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Echo > Comprehensive Transthoracic Echocardiogram TTE > Flashcards

Comprehensive Transthoracic Echocardiogram TTE Flashcards

Using ASE Guidelines and DeWitt Echocardiography

1
Q

According to ASE Guidelines list 2 parameters for measuring the IVS and posterior wall in the parasternal long axis view.

A

-At End diastole or peak R wave,
-largest volume,
-interface of compacted myocardium excluding other inserting structures, -just below MV leaflet tips, same time
-level of LVED dimension, only compacted tissue measured.

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2
Q

How does one determine which pulmonic valve cusp is the right posterior cusp in the RVOT view?

A

The right posterior cusp of the PV is easily identified because it is the cusp adjacent to the aortic valve.

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3
Q

Define Perpendicular

A

a 90° angle or T

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4
Q

Identify which image a sonographer uses to estimate the right atrial pressure. Then explain what finding would indicate a right atrial pressure of 8mmHg.

A

Using the subcostal view the sonographer would assess the IVC. There are two parameters: IVC size and IVC collapsibility.
If one of these is abnormal and the other is normal, the RAP is estimated at 8mmHg.

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5
Q

Describe the method to measure the pulmonary artery from the parasternal short axis view.

A

Midway between the PV and the PA bifurcation using and inner edge to inner edge technique at end diastole.

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6
Q

When measuring the left ventricular posterior wall care must me made to not include which structure and why?

A

The MV apparatus including chordae tendinae and papillary muscle.

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7
Q

Describe the method for measuring leading-edge to leading-edge.

A

The measurement begins at the first depth where the structure is seen and continue until the last depth the structure is seen.

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8
Q

In the parasternal long axis view, the __________ is located within the myocardium, while the __________ is posterior to the left atrium and a separate structure.

A

coronary sinus, descending AO

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9
Q

The posterior mitral valve leaflet is shaded in which color?

A

yellow

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10
Q

Define Compacted Myocardium.

A

The border between the anechoic blood filled chamber and the myocardium once it is dense, excluding any trabeculations.

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11
Q

In the PSAX view at the base, what chamber is the most anterior visualized?

A

RV

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12
Q

At what point in the cardiac cycle should the aorta be measure?

A

End Diastole

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13
Q

In the right ventricular inflow view, the _________ lies between the coronary sinus and the inferior vena cava.

A

eustachian valve

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14
Q

The left coronary cusp is outlined in what color?

A

Purple

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15
Q

Which measurement is made using inner-edge to inner-edge technique in the PLAX window?

A

LVOT, Annulus

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16
Q

Describe laminar flow patters

A

smooth, organized with parabolic velocity profile (slower flow near walls, faster in the center)

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17
Q

Describe turbulent flow

A

irregular, chaotic with irregular velocities due to the disordered movement, random directions

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18
Q

What view is the RV basal diameter in (for measuring purposes)?

A

Apical RV focus

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19
Q

how do you measure the RV basal diameter in Apical RV focused view?

A

end diastole, near TV annulus, compacted myocardium to compacted myocardium from septal wall to lateral wall of the RV

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20
Q

What is the normal measurement for the RV basal diameter in women?

A

3.98cm (greater than that is dilated)

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21
Q

What view is the IVS (for measuring purposes)?

A

PLAX LV focus view

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22
Q

How do you measure the IVS in PLAX?

A

end diastole, leading edge to leading edge, at the interface where the RV cavity meets compacted IVS & where the IVS meets the LV cavity

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23
Q

What is the normal measurement for the IVS in women?

A

6-9mm

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24
Q

In what view is the LVID (left ventricular internal dimension) for measuring purposes?

A

PLAX

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25
Q

How do you measure the LVID (left ventricular internal dimension) in PLAX?

A

end diastole & end systole, leading edge to leading edge, compacted myocardium of the IVS to the compacted myocardium of the posterior wall, just below the MV leaflets

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26
Q

What is the normal measurement for the LVID in women? (end diastole)

A

LVIDd 38-52mm

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27
Q

What is the normal measurement for the LVID in women? (end systole)

A

LVIDs 22-35mm

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28
Q

In what view is the LVPW? (left ventricle posterior wall) for measuring purposes?

