Case Study Format and Analysis Flashcards
What is the first step in analysis ( before and after the collation of dimensions, doppler values and other observations)?
Read the Clinical Overview / History and/or presentation for this particular patient.
- Do this before gathering the information from the exam. *Do this again before committing to any comments.
- Do this again to be certain your evaluation fits the patient presentation.
What is the first question regarding M-Mode?
Is this a complete or incomplete M-Mode?
A complete M-Mode consists of the Ao/LA, the Mitral Valve and the Left Ventricle motion and dimensions.
What are the questions to be answered in M-Mode regarding the Ao?
Ao size? (normal, dilated, aneurysmal)
Ao wall thickness? (normal, thickened)
Ao root motion? (normal, increased or decreased)
-any abnormalities regarding the Ao, such as aneurysm or dissection.
What are the questions to be answered in M-Mode regarding the Ao Valve?
Ao valve motion?
Cusp thickness?
Closure line?
Any visible fluttering?
What are the questions to be answered in M-Mode regarding the Mitral valve?
Mitral valve motion? Mitral leaflet excursion? What is the EPSS? Any early or premature closure of the leaflets? Any fluttering of the MV leaflets? Is there any MAC?
What are the questions to be answered in M-Mode regarding the Left Ventricle?
LV size? Wall motion? Any septal wall motion abnormalities? RVOT dimension? Any LVH
What is the format for 2D comments?
Chambers Valves Vessels Pericardial/Pleural Effusions? Mass, Thrombus, Vegetations?
What are the questions to be answered for 2D comments regarding the LV?
LV size LV shape Wall thickness Wall motion LVOT size Overall LV performance (EF) Any abnormalities, aneurysm, scarring, thinning?
What are the questions to be answered for 2D comments regarding the LA/IAS?
LA size and appearance
LA function
IAS appearance
IAS motion
What are the questions to be answered for 2D comments regarding the RV?
RV size RV shape RV wall thickness RV wall motion RV function (TAPSE)
What are the questions to be answered in M-Mode regarding the RV performance?
TAPSE
NL: 16-28mm
What are the questions to be answered for 2D comments regarding the RA?
RA size
What are the questions to be answered for 2D comments regarding all valves?
For all valves, be certain to comment on the supporting apparatus, including annulus, cusps, commissures, chordae,etc.
What are the questions to be answered for 2D comments regarding Ao valve?
valve appearance valve motion cusp thickness closure line commissures any abnormalities
What are the questions to be answered for 2D comments regarding the MV valve?
MV valve appearance leaflet excursion leaflet thickness valve annulus chordae coaptation pap muscles
What are the questions to be answered for 2D comments regarding the Tricuspid valve?
TV valve appearance leaflet excursion leaflet thickness valve annulus chordae coaptation pap muscles
What are the questions to be answered for 2D comments regarding the Pulmonic valve?
PV valve appearance leaflet excursion leaflet thickness valve annulus M-Mode of leaflet motion?
What are the questions to be answered for 2D comments for the Great Vessels, which vessels are to be addressed?
Aorta, ascending, transverse, descending (thoracic) abdominal. Pulmonary Artery (including left and right branches) IVC and SVC
What are the questions to be answered for 2D comments for the Aorta?
Ao size Abnormal motion or lack of motion wall thickness sinuses of Valsalva Sinotubular Junction evidence of aneurysm evidence of dissection evidence of coarctation
What are the questions to be answered for 2D comments for the PA?
Pa size
Vessel diameter
Wall thickness
Branch diameters
What are the questions to be answered for 2D comments for Pericardial Effusions or Pleural Effusions?
Location
Size
Grade of severity
Any evidence of tamponade
What are the questions to be answered for 2D comments for Mass/Thrombus/Vegetations?
Location
Size
Shape
Motion
What are the questions to be answered for 2D comments for the IVC?
IVC diameter
Wall thickness
Collapse on Inspiration
What is the purpose for Color Flow?
To evaluate blood flow across all valves, verifying laminar flow or identifying and qualifying turbulent and abnormal flow.
Regarding color flow, in addition to flow across valves, where else do you evaluate flow with color?
LVOT RVOT Great vessels Apical regions of ventricles IVC and Hepatics Pulmonary Veins
What critical measurement uses color flow to quantify regurgitation?
PISA
Proximal Isovelocity Area
What are the questions to be answered with Doppler?
Velocities and PG across all valves (normal, increased, decreased) What do abnormal findings indicate? Valve Areas, grade of stenosic lesion Evidence of regurgitation Evidence of PTHN Cardiac filling pressures LV Diastolic function
What is the equation to determine PG across a valve?
4(velocity2)=mmHg
What is the equation for determining valve area?
CSA (lvot) X VTI (lvot) / MV VTI = cm2
What is the equation for RVSP?
4(TR velocity2) + RAP
What is the equation for MPAP utilizing the rvot accel time?
80-(0.5 x rvot accel time) = mmHg
What is the equation for ERO?
effective regurgitant orifice
concept: regurgitant flow rate/regurge peak velocity
equation (MR):
6.28 X r2 X aliasing velocity/MR peak velocity
What is the equation for LAP?
E/eā x 1.25 + 1.9 = mmHg
What is the equation for PVR?
TR Velocity/ RVOT VTI x 10 +0.16 = WU
What is the equation for PAEDP?
4(PR-end diastolic velocity2)+RAP = mmHg
What is the equation for Mean PG?
2.4(velocity2)=mmHg
What is the equation for the Dimensionless Valve Index?
LVOT velocity/ Ao velocity = DVI
DVI <25 indicates stenosis
What is the equation for MPAP utilizing the PR velocity?
4 x (PR velocity2) = mmHg
What are the two ways to calculate MPAP and what pressure is this also estimating?
80 - (0.5 rvot accel time) = mmHg
4 x ( PR peak velocity2) = mmHg
pulmonary wedge pressure
What are the grades of aortic regurgitation based on Vena Contracta?
<3mm = Mild 4-5mm = Moderte 6mm = Severe
What are the grades of aortic regurgitation based on Pisa Radius?
10mm = Severe
