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Courses > Basic Cardiac Ultrasound (FATE) > Flashcards

Basic Cardiac Ultrasound (FATE) Flashcards

1
Q

FATE is an acronym for ______

A

Focus Assessed Transthoracic Echocardiography

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2
Q

True/False: FATE can be performed with the patient in the sitting position

A

True

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3
Q

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.

A

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.

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4
Q

The FATE examination requires a cardiac phased array probe

The USABCD recommend a _____ MHz multi-frequency phased array transducer.

A

The FATE examination requires a cardiac phased array probe

The USABCD recommend a 1.5-4 MHz multi-frequency phased array transducer.

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5
Q

Identify the structure and state its function

A

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

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6
Q

There basically two ways to hold the probe properly during the FATE examination

Identify these on the picture

A

i) The screwdriver grip is seen in the top two images, and the
ii) pencil or lipstick grip in the lower image

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7
Q

List the three recommended terms by the USABCD to describe movement of the probe during scanning

A
  1. Rotation
  2. Tilt
  3. Slide
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8
Q

True/False: as a novice, always, only move the probe in one direction at a time

A

True

The icond at the bottomindicates that movement should only take place in one place at a time

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9
Q

Explain what is meant by a “clean” rotation of the transducer

A

During a “clean” rotation, the direction of the tail of the transducer should be kept 100% stable

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10
Q

List the two directions used to describe rotational movements of the probe

A

i) Right = clockwise
ii) Left = anticlockwise

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11
Q

True/False: rotation is the most difficult transducer movement to communicate

A

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

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12
Q

Explain why a secondary reference point is important for sliding movements

A

Sliding of the probe can take place in any direction

For example, the image shows sliding exemplified in the parasternal long axis view

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13
Q

Identify the red and blue lines shown on the image

A

The red and blue radii diverge from the probe at the top of the monitor (skin surface)

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14
Q

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)

A

True

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15
Q

In FATE and adult cardiac ultrasound, the ultrasound image displays the sector with the two radii diverging from the ___ of the screen

A

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

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16
Q

Comment on the display of the sector on the following screen

A

Correct

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17
Q

Comment on the display of the sector on the following screen

A

Inverted

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18
Q

Comment on the display of the sector on the following screen

A

Up-Down

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19
Q

True/False: there is no role of ECG in echocardiography

A

False

Connect ECG to the patient to generate and save echocardiographic loops

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20
Q

The picture shows two ultrasound images, where B is an optimised image of A.

How is B optimised?

A

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

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21
Q

The picture shows two ultrasound images, where B is an optimised image of A.

How is B optimised?

A

Depth is increased

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22
Q

True/False: Reduction of the depth means that the time from emitted to received signal is reduced; this allows a lower frame rate.

A

False

Reduction of the depth means that the time from emitted to received signal is reduced; this allows a higher frame rate.

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23
Q

True/False: the sector angle (width) is important as it affects the frame rate dramatically

A

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

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24
Q

True/False: the sector angle (width) should always be set as wide as possible

A

False

By using a sector angle just wide enough to include all the relevant details, the capacity of the ultrasound system is best used

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25
Q

Define ‘time gain compensation (TGC)’

A

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

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26
Q

Select the image with the most appropriate TGC

A

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.

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27
Q

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.

A

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)

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28
Q

List the 4 questions that should be asked before scanning in a new position

A
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29
Q

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.

A

True

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30
Q

List the 4 structrues that can be visualised in the subcostal 4-chamber view (S4CH)

A
  1. LA
  2. RA
  3. LV
  4. RV
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31
Q

Label the S4CH

A
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32
Q

Which of the S4CH views is oriented correctly?

A

“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

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33
Q

List the 4 structrues that can be visualised in the apical 4-chamber view (A4CH)

A
  1. LA
  2. RA
  3. LV
  4. RV
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34
Q

Label the A4CH view

A
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35
Q

At the parasternal position - FATE position 3 - two different views are obtained.

Identify these views.