A

PLAX

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29
Q

How do you measure the LVPW in PLAX?

A

end diastole, leading edge to leading edge, compacted posterior wall of the LV cavity to the LVPW to the pericardial interface

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30
Q

What is the normal measurement of the LVPW in women?

A

27-38mm

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31
Q

In what view is the LVOT (for measuring purposes)?

A

PLAX zoomed/LVOT focused

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32
Q

How do you measure the LVOT in PLAX?

A

mid-systole, inner to inner, approx. 3-10mm from valve, compacted myocardium VS to anterior MV leaflet

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33
Q

What is the normal measurement for the LVOT in women?

A

18-22mm

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34
Q

In what view is the AO root (for measuring purposes)?

A

PLAX zoomed LVOT focused

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35
Q

How do you measure the AO root in PLAX?

A

mid-systole, inner to inner, right coronary & non coronary leaflet insertion points at maximal opening of the valve.

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36
Q

What is the normal measurement of the AO root in women?

A

23 +- 2mm

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37
Q

In what view is the ascending aorta (for measuring purposes)?

A

PLAX

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38
Q
A

ignore

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39
Q

In what view is the LA (for measuring purposes?)

A

PLAX

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40
Q

How do you measure the LA in PLAX?

A

end diastole, leading edge to leading edge, at the level of the SoVA of AO root to PW

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41
Q

What is the normal measurement of the LA in women?

A

27-38mm

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42
Q

In what view is the ascending AO (for measuring purposes)?

A

PLAX

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43
Q

How do you measure the ascending AO in PLAX?

A

end diastole, leading edge to leading edge, at the largest dimension above the AO sinus

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44
Q

What is the normal measurement of the ascending AO in women?

A

27 +- 4mm

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45
Q

What are the 3 equations for stroke volume (SV)?

A

1) SV = EDV-ESV
2) SV (cm ^3) = VTI (cm) x CSA (cm^2)
3) SV (mL) = Pi r ^2 (cm^2) x VTI (cm)

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46
Q

Define stroke volume (SV)

A

The volume of blood ejected by the LV during each contraction

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47
Q

What are some clinical applications in which you would use an equation for SV?

A

-valvular regurgitation
-post physiologic/pharmacologic interventions
-pulmonary to systemic blood flow for patients w/ intracardiac shunts
-cardiac function
-cardiac output
-LV function & volume
-valvular disease

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48
Q

Define the Velocity Pressure Relationship - Simplified Bernoulli Equation

A

Describes the relationship between the velocity of blood flow & the pressure gradient across a stenotic or regurgitant valve. An increase in velocity of a fluid results in a decrease in pressure.

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49
Q

What are some clinical applications for the velocity pressure relationship - simplified Bernoulli Equation?

A

-valvular stenosis
-valvular regurgitation
-artery pressures (pulmonary)
-septal defect

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50
Q

What is the Pressure Relationship - Simplified Bernoulli Equation?

A

ΔP = 4v²
ΔP = 1/2ρv² where ΔP is the pressure difference, ρ is the fluid density, and v is the velocity difference between two points in the flow

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51
Q

Define Preload

A

AKA end-diastolic pressure, the degree of stretch the ventricular myocytes stretch at the end of diastole.

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52
Q

What are some circumstances that influence Preload?

A

-venous return
-diastolic dysfunction
-mitral stenosis
-Anything that prevents blood from easily filling the ventricle.

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53
Q

Define Afterload

A

the resistance the heart must pump against in order to eject blood out of the ventricles

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54
Q

What are some circumstances that influence Afterload?

A

-valve hypertension
-valve stenosis

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55
Q

Using a PW Doppler to measure the flow area of the LVOT what view do I need to be in?

A

A4C or A5C

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56
Q

What normal flow pattern is this and in what view?

A

the flow pattern of a normal LVOT in A5C

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57
Q

What is the normal velocity range for the LVOT in A5C for a PW measurement?

A

0.7 - 1.1m/s

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58
Q

Using a PW Doppler to measure the flow area of the ascending AO forward flow through the AO valve, what view do I need to be in?

