Basic Cardiac Ultrasound (FATE) Flashcards
FATE is an acronym for ______
Focus Assessed Transthoracic Echocardiography
True/False: FATE can be performed with the patient in the sitting position
True
The FATE examination requires a cardiac phased array probe.
The probe scans with low/high frequency band width permitting good penetration and better visualisation of deeper located structures.
The FATE examination requires a cardiac phased array probe.
The probe scans with low frequency band width permitting good penetration and better visualisation of deeper located structures.
The FATE examination requires a cardiac phased array probe
The USABCD recommend a _____ MHz multi-frequency phased array transducer.
The FATE examination requires a cardiac phased array probe
The USABCD recommend a 1.5-4 MHz multi-frequency phased array transducer.
Identify the structure and state its function
The probe is fitted with an orientation marker (OM)
On the image the OM is indicated by a green arrow
The OM Facilitates the correct orientation of the probe on the patient
The OM (green arrow) has to be orientated in correct relationship with the corresponding orientation indicator (OI) on the monitor
There basically two ways to hold the probe properly during the FATE examination
Identify these on the picture
i) The screwdriver grip is seen in the top two images, and the
ii) pencil or lipstick grip in the lower image
List the three recommended terms by the USABCD to describe movement of the probe during scanning
- Rotation
- Tilt
- Slide
True/False: as a novice, always, only move the probe in one direction at a time
True
The icond at the bottomindicates that movement should only take place in one place at a time
Explain what is meant by a “clean” rotation of the transducer
During a “clean” rotation, the direction of the tail of the transducer should be kept 100% stable
List the two directions used to describe rotational movements of the probe
i) Right = clockwise
ii) Left = anticlockwise
True/False: rotation is the most difficult transducer movement to communicate
False
Tilting is the most difficult transducer movement to communicate because it can take place in two planes
Tilting can be i) upwards or downwards or ii) side to side
Explain why a secondary reference point is important for sliding movements
Sliding of the probe can take place in any direction
For example, the image shows sliding exemplified in the parasternal long axis view
Identify the red and blue lines shown on the image
The red and blue radii diverge from the probe at the top of the monitor (skin surface)
True/False: the orientation indicator (OI) is at the right side of the screen by convention in cardiac ultrasound (contrary to all other clinical ultrasound applications where the OI is placed on the left of the screen)
True
In FATE and adult cardiac ultrasound, the ultrasound image displays the sector with the two radii diverging from the ___ of the screen
True/False: In FATE and adult cardiac ultrasound, the ultrasound image displays the sector with the two radii diverging from the top of the screen
Comment on the display of the sector on the following screen
Correct
Comment on the display of the sector on the following screen
Inverted
Comment on the display of the sector on the following screen
Up-Down
True/False: there is no role of ECG in echocardiography
False
Connect ECG to the patient to generate and save echocardiographic loops
The picture shows two ultrasound images, where B is an optimised image of A.
How is B optimised?
Gain is increased
Gain is similar to the brightness control of a television
Signal amplification of the returning signal is called “gain”
Undergain = too dark
Overgain = too bright
The picture shows two ultrasound images, where B is an optimised image of A.
How is B optimised?
Depth is increased
True/False: Reduction of the depth means that the time from emitted to received signal is reduced; this allows a lower frame rate.
False
Reduction of the depth means that the time from emitted to received signal is reduced; this allows a higher frame rate.
True/False: the sector angle (width) is important as it affects the frame rate dramatically
True
A narrow sector angle (width) allows either:
i) a higher frame rate (the time required to build the image is reduced by reducing the number of beams for a whole sector) = increased temporal resolution
ii) a better lateral resolution (the line density can be increased)
= increased lateral resolution
True/False: the sector angle (width) should always be set as wide as possible
False
By using a sector angle just wide enough to include all the relevant details, the capacity of the ultrasound system is best used
Define ‘time gain compensation (TGC)’
A user-controlled selective amplification of signals reflected from particular depths in the tissue
TGC compensates for the depth-dependent attenuation of the ultrasound wave
Select the image with the most appropriate TGC
By fine-tuning TGC, optimal image quality can be achieved at all depths of the image.
The middle image has appropriate TGC.
In the top image, TGC is increased in the upper bands resulting in increased (more white) gain in the near field.
In the bottom image, TGC is increased in the lower bands.
A full Basic FATE examination includes images of the heart and pleura from four different positions, or “windows”, in the thorax.
Identify these positions on the following image.
