Echo bit of everything Flashcards
Pulsus Paradoxus
During INSPIRATION the RV shift the IVS towards the LV in diastole
During EXPIRATION the LV shift the IVS towards the RV
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Penetrating Ulcer
It’s an atherosclerotic ulcer that penetrated the intima tunica until rich the media tunica
Echo free space Anterior to Descending aorta, is called?
Pericalrdial effusion
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Pericarditis
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Apical HCMP
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Dilated Cardiomyopathy or
LBBB
Firts thing to evaluated in dilated Cardiomyophaty
Systolic function
How to know if the patient has a intrapulmonary shunt after contrast study?
If the bubbles appers in the LA and LV after 5 beast (counting from the full oapcification of the RA and RV)
Small pocket of Pericardium surrounding the great arteries posterioly
the transvers sinus
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Restricitve CDP
When could it be considered an atrial spetal aneurysms?
if the bulge is more than 1 cm
Does high output power destroid the microbubles?
yes, so careful adjustmen of instrument power O is needed during contrast study.
Usually MEchanical index aboit 0,5
Early Echo sing of Tamponade?
Right atrial Systolic collapse
Ealy sign because the right atrial has the lowets pressure
How to know if the patient has a intracardiac shunt after contrast study?
If the bubbles appers in the LA and LV before 3 beast
When the term Aneurysm is used on the Aorta?
when the dilatation of the aorta Exceeds the expected diameter by 50% or more
What are the most cause of death from Aortic Aneurysms?
Dissection and Ruptures
B bump indicated:
Systolic Disfunction:
Dilated cardiomyopathy
Echo finding on Cardiac Tamponade
-RA systolic collapse greater than one-third of systole
-RV diastoly collapse
-Severe IVC dilatation
-Reciprocal Respiratoy changes >25% in RV and LV filling
-Reciprocal respiratory changes in RV and LV volumen (septal Shifting)
-Reduce E’ in TDI
Classification of HOCM?
not obstructive, PG < 30mmhg
Obstuctive, PG > 30mmhhg
Provacate or latent, PG <30mmhg but the obstruction occurs just with excercise
what can it cause a Sweinging Heart? and is it demostrated in ECG
Large pericardial E.
In ECG, there is an alternation of QRS. one high and another small.
Vessels tha supply bood to the vessel?
Vaso Vasorum vessel
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RA Systole Collapse more than one-third of systole. Cardiac Tamponade
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SAM
Preture closure of the mitral valve. and it looks like subvalvular aortic but at the end of the signal opens a bit more
Can pericarditis be diagnosed just with ECho?
Not, it a clinical DX
Echo is looking for effusion, tamponade or thickening of the pericqrdium
Contraindication of contrast study?
Hypersensitivity to contrast agent or ingredients
It’s the only contraindication
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RV diastole collapase. Cardiac Tamponade
What are the BLIND SPOT of the Aorta in TTE?
Distal part of the Ao
Anterior part of the Arch
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Sinus of Valvasa Aneurysms on TEE
Types of Contrast Agent
Agitated Saline (right Heart)
Microbubles (LV and miocadial opacification)
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Cardiac Amyloidosis
symmetrci LV hyperttophy and it looks like speckel
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Aortic Arch Dissection
The echo contrast is mainly used for evaluation of what orifice in the atrial?
ostium secundum
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Pulsus alternans
Indicated Systolic disfunction
Name of th sign and DX
Cobweb sign
aortic dissection, the cobweb is always pointing towards the false lumen
Typical findings in marfan syndrome?
Effacement of the Sinotubular junction
Dilated Ao
MR
LV Enlargment
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Dinamic obstruction
SAM
Dagger Shaped
how many bubbles do you have to see when using Agitated SC in order to be severe?
1 - 9 small
10- 30 moderated
>30 SEVERE
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Intramural Hematoma
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Restrictive CDP
If there is a bulge in the Atrial septal lees than 1 cm, how is it called?