A

Top left: parasternal long axis view (PLAX)

Top right: parasternal short axis view (PSAX)

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36
Q

PLAX is obtained from position 3, by aiming the OM at the patient’s ______ shoulder

A

Right

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37
Q

List the 2 unique cardiac structures that can be visualised on the PLAX

A
  1. AO
  2. MV
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38
Q

Label the following PLAX

A
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39
Q

PSAX is obtained from position 3, by aiming the OM at the patient’s ______ shoulder

A

Left

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40
Q

List the 2 cardiac structures that can be visualised on the PSAX

A
  1. LV
  2. RV
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41
Q

Label the PSAX

A
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42
Q

True/False: the aortic and the mitral valve can be seen in the PLAX view, but not in the PSAX view

A

True

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43
Q

True/False: In D, the LV can be seen on the left of the screen

A

False

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44
Q

True/False: RA and LA can not be seen in B, and RA can not be seen in A

A

True

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45
Q

True/False: The liver can only be seen in the S4CH

A

True

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46
Q

True/False: D shows the A4CH, B shows the PSAX, C shows the S4CH and A the PLAX view

A

True

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47
Q

True/False: In all the views the LV can be seen

A

True

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48
Q

List the 3 structures that should be viewed in the pleural views

A
  1. Liver (right side)
  2. Spleen (left side)
  3. Diaphragm (both sides)
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49
Q

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

A

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)

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50
Q

The FATE position 1 is called the subcostal or _________ view of the heart

A

Subxiphoid

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51
Q

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 ____

A

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

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52
Q

Identify the FATE position

A

FATE position 1 - subcostal/subxiphoid view

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53
Q

True/False: In the S4CH view, the RA and LA appear in the near field and LA and LV appear in the far field

A

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

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54
Q

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)

A

True

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55
Q

Label the S4CH of FATE position 1

A
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56
Q

True/False: In S4CH of FATE position 1, the cardiac apex is still but the base is moving

A

True

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57
Q

Outline the patient position for S4CH view of FATE position 1

A
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58
Q

Outline the transducer placement for S4CH view of FATE position 1

A
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59
Q

Outline the orientation marker placement for S4CH view of FATE position 1

A
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60
Q

Outline the screen preset for S4CH view of FATE position 1

A
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61
Q

In S4CH view of FATE position 1, image improves in 50% with partial _________

A

In S4CH view of FATE position 1, image improves in 50% with partial inspiration

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62
Q

Relate the blood supply of the heart to the S4CH view obtained from FATE position 1

A
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63
Q

Explain how inspiration affects the S4CH view of FATE position 1

A

Forced inspiration will push the diaphragm down, and will usually facilitate the subcostal approach

Top: expiration

Bottom: inspiration

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64
Q

In the S4CH of FATE position 1, the heart is often “seen” through the _____

A

Liver

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65
Q

The extended FATE view obtained from FATE position 1 is ______

A

The IVC view

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66
Q

In FATE position 1, to obtain the IVC view (as opposed to the S4CH view), the OM on the transducer should be directed _______

A

Cranially

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67
Q

Outline the transducer placement and scanning plane for the longitudinal IVC view of FATE position 1

A

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

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68
Q

Label the long-axis IVC view

A
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69
Q

Identify the following image

A

Long axis IVC from FATE position 1

NB: in cardiac ultrasound, the OI is placed on the right of the screen

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70
Q

Identify the following image

A

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”)

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71
Q

Label the image

A
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72
Q

List two ways in which the IVC can be differntiated from the abdominal aorta, in the IVC view of FATE position 1

A

1) Identify the entry point of the IVC into the RA
2) Pulsation of the vessel suggests aortic imaging

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73
Q

The diameter of the IVC should be measured at end-expiration, ____ cm before it merges with the RA just proximal to the ______ vein

A

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

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74
Q

True/False: the diameter of the IVC is done on a 2D image or an an M-mode scan

A

True

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75
Q

Explain the two methods shown, used to measure IVC diameter

A

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

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76
Q

IVC diameter ___ cm and _____ collapse (inspiratory sniff) suggests normal RA pressure (0 - 5 mmHg)

A

IVC diameter <2.1cm and >50% collapse (inspiratory sniff) suggests normal RA pressure (0 - 5 mmHg)

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77
Q

IVC diameter ____ cm and ______ collapse (inspiratory sniff) suggests high RA pressure (10 - 20 mmHg)

A

IVC diameter >2.1 cm and <50% collapse (inspiratory sniff) suggests high RA pressure (10 - 20 mmHg)

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78
Q

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)

A

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)

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79
Q

__% collapse during spontaneous inspiration is normal

A

50% collapse during spontaneous inspiration is normal

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80
Q

True/False: in severe hypovolaemia, the IVC will often be constantly and extensively collapsed

A

True

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81
Q

List 4 conditions in which the IVC will often be distended without respiratory changes