Position 1: Subcostal 4-chamber view
Position 2: Apical 4-chamber view
Position 3: Parasternal views (long-axis and short-axis view)
Position 4: Pleural views (right and left pleura)
List the 4 questions that should be asked before scanning in a new position
True/False: the scanning procedure involves moving the probe in small circles until you recognize any anatomical structures on the screen and then stopping circling and optimizing the image in only one plane at a time by means of rotating, tilting, and/or sliding the transducer.
True
List the 4 structrues that can be visualised in the subcostal 4-chamber view (S4CH)
- LA
- RA
- LV
- RV
Label the S4CH
Which of the S4CH views is oriented correctly?
“B” shows the correct image presentation
The subcostal 4-chamber view, with the apex of the heart pointing towards the right of the screen, and the base of the heart pointing towards the left of the screen
List the 4 structrues that can be visualised in the apical 4-chamber view (A4CH)
- LA
- RA
- LV
- RV
Label the A4CH view
At the parasternal position - FATE position 3 - two different views are obtained.
Identify these views.
Top left: parasternal long axis view (PLAX)
Top right: parasternal short axis view (PSAX)
PLAX is obtained from position 3, by aiming the OM at the patient’s ______ shoulder
Right
List the 2 unique cardiac structures that can be visualised on the PLAX
- AO
- MV
Label the following PLAX
PSAX is obtained from position 3, by aiming the OM at the patient’s ______ shoulder
Left
List the 2 cardiac structures that can be visualised on the PSAX
- LV
- RV
Label the PSAX
True/False: the aortic and the mitral valve can be seen in the PLAX view, but not in the PSAX view
True
True/False: In D, the LV can be seen on the left of the screen
False
True/False: RA and LA can not be seen in B, and RA can not be seen in A
True
True/False: The liver can only be seen in the S4CH
True
True/False: D shows the A4CH, B shows the PSAX, C shows the S4CH and A the PLAX view
True
True/False: In all the views the LV can be seen
True
List the 3 structures that should be viewed in the pleural views
- Liver (right side)
- Spleen (left side)
- Diaphragm (both sides)
True/False: Since the orientation marker on the transducer should point in the cranial direction, the diaphragm is seen on the right side of a cardiologists screen and on the left side of a radiologist’s/emergency physician’s screen
True
By convention, the orientation indicator is placed on the right side of the screen by cardiologists, but on the left side of the screen by radiologists and emergency physicians
Since the orientation marker on the transducer should point in the cranial direction, the diaphragm is seen on the right side of a cardiologists screen (when cardiac transducer is chosen) and on the left side of a radiologist’s/emergency physician’s screen (when non-cardiac transucers are employed)
The FATE position 1 is called the subcostal or _________ view of the heart
Subxiphoid
The subcostal view is obtained by placing the transducer in the subcostal position, slighty to the ____ of the midline
The OM should be directed towards the patient’s ____
The subcostal view is obtained by placing the transducer in the subcostal position, slighty to the right of the midline
The OM should be directed towards the patient’s left
Identify the FATE position
FATE position 1 - subcostal/subxiphoid view
True/False: In the S4CH view, the RA and LA appear in the near field and LA and LV appear in the far field
False
As the RA and RV are placed anteriorly, they will appear in the near field and LA and LV appear in the far field
True/False: In the S4CH view, the apex of the heart is displayed on the right of the screen when the OM is correctly pointing towards the patient’s left shoulder (the right side of the screen)
True
Label the S4CH of FATE position 1
True/False: In S4CH of FATE position 1, the cardiac apex is still but the base is moving
True
Outline the patient position for S4CH view of FATE position 1
Outline the transducer placement for S4CH view of FATE position 1
Outline the orientation marker placement for S4CH view of FATE position 1
Outline the screen preset for S4CH view of FATE position 1
In S4CH view of FATE position 1, image improves in 50% with partial _________
In S4CH view of FATE position 1, image improves in 50% with partial inspiration
Relate the blood supply of the heart to the S4CH view obtained from FATE position 1
Explain how inspiration affects the S4CH view of FATE position 1
Forced inspiration will push the diaphragm down, and will usually facilitate the subcostal approach
Top: expiration
Bottom: inspiration
In the S4CH of FATE position 1, the heart is often “seen” through the _____
Liver
The extended FATE view obtained from FATE position 1 is ______
The IVC view
In FATE position 1, to obtain the IVC view (as opposed to the S4CH view), the OM on the transducer should be directed _______
Cranially
