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

Echo Basics Flashcards by Brian Chuong

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

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What does the left heart do?

Pump blood to the systemic system

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What does the right heart do?

Pumps blood to the pulmonary system

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What is part of the right heart?

Right atrium
Right ventricle
Pulmonary valve
Tricuspid valve

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What is part of the left heart?

Left Atrium
Left ventricle
Aortic valve
Mitral valve

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What is the pericardium?

Consist of fibrous pericardium and serous pericardium

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What is the fibrous pericardium?

outermost layer
Prevents over distention of the heart

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What is the serous pericardium?

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

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What is the Heart muscle layers?

endocardium
myocardium
epicardium

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What is the endocardium?

Thin layer between blood and myocardium

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What is the myocardium?

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

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What is the epicardium?

Essentially the inside edge of the myocardium

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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

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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)

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What is the interatrial septum?

Divides the RT and LT atria

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What are the 3 basic points of the ECG?

P wave
QRS complex
T wave

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What is the P wave?

Atrial depolarization*****
leads to atrial contraction
Late diastole
just before QRS
Should be smaller then T wave

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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

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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?

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

What are the four routine positions for images?

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

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

1. early filling 2. Diastasis 3. Late filling