A
  1. Severe volume overload
  2. Pulmonary embolus
  3. Right heart failure
  4. Pulmonary hypertension

NB: increased diameter and reduced dynamics is normal in long distance runners

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82
Q

True/False: IVC dynamics during positive pressure ventilation is easy to interpret

A

False

IVC dynamics during positive pressure ventilation is extremely difficult to interpret

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83
Q

True/False: Volume loading in fluid replete individuals will decrease IVC dynamics and is an indicator of underfilling

A

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

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84
Q

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

A

True

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85
Q

In the subcostal short axis view, the aorta is to the ____ of the screen and the IVC to the ____

A

In the subcostal short axis view, the aorta is to the right of the screen and the IVC to the left

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86
Q

The FATE position 2 is called the _____ view of the heart

A

The FATE position 2 is called the apical view of the heart

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87
Q

The A5CH view is obtained by placing the transducer _______ and the OM should be directed towards the patient’s ____ side

A

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

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88
Q

Identify the FATE position

A

A4CH view of FATE position 2

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89
Q

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

A

True

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90
Q

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

A

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

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91
Q

Label the A4CH view of FATE position 2

A
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92
Q

Outline the patient position for A4CH view of FATE position 2

A
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93
Q

Outline the transducer placement for the A4CH view of FATE position 2

A
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94
Q

Outline the orientation marker placement for the A4CH view of FATE position 2

A

Towards the patient’s left shoulder and backwards

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95
Q

Outline the screen preset for the A4CH view of FATE position 2

A
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96
Q

Name the view from FATE position 2 that can be obtained when the transducer tail is moved downwards

A
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97
Q

Name the view from FATE position 2 that can be obtained when the transducer tail is moved upwards

A
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98
Q

Name the starting point for obtaining the A4CH view

A

The ictus cordis (apex beat)

In most patients it is palable, in some it is visible

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99
Q

Relate the blood supply of the heart to the A4CH view obtained from FATE position 2

A
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100
Q

____ lateral position - approx. __ degrees - is generally the optimal position for the A4CH view

A

Left lateral position - approx. 45 degrees - is generally the optimal position for the A4CH view

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101
Q

The image of the A4CH view will often improve with inspiration/expiration

A

The image of the A4CH view will often improve with expiration

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102
Q

True/False: both the mitral and tricuspid valves can be evaluated in the A4CH veiw

A

True

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103
Q

The FATE position 3 is called the _____ view of the heart

A

Parasternal view

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104
Q

List the two different positions obtained from the FATE position 3

A
  1. PLAX
  2. PSAX
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105
Q

Identify the FATE view

A

PLAX from FATE position 3

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106
Q

Identify the FATE position

A

PSAX from FATE position 3

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107
Q

The PLAX view is obtained by placing the transducer _______ and the OM should be directed towards the patient’s ____ shoulder

A

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

108
Q

____ is the only basic FATE cardiac view where the OM is directed towards the right side of the patient

A

PLAX

109
Q

True/False: In the PLAX, the LV is located anteriorly, directly under the transducer and appears in the near field

A

False

In the PLAX, the RV is located anteriorly, directly under the transducer and appears in the near field

110
Q

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

A

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

111
Q

In the PLAX view, the apex appears on the ___ side of the screen, and the LA and AO appear on the ____ side

A

In the PLAX view, the apex appears on the left side of the screen, and the LA and AO appear on the right side

112
Q

Label the PLAX view obtained from FATE position 3

A
113
Q

Outline the patient position for PLAX view of FATE position 3

A
114
Q

Outline the transducer placement for PLAX view of FATE position 3

A
115
Q

Outline the orientation marker placement for PLAX view of FATE position 3

A
116
Q

Outline the screen preset for the PLAX view of FATE position 3

A
117
Q

Relate the blood supply of the heart to the PLAX view obtained from FATE position 3

A
118
Q

____ view is the standard view for measuring the dimensions of the heart

A

PLAX

119
Q

PLAX image quality often improves with _________

A

Expiration

120
Q

Left lateral position - approx __ - __ degrees - is generally the optimal position for the PLAX view

A

Left lateral position - approx 70 - 90 degrees - is generally the optimal position for the PLAX view

121
Q

True/False: In the PLAX view, the apex is generally not seen

A

True

122
Q

Identify the FATE view

A

PSAX

123
Q

The PSAX view is obtained by placing the transducer _______ and the OM should be directed towards the patient’s ____ shoulder

