Ch 2 Parasternal Flashcards
List the 3 reference points we use?
-Apex vs base
-Lateral vs medial
-Anterior vs posterior
List the images we take in the long axis?
-PLAX
-PLAX depth
-HPLAX (looking at asc ao)
-RVIT
-RVOT
List the images we take in the short axis?
-PSAX AV
-PSAX MV
-PSAX PM (pap muscles)
-PSAX apex
Should the non-coronary cusp have a coronary artery coming off it?
No, if there is it is likely a heart anomaly
List the 3 structures just after the aortic valve?
-Sinus of valsalva
-Sinotubular junction
-Ascending aorta
What is the depth in PLAX + depth PLAX set to?
PLAX: 1cm past descending thoracic AO
Depth PLAX: 15-20 cm
Should we see the LV apex in PLAX?
No
How can we acquire PLAX?
-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
What is the 1st parasternal image we take?
Depth PLAX
Is the right coronary cusp anterior or posterior to the non coronary cusp?
Anterior
There is fibrous continuity b/w the aortic root + what other structure?
Anterior MV leaflet
List the MV anatomy?
-Chordae tendineae
-Papillary muscles (prevents valves from fluttering back into atria)
How can we remove the papillary muscles from our image in PLAX?
Tilt inferiorly
Where would we look for pleural effusion + pericardial effusion in PLAX with regards to the descending thoracic aorta?
Pleural effusion: posterior to DTA
Pericardial effusion: anterior to DTA
The LA should be how much bigger than the AO?
1.5x bigger
Normal fluid level in pericardium during diastole?
3mm or less
Where do we angle to acquire RVIT?
Down/inferiorly towards pt’s right hip from PLAX
Why does the view RVIT have this name?
B/c image shows blood flowing inside the heart from the IVC/SVC
Can we see all 3 TV’s in the RVIT?
No, only septal + anterior leaflets
What is the eustachian valve + chiari network?
Fetal remnant / normal variants seen at junction of IVC + RA
(assess for this in RVIT)
How can we optimize the RVIT view?
-Show only right side heart
-TV leaflets should be symmetrical
-Center image by rocking probe
How do we angle to acquire RVOT?
Angle up/superiorly towards pt’s left shoulder from PLAX
Is RVOT described as a view or a specific anatomical location?
BOTH!!
Why does the view RVOT have this name?
B/c view shows blood going out of heart into the lungs for pulmonary circulation
Which pulmonary artery do we see in RVOT?
MPA
(the LPA may be seen as well at bottom of image)
How can we optimize the RVOT view?
-Rock to center RVOT + MPA
-Rotate to make PV leafletes symmetrical
-Translate/move up rib space for better window
How can we acquire + optimize HPLAX?
-Translate up rib space from PLAX
-Rotate to elongate asc AO
-Translate towards/away from sternum
What can we potentially visualize in HPLAX view?
-AO root
-RCC + NCC
(mainly assesses ascending ao)
How can we acquire PSAX?
-Rotate 90 degrees from PLAX
-Indicator points to pt’s left shoulder
Is it better to angle or translate superiorly + inferiorly when imaging in PSAX?
Translate
What is PSAX at the level of the AV called?
Base of the heart
What 3 structures do we occasionally see with PSAX at AV level?
-RCA
-LMCA (left main coronary artery)
-LAA (left atrial appendage)
(thrombus likes to hangout in appendages)
What is the main view to determine if the AV is bicuspid instead of being normally tricuspid?
PSAX at AV level
How can we optimize PSAX at AV level?
-Rotate to make AV leaflets Y shaped during diastole
-Rock to center AV
-Translate up rib space to see RVOT better
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?
-Zoom in during systole to show 3 cusps in AV (RCC, NCC, LCC)
-Medially for TV/RA
-Laterally for PV/PA
How do we angle to acquire PSAX at MV level?
Angle down/inferiorly from PSAX AO level (or translate down)
PSAX at MV level visualizes what part of heart?
Basal segment of heart
(MV = basal)
List the MV scallops?
-A1, A2, A3 (anterior part of fish mouth)
-P1, P2, P3 (posterior part of fish mouth)
What is the name of the normal shape that the MV looks like during PSAX?
Fish mouth (is stenotic if this shape is lost)
How can we optimize PSAX at MV level?
-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)
How do we angle to acquire PSAX at PM level?
Angle down/inferiorly from PSAX MV level (or translate down)
PSAX at PM level visualizes what part of the heart?
Mid segment
(PM = mid)
What do LV myocardial wall segments explain?
-Wall motion abnormalities
-Helps us identify which coronary artery is causing regional (a segment) or global (whole) wall motion abnormalities
How can we optimize PSAX at PM level?
-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
Should the chordae tendineae be seen in PSAX at PM level?
No!
How do we angle when acquiring PSAX at the apex?
Angle down/inferiorly from PSAX at PM level
(or translate down rib space)
Which PSAX view do we occasionally see the false tendon?
PSAX at apex (is just a normal variant)
PSAX at level of apex visualizes what part of heart?
Apical segment
(apex = apical)
What is the acronym for the wall segments seen in PSAX at apex level?
SALI - septal, anterior, lateral, inferior
(go clockwise starting at left side)
How do we know if we are fully at the level of the apex in PSAX?
When the LV cavity disappears during systole
How can we optimize PSAX at apex level?
-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)
What does ASH stand for?
Asymmetric septal hypertrophy
Which cusps of the AV are visible from standard PLAX view?
RCC + NCC
What is the primary goal for assessment in HPLAX?
Ensuring normal anatomy of the ascending AO
2D visualization of atrial contraction would occur at what point of the ECG?
Immediately following the P wave
(P wave shows atrial depolarization, than contraction occurs right after)
What anatomy structure are we typically not able to visualize in the PSAX view at the level of the AV?
Left ventricle
What view could potentially allow for evaluation of the proximal portion of the RCA + LCA in the same image?
PSAX at AV level
What valve has possibility for m-mode utilization that is not commonly performed?
PV
(think b/c we don’t do it in lab, but we could)
What is the coronary sinus?
Major cardiac vein responsible for draining deoxygenated blood from myocardium + empties back into the RA
What view is the coronary sinus easily seen if dilated?
PLAX
What are the 2 views we use to interrogate the AV, MV + LV via m-mode?
PLAX + PSAX