Outline the transducer placement and scanning plane for the longitudinal IVC view of FATE position 1
Start with the S4CH view
Look slightly to the back of the heart (slightly elevate the tail of the transducer)
Identify the IVC entry into the RA (IVC/RA junction)
Rotate counterclockwise until a longitudinal view of the IVC is displayed and the OM is pointing cranially
Depth: < 16-24cm when the IVC is identified
Label the long-axis IVC view
Identify the following image
Long axis IVC from FATE position 1
NB: in cardiac ultrasound, the OI is placed on the right of the screen
Identify the following image
Long axis IVC from FATE position 1
NB: in radiology and emergency medicine ultrasound, the OI is placed on the left of the screen (yellow “V”)
Label the image
List two ways in which the IVC can be differntiated from the abdominal aorta, in the IVC view of FATE position 1
1) Identify the entry point of the IVC into the RA
2) Pulsation of the vessel suggests aortic imaging
The diameter of the IVC should be measured at end-expiration, ____ cm before it merges with the RA just proximal to the ______ vein
The diameter of the IVC should be measured at end-expiration, 1 - 3 cm before it merges with the RA, just proximal to the hepatic vein
True/False: the diameter of the IVC is done on a 2D image or an an M-mode scan
True
Explain the two methods shown, used to measure IVC diameter
Top: measurement of the IVC diameter 1 - 3 cm from the RA entrance
Bottom: placement M-mode cursor line as perpendicular to the vessel walls as possible
IVC diameter ___ cm and _____ collapse (inspiratory sniff) suggests normal RA pressure (0 - 5 mmHg)
IVC diameter <2.1cm and >50% collapse (inspiratory sniff) suggests normal RA pressure (0 - 5 mmHg)
IVC diameter ____ cm and ______ collapse (inspiratory sniff) suggests high RA pressure (10 - 20 mmHg)
IVC diameter >2.1 cm and <50% collapse (inspiratory sniff) suggests high RA pressure (10 - 20 mmHg)
The relationship between the IVC and right atrium pressure can be characterised as follows:
IVC diameter <2.1cm and >50% collapse (inspiratory sniff) suggests normal RA pressure (0 - 5 mmHg)
IVC diameter >2.1cm and <50% collapse (inspiratory sniff) suggests high RA pressure (10 - 20 mmHg)
IVC diameter and collapse that do not fit into these two scenarios indicate _________ RA pressure increase (5 - 10 mmHg)
The relationship between the IVC and right atrium pressure can be characterised as follows:
IVC diameter <2.1cm and >50% collapse (inspiratory sniff) suggests normal RA pressure (0 - 5 mmHg)
IVC diameter >2.1cm and <50% collapse (inspiratory sniff) suggests high RA pressure (10 - 20 mmHg)
IVC diameter and collapse that do not fit into these two scenarios indicate intermediate RA pressure increase (5 - 10 mmHg)
__% collapse during spontaneous inspiration is normal
50% collapse during spontaneous inspiration is normal
True/False: in severe hypovolaemia, the IVC will often be constantly and extensively collapsed
True
List 4 conditions in which the IVC will often be distended without respiratory changes
- Severe volume overload
- Pulmonary embolus
- Right heart failure
- Pulmonary hypertension
NB: increased diameter and reduced dynamics is normal in long distance runners
True/False: IVC dynamics during positive pressure ventilation is easy to interpret
False
IVC dynamics during positive pressure ventilation is extremely difficult to interpret
True/False: Volume loading in fluid replete individuals will decrease IVC dynamics and is an indicator of underfilling
False
Volume loading in fluid replete individuals will decrease IVC dynamics but is not an indicator of underfilling
Using IVC dynamic changes for volume responsiveness should be done with caution and only in conjunction with all other available clinical information
True/False: in the correct IVC view, tilting the probe and directing the imaging plane to the patient’s left will display the abdominal aorta
True
In the subcostal short axis view, the aorta is to the ____ of the screen and the IVC to the ____
In the subcostal short axis view, the aorta is to the right of the screen and the IVC to the left
The FATE position 2 is called the _____ view of the heart
The FATE position 2 is called the apical view of the heart
The A5CH view is obtained by placing the transducer _______ and the OM should be directed towards the patient’s ____ side
The apical view is obtained by placing the transducer where the cardiac apex is most easily palpated
The OM should be directed towards the patient’s left side
Identify the FATE position
A4CH view of FATE position 2
True/False: In the A4CH view, as the transducer is placed at the apex, both the RV and LV appear in the near field and RA and LA appear in the far field
True
In the A4CH view, the ____ ventricle is displayed on the ___ side of the screen, when the OM is correctly pointing towards the patient’s left back
In the A4CH view, the left ventricle is displayed on the right side of the screen, when the OM is correctly pointing towards the patient’s left back