A

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

124
Q

True/False: In the PSAX view, the orientation marker on the transducer should be directed 90 degrees clockwise rotation from the PLAX view

A

True

125
Q

In the PSAX view, the ____ ventricle is placed anterior to the probe and appears in the near field

A

In the PSAX view, the ____ ventricle is placed anterior to the probe and appears in the near field

126
Q

In the PSAX view, the ____ wall and the papillary muscles of the ___ ventricle appear in the far field

A

In the PSAX view, the deeper placed posterior wall and the papillary muscles of the left ventricle appear in the far field

127
Q

In the PSAX view, the ____ ventricle appears on the left side of the screen, and the ___ ventricle appears on the right side

A

In the PSAX view, the right ventricle appears on the left side of the screen, and the left ventricle appears on the right side

128
Q

In the PSAX view, the OM of the probe is pointing towards the patient’s ____ shoulder

A

In the PSAX view, the OM of the probe is pointing towards the patient’s left shoulder

129
Q

Label the PSAX view

A
130
Q

Outline the patient position for PSAX view of FATE position 3

A
131
Q

Outline the transducer placement for PSAX view of FATE position 3

A
132
Q

Outline the OM placement for PSAX view of FATE position 3

A
133
Q

Outline the screen preset for PSAX view of FATE position 3

A
134
Q

Relate the blood supply of the heart to the PSAX view obtained from FATE position 3

A
135
Q

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

A

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

136
Q

In basic FATE, the PSAX view should be obtained at the mid-_______ level

A

In basic FATE, the PSAX view should be obtained at the mid-papillary level

137
Q

The left lateral position - approx __ degrees - is generally the optimal position for the PSAX view

A

The left lateral position - approx 80 degrees - is generally the optimal position for the PSAX view

138
Q
A
139
Q

FATE position 4 is called the ______ view

A

Pleural view

140
Q

Identify the FATE view

A

Pleural views of FATE position 4

141
Q

The pleural views are obtained with the OM on the transducer pointing _______

A

Cranially

142
Q

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)

A

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

143
Q

Label the pleural view of FATE position 4

A
144
Q

Outline the patient position for pleural views of FATE position 4

A
145
Q

Outline the transducer placement for pleural views of FATE position 4

A
146
Q

Outline the OM placement for pleural views of FATE position 4

A
147
Q

Outline the screen preset for pleural views of FATE position 4

A
148
Q

During inspiration, the diaphragm moves downwards/upwards

A

Downwards

149
Q

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

A

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

150
Q

Evaluation of pleural effusion should always be performed with the thorax in the ________ position

A

Evaluation of pleural effusion should always be performed with the thorax in the semierect position

151
Q

In the plerual views, the right and left ________ are fixed points and should always be identified

A

In the plerual views, the right and left diaphragms are fixed points and should always be identified

152
Q

Evaluation of the systolic cardiac function with ultrasound is performed by assessing i) endocardial (and/or myocardial) ________ during systole and ii) myocardial _______ during systole

A

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

153
Q

Diastolic cardiac function decsribes the ______ of the ventricles

A

Diastolic cardiac function decsribes the filling of the ventricles

154
Q

True/False: impaired diastolic dysfunction - also known as diastolic dysfunction - is characterised by increased filling of the ventricles despite decreased filling pressures

A

False

Impaired diastolic dysfunction - also known as diastolic dysfunction - is characterised by decreased filling of the ventricles despite increased filling pressure

155
Q

True/False: Reduced systolic function often accompanies diastolic dysfunction

A

True

As diastolic impairment induced stiffness of the left ventricle, reduced systolic function often accompanies diastolic dysfunction especially as reduced longitudinal deformation

156
Q

Describe the two features of diastolic dysfunction shown in the image

A

2D characteristics of LV diastolic dysfunction are:

1) LV myocardial hypertrophy and concomitant reduced LV cavity size
2) Enlarged LA

157
Q

True/False: LA enlargement is inversely proportional to the severity of the diatsolic dysfunction

A

False

LA enlargement is directly proportional to the severity of the diatsolic dysfunction

158
Q

_____ _______ is considered the gold standard for assessment of LV systolic function in daily clinical practice

A

Ejection Fraction (EF)

159
Q

True/False: LV EF can be reported either qualitatively or quanitatively

A

True

Simple qualitative judgement: eyeballing (normal, reduced - mild, moderate, severe)

