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MIDS 197 > Ch 9 Apical Measurements > Flashcards

Ch 9 Apical Measurements Flashcards

1
Q

What is the preferred method for 2D volume calculations, particularly LV EF + LA volume?

A

Biplane method of discs (modified simpson’s rule)

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2
Q

What is the biplane method of discs (modified simpson’s rule)?

A

Calculates ventricular volumes as a sum of a series of parallel slices (called discs) from the apex to base

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3
Q

List 2 advantages of using Simpson’s biplane method?

A

-2 planes of measurements give fewer assumptions about ventricular shape

-Changes in ventricular geometry caused by pathology won’t effect our accurate measurement of EF

(pathology such as Ao stenosis, volume overload + wall motion abnormalities due to MI or CAD)

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4
Q

Which views do we perform Simpson’s biplane measurements?

A

Zoomed up image of LV in AP4 + AP4

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5
Q

How do we get an EF by using Simpson’s biplane?

A

-By tracing the endocardial borders at end diastole + end systole
-Gives us an EF for AP4/AP2 + most importantly a biplane EF for both

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6
Q

List the 5 steps to perform a Simpson’s biplane measurement?

A

-Decrease depth + focus image on LV
-Place + set cursor on MV annulus
-Trace blood/tissue interface along endocardial border
-Place last cursor on lateral side of MV annulus
-Connect LV length line from MV annulus to apex of LV

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7
Q

Should AP4 + AP2 have very similar EFs?

A

Yes!

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8
Q

What is the normal range for end diastolic volume?

A

Women: 46-106 mL
Men: 62-150 mL

(males are larger b/c they have a bigger heart)

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9
Q

What is the normal range for end systolic volume?

A

Women: 14-42 mL
Men: 21-61 mL

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10
Q

What is the m/c used measurement for cardiac function?

A

LV EF

(EF = % of blood leaving heart during each contraction)

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11
Q

Formula for EF?

A

EF = (EDV - ESV) / EDV x 100

(this is the simplified version we use, the Simpson’s version is very complex)

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12
Q

Normal EF range?

A

Women: 54-74%
Men: 52-72%

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13
Q

How do we acquire a LA volume measurement?

A

-Measured at end systole in zoomed in AP4 + AP2
-Trace blood/tissue interface (endocardium) of LA
-Set first caliper under MV annulus, trace internal perimeter of LA + set second caliper under opposing annular side
-Adjust length line to be perpendicular to MV annulus, along length of LA

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14
Q

Upper normal limit for LA volume is what in men/women?

A

Men/women: 34 mL/m^2

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15
Q

List the ranges for a midly enlarged, moderately enlarged + severly enlarged LA volume in men/women?

A

Mild: 35-41 mL/m^2

Moderate: 42-48 mL/m^2

Severe: > 48 mL/m^2

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16
Q

Is LA volume indexed to BSA or gender?

A

BSA

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17
Q

What are some pathologies that could cause left atrial enlargement?

A

MV regurgitation

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18
Q

List 4 ways we can optimize our 2D image for best endocardial definition when we are going to do a Simpson’s biplane measurement?

A

-Gains
-Color maps/chroma maps
-Harmonics
-Dynamic range

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19
Q

Should pap muscles + trabeculations be ignored or included when doing a Simpson’s biplane measurement?

A

Ignored! Similar to how they are ignored in 2D linear measurements

(trace past the pap muscles b/c they are not the true LV wall + only exist in one plane)

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20
Q

How can we avoid LV shortening?

A

Drop down rib space or go more lateral if we are shortening the LV

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21
Q

Do diastole + systole measurements in AP4 + AP2 need to be performed in the same beat?

A

Yes!

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22
Q

LV length is perpendicular to what when doing a Simpson’s biplane measurement?

A

Base width - measured from center of MV annulus to LV apex

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23
Q

The length line variability b/w AP4 + AP2 should be what when doing a Simpson’s biplane?

A

<10%

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24
Q

Should the apex move much b/w diastole + systole when doing Simpson’s biplane measurements?

A

No!

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25
Q

EF variability b/w AP4 + AP2 should be within how many percentage points of each other when doing Simpson’s biplane measurements?

A

Within a few percentage points, unless WMAs are present

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26
Q

Are we allowed to “fudge” data when doing a Simpson’s biplane measurement?

A

NO, must get the entire LV in the sector and do it correctly. These are some of the most important images we take during an echo.

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27
Q

If we are foreshortening the LA, similar to the LV, how can we fix this?

A

-Drop down a rib space
-Angle slightly superior/inferior to ensure largest volume is assessed

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28
Q

The LA length is perpendicular to what structure when taking a left atrial volume measurement?

A

Perpendicular to the MV annular plane

29
Q

Variability b/w AP4 + AP2 for left atrial volume measurements is what?

A

<5mm

30
Q

LA length is measured from what 2 points when taking a LA volume measurement?

A

-From mid point of MV annulus
-To mid point of superior wall

31
Q

Should we include the LA appendage or PVs in our LA volume measurement?

A

NO!