Label the A4CH view of FATE position 2
Outline the patient position for A4CH view of FATE position 2
Outline the transducer placement for the A4CH view of FATE position 2
Outline the orientation marker placement for the A4CH view of FATE position 2
Towards the patient’s left shoulder and backwards
Outline the screen preset for the A4CH view of FATE position 2
Name the view from FATE position 2 that can be obtained when the transducer tail is moved downwards
Name the view from FATE position 2 that can be obtained when the transducer tail is moved upwards
Name the starting point for obtaining the A4CH view
The ictus cordis (apex beat)
In most patients it is palable, in some it is visible
Relate the blood supply of the heart to the A4CH view obtained from FATE position 2
____ lateral position - approx. __ degrees - is generally the optimal position for the A4CH view
Left lateral position - approx. 45 degrees - is generally the optimal position for the A4CH view
The image of the A4CH view will often improve with inspiration/expiration
The image of the A4CH view will often improve with expiration
True/False: both the mitral and tricuspid valves can be evaluated in the A4CH veiw
True
The FATE position 3 is called the _____ view of the heart
Parasternal view
List the two different positions obtained from the FATE position 3
- PLAX
- PSAX
Identify the FATE view
PLAX from FATE position 3
Identify the FATE position
PSAX from FATE position 3
The PLAX view is obtained by placing the transducer _______ and the OM should be directed towards the patient’s ____ shoulder
The PLAX view is obtained by placing the transducer in the III - IV intercostal space to the left of the sternum
The OM should be directed towards the patient’s right shoulder
____ is the only basic FATE cardiac view where the OM is directed towards the right side of the patient
PLAX
True/False: In the PLAX, the LV is located anteriorly, directly under the transducer and appears in the near field
False
In the PLAX, the RV is located anteriorly, directly under the transducer and appears in the near field
In the PLAX view, the ___ ventricle and the ____ atrium are located depper and appear in the far field with the _______ _____ interposed between the left and right ventricle
In the PLAX view, the left ventricle and the left atrium are located depper and appear in the far field with the ascending aorta interposed between left and right ventricle
In the PLAX view, the apex appears on the ___ side of the screen, and the LA and AO appear on the ____ side
In the PLAX view, the apex appears on the left side of the screen, and the LA and AO appear on the right side
Label the PLAX view obtained from FATE position 3
Outline the patient position for PLAX view of FATE position 3
Outline the transducer placement for PLAX view of FATE position 3
Outline the orientation marker placement for PLAX view of FATE position 3
Outline the screen preset for the PLAX view of FATE position 3
Relate the blood supply of the heart to the PLAX view obtained from FATE position 3
____ view is the standard view for measuring the dimensions of the heart
PLAX
PLAX image quality often improves with _________
Expiration
Left lateral position - approx __ - __ degrees - is generally the optimal position for the PLAX view
Left lateral position - approx 70 - 90 degrees - is generally the optimal position for the PLAX view
True/False: In the PLAX view, the apex is generally not seen
True
Identify the FATE view
PSAX
The PSAX view is obtained by placing the transducer _______ and the OM should be directed towards the patient’s ____ shoulder
The PSAX view is obtained by placing the transducer in the III - IV intercostal space to the left of the sternum
The OM should be directed towards the patient’s left shoulder
True/False: In the PSAX view, the orientation marker on the transducer should be directed 90 degrees clockwise rotation from the PLAX view
True
In the PSAX view, the ____ ventricle is placed anterior to the probe and appears in the near field
In the PSAX view, the ____ ventricle is placed anterior to the probe and appears in the near field
In the PSAX view, the ____ wall and the papillary muscles of the ___ ventricle appear in the far field
In the PSAX view, the deeper placed posterior wall and the papillary muscles of the left ventricle appear in the far field
In the PSAX view, the ____ ventricle appears on the left side of the screen, and the ___ ventricle appears on the right side
In the PSAX view, the right ventricle appears on the left side of the screen, and the left ventricle appears on the right side
In the PSAX view, the OM of the probe is pointing towards the patient’s ____ shoulder
In the PSAX view, the OM of the probe is pointing towards the patient’s left shoulder
Label the PSAX view
Outline the patient position for PSAX view of FATE position 3
Outline the transducer placement for PSAX view of FATE position 3
