Basic Cardiac Ultrasound (FATE) Flashcards
1
Q
FATE is an acronym for ______
A
Focus Assessed Transthoracic Echocardiography
2
Q
True/False: FATE can be performed with the patient in the sitting position
A
True
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.
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.
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
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
7
Q
List the three recommended terms by the USABCD to describe movement of the probe during scanning
A
- Rotation
- Tilt
- Slide
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
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
10
Q
List the two directions used to describe rotational movements of the probe
A
i) Right = clockwise
ii) Left = anticlockwise
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
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
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)
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
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
16
Q
Comment on the display of the sector on the following screen
A
Correct
17
Q
Comment on the display of the sector on the following screen
A
Inverted
18
Q
Comment on the display of the sector on the following screen
A
Up-Down
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
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
21
Q
The picture shows two ultrasound images, where B is an optimised image of A.
How is B optimised?
A
Depth is increased
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.
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
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
25
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
26
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.
27
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)
28
List the 4 questions that should be asked before scanning in a new position
29
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
30
List the 4 structrues that can be visualised in the subcostal 4-chamber view (S4CH)
1. LA
2. RA
3. LV
4. RV
31
Label the S4CH
32
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
33
List the 4 structrues that can be visualised in the apical 4-chamber view (A4CH)
1. LA
2. RA
3. LV
4. RV
34
Label the A4CH view
35
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)
36
PLAX is obtained from position 3, by aiming the OM at the patient's ______ shoulder
Right
37
List the 2 unique cardiac structures that can be visualised on the PLAX
1. AO
2. MV
38
Label the following PLAX
39
PSAX is obtained from position 3, by aiming the OM at the patient's ______ shoulder
Left
40
List the 2 cardiac structures that can be visualised on the PSAX
1. LV
2. RV
41
Label the PSAX
42
True/False: the aortic and the mitral valve can be seen in the PLAX view, but not in the PSAX view
True
43
True/False: In D, the LV can be seen on the left of the screen
False
44
True/False: RA and LA can not be seen in B, and RA can not be seen in A
True
45
True/False: The liver can only be seen in the S4CH
True
46
True/False: D shows the A4CH, B shows the PSAX, C shows the S4CH and A the PLAX view
True
47
True/False: In all the views the LV can be seen
True
48
List the 3 structures that should be viewed in the pleural views
1. Liver (right side)
2. Spleen (left side)
3. Diaphragm (both sides)
49
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)
50
The FATE position 1 is called the subcostal or _________ view of the heart
Subxiphoid
51
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**
52
Identify the FATE position
FATE position 1 - subcostal/subxiphoid view
53
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
54
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
55
Label the S4CH of FATE position 1
56
True/False: In S4CH of FATE position 1, the cardiac apex is still but the base is moving
True
57
Outline the patient position for S4CH view of FATE position 1
58
Outline the transducer placement for S4CH view of FATE position 1
59
Outline the orientation marker placement for S4CH view of FATE position 1
60
Outline the screen preset for S4CH view of FATE position 1
61
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**
62
Relate the blood supply of the heart to the S4CH view obtained from FATE position 1
63
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
64
In the S4CH of FATE position 1, the heart is often "seen" through the \_\_\_\_\_
Liver
65
The extended FATE view obtained from FATE position 1 is \_\_\_\_\_\_
The IVC view
66
In FATE position 1, to obtain the IVC view (as opposed to the S4CH view), the OM on the transducer should be directed \_\_\_\_\_\_\_
Cranially
67
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
68
Label the long-axis IVC view
69
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
70
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")
71
Label the image
72
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
73
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
74
True/False: the diameter of the IVC is done on a 2D image or an an M-mode scan
True
75
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
76
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)
77
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)
78
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)
79
\_\_% collapse during spontaneous inspiration is normal
**50%** collapse during spontaneous inspiration is normal
80
True/False: in severe hypovolaemia, the IVC will often be constantly and extensively collapsed
True
81
List 4 conditions in which the IVC will often be distended without respiratory changes
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
82
True/False: IVC dynamics during positive pressure ventilation is easy to interpret
False
IVC dynamics during positive pressure ventilation is extremely difficult to interpret
83
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
84
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
85
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
86
The FATE position 2 is called the _____ view of the heart
The FATE position 2 is called the **apical** view of the heart
87
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
88
Identify the FATE position
A4CH view of FATE position 2
89
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
90
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
91
Label the A4CH view of FATE position 2
92
Outline the patient position for A4CH view of FATE position 2
93
Outline the transducer placement for the A4CH view of FATE position 2
94
Outline the orientation marker placement for the A4CH view of FATE position 2
Towards the patient's left shoulder *and* backwards
95
Outline the screen preset for the A4CH view of FATE position 2
96
Name the view from FATE position 2 that can be obtained when the transducer tail is moved downwards
97
Name the view from FATE position 2 that can be obtained when the transducer tail is moved upwards
98
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
99
Relate the blood supply of the heart to the A4CH view obtained from FATE position 2
100
