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MIDS 197 > Ch 2 Parasternal > Flashcards

Ch 2 Parasternal Flashcards

1
Q

List the 3 reference points we use?

A

-Apex vs base
-Lateral vs medial
-Anterior vs posterior

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2
Q

List the images we take in the long axis?

A

-PLAX
-PLAX depth
-HPLAX (looking at asc ao)
-RVIT
-RVOT

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3
Q

List the images we take in the short axis?

A

-PSAX AV
-PSAX MV
-PSAX PM (pap muscles)
-PSAX apex

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4
Q

Should the non-coronary cusp have a coronary artery coming off it?

A

No, if there is it is likely a heart anomaly

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5
Q

List the 3 structures just after the aortic valve?

A

-Sinus of valsalva
-Sinotubular junction
-Ascending aorta

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6
Q

What is the depth in PLAX + depth PLAX set to?

A

PLAX: 1cm past descending thoracic AO
Depth PLAX: 15-20 cm

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7
Q

Should we see the LV apex in PLAX?

A

No

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8
Q

How can we acquire PLAX?

A

-Pt in LLD
-3rd or 4th intercostal space
-Indicator to pt’s right shoulder (11 o’clock)
-LV + IVS must be flat and show no apex
-MV should be in center of image

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9
Q

What is the 1st parasternal image we take?

A

Depth PLAX

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10
Q

Is the right coronary cusp anterior or posterior to the non coronary cusp?

A

Anterior

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11
Q

There is fibrous continuity b/w the aortic root + what other structure?

A

Anterior MV leaflet

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12
Q

List the MV anatomy?

A

-Chordae tendineae
-Papillary muscles (prevents valves from fluttering back into atria)

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13
Q

How can we remove the papillary muscles from our image in PLAX?

A

Tilt inferiorly

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14
Q

Where would we look for pleural effusion + pericardial effusion in PLAX with regards to the descending thoracic aorta?

A

Pleural effusion: posterior to DTA
Pericardial effusion: anterior to DTA

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15
Q

The LA should be how much bigger than the AO?

A

1.5x bigger

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16
Q

Normal fluid level in pericardium during diastole?

A

3mm or less

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17
Q

Where do we angle to acquire RVIT?

A

Down/inferiorly towards pt’s right hip from PLAX

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18
Q

Why does the view RVIT have this name?

A

B/c image shows blood flowing inside the heart from the IVC/SVC

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19
Q

Can we see all 3 TV’s in the RVIT?

A

No, only septal + anterior leaflets

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20
Q

What is the eustachian valve + chiari network?

A

Fetal remnant / normal variants seen at junction of IVC + RA

(assess for this in RVIT)

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21
Q

How can we optimize the RVIT view?

A

-Show only right side heart
-TV leaflets should be symmetrical
-Center image by rocking probe

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22
Q

How do we angle to acquire RVOT?

A

Angle up/superiorly towards pt’s left shoulder from PLAX

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23
Q

Is RVOT described as a view or a specific anatomical location?

A

BOTH!!

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24
Q

Why does the view RVOT have this name?

A

B/c view shows blood going out of heart into the lungs for pulmonary circulation

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25
Q

Which pulmonary artery do we see in RVOT?

A

MPA

(the LPA may be seen as well at bottom of image)

26
Q

How can we optimize the RVOT view?

A

-Rock to center RVOT + MPA
-Rotate to make PV leafletes symmetrical
-Translate/move up rib space for better window

27
Q

How can we acquire + optimize HPLAX?

A

-Translate up rib space from PLAX
-Rotate to elongate asc AO
-Translate towards/away from sternum

28
Q

What can we potentially visualize in HPLAX view?

A

-AO root
-RCC + NCC

(mainly assesses ascending ao)

29
Q

How can we acquire PSAX?

A

-Rotate 90 degrees from PLAX
-Indicator points to pt’s left shoulder

30
Q

Is it better to angle or translate superiorly + inferiorly when imaging in PSAX?

A

Translate

31
Q

What is PSAX at the level of the AV called?

A

Base of the heart

32
Q

What 3 structures do we occasionally see with PSAX at AV level?