A

SSN through LV Apex

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59
Q

What normal flow pattern is this and in what view?

A

the ascending AO forward flow through the AOV, SSN-LV Apex view

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60
Q

What is the normal velocity range for the ascending AO forward flow through the AOV for a PW measurement?

A

(less than) < 2m/s

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61
Q

Using a PW Doppler to measure the flow area of the descending AO Thoracic, what view do I need to be in?

A

SSN, Subcostal

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62
Q

What normal flow pattern is this and in what view?

A

descending AO Thoracic, SSN/Subcostal

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63
Q

What is the normal velocity range for the descending AO Thoracic for a PW measurement?

A

100-140cm/sec

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64
Q

Using a PW Doppler to measure the flow area of the descending AO proximal abdominal, what view do I need to be in?

A

SSN/subcostal

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65
Q

What normal flow pattern is this and in what view?

A

descending AO proximal abdominal
SSN/subcostal

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66
Q

What is the normal velocity range for the descending AO proximal abdominal for a PW measurement?

A

60 - 100cm/sec

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67
Q

Using a PW Doppler to measure the flow area of the LV Inflow (mitral) what view do I need to be in?

A

A3C, A4C, APICAL LAX

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68
Q

What normal flow pattern is this and in what view?

A

LV inflow (mitral), A4C

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69
Q

What’s the E Wave characteristics for LV Inflow of the A4C view?

A

-early diastole
-passive filling of the LV
-usually 1cm/sec

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70
Q

What’s the A Wave characteristics for LV Inflow of the A4C view?

A

-flow from atrial contraction
-varies by many conditions

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71
Q

Using a PW Doppler to measure the flow area of the RVOT & what view do I need to be in?

A

PLAX, PSAX (AV level), SUB Short-Axis

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72
Q

What normal flow pattern is this and in what view?

A

RVOT, PSAX

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73
Q

What is the normal velocity range for the RVOT for a PW measurement?

A

0.5 - 1.3m/s

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74
Q

Using a PW Doppler to measure the flow area of the RVIT Tricuspid TV Inflow & TV regurgitation what view do I need to be in?

A

A3C

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75
Q

What normal flow pattern is this and in what view?

A

RVIT Tricuspid TV Inflow & TV regurgitation, A3C

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76
Q

What is the normal velocity range for the RVIT Tricuspid TV Inflow & TV regurgitation for a PW measurement?

A

0.3 - 0.7m/s

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77
Q

Using a PW Doppler to measure the flow area of the LA Inflow Pulmonary Valve, what view do I need to be in?

A

A4C

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78
Q

What normal flow pattern is this and in what view?

A

LA Inflow Pulmonary Valve, A4C

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79
Q

What is the normal velocity range for the LA Inflow Pulmonary Valve for a PW measurement?

A

0.5m/s

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80
Q

Using a PW Doppler to measure the flow area of the RA Inflow (Hepatic veins) what view do I need to be in?

A

SSN/Subcostal

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81
Q

What normal flow pattern is this and in what view?

A

RA Inflow (Hepatic veins), Subcostal

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82
Q

What is the key factor to obtain accurate color flow doppler and spectral doppler?

A

Making sure your angle is 0 degrees/ parallel to flow

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83
Q

What is the appropriate color Nyquist limit setting for Adult Echos?

A

60cm/sec

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84
Q

What is the appropriate sweep speed setting for measuring elements of time on the spectral doppler graph?

A

100mm/sec

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85
Q

What normal flow pattern is this and in what view?

A

RVOT, PSAX

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86
Q

List some RV characteristics

A

-thin
-most arteries chamber
-moderator band
-complex crescent shape

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87
Q

What is the wall thickness of the RV?

A

1-5mm

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88
Q

When do you measure RVOT?

A

end-diastole

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89
Q

When do you measure the IVS?

A

end-diastole

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90
Q

Which valve has an E & A wave?

A

Mitral

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91
Q

When does the E & A wave happen?

A

during systole

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92
Q

What vessel has an S,D, & A Wave?