\_\_\_\_ 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
101
The image of the A4CH view will often improve with inspiration/expiration
The image of the A4CH view will often improve with **expiration**
102
True/False: both the mitral and tricuspid valves can be evaluated in the A4CH veiw
True
103
The FATE position 3 is called the _____ view of the heart
Parasternal view
104
List the two different positions obtained from the FATE position 3
1. PLAX
2. PSAX
105
Identify the FATE view
PLAX from FATE position 3
106
Identify the FATE position
PSAX from FATE position 3
107
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
108
\_\_\_\_ is the only basic FATE cardiac view where the OM is directed towards the right side of the patient
PLAX
109
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
110
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
111
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
112
Label the PLAX view obtained from FATE position 3
113
Outline the patient position for PLAX view of FATE position 3
114
Outline the transducer placement for PLAX view of FATE position 3
115
Outline the orientation marker placement for PLAX view of FATE position 3
116
Outline the screen preset for the PLAX view of FATE position 3
117
Relate the blood supply of the heart to the PLAX view obtained from FATE position 3
118
\_\_\_\_ view is the standard view for measuring the dimensions of the heart
PLAX
119
PLAX image quality often improves with \_\_\_\_\_\_\_\_\_
Expiration
120
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
121
True/False: In the PLAX view, the apex is generally not seen
True
122
Identify the FATE view
PSAX
123
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
124
True/False: In the PSAX view, the orientation marker on the transducer should be directed 90 degrees clockwise rotation from the PLAX view
True
125
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
126
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
127
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
128
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
129
Label the PSAX view
130
Outline the patient position for PSAX view of FATE position 3
131
Outline the transducer placement for PSAX view of FATE position 3
132
Outline the OM placement for PSAX view of FATE position 3
133
Outline the screen preset for PSAX view of FATE position 3
134
Relate the blood supply of the heart to the PSAX view obtained from FATE position 3
135
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
136
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
137
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
138
139
FATE position 4 is called the ______ view
Pleural view
140
Identify the FATE view
Pleural views of FATE position 4
141
The pleural views are obtained with the OM on the transducer pointing \_\_\_\_\_\_\_
Cranially
142
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
143
Label the pleural view of FATE position 4
144
Outline the patient position for pleural views of FATE position 4
145
Outline the transducer placement for pleural views of FATE position 4
146
Outline the OM placement for pleural views of FATE position 4
147
Outline the screen preset for pleural views of FATE position 4
148
During inspiration, the diaphragm moves downwards/upwards
Downwards
149
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
150
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
151
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
152
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
153
Diastolic cardiac function decsribes the ______ of the ventricles
Diastolic cardiac function decsribes the **filling** of the ventricles
154
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
155
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
156
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
157
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
158
\_\_\_\_\_ _______ is considered the gold standard for assessment of LV systolic function in daily clinical practice
Ejection Fraction (EF)
159
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
160
The most frequently used method for the measurement of the EF is \_\_\_\_\_\_\_
Eyeballing
161
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
162
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
163
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
164
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
165
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)
166
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
167
List 4 pathologies that may confound the interpretation of LV systolic function
1) Pericardial effusion
2) Adjacent chamber dilatation
3) LV dilatation
4) Hypovolaemia
168
State the equation for EF
169
M-mode is an abbreviation for "\_\_\_\_\_\_\_ mode"
M-mode is an abbreviation for **motion** mode
170
True/False: M-mode is a two-dimensional modality
False
M-mode is a **one-dimensional** modality
171
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
172
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
173
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)
174
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
175
Identify the structures transected to collect the echocardiographic M-mode data in the PLAX view
1) LV
2) AML
3) AAo and LA
176
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
177
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
178
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
179
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
180
State the formula for FS
181
\_ \* FS is a rough measure of EF
2 \* FS
182
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
183
LV dimensions have historically been measured on a ______ scan
M-mode
184
Referene values for LV size, mass and geometry given by the European society of Cardiology differ by gender
True
185
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**
186
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
187
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)
188
Mitral septal separation should be less than _ cm
1 cm
189
"Green box" and "green line" refer to M-mode at the level of the \_\_\_\_\_\_\_
AML
190
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
191
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
192
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
193
Label the image
194
True/False: MSS can be eyeballed
True
195
MAPSE stands for ____ \_\_\_\_\_\_ _____ \_\_\_\_\_\_ \_\_\_\_\_\_
Mitral annular plane systolic excursion
196
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
197
From an M-mode recording in the ____ view, the MAPSE can be obtained
A4CH
198
MAPSE is given by the movement of the ___________ plane during systole
Atrio-Ventricular Plane
199
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
200
Normal MAPSE value is __ mm
\>11 mm
201
MAPSE is primarily a measure of LV systolic/diastolic function
Systolic
202
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
203
Normal size of the RV is approx. \_\_\_\_\_\_\_\_\_
2/3 of the LV
204
Which FATE views can be used for *eyeballing* RV function?