Quantitatively: i) FS ii) MSS iii) MAPSE

160
Q

The most frequently used method for the measurement of the EF is _______

A

Eyeballing

161
Q

True/False: EF is solely a measure of the LV function, and is not a measure of adequete circulation

A

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

162
Q

Explain the importance of correlating the patient’s clinical state with the EF assessment in cradiac ultrasound

A

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

163
Q

True/False: all imaging views can be used for the eyeballing method to evaluate the overall function of the heart chambers

A

True

Combined information from different views is recommended

164
Q

PSAX views of a heart with hypovolaemia, may show the “______ ventricle” pattern

A

“Kissing ventricle” pattern

The walls of the LV touch eachother due to the small volume of the LV in systole

165
Q

Explain how a patient with the “kissing ventricle” pattern should be managed

A

EF alone is of no clinical value - the real problem is hypovolaemia

Treat the patient with volume or norepinephrine (or both)

166
Q

True/False: If the “kissing ventricle” pattern is seen on cardiac ultrasound, the patient should be given inotropes (beta-1 stimulation)

A

False

The myocardial function is good and the EF is high

Hypovolaemia is the real problem, and should be managed with volume +/- norepinephrine

167
Q

List 4 pathologies that may confound the interpretation of LV systolic function

A

1) Pericardial effusion
2) Adjacent chamber dilatation
3) LV dilatation
4) Hypovolaemia

168
Q

State the equation for EF

A
169
Q

M-mode is an abbreviation for “_______ mode”

A

M-mode is an abbreviation for motion mode

170
Q

True/False: M-mode is a two-dimensional modality

A

False

M-mode is a one-dimensional modality

171
Q

In M-mode, movement of the myocardium is depicted relative to a cursor line emitted from the transducer

Depth = ________ axis

Time = _________ axis

A

In M-mode, movement of the myocardium is depicted relative to a cursor line emitted from the transducer

Depth = vertical axis

Time = horizontal axis

172
Q

True/False: M-mode provides no spatial information beyond the width of one ultrasound beam

A

True

Conversion of M-mode data to area/volume estimates should be done with caution

173
Q

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)

A

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)

174
Q

True/False: The 2D image and the corresponding M-mode image recording have inverted greyscales

A

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

175
Q

Identify the structures transected to collect the echocardiographic M-mode data in the PLAX view

A

1) LV
2) AML
3) AAo and LA

176
Q

Outline the M-mode measure(s) of LV function obtained from the transection line shown in red in the PLAX view

A

Through the LV:

i) LV dimensions (LVDd and LVSd)
ii) FS

177
Q

Outline the M-mode measure(s) of LV function obtained from transection line shown in green in the PLAX view

A

Through the AML:

i) MSS

178
Q

Outline the M-mode measure(s) of LV function obtained from transection line shown in blue in the PLAX view

A

Through the AAO and LA:

i) LA dimension

179
Q

Label the M-mode measures of LV function in the PLAX view 3

A

A) IVS

B) PW

C) AML

D) PML

E) AAo

F) LA

180
Q

State the formula for FS

A
181
Q

_ * FS is a rough measure of EF

A

2 * FS

182
Q

2 * FS is a rough measure of EF

Ultrasound systems use the _______ formula for a more precise calculation of EF

A

Ultrasound systems use the Teichholz formula for a more precise calculation of EF

183
Q

LV dimensions have historically been measured on a ______ scan

A

M-mode

184
Q

Referene values for LV size, mass and geometry given by the European society of Cardiology differ by gender

A

True

185
Q

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 ______ ________ _______

A

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

186
Q

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

A

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

187
Q

The shortest distance between the anterior mitral leaflet and inter-ventricular septum is called ____ ______ __________

A

The shortest distance between the anterior mitral leaflet and inter-ventricular septum is called mitral septal separation (MSS)

188
Q

Mitral septal separation should be less than _ cm

A

1 cm

189
Q

“Green box” and “green line” refer to M-mode at the level of the _______

A

AML

190
Q

The dimensions of the LV myocardium and LV cavity should be measured from the ____ view, alternatively in the ____ view

A

The dimensions of the LV myocardium and LV cavity should be measured from the PLAX view, alternatively in the PSAX view

191
Q

Identify the image

A

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

192
Q

True/False: The MSS is the shortest distance between the anterior and posterior mitral valves

