ASE Book 2nd edition: Transthoracic Echocardiography

Question 1

when first starting your TTE exam, you don’t wanna immediately start measurements… instead you should survey what?

Answer 1

should come in from a wider view first to survey at least the descending thoracic aorta in order to detect any pericardial/pleural effusions AND posterior mediastinal pathology such as masses.

Question 2

For PLAX view of LV, what plane is imaged?

Answer 2

sagittal plane

Question 3

T or F the true LV apex is NOT visualized in a PLAX view

Answer 3

True

Question 4

what walls can you see of LV in PLAX

Answer 4

mid and basal LV anteroseptal and inferolateral (aka posterior) walls on left half of image

Question 5

this can be seen in PLAX view outside of pericardium, posterior to the left atrium

Answer 5

descending aorta

Question 6

this can be seen posterior to the mitral annulus in PLAX view

Answer 6

coronary sinus

Question 7

PLAX view, which cusps of aortic valve are typically seen? describe orientation

Answer 7

right coronary cusp (RCC) is typically anterior

non coronary cusp (NCC) typically posterior

Question 8

PLAX view can identify prolapse of this and excessive motion of this

Answer 8

can identify prolapse of the mitral leaflets past the annular plane or excessive anterior motion of the leaflets during systole

Question 9

Color Flow Doppler can provide an initial assessment of

Answer 9

mitral and aortic valve function

Question 10

PLAX RV inflow - transducer movement…

Answer 10

angle from standard PLAX inferomedially with slightly clockwise rotation and movement of transducer toward apex for RV inflow

Question 11

PLAX RV inflow view is one of several views that allows

Answer 11

Doppler interrogation of tricuspid regurgitation and its peak velocity

Question 12

RV outflow view in PLAX, how to obtain

Answer 12

move transducer slightly toward base and angulate laterally

Question 13

What two valves are perpendicular to each other in terms of views

Answer 13

When the aortic valve is seen in short axis, the pulmonic valve is seen in long axis and vice versa

Question 14

Color Doppler may be useful in this view to identify the location of mitral regurgitant jets

Answer 14

SAX mitral view

ALL P-SAX views are excellent for assessing segmental LV wall motion and thickening.

Question 15

Think.. an apical 4 chamber view is perpendicular to a SAX or PLAX view? TRUE OR FALSE

Answer 15

TRUE!

Question 16

4 chamber view useful for

Answer 16

LV systolic and diastolic function may be assessed in this view using tissue Doppler

To estimate LV ejection fraction (apical 4-chamber and then combined with a 2-chamber view)

to view inferoseptal and anterolateral walls of LV

biatrial size and AV function

Doppler interrogation of MV and TV function AND pulmonary venous flow

RV function and dimension (RV systolic function), TAPSE (m-mode), fractional are change (2-D), tricuspid lateral annular systolic velocity on tissue Doppler imaging

Question 17

IVC sniff test, IVC remains dilated… that means that

Answer 17

the patient will have elevated right heart pressures