formula

A

Bandwidth/center frequency

156
Q

Uhl’s anomaly

A

Parchment of the RV. Thinning. Dilated RV

157
Q

Down’s syndrome congenital cardiac defect

A

Complete AV canal

158
Q

Noonan’s syndrome congenital cardiac defect

A

Pulmonary Stenosis

159
Q

Holt Oram congenital cardiac defect

A

ASD

160
Q

Fetal Alcohol cardiac defect

A

VSD

161
Q

Turner’s congenital cardiac defect

A

Coarctation of the Aorta

162
Q

Most common primary cardiac malignancy

A

Angiosarcoma

163
Q

Angiosarcoma

A

most common primary cardiac malignancy
usually in RA
presents with pericardial eff/tamponade

164
Q

Doppler shift equation

A

Fd= [2Fo x velocity x cos theta] / propagation speed

Fo in Hz, velocities in m/s

165
Q

PRP formula

A

PRP = (13 microseconds/cm) x depth cm

166
Q

Frame time formula

A

Frame Time = PRP x # lines in sector

167
Q

Frame Rate

A

Frame Rate = 1/Frame time

168
Q

Worst case penetration is…

A

200 wavelengths

169
Q

Max depth penetration is equal to

A

200 x wavelength

170
Q

Wavelength =

A

Wavelength = velocity / frequency

171
Q

Lipomatous Hypertrophy of Atrial Septum (LHAS)

A

LHAS is infiltration of fat into interatrial septum > 2cm

172
Q

Dimensionless Index

A

LVOT VTI/ Ao VTI

173
Q

Severe AI Dimensionless Index

A

< 0.25

174
Q

%Reflection

A

= [z2-z1]squared / [Z2 + Z1]squared

175
Q

Class I recommendations for AVR in AS… (3)

A
  1. Severe AS undergoing CABG
  2. Symptomatic severe AS
  3. Severe AS undergoing other valve or aortic surgery
176
Q

M mode sign of constriction.

A

Early and late diastolic notching of the septum.

177
Q

MPI formula

A

MPI = [IVCT + IVRT] / Ejection Time

178
Q

Resistance Formula

A

Resistance = (8 x length x viscosity) / (pi x r to the 4th)

179
Q

Cosine 0

A

1

180
Q

Cosine 30

A

0.86

181
Q

Cosine 60

A

0.5

182
Q

Cosine 90

A

0

183
Q

Mean Gradient (from peak gradient measurement)

A

Mean Gradien = 0.7 x peak gradient

184
Q

Relative Wall Thickness formula

A

RWT = (2 x posterior wall thickness) / LVEDd

185
Q

TAPSE cut off for RV dysfxn

A

< 1.6 cm

186
Q

Strain formula

A

change in length / initial length

187
Q

Normal Strain

A

-20%

188
Q

E to E prime ratio

A

< 8 normal

>15 ~ PCWP >20

189
Q

Indications for surgery in MS

A

Any degree of LV dysfunction ( EF < 60% or LVESD > 40mm)

190
Q

TS gradients

A

Normal < 2 mmHg, Severe > or = 7 mmHg

191
Q

TVA (using PHT)

A

TVA = 190 / PHT

PHT > 190 c/w severe TS

192
Q

Mean PV gradient when should go for valvuloplasty

A

30-40 mmHg

193
Q

Duke’s Major Criteria

A
  1. positive BCx’s
  2. typical organism for IE in 2 Cx’s
  3. echo e/o valve issue (veg, new reg, dehiscience)
  4. Abscess
194
Q

PPM via EROAi

A

EROAi > 0.85 = no PPM
EROAi 0.66 -0.85 = moderate PPM
EROAi < 0.65 = severe PPM

195
Q

PPM vs Obstructed prosthesis

A

Both have increased velocity, increased mean gradients and low dimensionless index (< 0.25)
But… Obstructed prosthesis has prolonged acceleration time (>100ms) and rounded contour while PPM has low accel time (< 100 ms) and triangular contour.

196
Q

MPI numbers

A

< 0.4 normal
mild LV dysfxn 0.4-0.5
mod LV dysfxn 0.6-0.9
Severe LV dysfxn >1

197
Q

Normal Dp/Dt

A

> 1200

198
Q

Indications for Aortic aneurysm repair

A

Asc. Ao 5.5 cm or 5 cm in Marfan’s or bicuspid valve
enlarging by > 1 cm / yr
symptomatic
traumatic or infxs
or if going for Ao valve surgery and asc ao is > 4.5cm

199
Q

Shone’s Syndrome

A
  1. Supravalvular membrane (mitral valve)
  2. Parachute MV
  3. Subaortic valvular stenosis
  4. Coarctation of the aorta
200
Q

Focal length

A

(Transducer diameter squared x frequency) / 6

201
Q

6 ways to get rid of aliasing

A
  1. Shift the nyquist scale
  2. Use a lower frequency transducer
  3. Select a new view with a shallower sample volume.
  4. Switch to CW
  5. Select a new view with angle closer to 90 degrees
  6. Move the baseline.

Echocardiography (2 decks)

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