A

Pulmonary valve

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93
Q

What is the P Wave?

A

the atrial kick

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94
Q

What 2 structures have similar flow?

A

Pulmonary valve & IVC

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95
Q

Why is the tricuspid the biggest?

A

because it works at lower pressure

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96
Q

Which valve is the biggest?

A

Tricuspid

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97
Q

What 3 things drain into the RA?

A

-coronary sinus
-IVC
-SVC

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98
Q

What 4 things drain into the LA?

A

-right 7 left pulmonary valves
-Superior & inferior pulmonary valves

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99
Q

What is an indication that the IVC is dilated?

A

RA pressure is too high

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100
Q

What does ET mean and when does it happen?

A

ejection time, during systole

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101
Q

When do you measure the AO diameter?

A

end-diastole

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102
Q

When in A2C what do you NOT want to see?

A

the RV

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103
Q

How do you get to A2C?

A

90 degrees from A4C then turn another 30 degrees

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104
Q

What does the arrow reveal?

A

Moderator band

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105
Q

What does the arrow reveal?

A

LV false tendon

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106
Q

In the PLAX LV what 12 things do we document?

A

-RV wall
-RVOT prox
-IVS
-LVIDd
-LVIDs
-PWT
-LA
-LVOT
-AOV annulus
-SoVa
-Sinotubular junction
-Prox. AAO

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107
Q

What 8 structures in the PLAX LV do we measure at End-diastole?

A

-RV wall
-RVOT prox
-IVS
-LVIDd
-PWT
-SoVa
-Sinotubular Junction
-Prox. AAO

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108
Q

What 2 structures in the PLAX LV do we measure at End-systole?

A

-LVIDs
-LA

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109
Q

What 2 structures in the PLAX LV do we measure mid-systole?

A

-LVOT
-AOV annulus

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110
Q

What is LVEF?

A

a measurement of how much blood is pumped out of the LV chamber per contraction or heartbeat

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111
Q

What is FS?

A

a % of the LV size reduction from diastole to systole as measure from the basal segments via M-mode or 2D linear measurements

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112
Q

What is the best method of measurement to acquire the LV volume and LVEF?

A

2D biplane method of disk summation

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113
Q

Describe the RV

A

-thin
-squeezes concentrically during systole
-smaller
-more trabeculated
-complex crescent (triangular) shape

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114
Q

What is the most anterior chamber?

A

The RV

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115
Q

What is the RVOT prox normal range?

A

20 - 30mm

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116
Q

RVOT can be measure in what 2 planes?

A

PLAX & PSAX base

117
Q

What 2 structures are 1:1 ratio in thickness?

A

the IVS & LVPW

118
Q

What 2 structures are thicker than the RV wall?

A

the IVS & LVPW

119
Q

When do you acquire the IVS dimension in PLAX?

A

end-diastole

120
Q

When do you acquire the PWT (posterior wall thickness) in PLAX?

A

end-diastole

121
Q

what is the normal range in both male and female for the IVS & PWT?

A

females: 6 - 9mm
males: 6 - 10mm

122
Q

What is the largest chamber?

A

the LV

123
Q

Where is the LV located?

A

posterior and lateral to the RV

124
Q

Describe the LV

A

-longer than RV
-less trabeculated than RV
-may possess false tendon
-ellipsoid in shape

125
Q

What are the normal ranges for LV dimensions for end-diastole?

A

females: 38 - 52mm
males: 42 - 58mm

126
Q

What are the normal ranges for the LV dimensions for end-systole?

A

females: 22 - 35mm
males: 25 - 40mm

127
Q

What does the LVOT do?

A

allows laminar flow from the LV out to the aorta

128
Q

What is the normal range for the LVOT diameter?

A

18 - 22mm

129
Q

How far do you measure the LVOT from the aortic orifice?

A

5 - 10mm

130
Q

Where do you measure the LVOT?

A

inner edge to inner edge of the septal endocardium to the inner edge of the anterior mitral valve leaflet, proximal and parallel to the plane of the AOV

131
Q

What is the AMVL (anterior mitral valve leaflet) part of?

