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Principles I > basic transesophageal echocardiography > Flashcards

basic transesophageal echocardiography Flashcards

1
Q

what does air look like in a TEE?

A

light/white

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2
Q

what does blood/fluid look like in a TEE?

A

dark

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3
Q

what is color flow good to determine?

A

regurgitation

blue away, red toward

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4
Q

how does the Echo work?

A

piezoelectric crystals (quartz)

  • reflect sound waves
  • generate dynamic images of the heart
  • high frequency sound (ultrasound) 2-10 Mhz
  • sound wave velocity based on tissue type, speed of sound through tissue is constant
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5
Q

what is B-mode for image display?

A

brightness mode

  • amplitude of the returning echo gives 2 dimensional view
  • 2D mode: send ultrasound pulses across a sector of cardiac anatomy displaying a tomograph
  • displays shape and lateral motion
  • normal mode
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6
Q

what is M-mode for image display?

A

motion mode

  • one dimensional view
  • pulsations at very high rates yielding real-time dynamic images
  • best mode for timing cardiac events
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7
Q

describe category I indications for TEE

A
  • supported by strong evidence or expert opinion

- TEE improves clinical outcomes

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8
Q

describe category II indications for TEE

A
  • supported by weaker evidence or expert consensus

- TEE MAY improve outcomes

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9
Q

describe category III indications for TEE

A
  • little current scientific evidence or expert support

- TEE infrequently improves clinical outcomes and may even be harmful

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10
Q

what are some category I indications for TEE?

A
  • acute, persistent life threatening disturbances
  • RV & LV global and regional function & contractility
  • myocardial ischemia: assessing wall motion
  • valve repair (primarily mitral valve)
  • obstructive cardiomyopathy
  • infective endocarditis and valve vegetation
  • aortic valve dissection or aneurysm
  • congenital heart surgery
  • detection of intracardiac shunting
  • thoracic aortic aneurysm
  • pericardial window
  • detect residual intracardiac air & embolic matter
  • atrial thrombus (stroke etiology)
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11
Q

what is the best use of TEE?

A

looking at contractility and volume

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12
Q

what are some category II indications for TEE?

A
  • valve replacement
  • myocardial aneurysm repair
  • cardiac assist devices
  • pulmonary endarterectomy
  • suspected cardiac trauma
  • myocardial/intracardiac mass resection
  • foreign body detection and/or removal
  • pericardial surgery
  • cardiac or pulmonary transplantation
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13
Q

what is an absolute contraindication for TEE?

A

esophageal surgery

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14
Q

what are relative contraindications for TEE?

A
  • inexperienced anesthetist
  • hx of sysphagia
  • esophageal varices or strictures
  • hiatal hernia
  • coagulopathy
  • cervical spine instability
  • mediastinal radiation
  • upper airway pathology
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15
Q

what are the advantages of TEE as a cardiac monitor?

A
  • doesn’t interfere with surgical field
  • probe is stabilized, no loss of image
  • regional wall abnormalities; ischemia can be detected before appearing on EKG
  • sound waves pass only through esophagus not chest wall or boney structures, so image distortion d/t interference is very unlikely
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16
Q

when may basic TEE intraop exams be utilized?

A
  • unexplained hemodynamic instability
  • pulmonary embolism
  • hypovolemia
  • depressed myocardial function (abnormal wall motion indicative of acute ischemia
  • pneumothorax
  • pericardial effusions
  • cause of PEA
17
Q

describe an advanced comprehensive perioperative TEE exam

A
  • 20 multiplane views
  • assessing volumes and chamber size
  • assessing cardiac output
  • assess stroke volume, ejection fraction
18
Q

describe non-comprehensive basic perioperative TEE exam

A
  • 11 most relevant views
  • hx of significant comorbidities
  • hemodynamic instability expected during surgery
  • known or suspected CV compromise
  • unexplained persistent hypotension, hypoxemia, or major thoracic or abdominal trauma
19
Q

how does TEE knobs work?

A
  • bottom knob: clockwise anteflex, counterclockwise retroflex
  • top knob: right and left flex
  • side button: rotates beam from 0-180 degrees
20
Q

describe TEE insertion and technique

A

-insert through mouth down esophagus
-keep probe in “unlocked” neutral position
three levels:
-upper esophageal 20-30 cm
-mid esophageal 30-40 cm
-transgastric 40-45 cm

21
Q

what are the most common views?

A
  • Mid esophageal (ME) 4 chamber: looks at a 0 degree plane

- mid esophageal 2 chamber: turns 90 degrees to isolate the LV

22
Q

what view is good to assess ischemia?

A

transgastric mid short axis view (TG mid SAX)

23
Q

what does the ME 4 chamber view show?

A
  • Left atrium
  • left ventricle
  • right atrium
  • right ventricle
  • mitral valve
  • tricuspid valve
  • 0 degree plane, 30-35 cm
24
Q

what can the ME 4 chamber view be used to assess?

A
  • valve disease
  • ventricular function
  • atrial septal defect (ASD)
  • effusions
25
Q

what does the ME 2 chamber view show?

A
  • left atrium
  • left ventricle
  • mitral valve
  • left atrial appendage (LAA)
  • coronary sinus
  • 90 degree plane, 30-35 cm
26
Q

what can be assessed with the ME 2 chamber view?

A
  • mitral valve disease
  • LV size and function
  • LAA thrombus
27
Q

what does the ME LAX view look at?

A
  • mitral valve
  • aortic valve
  • left ventricular outflow tract (LVOT)
  • septal
  • 120-130 degree plane, 30-35 cm
28
Q

what can be assessed with the ME LAX view?

A
  • LVOT
  • Aortic valve disease
  • anterior mitral valve leaflet (AMVL)
  • posterior mitral valve leaflet (PMVL)
29
Q

what does the transgastric mid SAX look at?

A

views 6 LV segments

*0 degree plane, down about 40 cm

30
Q

what can be assessed with the TG mid SAX view?

A
  • LV size
  • LV function (contractility)
  • ejection fraction
  • effusions
  • volume status
31
Q

what does the ME AV SAX look at?

A
  • aortic valve
  • LA size
  • atrial septum
  • left atrial appenadage (LAA)
32
Q

what can be assessed with the ME AV SAX view?

A
  • atrial septal defect
  • aortic valve disease
  • thrombus in LAA
33
Q

describe TEE use during resuscitation

A
  • identify reversible causes of PEA
  • can identify images during chest compressions
  • pulse detection inaccurate
  • allows full resuscitation efforts (esophageal damage during chest compressions rare; able to deliver shock)
34
Q

what is the one view to monitor effective chest compressions?

A

-ME 4 chamber

Principles I (18 decks)

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