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MIDS 197 > Ch 7 Apical > Flashcards

Ch 7 Apical Flashcards

1
Q

List the apical views we do?

A

-AP4 (home base)
-Modified AP4 (RV focus)
-AP5
-AP2
-AP3 (apical long axis, like PLAX)

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2
Q

How to obtain AP4?

A

-Pt in LLD
-Probe in 4th, 5th or 6th intercostal space (often in inframammary fold)
-Indicator facing to the right at pt’s left side (3 o’clock)
-Can palpate for apical pulse (not always possible)

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3
Q

What structures can we see in AP4?

A

-LA (RUPV or RLPV sometimes)
-MV (ant/post leaflets)
-IAS
-LV (IS + AL wall segs)
-IVS
-RV
-TV (ant/sept leaflets)

(leaflets spell “ASAP”, wall segs spell “ISAL”)

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4
Q

What does the moderator band do?

A

Helps regulate size of RV

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5
Q

List distinguishing features with AP4?

A

-Moderator band in RV
-Trabeculations in RV
-False tendon in LV (normal variant)
-Chordae tendinae in LV

-IVS + IAS are vertical
-All 4 chambers are seen
-Full excursion of MV + TV leaflets

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6
Q

List 3 additional AP4 structures of interest we may see?

A

-Coronary sinus (angle posterior)
-Pericardium (check for presence of effusion)
-Normal RA variants (chiari network + eustachian valve)

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7
Q

What is the coronary sinus?

A

Returns deoxygenated blood from myocardium into RA

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8
Q

How can we bring the coronary sinus into our AP4 view?

A

Angle posterior/inferior

(image shows CS going through IAS into the RA)

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9
Q

Name 2 normal RA variants?

A

-Chiari Network
(normal adult variant that looks like a web + is a longer protrusion than an eustachian valve)

-Eustachian valve
(remnant from fetal life, is a shorter protrusion than a chiari network)

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10
Q

Which apical view are we assessing for any pacemaker wires?

A

AP4 + modified AP4 (look in RA + RV)

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11
Q

What must we ensure we are NEVER doing when imaging the apex?

A

Do not foreshorten it!

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12
Q

What does foreshortening the apex mean?

A

Means we are not visualizing the true LV apex + are overestimating the EF

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13
Q

Should the LV apex squeeze down much?

A

No

(should see IS + AL walls should be coming in toward one another)

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14
Q

Should the LV appear bullet shaped or globular?

A

Bullet!!

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15
Q

How can we fix our view if our LV appears foreshortened?

A

-Translate down rib space + more laterally
-Rotate slightly to expand chambers
-Adjust gains to see endocardium better
-Utilize pt breathing (sm breathe in or all breathe out)

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16
Q

What technique can we do to center our LV in the middle of our sector in AP4?

A

Rock the probe

(tilted to right = move lateral, tilted to left = move medial)

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17
Q

How can we get the modified AP4 view?

A

-Rotate slightly counter clockwise from AP4
-Move probe slightly lateral

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18
Q

Purpose of modified AP4?

A

RV focused view:
-Better visualization of complete RV width
-Better assessment of RV function

19
Q

Do we visualize both apex’s in modified AP4?

A

Yes - LV apex still seen in center of image, while RV apex is also visualized fully now

20
Q

How do pacer wires look on u/s?

A

Hyperechoic line coming from RV apex

21
Q

How does viewing the moderator band + RV trabeculations help us when scanning prenatally?

A

Helps us determine ventricular situs prenatally

22
Q

Does the RV or LV have more trabeculations?

A

RV

23
Q

Structures visualized in modified AP4?

A

-RV
-TV (ant/sept)
-RA
-LV
-MV (ant/post)
-LA

-Moderator band RV
-Trabeculations RV

24
Q

How to optimize for the modified AP4 view?

A

-Ensure no RV apex foreshortening!!
-Fine adjustments with probe rotation counter clockwise to extend RV width fully
-Translate probe laterally to elongate RV
-Angle anteriorly/superiorly to see apex

25
Q

How can we acquire the AP5 view?

A

Angle anteriorly/superiorly from AP4

(angle until we see LVOT + AoV in center)

26
Q

What structures are seen in AP5?

A

-LV
-LVOT
-AoV
-IVS

(MV, LA, RV, TV + RA are not mandatory to see)

27
Q

M/c location of VSDs?

A

Perimembranous area

28
Q

4 things we are assessing for in AP5?

A

-LVOT for obstructions
-AoV for structure/function
-LV for size/function/thrombus
-VSD (good at seeing perimembranous ones)

29
Q

How can we optimize for AP5?

A

-Ensure LV apex is not foreshortened!!
-Rock to center LV
-Angle anteriorly to see LVOT + AoV
-Rotate counter clockwise to open up AoV to see both cusps + to see Ao root

(some structures may be out of plane for this view which is fine: IAS, LA/RA, TV/MV)

30
Q

What are blood clots due to?

A

Due to areas of slow flow

31
Q

How do we obtain the AP2 view?

A

Rotate 60 degrees counter clockwise from AP4
(indicator points to pt’s left shoulder)

32
Q

What is the hardest view for beginners?

A

AP2

33
Q

Structures visualized in AP2?

A

-LV (inf/ant walls: think spells “INFANT”)
-LA
-LAA (left atrial appendage at times)
-MV (ant/post leaflets)

34
Q

List 2 additional AP2 structures of interest we may see?

A

-Descending thoracic AO
(angle posteriorly + rotate counter clockwise)

-LAA

35
Q

What is a LAA?

A

-Remnant of embryonic LA
-May play a role in modulating LA pressure
-Site for thrombus (blood clot) formation

36
Q

Which view can we assess for coronary sinus dilatation + descending AO aneurysm/dissection?

A

AP2

37
Q

How can we optimize for AP2?

A

-Ensure LV apex is not foreshortened!!
-Rock to center LV
-Rotate counter clockwise if we see any right sided structures
-Rotate clockwise if we see LVOT + AoV
-Sm breathe in can help bring in anterior wall (remember “infant” wall segments)

38
Q

In which view does the MV look like a flying UFO/disk?

A

AP2

39
Q

How can we obtain AP3?

A

Rotate 30 degrees further counter clockwise from AP2

(point indicator to pt’s right shoulder + angle inferiorly)

40
Q

Which view is similar to PLAX?

A

AP3 - b/c it is the apical long axis

(can gets lots of info here, similar to PLAX but with the inclusion of the LV apex now)

41
Q

Structures visualized in AP3?

A

-LV (IS + AS wall segs + apex seen)
-IVS
-LVOT
-LA
-MV (ant/post leaflets)
-Descending AO
-RVOT

42
Q

How can we optimize for AP3?

A

-Ensure LV apex is not foreshortened!!
-Rock to center LV
-Rotate counter clockwise to open up AoV to see both cusps + to see AO root

(view shows AO root on the right side of screen, while LA is on left side of screen)

43
Q

Is right or left handed scanning best for apical views?

A

LEFT!!!

MIDS 197 (15 decks)

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