A

it is continuous with the posterior wall oof the aorta

132
Q

Which is more liable with an unrestricted opening? The AMVL or the PMVL?

A

AMVL

133
Q

Does the MV prolapse beyond the annular place into the LA?

A

no

134
Q

What is the most posterior chamber?

A

the LA

135
Q

Which chamber is the reservoir that receives pulmonary Venus return?

A

the LA

136
Q

Which chamber is a contractile pump?

A

the LA

137
Q

Is the LA gender dependent?

A

yes

138
Q

In PLAX when do you acquire the LA linear dimension?

A

end-systole

139
Q

Where do you acquire the LA linear dimensions? (how do you measure)

A

perpendicular to the AO root, at the level of the AO sinuses using the leading edge to leading edge technique

140
Q

Does the PLAX provide the most accurate assessment of the LA size?

A

no

141
Q

What’s another method that could be used to assess the LA size?

A

LAVi (LA volume index)

142
Q

What 2 structures can be seen within the myocardium of the SAX view?

A

the coronary sinus & DAO

143
Q

Where is the CS and DAO located in the SAX view?

A

posterior to the left atrioventricular junction (LA-LV junction)

144
Q

When does the CS diameter narrow?

A

during atrial contraction

145
Q

In what other planes can the CS be visualized?

A

the A4C & A2C

146
Q

What is the arrow pointing to?

A

AMVL continuity

147
Q

In the PLAX plane what 2 AO cusps are visualized?

A

the RCC & NCC

148
Q

Which AO cusp is not visualized in the PLAX view?

A

the LCC

149
Q

Are the LVOT and AOV annulus systolic or diastolic measurements?

A

systolic

150
Q

Do you acquire the AOV annulus during end diastole?

A

no

151
Q

Which technique do you use to measure the AOV annulus diameter in PLAX?

A

Inner edge to inner edge

152
Q

Which technique do you use to measure the SoVa, Sinotubular junction & Prox. AAO?

A

leading edge to leading edge

153
Q

When do you measure the SoVa, Sinotubular junction & Prox. AAO?

A

end-diastole

154
Q

Where do you point the beam to get the LAX RVIT?

A

inferior

155
Q

Where are the anterior and posterior tricuspid valves?

A

between RA & RV

156
Q

Which TV leaflet is not visualized in the PLAX view of the RVIT?

A

the medial/septal TV

157
Q

What is a normal embryonic remnant located at the junction of the IVC and RA?

A

the eustachian valve

158
Q

What network is a normal embryonic remnant that originates from either the eustachian valve or the basin valve and may extend too the fossa ovalis?

A

the Chiari network

159
Q

Is it normal to have a trace to mild TR?

A

yes

160
Q

Where do you place the gate to acquire TV inflow with the PWD?

A

between the tips of the TV leaflets in the RVIT

161
Q

Which wave form is this? is it PW or CW?

A

TV Inflow, PW

162
Q

Which wave form is this? is it PW or CW?

A

TV & Peak TRV, CW

163
Q

What is used to estimate the RVSP (right ventricular systolic pressure?) & the degree of PH (pulmonary hypertension)?

A

the peak TRV (TR velocity) & mean RA pressure (RAP)

164
Q

What = SPAP (systolic pulmonary artery pressure)?

A

RVSP (right ventricular systolic pressure)

165
Q

What is RVSP dependent on?

A

-age
-weight
-stroke vol.
-BP

166
Q

How do you calculate the RV-RA PG?

A

using the Bernoulli equation 4V^2 (where V) = peak TRV

167
Q

What does the RAP equal to in patients with a central venous line?

A

central venous pressure (CVP)

168
Q

What method is used when an increased RAP leads to a dilated IVC w/ diminished inspiratory collapse?

A

3/8/15 method

169
Q

What is a normal IVC & collapse % upon inspiration/sniff test?

A

IVC < 2.1cm & collapses > 50% upon inspiration/sniff test

170
Q

What is considered a normal RVSP for the PH scale?

A

18 - 25mmHg

171
Q

Where do you aim the beam to get the LAX RVOT?

A

Superior & lateral (toward patient’s L shoulder)

172
Q

How would you describe the ROVT anterior wall?