Outline the OM placement for PSAX view of FATE position 3
Outline the screen preset for PSAX view of FATE position 3
Relate the blood supply of the heart to the PSAX view obtained from FATE position 3
True/False: The PSAX view is unsuitable for assessment of global and regional LV function as myocardium with blood supply from only two coronary arteries are represented
False
The PSAX view is suitable for assessment of global and regional LV function as myocardium with blood supply from all three coronary arteries are represented
In basic FATE, the PSAX view should be obtained at the mid-_______ level
In basic FATE, the PSAX view should be obtained at the mid-papillary level
The left lateral position - approx __ degrees - is generally the optimal position for the PSAX view
The left lateral position - approx 80 degrees - is generally the optimal position for the PSAX view
FATE position 4 is called the ______ view
Pleural view
Identify the FATE view
Pleural views of FATE position 4
The pleural views are obtained with the OM on the transducer pointing _______
Cranially
In the pleural views, the lungs are displayed on the ____ side of the screen, and the solid organs on the ____ side of the screen (liver or spleen)
In the pleural views, the lungs are displayed on the right side of the screen, and the solid organs on the left side of the screen (liver or spleen)
NB: this is due to the convention of cardiac ultrasound, the OI is placed on the right side of the screen
Label the pleural view of FATE position 4
Outline the patient position for pleural views of FATE position 4
Outline the transducer placement for pleural views of FATE position 4
Outline the OM placement for pleural views of FATE position 4
Outline the screen preset for pleural views of FATE position 4
During inspiration, the diaphragm moves downwards/upwards
Downwards
The ____ is used as the reference point when diaphragm and pleura on the patient’s right side are examined
The _____ is used as the reference point when diaphragm and pleura on the patient’s left side are examined
The liver is used as the reference point when diaphragm and pleura on the patient’s right side are examined
The spleen is used as the reference point when diaphragm and pleura on the patient’s left side are examined
Evaluation of pleural effusion should always be performed with the thorax in the ________ position
Evaluation of pleural effusion should always be performed with the thorax in the semierect position
In the plerual views, the right and left ________ are fixed points and should always be identified
In the plerual views, the right and left diaphragms are fixed points and should always be identified
Evaluation of the systolic cardiac function with ultrasound is performed by assessing i) endocardial (and/or myocardial) ________ during systole and ii) myocardial _______ during systole
Evaluation of the systolic cardiac function with ultrasound is performed by assessing i) endocardial (and/or myocardial) movement during systole and ii) myocardial thickening during systole
Diastolic cardiac function decsribes the ______ of the ventricles
Diastolic cardiac function decsribes the filling of the ventricles
True/False: impaired diastolic dysfunction - also known as diastolic dysfunction - is characterised by increased filling of the ventricles despite decreased filling pressures
False
Impaired diastolic dysfunction - also known as diastolic dysfunction - is characterised by decreased filling of the ventricles despite increased filling pressure
True/False: Reduced systolic function often accompanies diastolic dysfunction
True
As diastolic impairment induced stiffness of the left ventricle, reduced systolic function often accompanies diastolic dysfunction especially as reduced longitudinal deformation
Describe the two features of diastolic dysfunction shown in the image
2D characteristics of LV diastolic dysfunction are:
1) LV myocardial hypertrophy and concomitant reduced LV cavity size
2) Enlarged LA
True/False: LA enlargement is inversely proportional to the severity of the diatsolic dysfunction
False
LA enlargement is directly proportional to the severity of the diatsolic dysfunction
_____ _______ is considered the gold standard for assessment of LV systolic function in daily clinical practice
Ejection Fraction (EF)
True/False: LV EF can be reported either qualitatively or quanitatively
True
Simple qualitative judgement: eyeballing (normal, reduced - mild, moderate, severe)
Quantitatively: i) FS ii) MSS iii) MAPSE
The most frequently used method for the measurement of the EF is _______
Eyeballing
True/False: EF is solely a measure of the LV function, and is not a measure of adequete circulation
True
EF does not take into account the importance of pathological conditions that impair circulation
Several life-threatening conditions - where the myocardial deformation is normal - may invalidate the EF as a measure of the adequacy of circulation