A

False

MSS is the shortest distance between the IVS and the AML

193
Q

Label the image

A
194
Q

True/False: MSS can be eyeballed

A

True

195
Q

MAPSE stands for ____ ______ _____ ______ ______

A

Mitral annular plane systolic excursion

196
Q

Identify the red line and green line

A

Red: indicates where to place the cursor line in MAPSE

Green: shows the direction of the AV-plane tracked in MAPSE

197
Q

From an M-mode recording in the ____ view, the MAPSE can be obtained

A

A4CH

198
Q

MAPSE is given by the movement of the ___________ plane during systole

A

Atrio-Ventricular Plane

199
Q

To obtain the MAPSE in A4CH, the cursor line should be placed through the __ plane on the ______ wall

A

To obtain the MAPSE in A4CH, the cursor line should be placed through the AV plane on the lateral wall

200
Q

Normal MAPSE value is __ mm

A

>11 mm

201
Q

MAPSE is primarily a measure of LV systolic/diastolic function

A

Systolic

202
Q

True/False: simple qualitative judegment of the size of the RV is the most common method for assessment of the RV

A

True

EF is generally not reported due to ill-suited geometry

203
Q

Normal size of the RV is approx. _________

A

2/3 of the LV

204
Q

Which FATE views can be used for eyeballing RV function?

A

All 4 FATE views

205
Q

_____ is used for semi-quantitative measurement of RV function

A

A4CH

206
Q

The preferred method used for semi-quantitative measurement of RV function is ______ since longitudinal contraction predominates

A

TAPSE

207
Q

TAPSE stands for ___ _____ ______ _______ _______

A

tricuspid annular plane systolic excursion

208
Q

RV enlargement and myocardial dysfunction is seen in _______ and _______

A

1) Right side MI
2) Pressure increase (pulmonary embolus and chronic pulm. hypertension)

209
Q

In acute RV enlargement, the high pressure in the RV will compress the LV, resulting in _______

A

paradoxical interventricular septal movement and D-shape of the LV

210
Q

To obtain the TAPSE in A4CH, the cursor line should be placed through the __ plane on the ____ side

A

AV plane

Right side

211
Q

Identify the red line and green line

A

Red line: where to place the cursor line to obtain TAPSE

Green arrow: direction of the AV-plane tracked in TAPSE

212
Q

To calculate MAPSE/TAPSE, measure the distance i.e. the dimensional change from ______ to ______ of the AV-plane

A

MAPSE is the dimensional change from diastole to systole of the AV-plane

213
Q

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

A

R-wave

Longest

214
Q

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

A

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

215
Q

Normal TAPSE value is ___ mm

A

> 16-20mm (even higher values can sometimes be seen in young and healthy adults)

216
Q

TAPSE is primarily a measure of RV systolic/diastolic function

A

Systolic

217
Q

True/False: TAPSE is generally not converted to ejection fraction of the RV - ejection fraction normally applies to the LV

A

True

218
Q

Both LA diameter and RV size have historically been measured on an ______ scan guided by a 2D _____ view

A

The LA diameter has historically been measured on an M-mode scan guided by a 2D PLAX view

219
Q

The most accurate measure of LA size is using ______ from an A4CH view

A

Planimetry

220
Q

LA diameter is measured in diastole/systole

A

Diastole

221
Q

RV dimension is measured on the ____ view

A

A4CH (or modified 4 chamber view)

222
Q

Label the 3 different measures on an image of a modified apical 4 chamber view in diastole

A

Yellow arrow: mid-cavity diameter

Blue arrow: basal diameter

White arrow: base-to-apex length

223
Q

The mid-cavity diameter of the RV is measured at the level of the ______

A

Papillary muscles of the LV

224
Q

_______ ________ is generally considered the gold standard for evaluating LV function althouhg it can be very misleading and does not reflect overall circulation

A

Ejection fraction is generally considered the gold standard for evaluating LV function althouhg it can be very misleading and does not reflect overall circulation

225
Q

Ejection fraction should always be related to the absolute size of the chamber in systole/diastole

A

Diastole

226
Q

Myocardial systolic function is characterised by ________ movement and thickening during systole

A

Myocardial systolic function is characterised by endocardial movement and thickening during systole