A

thin

173
Q

What’s another name for the conus arteriosus?

A

Infundibulum

174
Q

How would you describe the infundibulum?

A

-smooth-walled
-no trabeculations
-funnel shaped

175
Q

Where is the infundibulum located?

A

part of the RVOT at the entrance of the pulmonary trunk

176
Q

How would you describe the PV cusps?

A

thin, delicate, pliable

177
Q

Which PV cusp is not visualized from the LAX view of the RVOT?

A

the anterior PV cusp

178
Q

Which is smaller the AO for the PA?

A

PA

179
Q

Where does the main Pulmonary Artery splits? and into what?

A

at the PA bifurcation into the R & L PA

180
Q

Where do you measure to diameter of the PA in the LAX view?

A

midway between the PV & PA bifurcation

181
Q

What is this M-mode showing?

A

PV

182
Q

When doing an M-mode of the PV does it show 1 or 2 cusps?

A

1

183
Q

What does this show?

A

a normal PV a-wave

184
Q

What does this show?

A

Absent PV a-wave & flying W which means PH

185
Q

What does the arrow show?

A

LA Appendage

186
Q

What plane and is it diastole or systole?

A

PSAX, systole

187
Q

Label including the *

A
  1. Anteritor TV leaflet
  2. Medial TV leaflet
  3. AOV RCC
  4. AOV LCC
  5. AOV NCC
  6. Right posterior PV cusp
  7. Anterior PV cusp
    * NCC is always adjacent to the IAS
188
Q

When do you acquire BOTH the proximal and distal RVOT diameter?

A

end-diastole

189
Q

What does this show and in what plane?

A

PSAX, Trileaflet AOV

190
Q

Where does the IAS normally bow toward?

A

the RA

191
Q

Why does the IAS bow toward the RA?

A

because the LAP (pressure) is slightly greater than the RAP

192
Q

How do you acquire the SAX Basal/MV view?

A

angling the transducer more lateral/inferior towards the apex from the SAX base

193
Q

What waveform is this and is it PW or CW?

A

PV & PR, CW

194
Q

What Color Doppler is this of?

A

RVOT

195
Q

What color doppler is this of?

A

RVIT

196
Q

What color doppler is this of?

A

AOV

197
Q

What does this show? In what view? Systole or Diastole?

A

MV leaflets, PSAX basal/MV view, systole

198
Q

What does this show? In what plane? Systole or Diastole?

A

MV leaflets, PSAX basal/MV view, diastole

199
Q

Label

A
  1. Anterior MV leaflet
  2. Posterior MV leaflet
  3. Basal Anteroseptal wall
  4. Basal Anterior wall
  5. Basal anterolateral wall
  6. Basal inferolateral wall
  7. Basal inferior wall
  8. Basal inferoseptal wall
200
Q

What does this show? In what plane? Systole or Diastole?

A

PM, PSAX, mid systole

201
Q

What does this show? In what plane?

A

Apex, PSAX

202
Q

What is SALI an acronym for?

A

the LV walls
Septal
Anterior
Lateral
Inferior

203
Q

Label

A
  1. anterior TV leaflet
  2. medial TV leaflet
  3. anterior MV leaflet
  4. posterior MV leaflet
  5. basal inferoseptal wall
  6. mid inferoseptal wall
  7. apical septal wall
  8. apical cap
  9. apical lateral wall
  10. mid anterolateral wall
  11. basal anterolateral wall
  12. IAS
  13. MV
  14. TV
  15. PV4
  16. IVS
204
Q

Label

A
  1. basal inferior wall
  2. mid inferior wall
  3. apical inferior wall
  4. apical cap
  5. apical anterior wall
  6. mid anterior wall
  7. basal anterior wall
  8. LAA
  9. PV4
  10. DAO
205
Q

what does TAPSE stand for?

A

Tricuspid
Annular
Plane
Systolic
Excursion

206
Q

What does TAPSE provide?

A

a simple but good estimate of global RV systolic function

207
Q

How does TAPSE measure?

A

measures the longitudinal systolic performance of the RV wall.

