Echo Flashcards
Normal LV dimensions
40/60-2
35/50+2
Normal LA size in Plax and A4C
4and 5.2
PAH formulas for Mean PAP
- 79-(0.45xAcclrn time)
- 4V2 PEAK PR+ RAP
- VTI of TR jet +RAP
- 90- 0.62 x Acclrn time
- Mean = 2/3 PADP+1/3 PASP
- 0.61 x PASP +2
Rough estimate-80-(0.5xAT)
In acute MR echo precaution..
Can have misleadingly small central jets
Venae contracta width reflects the
ROA
How to look for VCW
PLAX or A4C:: (40-70 cm/s-Nyquist limit)
For PISA 15-40
How to do PISA
- A4C view
- 15-40 cm/s - Nyquist limit
- Midsystole
- Find PISA radius
- Now measure MR VTI
- Machine will give EROA;
Later calculate Regurgitant Vol somehow 😬😬
EROA-most robust parameter
PASP from TR jet probability of PAH
Upto 2.8 m/s -Low probability
- 5m/s or more-High probability
- 9 -3.4 - intermediate probability
Gradient values corresponding is 31 (2.8)and 49 (3.5)without RAP
In Afib how many beats are to be taken to get average RVSP
8 beats
In presence of RVOT obstruction or PS how can u use TR jet to assess PASP?
Minus the RVOT gradient from the TR gradient
ie TR gradient - RVOT gradient
Faster the heart rate –—–the frame rate for assessing Regurgitant jets
Higher
Min frame rate required is 20
Doppler sweep speed for assessing PR/TR jets
100 mm/s
RVOT acclrn time and PAH
> 130 ms is normal
<100 highly suggestive of PAH
CAN calculate MEAN pressure from AT
In ebsteins the displacement index is
More than8 mm/m2 ie per BSA
How to demonstrate LEFT SVC in TTE
Agitated saline injection through LEFT antecubital vein
Severe biatrial enlargement is seen in RCM or CP?
In RCM
In CP Bi atrial enlargement is moderate
Type of delivery preferred in Pregnancy and heart disease
Vaginal delivery:Minimise Valsalva-ie “Cardiac delivery “
Velocity of PW at Pulmonary valve level
0.8-1.2 m/s
Normal PV acceleration time
More than 130 ms
PV Acceleration time of —- indicates severe PAH
Less than 80 ms
Grading of PAH by PASP
Mild >40
Moderate >50
Severe > 60
From 1,2,3 sonography
Familial RCMP is a different phenotypic expression of
Familial HCM 😳
Deceleration time in Gd3DD
Less than 140 ms
Echo clues of Sarcoidosis
1.BASAL LV abnormalities- RWMA in basal post, lat segments
LV aneurysms mostly basal
- Septal thinning; Hyperechoic septum
- May resemble HCM
- RV dilatation, hypokinesis
Initial test for Primary Aldosteronism
PAC/PRA ratio
A condition where there is dissociation between Short and long axis systolic function
Amyloid cardiomyopathy
Do strain rate imaging
Long axis dysfunction is far greater than in HCM, Aortic stenosis etc
Severe impairment of basal strain with preserved Apical strain is typical of Amyloidosis
Sparkling myocardium is seen in —% of Amyloid cardiomyopathy
30% only
Specificity only 75%
Atrial septal thickening is a feature of Amyloidosis- addln point
Paradoxical septal motion means
SYSTOLIC movt of IVS towards RV
Paradoxical septal motion and PR
Simple sign of SEVERE PR
PHT of ____ms indicates significant PR
< 100 ms
From a PPT
In A4C AML is located near
SEPTUM
PML is located at the lateral annulus
ASS-Anterior leaflet near Septum-ASs
Normal thickness of Mitral valve
4-5 mm
Score of 2 in Wilkins score means
Only upto 1/3 rd is involved
M- mid and base moves well ; distal 1/3 rd affected
S- upto 1/3 rd of chordae involved
C- upto 1/3rd of leaflet. If it extends to mid it becomes next grade
T- upto 1/3 rd is thickened.