32
Q

What happens if the LA length is not measured perpendicular to the MV annular plane when taking a LA volume measurement?

A

It creates a region of dead space, underestimating the true LA volume

33
Q

What happens if the LA is foreshortened + the LA length is not perpendicular to MV annular plane when taking a LA volume?

A

It creates 2 areas of dead space that is not calculated in the LA volume, therefore underestimating the true LA volume

34
Q

What happens if we include a PV into our LA volume?

A

We will overestimate the size of the LA

35
Q

When are the RA linear measurements done? What view are they done in?

A

-End systole
-AP4

(think any measurements of the atria are always done in systole)

36
Q

How do we take an RA major dimension?

A

Measure length of atria from superior to inferior

37
Q

How do we take an RA minor dimension?

A

Measure width from lateral RA wall to IAS at the mid atrial level (defined by half of the RA long axis/length)

38
Q

What is the normal RA major dimension range?

A

Less than 5.3 cm

39
Q

What is the normal RA minor dimension range?

A

Less than 4.4 cm

40
Q

How to do an RA volume tracing?

A

-Perform in AP4
-Trace blood/tissue interface (endocardium)
-Start under TV annulus
-RA length done at center of area under the TV annulus to the superior RA wall
-RA length is perpendicular to TV annular plane

(currently the ASE recommended way to quantify RA volume)

41
Q

Why is the RA volume not a biplane measurement?

A

B/c we don’t have a verified second plane for the RA

(is technically more of an area than a volume)

42
Q

What is the RA volume abnormal cut off in men + women?

A

Women: > 33 mL/m^2
Men: >39 mL/m^2

43
Q

If we can not visualize a structure that well, should we still measure it to get some data?

A

No, no data is better than wrong data

44
Q

What does TAPSE stand for?

A

Tricuspid annular plane systolic excursion

45
Q

What does TAPSE assess?

A

Quantification of RV systolic function

(it is used in tandem with other measurements to create a complete clinical picture)

46
Q

In which view is TAPSE typically performed in?

A

AP4 usually, can be done in MOD AP4 depending on visibility + angulation to m-mode cursor

47
Q

Where is the m-mode cursor placed when doing TAPSE?

A

-Placed through the anterior TV annulus
-In line with the plane in which the annulus will move most PERPENDICULAR to the cursor throughout the cardiac cycle

48
Q

Which part of the TAPSE tracing is measured?

A

The brightest/most continuous line is measured

(via slope or inferior/superior length)

49
Q

Which part of the cardiac cycle is the TAPSE measurement done in?

A

-From end diastole to end systole
-Begins at R wave on ECG

50
Q

What is the TAPSE normal range?

A

> 1.7cm or 17mm

51
Q

In which view is the RVD1 + RVD2 measurements taken in? What part of the cardiac cycle?

A

MOD AP4 at end diastole

52
Q

Where is the RVD1/RVIDd measurement taken?

A

Basal 1/3 of the RV

(also called RV basal dimension)

53
Q

Where is the RVD2 measurement taken?

A

Middle 1/3 of the RV, at the level of the pap muscles

(also called RV mid dimension)

54
Q

Are the RVD1 + RVD2 measurements done inner to inner or outer to outer?

A

Inner to inner edge + parallel to TV annulus

55
Q

Does the RV apex need to be seen when doing RVD1 + RVD2 measurements?

A

Yes

56
Q

Do we do the RVD1 or RVD2 measurement in lab?

A

RVD1/RVIDd

57
Q

What is the normal range for RV chamber size in RVD1?

A

2.5 - 4.1 cm

(RVD1 = RV basal diameter)

58
Q

What is the normal range for RV chamber size in RVD2?

A

1.9 - 3.5 cm

(RVD2 = RV mid diameter)

59
Q

What does “FAC” stand for?

A

Fractional area change

(think RV systolic function)

60
Q

In which view is RV FAC obtained in?

A

MOD AP4 or AP4 view

61
Q

What information does RV FAC provide to us?

A

Provides an estimate of global RV systolic function (RV EF adjacent)

62
Q

In which part of the cardiac cycle is RV FAC done in?

A

Endocardial tracing measured at end diastole + end systole

63
Q

How do we trace the RV FAC?

A

From TV annulus along the RV free wall to the apex + back to the annulus along the IVS

64
Q

Is RV FAC or TAPSE a better assessment of RV global function?

A

FAC - provides greater detail

(TAPSE only measures RV function in a single dimension)

65
Q

What is the equation for RV FAC?

A

RV FAC (%) = 100(EDA-ESA)/EDA

66
Q

RV FAC reflects what 2 components of RV contraction?

A

Both longitudinal + radial components

67
Q

Should we include or exclude the trabeculations in the RV during a RV FAC?

A

Include them in our measurement (ignore them)

68
Q

What RV FAC % indicates RV systolic dysfunction?

A

RV FAC < 35%

69
Q

Why is it not possible to volumetrically quantify the RV the same way as the LV?

A

B/c we do not have a verified second view/plane

MIDS 197 (15 decks)

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