Explain the importance of correlating the patient’s clinical state with the EF assessment in cradiac ultrasound
Progressive hypovolaemia (e.g. blood loss) will reduce EDV and thus increase EF
SV increases with EF
Thus, EF can go up to almost 100% without providing any clinically useful information about cardiac deformation or adequacy of circulation
Therefore, it is important to recognize the hypovolaemic state
True/False: all imaging views can be used for the eyeballing method to evaluate the overall function of the heart chambers
True
Combined information from different views is recommended
PSAX views of a heart with hypovolaemia, may show the “______ ventricle” pattern
“Kissing ventricle” pattern
The walls of the LV touch eachother due to the small volume of the LV in systole
Explain how a patient with the “kissing ventricle” pattern should be managed
EF alone is of no clinical value - the real problem is hypovolaemia
Treat the patient with volume or norepinephrine (or both)
True/False: If the “kissing ventricle” pattern is seen on cardiac ultrasound, the patient should be given inotropes (beta-1 stimulation)
False
The myocardial function is good and the EF is high
Hypovolaemia is the real problem, and should be managed with volume +/- norepinephrine
List 4 pathologies that may confound the interpretation of LV systolic function
1) Pericardial effusion
2) Adjacent chamber dilatation
3) LV dilatation
4) Hypovolaemia
State the equation for EF
M-mode is an abbreviation for “_______ mode”
M-mode is an abbreviation for motion mode
True/False: M-mode is a two-dimensional modality
False
M-mode is a one-dimensional modality
In M-mode, movement of the myocardium is depicted relative to a cursor line emitted from the transducer
Depth = ________ axis
Time = _________ axis
In M-mode, movement of the myocardium is depicted relative to a cursor line emitted from the transducer
Depth = vertical axis
Time = horizontal axis
True/False: M-mode provides no spatial information beyond the width of one ultrasound beam
True
Conversion of M-mode data to area/volume estimates should be done with caution
Because the ultrasound is emitted from the top of the sector (red box) the anatomical structures ____ to the transducer are displayed at the top of each box and _____ structures are displayed closer to the bottom of each box (yellow and red)
Because the ultrasound is emitted from the top of the sector (red box) the anatomical structures close to the transducer are displayed at the top of each box and deeper structures are displayed closer to the bottom of each box (yellow and red)
True/False: The 2D image and the corresponding M-mode image recording have inverted greyscales
False
The greyscale valye is the same so that the white in the 2D image remains white in the M-mode recording and vice versa
Identify the structures transected to collect the echocardiographic M-mode data in the PLAX view
1) LV
2) AML
3) AAo and LA
Outline the M-mode measure(s) of LV function obtained from the transection line shown in red in the PLAX view
Through the LV:
i) LV dimensions (LVDd and LVSd)
ii) FS
Outline the M-mode measure(s) of LV function obtained from transection line shown in green in the PLAX view
Through the AML:
i) MSS
Outline the M-mode measure(s) of LV function obtained from transection line shown in blue in the PLAX view
Through the AAO and LA:
i) LA dimension
Label the M-mode measures of LV function in the PLAX view 3
A) IVS
B) PW
C) AML
D) PML
E) AAo
F) LA
State the formula for FS
_ * FS is a rough measure of EF
2 * FS
2 * FS is a rough measure of EF
Ultrasound systems use the _______ formula for a more precise calculation of EF
Ultrasound systems use the Teichholz formula for a more precise calculation of EF
LV dimensions have historically been measured on a ______ scan
M-mode
Referene values for LV size, mass and geometry given by the European society of Cardiology differ by gender
True
With FS in the PLAX M-mode recording, the cursor line on the main screen should be placed as perpendicular as possible to the _____ and ______, and just distal to the tip of the ______ ________ _______
With FS in the PLAX M-mode recording, the cursor line on the main screen should be placed as perpendicular as possible to the septum and posterior wall, and just distal to the tip of the anterior mitral leaflet
With FS in the PLAX M-mode recording, the LV measurement on the M-mode image should mark endocardium in diastole from the _____ in ECG (septum and posterior wall - red)
Repeat for systole where the posterior wall is maximally __________ - yellow
With FS in the PLAX M-mode recording, the LV measurement on the M-mode image should mark endocardium in diastole from the R wave in ECG (septum and posterior wall - red)
Repeat for systole where the posterior wall is maximally contracted - yellow
The shortest distance between the anterior mitral leaflet and inter-ventricular septum is called ____ ______ __________