208
Q

Is TAPSE angle dependent?

A

yes

209
Q

What does this M-mode depict?

A

TAPSE

210
Q

Where do you put the cursor to acquire TAPSE?

A

through the RV & RA through the lateral TV annulus, the cursor should be perpendicular to the annulus and parallel to the movement

211
Q

What do you measure TAPSE on the M-mode image?

A

the peak systolic longitudinal motion of the TV annular motion from end diastole to end systole

212
Q

What is different about the RV compared to the LV?

A

-RV chamber is no more than 2/3s the size of the LV
-has more trabeculations
-has a moderator band

213
Q

What does this image show and in what window?

A

prominent moderator band, A4C

214
Q

Do you need to compare RV size with LV size? if so, when?

A

yes, always

215
Q

What does this image show? what window?

A

RV linear dimensions:
basal (blue)
mid (red)
longitudinal (yellow)
A4C RV focused

216
Q

What is the normal range for the RAV (RA volume)?

A

females: 21 +- 6mL/m^2
males: 25 +- 7mL/m^2

217
Q

When do you measure the RA single plane?

A

end-systole

218
Q

What is the normal range for the RA area for single plane?

A

< 18cm^2

219
Q

What does this image show?

A

Single-plane RAV-RA area (red) Major (yellow)

220
Q

What does this image show?

A

RA area (red) major (yellow) minor (blue)

221
Q

What is this equation and what is it used for?

A

single plane volume, ONLY for RA

222
Q

What is the arrow showing?

A

ICD wire in RA

223
Q

What is the arrow pointing at?

A

dilated CS

224
Q

What does the LV form?

A

the apex

225
Q

What is the Biplane Method of Disk?

A

measures the LVEF. provides an estimate of the LV volume through a process of dividing the cavity into multiple disks with equal height.

226
Q

What is the number of disks determined (in the biplane method of disks)?

A

determined by the length of the cavity and the disk volumes

227
Q

What are the disk volumes determined by (in the biplane method of disks)?

A

determined by the length and width of each disk

228
Q

What does this image depict?

A

biplane method of disks

229
Q

What does the blue and red depict?

A

EDV & ESV (blue) LV length (red)

230
Q

Where do you acquire the LV dimensions for the biplane method of disks?

A

the calipers placed at the interface between the compacted (solid, homogenous wall separate from the trabeculated) and noncompacted myocardium

231
Q

What is the equation for the LAVi (LA volume index)

A

LAVi = LAV/BSA

232
Q

What is the equation for the LVEF%?

A

LVEF% = (EDV - ESV) / EDV x 100

233
Q

What does this image show? is it PW or CW?

A

MV Inflow, PW

234
Q

What does this image show? What kind of Doppler?

A

MV Annulus, Tissue Doppler Imaging (TDI)

235
Q

What does this image show? is it PW or CW?

A

PV4, PW

236
Q

What does this image show? Diastole or Systole? End?

A

A5C, end-systole

237
Q

What does this image show? What window?

A

Zoom AOV & LVOT, A5C

238
Q

When should you calculate peak velocity, mean PG, and AOV area (AVA)? (hint* A5C)

A

-suspected of AO stenosis
-if patient has undergone an AOV repair/replacement w/ a prosthetic valve

239
Q

What is the normal range of the LVOT in the A5C?

A

0.8 - 1m/s

240
Q

If LVOT peak velocity is > 2m/s what does this indicate?

A

LVOTO

241
Q

If LVOTO is present what do you need to switch PW to and acquire?

A

CW and acquire the peak velocity and PG

242
Q

What does this image show? What window?

A

LA, MV, LV, LVOT, AOV in A5C

243
Q

What does this image show? What window?

A

Focus AOV & IVRT, A5C

244
Q

What does this image show? PW or CW?

A

AOV, CW

245
Q

What does this image show? PW or CW?

A

IVRT, CW

246
Q

What does this image show? PW or CW?

A

AR & AS, CW

247
Q

What does this image show? What window?

A

Gate LVOT, A5C

248
Q

What does this image show? PW or CW?

A

LVOT, PW

249
Q

What does this image show? PW or CW?

