ECHO Flashcards
MV tenting area
A tenting area of 6 cm2 or more usually indicates grade 3 or higher mitral regurgitation
Simplified Bernoulli equation
Assessment of RVSP
Doppler calculation of AVA
Doppler calculation of MVA
MV mean gradient by Doppler
Grading of MS
FLOW RATE
STROKE DISTANCE
STROKE DISTANCE (TVI) = distance in cm blood travels with each stroke
STROKE VOLUME
calculation stroke volume
AVA by continuity
HYDRAULIC ORIFICE FORMULA
4 PRIMARY PARAMETERS OF
DIASTOLIC FUNCTION
1) E/A ratio
2) e’ velocity
3) PA systolic pressure
4) pulmonary vein velocities
“W” in RVOT velocity
a sign of pulmonary hypertension
LV remodeling parameters
Relative Wall Thickness
(2 * PWTd) / LVIDd
(2 x posterior wall thickness) / LV internal dimension
[in diastole]
patterns of remodeling
M-mode in pulmonary hypertension
M-mode Ebstein anomaly
M-mode dilated cardiomyopathy
Dimensionless index
<0.25 is bad
AVP EOA calculation
stroke volume / TVIAVP
Aortic valve PPM
Mitral valve PPM
AR quantification by JET WIDTH
AR quantification by JET AREA
AR quantification by VENA CONTRACTA size
AR quantification by color in aorta
AR quantification by REGURGITANT VOLUME
AR quantification by RFraction%
AR quantification by ERO cm2
DIASTOLOGY
MVA duration - PVa duration
>30 msec —-> LVEDP>15
DIASTOLOGY
Abnormal Valsalva - mitral inflow
DIASTOLOGY
Mitral annulus TDI “NORMAL”
DIASTOLOGY
Mitral annulus TDI “Grade 1”
DIASTOLOGY
Mitral annulus TDI “Grade 2”
DIASTOLOGY
Mitral annulus TDI “Grade 3”
DIASTOLOGY
Mitral inflow “Grade 3”
DIASTOLOGY
Mitral inflow “Grade 2”
DIASTOLOGY
Mitral inflow “Grade 1”
DIASTOLOGY
Mitral inflow “NORMAL”
mitral prolapse
SAM
MITRAL REGURGITATION
ERO CALCULATION
MR calculation by PISA
Normal gradient across TRICUSPID VALVE
<2 mm Hg
Gradient in severe tricuspid stenosis
> 7 mm Hg
TV area
190/PHT
dP/dt measurement
Pathognomonic M-mode sign of elevated LVEDP
B-bump
VELOCITY OF SOUND THROUGH SOFT TISSUE
1540 m/sec
WAVE EQUATION
velocity = frequency x wavelength
how long does it take for US to cover 1 cm (go-return time)?
13 microsec
4 components of Wilkins-Abascal score
1) valve mobility
2) subvalvular thickening
3) valve thickening
4) calcification
Graded 1-4 each; has to be <8
Depth of focus
(crystal diameter2) divided by wavelength multiplied by 4
Nyquist limit
PRF/2
dP/dT
Thus, dP/ dt is P1-P2 (32) divided by the time interval in seconds it takes for MR jet to go from 1 to 3 m/sec. A normal dP/ dt is more than 1000 mm Hg/ sec.
PAP estimation by TR jet
estimation of RAP by IVC
small <1.2 cm – spontaneous collapse – volume depletion
normal 1.7 cm – decrease by >50% – 0-5 mm Hg
dilated > 1.7 cm – decrease by >50% – 6-10 mm Hg
dilated > 1.7 cm – decrease by <50% – 10-15 mm Hg
dilated > 1.7 cm – no change – 15-20 mm Hg
fractional shortening
100 × (LV EDD − LV ESD)/ LV EDD
abnormal TAPSE
< 2 cm
LV inflow measurements
LA inflow
E/E’
A ratio of the transmitral E velocity to the tissue Doppler E′ velocity greater than 15 predicts an LV end-diastolic pressure more than 15 mm Hg.
IVRT
The IVRT (normal 50-100 ms) is prolonged with impaired relaxation but is shortened with severe diastolic dysfunction and impaired compliance.
Diastology - normal E deceleration time
150 - 200 msec
Diastology
calculation of MV gradient
to calculate the velocity on the curve where the gradient is 1/2 the maximum gradient…….
maximum velocity is divided by 1.4
Carpentier classification of MR
PISA calculation
PISA surface area x Valiasing
ERO = ———————————————–
VmaxMR
Acceleration time cutoff for PPM
> 100 msec
Causes of diastolic MR
- 1st degree AVB
- diminished LV systolic function