A

-RCA
-LMCA (left main coronary artery)
-LAA (left atrial appendage)

(thrombus likes to hangout in appendages)

33
Q

What is the main view to determine if the AV is bicuspid instead of being normally tricuspid?

A

PSAX at AV level

34
Q

How can we optimize PSAX at AV level?

A

-Rotate to make AV leaflets Y shaped during diastole
-Rock to center AV
-Translate up rib space to see RVOT better

35
Q

How do we optimize + angle to see all 3 valves in the PSAX AV level view, as it is hard to capture them all in 1 image?

A

-Zoom in during systole to show 3 cusps in AV (RCC, NCC, LCC)
-Medially for TV/RA
-Laterally for PV/PA

36
Q

How do we angle to acquire PSAX at MV level?

A

Angle down/inferiorly from PSAX AO level (or translate down)

37
Q

PSAX at MV level visualizes what part of heart?

A

Basal segment of heart

(MV = basal)

38
Q

List the MV scallops?

A

-A1, A2, A3 (anterior part of fish mouth)
-P1, P2, P3 (posterior part of fish mouth)

39
Q

What is the name of the normal shape that the MV looks like during PSAX?

A

Fish mouth (is stenotic if this shape is lost)

40
Q

How can we optimize PSAX at MV level?

A

-Rotate to open MV leaflets upwards
-Ensure LV is round, RV is crescent
-Rock to center LV

(if MV opens to left = under rotated, if MV opens to right = over rotated)

41
Q

How do we angle to acquire PSAX at PM level?

A

Angle down/inferiorly from PSAX MV level (or translate down)

42
Q

PSAX at PM level visualizes what part of the heart?

A

Mid segment

(PM = mid)

43
Q

What do LV myocardial wall segments explain?

A

-Wall motion abnormalities
-Helps us identify which coronary artery is causing regional (a segment) or global (whole) wall motion abnormalities

44
Q

How can we optimize PSAX at PM level?

A

-Rotate to ensure LV appears round + RV is crescent shaped
-Rock to center LV
-Angle (sweep) inferiorly/superiorly to ensure at right level of PMs (they look like pacman)
-Translate down rib space to better see PMs

45
Q

Should the chordae tendineae be seen in PSAX at PM level?

A

No!

46
Q

How do we angle when acquiring PSAX at the apex?

A

Angle down/inferiorly from PSAX at PM level
(or translate down rib space)

47
Q

Which PSAX view do we occasionally see the false tendon?

A

PSAX at apex (is just a normal variant)

48
Q

PSAX at level of apex visualizes what part of heart?

A

Apical segment

(apex = apical)

49
Q

What is the acronym for the wall segments seen in PSAX at apex level?

A

SALI - septal, anterior, lateral, inferior

(go clockwise starting at left side)

50
Q

How do we know if we are fully at the level of the apex in PSAX?

A

When the LV cavity disappears during systole

51
Q

How can we optimize PSAX at apex level?

A

-Rock to center LV
-Angle/sweep down inferiorly out of LV to ensure at correct level of apex
-Translate to lower rib space

(should be NO pap muscles (pacman) seen at apex)

52
Q

What does ASH stand for?

A

Asymmetric septal hypertrophy

53
Q

Which cusps of the AV are visible from standard PLAX view?

A

RCC + NCC

54
Q

What is the primary goal for assessment in HPLAX?

A

Ensuring normal anatomy of the ascending AO

55
Q

2D visualization of atrial contraction would occur at what point of the ECG?

A

Immediately following the P wave

(P wave shows atrial depolarization, than contraction occurs right after)

56
Q

What anatomy structure are we typically not able to visualize in the PSAX view at the level of the AV?

A

Left ventricle

57
Q

What view could potentially allow for evaluation of the proximal portion of the RCA + LCA in the same image?

A

PSAX at AV level

58
Q

What valve has possibility for m-mode utilization that is not commonly performed?

A

PV

(think b/c we don’t do it in lab, but we could)

59
Q

What is the coronary sinus?

A

Major cardiac vein responsible for draining deoxygenated blood from myocardium + empties back into the RA

60
Q

What view is the coronary sinus easily seen if dilated?

A

PLAX

61
Q

What are the 2 views we use to interrogate the AV, MV + LV via m-mode?

A

PLAX + PSAX

MIDS 197 (15 decks)

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