A

LVOTO, CW

250
Q

What does the LAA act as?

A

a decompression chamber

251
Q

What does the LAA decompression chamber do?

A

helps decrease LAP whenever elevated or during normal LV systole

252
Q

What does this image depict? In what window? systole or diastole?

A

A2C, systole

253
Q

What is the arrow showing, what window?

A

LAA & PV4 in A2C

254
Q

What does this image show? What window?

A

DAO, A2C

255
Q

How do you get to A2C?

A

rotate transducer ~60 - 90 degrees counter clockwise from the A4C

256
Q

How do you get to A3C?

A

rotate transducer ~30 - 60 degrees counter clockwise from A2C

257
Q

What’s another name for the A3C?

A

Apical LAX

258
Q

What does this image show? What window? diastole or systole?

A

LA, MV, LV, LVOT, AOV, AO root, A3C, systole

259
Q

What does this image show? What window?

A

LA, MV, LV, LVOT, AOV, AO root, A3C

260
Q

Label

A
  1. basal inferolateral wall
  2. mid inferolateral wall
  3. apical lateral wall
  4. apical cap
  5. apical septal wall
  6. mid anteroseptal wall
  7. basal anteroseotal wall
261
Q

Which direction do you angle the beam to get A3C RVIT?

A

medial and inferior from the A3C

262
Q

What is the A3C useful for the RVIT?

A

it yields the optimal doppler angle and absolute peak TRV for the RVSP calculation

263
Q

What does this image depict? In what window?

A

A3C, OFF-AXIS

264
Q

What does this image depict? In what window?

A

RVIT, A3C

265
Q

What does this image depict? In what window?

A

TR, A3C

266
Q

What does this image show? PW or CW? from what window?

A

TV & PEAK TRV, A3C, CW

267
Q

Why are subcostal views vital to the pediatric and adult echos exam?

A

because they provide visualization anterior and posterior to the heart and lay out the relationship between the heart and surrounding structures

268
Q

What does this image depict? In what window?

A

RV wall thickness, SUB 4C

269
Q

What does this image depict? In what window?

A

RV, Sub 4C

270
Q

What does this image depict? In what window?

A

lipomatous hypertrophy of the IAS (LHIS)

271
Q

What does the arrow show? In what window?

A

Chiari network, sub 4c

272
Q

lipomatous hypertrophy of the IAS (LHIS)?

A

a fatty infiltration of the IAS sparring the fossa ovalis giving it s dumb-bell shape

273
Q

How do you get to a Sub SAX Window?

A

rotate transducer ~60 - 90 counter clockwise from the SUB 4C

274
Q

What’s another name for Sub SAX?

A

Subcostal short axis

275
Q

What views from the SUB SAX are similar to the left PSAX?

A
  • the base
  • MV
  • LV
276
Q

What window is occasionally the only window with quality images particularly with patients with Chronic Obstructive Pulmonary Disease? (COPD)

A

SUB SAX

277
Q

What angle does the transducer need to go in order to get the subcostal inferior vena cava?

A

more medial from the SUB SAX BASE

278
Q

In addition to the IVC who other structures can be seen from the SUB IVC view?

A

liver
hepatic vein
SVC
RVIT

279
Q

What view would I use to check the hepatic vein for dilation?

A

SUB IVC

280
Q

What does the “sniff test” do?

A

helps visualize the collapse of the IVC by estimating the mean RAP

281
Q

What structure should be acquired always but especially those with abdominal pain?

A

the DAO

282
Q

What does the DAO need to be evaluated?

A

to see if there is any indication of AO dissectioon

283
Q

What should the general diameter of the DAO be?

A

< 3cm

284
Q

What structures can be view in the SUPRA LAX window?

A

-AAO
-AO arch with branches
-thoracic DAO

285
Q

What is the normal velocity of the AAO?

A

< 2m/s

286
Q

What is the normal velocity of the thoracic DAO?

A

< 2m/s

287
Q

What structures can be seen in the SUPRA SAX window?

A

-AO arch
-RPA
-SVC
-L/R innominate vein
-PV4

288
Q
A

Echo (8 decks)

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