The shortest distance between the anterior mitral leaflet and inter-ventricular septum is called mitral septal separation (MSS)
Mitral septal separation should be less than _ cm
1 cm
“Green box” and “green line” refer to M-mode at the level of the _______
AML
The dimensions of the LV myocardium and LV cavity should be measured from the ____ view, alternatively in the ____ view
The dimensions of the LV myocardium and LV cavity should be measured from the PLAX view, alternatively in the PSAX view
Identify the image
The image shows the measurement points for dimensions of the interventricular septum (1-2), left ventricle (2-3) and posterior wall (3-4)
The yellow arrow indicates the moderator band that should not be measured
True/False: The MSS is the shortest distance between the anterior and posterior mitral valves
False
MSS is the shortest distance between the IVS and the AML
Label the image
True/False: MSS can be eyeballed
True
MAPSE stands for ____ ______ _____ ______ ______
Mitral annular plane systolic excursion
Identify the red line and green line
Red: indicates where to place the cursor line in MAPSE
Green: shows the direction of the AV-plane tracked in MAPSE
From an M-mode recording in the ____ view, the MAPSE can be obtained
A4CH
MAPSE is given by the movement of the ___________ plane during systole
Atrio-Ventricular Plane
To obtain the MAPSE in A4CH, the cursor line should be placed through the __ plane on the ______ wall
To obtain the MAPSE in A4CH, the cursor line should be placed through the AV plane on the lateral wall
Normal MAPSE value is __ mm
>11 mm
MAPSE is primarily a measure of LV systolic/diastolic function
Systolic
True/False: simple qualitative judegment of the size of the RV is the most common method for assessment of the RV
True
EF is generally not reported due to ill-suited geometry
Normal size of the RV is approx. _________
2/3 of the LV
Which FATE views can be used for eyeballing RV function?
All 4 FATE views
_____ is used for semi-quantitative measurement of RV function
A4CH
The preferred method used for semi-quantitative measurement of RV function is ______ since longitudinal contraction predominates
TAPSE
TAPSE stands for ___ _____ ______ _______ _______
tricuspid annular plane systolic excursion
RV enlargement and myocardial dysfunction is seen in _______ and _______
1) Right side MI
2) Pressure increase (pulmonary embolus and chronic pulm. hypertension)
In acute RV enlargement, the high pressure in the RV will compress the LV, resulting in _______
paradoxical interventricular septal movement and D-shape of the LV
To obtain the TAPSE in A4CH, the cursor line should be placed through the __ plane on the ____ side
AV plane
Right side
Identify the red line and green line
Red line: where to place the cursor line to obtain TAPSE
Green arrow: direction of the AV-plane tracked in TAPSE
To calculate MAPSE/TAPSE, measure the distance i.e. the dimensional change from ______ to ______ of the AV-plane
MAPSE is the dimensional change from diastole to systole of the AV-plane
In M-mode analysis of MAPSE/TAPSE, mark the AV-plane in diastole at the ______ or the longest/shortest distance from the top of the M-mode image
R-wave
Longest
In M-mode analysis for MAPSE/TAPSE, mark the AV-plane in systole at the longest/shortest distance from the systolic top of the M-mode recording to the diastolic AV plane
In M-mode analysis of MAPSE/TAPSE, mark the AV-plane in systole at the shortest distance from the systolic top of the M-mode recording to the diastolic AV plane
Normal TAPSE value is ___ mm
> 16-20mm (even higher values can sometimes be seen in young and healthy adults)
TAPSE is primarily a measure of RV systolic/diastolic function
Systolic
True/False: TAPSE is generally not converted to ejection fraction of the RV - ejection fraction normally applies to the LV
True
Both LA diameter and RV size have historically been measured on an ______ scan guided by a 2D _____ view
The LA diameter has historically been measured on an M-mode scan guided by a 2D PLAX view
The most accurate measure of LA size is using ______ from an A4CH view
Planimetry
LA diameter is measured in diastole/systole
Diastole
RV dimension is measured on the ____ view
A4CH (or modified 4 chamber view)
Label the 3 different measures on an image of a modified apical 4 chamber view in diastole
Yellow arrow: mid-cavity diameter
Blue arrow: basal diameter
White arrow: base-to-apex length
The mid-cavity diameter of the RV is measured at the level of the ______
Papillary muscles of the LV
_______ ________ is generally considered the gold standard for evaluating LV function althouhg it can be very misleading and does not reflect overall circulation
Ejection fraction is generally considered the gold standard for evaluating LV function althouhg it can be very misleading and does not reflect overall circulation
Ejection fraction should always be related to the absolute size of the chamber in systole/diastole
Diastole
