A4C 2D Protocol

Question 1

apical window may be anywhere from the _______ line to the _______ line (___/___ intercostal space)

Answer 1

anterior axillary
posterior axillary
4/5

Question 2

PMI

Answer 2

point of maximal impulse
(feeling to find heart apex; never actually used)

Question 3

apical probe points where on clock

Answer 3

2-3:00

Question 4

if you are too medial the ____ will be sliced off; this is called ______

Answer 4

apex
foreshortening

Question 5

what else do we enter for sait echo protocol for patient info

Answer 5

height/weight

Question 6

biplane measurements means

Answer 6

from 2 different planes of imaging

Question 7

2 biplane measurements in apical views

Answer 7

LA volume
Simpson’s EF (LV) (ejection fraction)

Question 8

what is the method of disks

Answer 8

disks places throughout traced volumes at 5mm intervals

Question 9

LA volume measurement is taken during (heart cycle)

Answer 9

end-systole (LA is the largest)

Question 10

what two planes is LA volume taken in

Answer 10

A4C and A2C

Question 11

LAVI

Answer 11

LA volume index
volume divided by patients’ BSA

Question 12

LA volume calculation

Answer 12

Avg LA Vol = (A4C LA Vol + A2C LA Vol)/2

Question 13

LAVI calculation

Answer 13

LA vol/BSA

Question 14

LA trace from ____ side of MV ____ and around to the ____

Answer 14

medial
annulus
lateral

Question 15

(LA trace)
align the vertical axis from the _____ of the MV annular diameter to the middle of the _____ of the LA

Answer 15

middle
roof

Question 16

length of LA must be close in A4C and A2C; within ____ mm

Answer 16

5

Question 17

LA volume index normal, mildly abnormal, moderately abnormal, and severely abnormal

Answer 17

less than or equal to 34
35-41
42-48
more than or equal to 48

Question 18

Trace LV when for Simpson’s EF and what views

Answer 18

at end-diastole and again at end systole in A4C and A2C

Question 19

is the pap muscle included in LV volume

Answer 19

yes

Question 20

Simpson’s EF normal for male and female

Answer 20

M 52-72
F 54-74

Question 21

Simpson’s EF severe

Answer 21

less than 30

Question 22

LV EDV (M/F)

Answer 22

M ≤ 128
F ≤ 91

Question 23

LV ESV (M/F)

Answer 23

M ≤ 51
F ≤ 35

Question 24

in A4C 2D, if you see AV you are angled too ____

Answer 24

anteriorly

Question 25

in A4C 2D, if you dont see enough LA, you are angled too _____

Answer 25

posteriorly

Question 26

A4C 2D protocol images (9)

Answer 26

A4C 2D
A4C LA volume trace
A4C reduced depth
A4C LV trace (Simpson’s) end diastole
A4C LV trace (Simpson’s) end systole
A4C RV base dimension
A4C RA Vol Index
A4C Rt focus view
A4C RV TAPSE (m-mode)

Question 27

Normal LAVI

Answer 27

less than or equal to 34 ml/m^2

Question 28

what is the reason for A4C reduced depth

Answer 28

optimize LV walls to asses wall motion

Question 29

A4C LV trace (Simpson’s) is done from what depth (both end diastole and end systole)

Answer 29

reduced depth

Question 30

what do you have to remember when taking the EDV and ESV A4C LV trace (Simpson’s)

Answer 30

always take both on the same beat

Question 31

normal EF of heart (Simpson’s) vs reduced EF

Answer 31

> 55%
vs
<55%

Question 32

when do you measure RV base dimension and where

Answer 32

end diastole
basal 1/3 portion of RV (just inferior to TV leaflets)

Question 33

RVIDd

Answer 33

RV internal dimension end-diastole

Question 34

Normal RVIDd base

Answer 34

≤41mm/4.1cm

Question 35

normal RVIDd mid

Answer 35

<35mm/3.5cm (don’t take this photo unless enlarged)

Question 36

RV in the A4C views should be _____ the size of the LV

Answer 36

less than 2/3

Question 37

RAVI

Answer 37

right atrium volume index

Question 38

Normal RAVI (F/M)

Answer 38

F ≤27 mL/m^2
M ≤32 mL/m^2

Question 39

to get from A4C to A4C Rt focus view how do you move

Answer 39

more laterally to use LV as window for RV

Question 40

A4C RV TAPSE (Stands for)

Answer 40

tricuspid annular plane systolic excursion