All 4 FATE views
205
\_\_\_\_\_ is used for semi-quantitative measurement of RV function
A4CH
206
The preferred method used for semi-quantitative measurement of RV function is ______ since longitudinal contraction predominates
TAPSE
207
TAPSE stands for ___ \_\_\_\_\_ ______ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_
tricuspid annular plane systolic excursion
208
RV enlargement and myocardial dysfunction is seen in _______ and \_\_\_\_\_\_\_
1) Right side MI
2) Pressure increase (pulmonary embolus and chronic pulm. hypertension)
209
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
210
To obtain the TAPSE in A4CH, the cursor line should be placed through the __ plane on the ____ side
AV plane
Right side
211
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
212
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
213
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
214
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
215
Normal TAPSE value is ___ mm
\> 16-20mm (even higher values can sometimes be seen in young and healthy adults)
216
TAPSE is primarily a measure of RV systolic/diastolic function
Systolic
217
True/False: TAPSE is generally not converted to ejection fraction of the RV - ejection fraction normally applies to the LV
True
218
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
219
The most accurate measure of LA size is using ______ from an A4CH view
Planimetry
220
LA diameter is measured in diastole/systole
Diastole
221
RV dimension is measured on the ____ view
A4CH (or modified 4 chamber view)
222
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
223
The mid-cavity diameter of the RV is measured at the level of the \_\_\_\_\_\_
Papillary muscles of the LV
224
\_\_\_\_\_\_\_ ________ 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
225
Ejection fraction should always be related to the absolute size of the chamber in systole/diastole
Diastole
226
Myocardial systolic function is characterised by ________ movement and thickening during systole
Myocardial systolic function is characterised by **endocardial** movement and thickening during systole
227
M-mode assessment of cardiac dimensions transects the heart at __ levels
_3 levels:_
i) Aorta-LA
ii) AMVL
iii) LV
228
For M-mode recording of the LV ventricle, the cursor line should be \_\_\_\_\_\_\_
Perpendicular to the septum and posterior wall, just off the AMVL
229
For assessment of MAPSE and TAPSE, the ____ view is used
A4CH
230
True/False: In LVH, MAPSE is often increased
False
In LVH, MAPSE is often decreased
231
True/False: TAPSE generally has a higher size than MAPSE, which in general has a bigger size than MSS
True
232
True/False: MSS is the distance from the AMVL to the posterior wall
False
233
True/False: If MAPSE decreases, TAPSE will also decrease
False
234
On the M-mode recording, identify the *systole* for MAPSE analysis
**A** represents the *systole* for MAPSE analysis
235
On the M-mode recording, identify the *diastole* for MAPSE analysis
**C** represents the *diastole* for MAPSE analysis
236
Identify the pathology if the following 2D echocardiographic characteristics are present
Dilated, poorly functioning LV
237
List some examples of typical clinical conditions that result in dilated, poorly functioning LV
238
Identify the pathology if the following 2D echocardiographic characteristics are present
Hypertrophic LV diastolic dysfunction
239
List some examples of typical clinical conditions that result in hypertrophic LV diastolic dysfunction
240
Identify the pathology if the following 2D echocardiographic characteristics are present
Pericardial effusion (cardiac tamponade)
241
True/False: cardiac tamponade is a echocardiographic diagnosis
False
Cardiac tamponade is a CLINICAL diagnosis
242
True/False: pericardial effusion can often be seen with ultrasound, but the sonographc size is not important
True
243
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
244
Identify the pathology if the following 2D echocardiographic characteristics are present
Dilated, poorly functioning right ventricle
245
List some examples of typical clinical conditions that result in dilated, poorly functioning right ventricle
246
In acute enlargement, the RV will compress the LV resulting in typical paradoxical interventricular septal movement and __ shape of the LV
D-shape
247
Identify the pathology if the following 2D echocardiographic characteristics are present: mass that exerts its "own" movement (2D and M-mode)
Pedunculated mass
248
List some examples of typical clinical conditions that result in pedunculated masses
249
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
250
WIth regards to pedunculated masses seen on 2D echocardiography: ______ often originate from the LA
**Myxomas** often originate from the LA
251
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
252
True/False: pedunculated masseses are shown on FATE cards
False
253
Identify the pathology that should be considered in all patients with the following clinical conditions
254
Identify the pathology if the following 2D echocardiographic characteristics are present
Pleural effusion
255
Identify the pathology that should be considered in all patients with the following clinical conditions
256
Identify the pathology that should be considered in all patients with the following clinical conditions
Pulmonary oedema
257
The 2D echocardiographic characteristic of pulmnary oedema is \_\_\_\_\_\_\_
B-lines
258
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)
259
B-lines are not normal at the ________ part of the thorax
B-lines are not normal at the **anterior** part of the thorax
260
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
261
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
262
The presence of lung _____ excludes pneumothorax
The presence of lung sliding excludes pneumothorax
263
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
264
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