No 0 score in Wilkins. Min score is 4
Score 3 of Wilkins is
Involvement of middle 1/3 rd or more M- mid doesn't move S- mid and more C- mid and more T- is different, entire valve 5-8 mm
Score 4 is entire valve involved
Score 1 is near normal
Score 2 is upto 1/3 involved
RA finding in tamponade
RA Systolic collapse more than 1/3 rd of Systole . Collapse starts in End diastole
Highly sensitive and specific
Transient RA collapse can occur without tamponade
RV collapse starts in early diastole
Doppler finding in tamponade
> 25% variation in Mitral E velocity
An inspiratory reduction of at least 25%
Collapse in Cardiac tamponade
Late diastolic RA &
Early diastolic RV
Hepatic vein Doppler in Constriction and Restriction
Constriction- Expiratory diastolic flow reversal
Restriction - Inspiratory diastolic flow reversal
Normal respiratory variation in tricuspid,Mitral inflows and Pulmonary, Aortic outflows
Tricuspid-25% or less
Mitral-15% or less
Aortic and Pulmonary-10% or less
The diastolic collapse of RA/RV free walls is more during
Expiration
Fluid required for Pericardial effusion to be evident on CXR
400-500 ml
Tricuspid annular systolic motion velocity < …….is abnormal
10cm/s
PSAX- RCA is seen at ——-position and LCx at ———/
RCA -11 O clock in 45% - rest nearby
LCA- 4 O clock in around 45% -rest nearby.
So roughly 11 and 4
Nagueh formula
1.24 x e/e’(septal+lateral/2) + 1.9
<8 normal
>15 elevated filling pressure
8-15 - grey zone
MPA is measured at
Bifurcation level below Pulm Valve or at RPA level
2.2 cm is DILATED
Normal LA size AP dimensions
Max 3.8 /4 : females/ males respective
ASE 2015 Guidelines
M mode or 2D same value
LA length is also known as———/ And is measured from ———-to ——-
Major dimension
Mitral annulus level to LA ceiling
LA minor dimension is from lateral wall to IAS
Both in A4C view
RA major and minor also similarly
RV inflow view will show ———-and ———— walls of RV
Anterior and Inferior
RV dimension at its base is measured in which view
RV focused view from Apex
RA volume upper limit ASE 2015
33 and 39 ml/ m2 ::female/ male
RV size values -abnormal is
MORE THAN 41/35/86
Prox/Dist- 33/27
RV measurement in ARVD is at
RVOT Prox in PLAX
RV size versus LV size Qualitative evaln
Normal RV-< 2/3 of LV
MODERATE: RV > LV
SEVERE: when RV forms apex
Maximum normal RV wall thickness is
5 mm
ASE 2015
Minimum TAPSE in a normal RV
17 mm
Minimum S’ of normal RV is
9.5 cm/s.
Less than this is abnormal
Minimum RV FAC in a normal RV
35%
Less than this is abnormal
If u take RVEF(3D)- it’s 45%
2015
Abnormal MPI of RV is
> 0.43 by PW (TR jet required). or Use RVOT ejection time separately
OR > 0.54 by Tissue Doppler
ASE 2015
MPI is (Myocardial Performance Index) ratio of
Isovolumic time to Ejection time
Abnormal RV E/e’ is
MORE THAN 6
PE echo findings are seen ——-% of PE patients
30-40%
60/60 sign means
RVSP < 60 by TR jet. (Untrained RV cannot acutely generate high pressures)
PA acceleration time < 60 msec ( ends fast because of high impedance)
RA pressure from IVC ,; numbers to remember
2.1, 50%, 3,8,15
Mild / Mod/ Severe PAH classfn
No clear recommendation /data for same
35/50/70 used by many
Inverted T sign in Echo is used to differentiate——from ——-
IWMI from PE
LA normal dimensions
AP view-3.8/4.00 female/male
LA biplane vol- 34ml/m2 or less
Normal RA size
Major axis-M/F- 2.8/2.7 cm/ m2
Minor axis- M/F- 2.2 cm/m2
RA volume single plane-M/F- 27/32ml/m2
ASE 2015
Why TEE should not be used for LA size
Entire LA cannot be seen in TEE
LA should be measured at end of
LV systole
Precautions while measuring LA size
Base of LA should be at its largest size.
LA length should be maximized
And take the Mitral annulus plane and not Mitral leaflets
For biplane difference in length in 2 views should be less than 5 mm. Shortest of the two is taken
No use doing LA area . Go for Volume . But LA area is more representative than AP only
Difference between LA volume single and biplane
Single is lower by 1-2 ml/m2
LA max size in A4C
Major- 52/54 female/male
Minor- 44/43
2015 -ACCHA
N.B- rounded off values
Diastolic dysfunction echo parameters-2016 ASE guidelines
e’-7/10; E/e’-14;TR-2.8,LA-34 ml/m2
For patients with normal LV
For those with reduced EF/ or with DD to grade DD-
Use the last 3 parameters - to identify whether Gd1or 2or cannot determine
Before that do E/A-<=0.8/50cm/s; is Gd1 >=2 is Gd3.
To grade it from 1-3
LA volume formula - biplane area length method
A1xA2x 0.85 /L
