Echo Basics Flashcards
What is the location of the heart?
- Middle mediastinum
- 2/3 of the heart lies to the left of the sternum
- Lies on a 45 degree angle
What does the left heart do?
Pump blood to the systemic system
What does the right heart do?
Pumps blood to the pulmonary system
What is part of the right heart?
- Right atrium
- Right ventricle
- Pulmonary valve
- Tricuspid valve
What is part of the left heart?
- Left Atrium
- Left ventricle
- Aortic valve
- Mitral valve
What is the pericardium?
Consist of fibrous pericardium and serous pericardium
What is the fibrous pericardium?
- outermost layer
- Prevents over distention of the heart
What is the serous pericardium?
- 2 layers between which has 20-50 ml of fluid
- parietal layer
- visceral layer (epicardium)
What is the Heart muscle layers?
- endocardium
- myocardium
- epicardium
What is the endocardium?
Thin layer between blood and myocardium
What is the myocardium?
Thickets layer of striated muscle fibers
- LV = 6-10 mm
- RV = 3-5 mm
What is the epicardium?
Essentially the inside edge of the myocardium
What is the Great vessels directions and flow direction?
- Right in and left out. Enters from SVC and IVC and exits Aorta
- Left heart in and Right out: 4 Pulmonary veins (RT, LT, Upper, Lower) to the pulmonary artery
What is the interventricular septum?
- Divides RT and LT ventricles
- High pressure in the LV pushes the septum towards RV (RV has about 1/4 the pressure of the LV)
What is the interatrial septum?
Divides the RT and LT atria
What are the 3 basic points of the ECG?
- P wave
- QRS complex
- T wave
What is the P wave?
- Atrial depolarization*****
- leads to atrial contraction
- Late diastole
- just before QRS
- Should be smaller then T wave
What is the QRS wave?
- Ventricular depolarization***
- Leads to ventricular contraction
- early systole
- should come to a high point
- Should be much taller than T wave
What is the T wave?
- Ventricular repolarization
- Leads to ventricular relaxation
- Late systole
- After QRS complex
- Should be much taller than P wave but shorter then QRS complex
What is the most reflective structure during a echocardiogram?
Pericardium
What is the color and texture of the myocardium?
Medium gray and homogenous in echotexture
What is the differences between the valves and the walls when perpendicular to the ultrasound beam during a ECG?
The valves are slightly more echogenic
How does the blood within the chambers appear during a ECG?
Anechoic
How will we position the patient?
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)
Which transducer will we use for ECG?
2-4 Mhz range sector probe with tissue harmonics
What breathing techniques should the patient use for ECG?
- majority of patients will use normal respiration
- Moderate breath in and holding for subcoastal views
- Powerful sniffing to demonstrate IVC collapse in subcoastal views
- valsalva maneuver for certain tests
- When ribs or lungs interfere, having patient either hold their breath or expel all their air and not breath, may improve the image
What are the four routine positions for images?
- parasternal
- Apical
- subxiphoid
- suprasternal
What is Parasternal?
Second to third rib space, left parasternal
What is the apical window?
fifth rib space, mid-clavicular line, anterior, mid or even posterior axillary line
What is subxiphoid?
Under xiphoid
What is supraxiphoid?
Suprasternal notch
What is a pressure gradient?
The difference of pressure between two adjacent locations within the heart or vascular system
What is the natural flow direction?
Higher to lower pressure until pressures equalize
Cardiac flow is determined by what?
Pressure gradients
In terms of pressure the right heart is generally?
Low pressure
In terms of pressure the left heart is generally?
High pressure
In order for the blood to flow from the right atria to the right ventricle what must happen?
RA > RV pressure opens the Tricuspid valve
What causes the Tricuspid valve to shut?
When the pressure in the RV is greater then the RA
Depolarization causes what?
Contraction
What are the four stages of the cardiac cycle?
- IVCT (Isovolumic contraction time)
- Systole
- IVRT (Isovolumic relaxation time)
- Diastole
What is isovolumic contraction time?
Time between MV closure and AV opening
What is Ventricular Systole?
The period of time it takes for the ventricles to eject their contents
What is Isovolumic Relaxation time?
The period after the AV has closed by before the MV opens
When does diastole start?
When the LV/RV pressure falls below that of the atria
What are the three phases of diastole?
- early filling
- Diastasis
- Late filling
