Ch 1 Intro Flashcards
The SA node recharges/repolarizes while which chamber refills?
While atria refills
The AV node recharges/repolarizes while which chamber refills?
While ventricles refill
What is systole + how much of the cardiac cycle does it make up?
-Contraction of ventricles
-Begins at mitral valve closure, ends at aortic valve closure
-1/3 of cycle
What is diastole + how much of the cardiac cycle does it make up?
-Relaxation of ventricles
-Begins at aortic valve closure, ends at mitral valve closure
-2/3 of cycle
What mechanism causes valves to close?
Pressure gradient
What valves are open during diastole?
AV valves open, semilunar valves closed (b/c blood filling into ventricles)
What valves are open during systole?
Semilunar valves open, AV valves closed (b/c blood pumping out of body)
End of diastole allows for the ventricles to reach their largest or smallest diameter?
Largest (b/c filled with blood)
End of systole allows for the ventricles to reach their largest or smallest diameter?
Smallest (b/c blood has been pumped out of the ventricles)
What valve separates the biggest pressure differential?
Mitral/bicuspid valve
Where blood goes, does pressure increase or decrease?
Increases
Which side of the heart has high pressure + which side has low pressure?
Left: high (systemic circulation)
Right: low (lungs/pulmonary circulation)
Which chamber has the highest + lowest pressure?
RA: lowest
LV: highest
How many pulmonary arteries + veins are there?
Arteries: 2
Veins: 4
During what part of the cardiac cycle do the coronary arteries fill?
Diastole (b/c they are no longer compressed like in systole)
Which side of heart has highest level of oxygenation?
Left b/c has oxygenated blood (right has deoxygenated blood)
Deoxygenated blood returns to the RA via what?
SVC + IVC
The coronary arteries come off what structure?
Aorta
What do we evaluate during an echocardiogram?
-Chambers (size, structure, function)
-Valves (stenosis, regurgitation, area)
-Estimate pressure inside heart
-Recognize issues with other parts of the body via the heart
What is the m/c reason for an echo to be ordered?
Heart murmur (extra noise heard during a heartbeat)
Is a TTE or TEE more invasive?
TEE b/c goes down esophagus
What is an acoustic window?
Probe location that provides access for cardiac imaging
What is an imaging plane?
Orthogonal view of the heart (the view/slice we are in)
Differentiate move, translation, tilt, angle + rotate?
Move: pick up + move probe to different part of chest
Translation: moving probe across chest while keeping contact with skin
Tilt: rocking probe (heel/toe) within same imaging plane to center structure
Angle: side to side movement of probe from fixed point to view different anatomy
Rotate: twist probe (ex from sag to trv)
4 acoustic window/transducer locations we use?
-Parasternal (medial chest)
-Apical (lateral chest)
-Subcostal (stomach)
-Suprasternal (neck)
List the imaging planes/views we do?
-Short axis (trv)
-Long axis (sag)
-5,4,3,2 chamber views
What are the 3 reference points we use?
-Apex vs base
-Lateral vs medial
-Anterior vs posterior
Do cardiac sonographers perform TTEs + TEEs?
TTEs (imaging through thorax/chest), we only assist the cardiologist with TEEs
Are echo exams operator dependent?
Yes, highly! The quality of our images is dependent on our skill
Where do the 3 ECG leads go?
Salt (RA), pepper (LA) + ketchup (left side under ribs)
When would we use the pedof blind probe?
When dealing with aortic stenosis
List 5 emergency indications for an echocardiogram where we could inform the cardiologist asap?
-Cardiac arrest (heart stops)
-Pericardial tamponade (too much fluid causing compression of heart)
-Aortic dissection (tear in AO)
-Cardiogenic shock (heart can’t pump enough blood)
-Pulmonary embolism (block in pulmonary arteries)
-Newly decreased ejection fraction
-Thrombus
-New onset arrhythmia
What types of doppler do we use to assess the hemodynamics of the heart?
-Color doppler (qualitative)
Spectral doppler: quantitative
-Pulse wave
-Continuous wave
What 3 questions do pt’s often have?
-Length of exam
-Positioning of pt
-Timing of results
What is 2D B-Mode imaging?
Real time cross sectional images of heart achieved by repeated multiple u/s scan lines being compiled into a 2D image
Quality of 2D B-Mode images depend on what 4 factors?
-Selecting correct probe pre set
-Depth
-Frequency
-Frame rate gains
Can we assess the heart quantitatively or qualitatively with 2D B-Mode imaging?
Both!
Quantitative: numbers, is measurable
Qualitative: characteristics not expressed by #s
Can we do measurements offline or does it have to be done on the u/s machine?
Either!
What is M-Mode imaging?
-Motion mode
-Single narrow beam of u/s repeated multiple times
-Tracing of depth on y-axis + x-axis
Advantage + disadvantage of M-Mode imaging?
Advantage: high frame rate to evaluate ventricular motion + opening/closing of valves
Disadvantage: hard to interpret b/c cursor must be perpendicular
Can we assess the heart quantitatively or qualitatively with CD?
Qualitatively - shows direction of flow with respect to the probe (BART)
Is CD a form of pulse wave doppler?
Yes
What can CD detect?
-Abnormal backwards flow of valves
-Turbulent flow at obstructions
-Shunts (hole in heart)
Can we assess the heart quantitatively or qualitatively with pulse wave doppler?
Quantitatively
What does PW doppler show on u/s?
Direction + velocity of flow with respect to time in 1 location, through 1 SPECIFIC location
(flow above baseline: towards probe
below baseline: away from probe)
What is PW doppler used for?
To evaluate flow at a specific location
Is PW doppler subject to aliasing?
Yes
Is PW doppler best for low or high flow states?
Low
Can we assess the heart quantitatively or qualitatively with continuous wave doppler?
Quantitatively
What does CW doppler show on u/s?
Shows direction + velocity of flow with respect to time in 1 location, can NOT localize a specific location
(flow above baseline: towards probe
below baseline: away from probe)
What is CW doppler used for?
To measure differences in pressure from 1 side of a tight valve to the other side
Does sampling occur along the entire cursor line with CW doppler?
Yes
List 3 conditions affecting image quality?
-Increased probe distance from hrt (adipose tissue)
-Decreased u/s penetration (scar tissue)
-Air containing tissues b/w probe + hrt (chronic lung disease, recent cardiac surgery)
What do we report on after an exam?
-Size of chambers
-Valves
-Presence/degree of valve stenosis + regurgitation
-Function of ventricles
-Size/dilation of AO root + ascending AO
-Presence of pericardial fluid
-Technical quality of exam
-Segmental wall motion abnormalities
-BP + HR
-Height + weight for body surface area (BSA)
What is endocarditits?
Bacterial growth inside heart
Where is the lubricating fluid in heart?
B/w the epicardium + pericardium
Name of indentation found in the center of a normal interatrial septum?
Fossa ovalis
Name the coronary artery that runs adjacent/beside the middle cardiac vein?
Right posterior descending artery
(aka posterior interventricular artery)
What does the right coronary artery divide into?
-Right posterior descending (posterior side of heart)
-Right marginal (anterior side of heart)
Name the coronary artery that runs adjacent to the small cardiac vein?
Right marginal artery
Name the coronary artery that runs adjacent to the great cardiac vein?
LAD - left anterior descending
(aka anterior interventricular artery)
What does the left coronary artery divide into?
-LAD
-Left circumflex
On an ECG, systole occurs during which wave forms?
Peak of R wave to end of T wave
On an ECG, diastole occurs during which wave forms?
End of T wave to peak of R wave
