Echo Basics

Question 1

What is the location of the heart?

Answer 1

1. Middle mediastinum
2. 2/3 of the heart lies to the left of the sternum
3. Lies on a 45 degree angle

Question 2

What does the left heart do?

Answer 2

Pump blood to the systemic system

Question 3

What does the right heart do?

Answer 3

Pumps blood to the pulmonary system

Question 4

What is part of the right heart?

Answer 4

1. Right atrium
2. Right ventricle
3. Pulmonary valve
4. Tricuspid valve

Question 5

What is part of the left heart?

Answer 5

1. Left Atrium
2. Left ventricle
3. Aortic valve
4. Mitral valve

Question 6

What is the pericardium?

Answer 6

Consist of fibrous pericardium and serous pericardium

Question 7

What is the fibrous pericardium?

Answer 7

1. outermost layer
2. Prevents over distention of the heart

Question 8

What is the serous pericardium?

Answer 8

1. 2 layers between which has 20-50 ml of fluid
2. parietal layer
3. visceral layer (epicardium)

Question 9

What is the Heart muscle layers?

Answer 9

1. endocardium
2. myocardium
3. epicardium

Question 10

What is the endocardium?

Answer 10

Thin layer between blood and myocardium

Question 11

What is the myocardium?

Answer 11

Thickets layer of striated muscle fibers
- LV = 6-10 mm
- RV = 3-5 mm

Question 12

What is the epicardium?

Answer 12

Essentially the inside edge of the myocardium

Question 13

What is the Great vessels directions and flow direction?

Answer 13

1. Right in and left out. Enters from SVC and IVC and exits Aorta
2. Left heart in and Right out: 4 Pulmonary veins (RT, LT, Upper, Lower) to the pulmonary artery

Question 14

What is the interventricular septum?

Answer 14

1. Divides RT and LT ventricles
2. High pressure in the LV pushes the septum towards RV (RV has about 1/4 the pressure of the LV)

Question 15

What is the interatrial septum?

Answer 15

Divides the RT and LT atria

Question 16

What are the 3 basic points of the ECG?

Answer 16

1. P wave
2. QRS complex
3. T wave

Question 17

What is the P wave?

Answer 17

1. Atrial depolarization*****
2. leads to atrial contraction
3. Late diastole
4. just before QRS
5. Should be smaller then T wave

Question 18

What is the QRS wave?

Answer 18

1. Ventricular depolarization***
2. Leads to ventricular contraction
3. early systole
4. should come to a high point
5. Should be much taller than T wave

Question 19

What is the T wave?

Answer 19

1. Ventricular repolarization
2. Leads to ventricular relaxation
3. Late systole
4. After QRS complex
5. Should be much taller than P wave but shorter then QRS complex

Question 20

What is the most reflective structure during a echocardiogram?

Answer 20

Pericardium

Question 21

What is the color and texture of the myocardium?

Answer 21

Medium gray and homogenous in echotexture

Question 22

What is the differences between the valves and the walls when perpendicular to the ultrasound beam during a ECG?

Answer 22

The valves are slightly more echogenic

Question 23

How does the blood within the chambers appear during a ECG?

Answer 23

Anechoic

Question 24

How will we position the patient?

Answer 24

1.Left Lateral Decubitus for most views with the left arm extended above the head and the right arm at the patients side.
2. supine with knee flexed (for subcostal views)

Question 25

Which transducer will we use for ECG?

Answer 25

2-4 Mhz range sector probe with tissue harmonics

Question 26

What breathing techniques should the patient use for ECG?

Answer 26

1. majority of patients will use normal respiration 2. Moderate breath in and holding for subcoastal views 3. Powerful sniffing to demonstrate IVC collapse in subcoastal views 4. valsalva maneuver for certain tests 5. When ribs or lungs interfere, having patient either hold their breath or expel all their air and not breath, may improve the image

Question 27

What are the four routine positions for images?

Answer 27

1. parasternal 2. Apical 3. subxiphoid 4. suprasternal

Question 28

What is Parasternal?

Answer 28

Second to third rib space, left parasternal

Question 29

What is the apical window?

Answer 29

fifth rib space, mid-clavicular line, anterior, mid or even posterior axillary line

Question 30

What is subxiphoid?

Answer 30

Under xiphoid

Question 31

What is supraxiphoid?

Answer 31

Suprasternal notch

Question 32

What is a pressure gradient?

Answer 32

The difference of pressure between two adjacent locations within the heart or vascular system

Question 33

What is the natural flow direction?

Answer 33

Higher to lower pressure until pressures equalize

Question 34

Cardiac flow is determined by what?

Answer 34

Pressure gradients

Question 35

In terms of pressure the right heart is generally?

Answer 35

Low pressure

Question 36

In terms of pressure the left heart is generally?

Answer 36

High pressure

Question 37

In order for the blood to flow from the right atria to the right ventricle what must happen?

Answer 37

RA > RV pressure opens the Tricuspid valve

Question 38

What causes the Tricuspid valve to shut?

Answer 38

When the pressure in the RV is greater then the RA

Question 39

Depolarization causes what?

Answer 39

Contraction

Question 40

What are the four stages of the cardiac cycle?

Answer 40

1. IVCT (Isovolumic contraction time) 2. Systole 3. IVRT (Isovolumic relaxation time) 4. Diastole

Question 41

What is isovolumic contraction time?

Answer 41

Time between MV closure and AV opening

Question 42

What is Ventricular Systole?

Answer 42

The period of time it takes for the ventricles to eject their contents

Question 43

What is Isovolumic Relaxation time?

Answer 43

The period after the AV has closed by before the MV opens

Question 44

When does diastole start?

Answer 44

When the LV/RV pressure falls below that of the atria

Question 45

What are the three phases of diastole?

Answer 45

1. early filling 2. Diastasis 3. Late filling