227
Q

M-mode assessment of cardiac dimensions transects the heart at __ levels

A

3 levels:

i) Aorta-LA
ii) AMVL
iii) LV

228
Q

For M-mode recording of the LV ventricle, the cursor line should be _______

A

Perpendicular to the septum and posterior wall, just off the AMVL

229
Q

For assessment of MAPSE and TAPSE, the ____ view is used

A

A4CH

230
Q

True/False: In LVH, MAPSE is often increased

A

False

In LVH, MAPSE is often decreased

231
Q

True/False: TAPSE generally has a higher size than MAPSE, which in general has a bigger size than MSS

A

True

232
Q

True/False: MSS is the distance from the AMVL to the posterior wall

A

False

233
Q

True/False: If MAPSE decreases, TAPSE will also decrease

A

False

234
Q

On the M-mode recording, identify the systole for MAPSE analysis

A

A represents the systole for MAPSE analysis

235
Q

On the M-mode recording, identify the diastole for MAPSE analysis

A

C represents the diastole for MAPSE analysis

236
Q

Identify the pathology if the following 2D echocardiographic characteristics are present

A

Dilated, poorly functioning LV

237
Q

List some examples of typical clinical conditions that result in dilated, poorly functioning LV

A
238
Q

Identify the pathology if the following 2D echocardiographic characteristics are present

A

Hypertrophic LV diastolic dysfunction

239
Q

List some examples of typical clinical conditions that result in hypertrophic LV diastolic dysfunction

A
240
Q

Identify the pathology if the following 2D echocardiographic characteristics are present

A

Pericardial effusion (cardiac tamponade)

241
Q

True/False: cardiac tamponade is a echocardiographic diagnosis

A

False

Cardiac tamponade is a CLINICAL diagnosis

242
Q

True/False: pericardial effusion can often be seen with ultrasound, but the sonographc size is not important

A

True

243
Q

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

A

Pleural effusion

244
Q

Identify the pathology if the following 2D echocardiographic characteristics are present

A

Dilated, poorly functioning right ventricle

245
Q

List some examples of typical clinical conditions that result in dilated, poorly functioning right ventricle

A
246
Q

In acute enlargement, the RV will compress the LV resulting in typical paradoxical interventricular septal movement and __ shape of the LV

A

D-shape

247
Q

Identify the pathology if the following 2D echocardiographic characteristics are present: mass that exerts its “own” movement (2D and M-mode)

A

Pedunculated mass

248
Q

List some examples of typical clinical conditions that result in pedunculated masses

A
249
Q

Any abnormal, pedunculated mass may be a vegetation as vegetations often originate from valve leaflets, but may originate from any cardiac or vascular structure

A

True

250
Q

WIth regards to pedunculated masses seen on 2D echocardiography: ______ often originate from the LA

A

Myxomas often originate from the LA

251
Q

WIth regards to pedunculated masses seen on 2D echocardiography: _____ mainly originate from low flow areas, atrial appendages, areas with reduced myocardial movement, or aneurysms

A

Thrombus mainly originate from low flow areas, atrial appendages, areas with reduced myocardial movement, or aneurysms

252
Q

True/False: pedunculated masseses are shown on FATE cards

A

False

253
Q

Identify the pathology that should be considered in all patients with the following clinical conditions

A
254
Q

Identify the pathology if the following 2D echocardiographic characteristics are present

A

Pleural effusion

255
Q

Identify the pathology that should be considered in all patients with the following clinical conditions

A
256
Q

Identify the pathology that should be considered in all patients with the following clinical conditions

A

Pulmonary oedema

257
Q

The 2D echocardiographic characteristic of pulmnary oedema is _______

A

B-lines

258
Q

One to _____ B-lines is normal at the basic parts of the lings (position 4)

A

One to Three B-lines is normal at the basic parts of the lings (position 4)

259
Q

B-lines are not normal at the ________ part of the thorax

A

B-lines are not normal at the anterior part of the thorax

260
Q

True/False: The presence of B-lines excludes pneumothorax in that lung

A

False

The presence of B-lines excludes pneumothorax at the scanning point

Pneumothroax can be present in other parts of the thorax

261
Q

The presence of lung or pleural ________ during positive pressure ventilation on both sides ensures correct placement of the endotracheal tube

A

The presence of lung or pleural sliding during positive pressure ventilation on both sides ensures correct placement of the endotracheal tube

262
Q

The presence of lung _____ excludes pneumothorax

A

The presence of lung sliding excludes pneumothorax

263
Q

True/False: the absence of lung sliding is equal to the presence of pneumothroax

A

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

264
Q
A
265
Q
A

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