Anatomy & Hemodynamics Flashcards
Which valve is the most anterior?
Pulmonary valve
Which valve separates the areas of greatest pressure differences?
Mitral valve
Where does the LAD lie?
In the anterior interventricular groove or sulcus
Why does the mitral valve have 2 leaflets?
2 cusps for high pressure
What is the first standard view on TTE?
Parasternal window long axis view (LAX)
Which aortic leaflet is the superior one in the parasternal long axis view?
Right leaflet (RCC). The posterior leaflet is the noncoronary.
From the left parasternal window in which of the following are you most likely to get accurate velocity measurements?
Pulmonary artery
What is the 2nd standard view in TTE?
RVIT inflow tract
Name the tricuspid leaflets seen in RVIT?
Posterior and anterior (L to R)
RVIT is only view to what?
RVIT is only standard view in which you see the posterior TV leaflet. If still seeing LV might be septal leaf.
Red inflow in the RA on RVIT view would be?
IVC
3rd standard view in TTE?
Parasternal short axis (SAX) apex, pap, mv, av levels
Where is the LAA on TTE?
Sometimes in the parasternal SAX AoV level. Better seen in apical 2CH
What is always on the noncoronary cusps side?
Intra-atrial septum (IAS)
The coronary arteries come off the?
Sinuses of valsalva (if not an answer coronary sinuses would be correct)
Coronaries come of where ?
They come off above the AoV
During which phase do the coronaries fill?
Early diastole (fill throughout diastole but fill most in early)
What is the Ao sinotubular junction?
Transition between the sinuses of valsalva and the tubular portion of the ascending aorta
What is the Ao sinuses?
The maximal diameter in the sinuses of valsalva
How many wall segments?
17
What is the structure under the aortic arch?
Right pulmonary artery
Name the vessels coming off the aortic arch and most proximal or distal?
Innominate (prox) left carotid and left subclavian (distal)
What is aortic coarctation?
The shrinking “rubber band” of the prox descending aorta
Where do most aortic coarctation occur?
After the take off of the left subclavian artery, or within the aortic isthmus
What cardiac pathology is associated with bicuspid aortic valves?
Coarctation of the aorta
Where is the 2nd region to be scanned in standard TTE?
Apical
What is the 4th standard view in TTE?
Apical 4CH
Where are the pulmonary veins located? Which ones are seen in the apical 4CH view?
R and L upper (superior) pulmonary veins
Which other view would give you the same information as the PLAX?
Apical Long axis(3)
Which standard 2D TTE view typically allows viewing of the LAA?
Apical 2 CH
In apical 2 CH view, the LAA is on what side of heart?
Anterior
Where would pleural effusion be located?
Posterior to the DTA
Where is the coronary sinus located?
Posterior AV groove / sulcus
To visualize the coronary sinus in apical 4 CH view you should tilt the transducer?
Posterior (beam not transducer)
Which valve sits at the opening of the coronary sinus?
Thebesian
Which valve sits at the opening of the IVC?
Eustachian
What portion of the pulmonary venous PW Doppler represents atrial systole?
A wave
At what tempature is it unsafe to use a TEE probe?
40-45c (overheating pick the highest range)
At what degrees would you see a 4CH view in TEE?
0 degrees
At what degrees would you see the SAX view in TEE?
60 degrees
At what degrees would you be able to see the LAA appendage in TEE?
73 degrees (decrease depth)
ME?
Mid esophageal (TEE)
What degrees at the ME level would you need to see the 4CH view in TEE?
0 degrees
What degrees at the ME level would you need to see the 2CH view in TEE?
90 degrees
What degrees at the ME level would you need to see the LAX view in TEE?
120 degrees
What degrees at the ME level would you need to see the AV SAX view in TEE?
60 degrees
What is the normal electrical activation order?
SA node, AV node, Bundle of his, R & L bundle branches and purkinje fibers.
Which part of the electrical system has the fastest intrinsic rate?
SA node (pacemaker of heart)
What is the pacemaker of the heart?
Sa node
What is the absolute refractory state?
That period when a muscle cell is not excitable - from phase 1 until into phase 3, the relative refractory period is during phase 3 and the muscle might contract if the stimulus is strong.
What does the P wave on ECG represent?
Atrial systole
What does the T wave in ECG represent?
Ventricular diastole (repolarization)
What is the P-R interval?
Includes P-R segment (from atrial to ventricular depolarization)
What is the QRS complex?
Ventricular systole (depolarization)
What is the normal duration for the QRS complex?
0.10 s
How long is one small box on ECG in seconds?
0.04 s
Normal QRS complex has?
Less than 3 little boxes (less than 0.12 s)
What is a normal P-R interval?
Less than 1 big box (less than 0.2 s)
Echo findings for preload vs afterload?
Preload - dilation
Afterload- hypertrophy
Another name for the RA?
Todaro
Where is the chiari network?
RA
Acute Ai is ______ because we shift up the starling curve. Chronic ai is _____ when we drop off the end
Hypercontractile, failure
Which study does not allow for the calculation of ef?
CXR
How does switching to a lower frequency transducer affect aliasing?
Aliasing will occur at higher velocities
What does VTI x CSA?
Doppler stroke volume
Does venous return increase or decrease with inspiration?
Increase INspration
Inhilation of amyl nitrate causes?
Decreased afterload
Mitral valve velocity during inspiration?
Decreases
What is the normal pressures in the pul artery?
25/10
Were is LV pressure the lowest ?
Early diastole
Where is the O2 saturation the lowest?
Coronary sinus
Best cath technique for LV function?
LV angiogram
What is the PCW (pulmonary capillary wedge) measuring?
La pressure
Pericardial effusions in 2D can have swing motion & a possible?
Dilated IVC
For constrictive pericarditis the m-mode will show?
Thick pericardium & paradoxical septal motion & flat LV posterior wall motion in diastole
Constrictive pericarditis in 2D show diastolic dysfunction and?
Dilated IVC without respiration collapse, has prominent E & sm A. Also has respiration variation on mitral PW
What increases afterload
Hypertension, AS & PS
A pt has a blood pressure of 130/80 and a vsd jet of 5/m sec. What is their right ventricular systolic pressure ?
30 mmhg