Myocardial systolic function is characterised by ________ movement and thickening during systole
Myocardial systolic function is characterised by endocardial movement and thickening during systole
M-mode assessment of cardiac dimensions transects the heart at __ levels
3 levels:
i) Aorta-LA
ii) AMVL
iii) LV
For M-mode recording of the LV ventricle, the cursor line should be _______
Perpendicular to the septum and posterior wall, just off the AMVL
For assessment of MAPSE and TAPSE, the ____ view is used
A4CH
True/False: In LVH, MAPSE is often increased
False
In LVH, MAPSE is often decreased
True/False: TAPSE generally has a higher size than MAPSE, which in general has a bigger size than MSS
True
True/False: MSS is the distance from the AMVL to the posterior wall
False
True/False: If MAPSE decreases, TAPSE will also decrease
False
On the M-mode recording, identify the systole for MAPSE analysis
A represents the systole for MAPSE analysis
On the M-mode recording, identify the diastole for MAPSE analysis
C represents the diastole for MAPSE analysis
Identify the pathology if the following 2D echocardiographic characteristics are present
Dilated, poorly functioning LV
List some examples of typical clinical conditions that result in dilated, poorly functioning LV
Identify the pathology if the following 2D echocardiographic characteristics are present
Hypertrophic LV diastolic dysfunction
List some examples of typical clinical conditions that result in hypertrophic LV diastolic dysfunction
Identify the pathology if the following 2D echocardiographic characteristics are present
Pericardial effusion (cardiac tamponade)
True/False: cardiac tamponade is a echocardiographic diagnosis
False
Cardiac tamponade is a CLINICAL diagnosis
True/False: pericardial effusion can often be seen with ultrasound, but the sonographc size is not important
True
Patients with clinically important pericardial effusion often have concomitant ______ effusion. If so, draining of this often stabilises the patient immediately until pericardiocentesis can be performed
Pleural effusion
Identify the pathology if the following 2D echocardiographic characteristics are present
Dilated, poorly functioning right ventricle
List some examples of typical clinical conditions that result in dilated, poorly functioning right ventricle
In acute enlargement, the RV will compress the LV resulting in typical paradoxical interventricular septal movement and __ shape of the LV
D-shape
Identify the pathology if the following 2D echocardiographic characteristics are present: mass that exerts its “own” movement (2D and M-mode)
Pedunculated mass
List some examples of typical clinical conditions that result in pedunculated masses
Any abnormal, pedunculated mass may be a vegetation as vegetations often originate from valve leaflets, but may originate from any cardiac or vascular structure
True
WIth regards to pedunculated masses seen on 2D echocardiography: ______ often originate from the LA
Myxomas often originate from the LA
WIth regards to pedunculated masses seen on 2D echocardiography: _____ mainly originate from low flow areas, atrial appendages, areas with reduced myocardial movement, or aneurysms
Thrombus mainly originate from low flow areas, atrial appendages, areas with reduced myocardial movement, or aneurysms
True/False: pedunculated masseses are shown on FATE cards
False
Identify the pathology that should be considered in all patients with the following clinical conditions
Identify the pathology if the following 2D echocardiographic characteristics are present
Pleural effusion
Identify the pathology that should be considered in all patients with the following clinical conditions
Identify the pathology that should be considered in all patients with the following clinical conditions
Pulmonary oedema
The 2D echocardiographic characteristic of pulmnary oedema is _______
B-lines
One to _____ B-lines is normal at the basic parts of the lings (position 4)
One to Three B-lines is normal at the basic parts of the lings (position 4)
B-lines are not normal at the ________ part of the thorax
B-lines are not normal at the anterior part of the thorax
True/False: The presence of B-lines excludes pneumothorax in that lung
False
The presence of B-lines excludes pneumothorax at the scanning point
Pneumothroax can be present in other parts of the thorax
The presence of lung or pleural ________ during positive pressure ventilation on both sides ensures correct placement of the endotracheal tube
The presence of lung or pleural sliding during positive pressure ventilation on both sides ensures correct placement of the endotracheal tube
The presence of lung _____ excludes pneumothorax
The presence of lung sliding excludes pneumothorax
True/False: the absence of lung sliding is equal to the presence of pneumothroax
False
The absence of lung sliding is NOT equal to the presence of pneumothorax
Lung or pleural sliding is only possible if the two pleural blades are in contact with each other