Redundant Atrial Septum
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HTN .: Findings
1- LV Hypertrophy
2- AV Sclerosis
3- Calcificated MV
4- Ao dilatation
Effacement of the sinutubular junction is characteristis of:
Marfan syndrome
Does the Micarobubles (Agent contrats) have a lower impidence than the blood
true
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Systoly disfunction
Decrease on Anteroo-posterio movement of the Aortic root
Premature clusure of the AV
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Left Ventricle non compaction cardiomyopathy
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Intramural Hematoma. it’s demostrated as a thick wall betwwen the lumen of the vessel and the brignnes of the adventicia tunica on the botton
Autoinmune system responde causing pericarditis after damage to a hear tissue?
Also called, Post Miocardial Infarctation Syndrome
Dressler’s Syndorme
Name of the effects that creates SAM
Drag Effect or Venturi Effect
The Reciprocal Respiratory changes in volumen is Known as:
Pulsus Paradoxus
most common cause of Atrial enlargment?
HTN
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Mid LVOT obstruction (lobster signal)
how differenciate between Ascites and pericardial Effusion?
the Falciform ligamente is floating in ascites
Measurements of the aorta are made at:
End diastole, inner edge to inner edge
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Eustacian valve. localized superior to the IVC
Dx
Stranding in purulent effusion
Sign of Aortic Dissection?
Ao dilatation
Ao regurgitation
Pericardial Effusion
A new regional wall motion abnormality
Most sensitive Echo finding in Cardiac Tamponade?
IVC dilated
(whiout it, there is not cardiac Tamponade)
indicates hemorrghe, malignat etiology or infamatory desiase
Stranding
often seeing in infected pericardiatis
Name of the Cardiomyphathy produced by strees
TAKOTSUBO cardiomyopathy
or octopus
Debakey Aortic Dissection Classification?
Tipe I: includes ascending, Arch and Descending
Tipe II: includes Just the ascending Aorta
Tipe III: includes just the Descending Aorta
Atherosclerosis of the Aorta may lead to:
Dilatation
Aneurysm
Dissection
how much is the normal pericardial Fluid?
5 to 10 ml between Visceral and Parietal pericardium
Causes of Aortic Dilatation?
HTN
BIcuspid Valve
Marfan Syndrome
Dilated cardiomyopathy is known as:
HFrEF: hear failure with reduced ejection fraction
IT is a systolic failure
What is this?
Coumadin Ridge, is part of the LA that lies between the LA appendage and the Left superior pulmonary vein
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SAM
“it may look like Late systolic hammocking but the C-D slope in Sam goes up and in late systolic H just goes down@
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Thoracic Aortic Aneurysms
Stanford Classificacion of Aorta Dissection?
Stanford A: Just the Ascending but may propagates to the arch and the descending Ao
Stanford B: Just Descending Ao
What is the best view to evaluated Pericardial Effusion?
Subcostal view
PF could be evaluated in
4CV
PSAX
Subcostal view (best one)
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Atrial spetal aneurysms
Characteristic of Constrictive Pericarditis
Impared Diastolic filling
Early diastolic Filling is rapid which leads E/A radio >2
Grade 3 diastole disfunction (restrictie pattern but with normal E’)
Normal E’ but E wave bigger than A wave like in patient with Super nomal filling
Increasing in the pericardial Pressure excciding the cardiac pressure chambers without IVC dilatation
Tamponade physiology
Acumulation of cell or proteins in the myocardial will lead to:
Restrictive CDP
Amyloidosis
Sarcoidosis
Hemocromatosis
Scleroderma
Severity of the Pericardial Effusion?
Small PF <0,5cm
Moderate PF 0,5 to 2 cm
Severe PF >2cm
Characteristic of True lumen in Ao dissection?
Concave
Large in Ascending and Aortic Root
Small is Descending Ao
never has a coweb
Rare formation of thrombus
The true lumen expand in systole
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Pericardial Cist
Hypotension, decrease in the CO and pericardial pressure above cardiac chambers pressure, with dilation of the IVC
Cardiac Tamponade
Explain this image
Reciporcal variation changes during diastole in LV inflow
during experiation the lv inflow and the lvot outflow decreases while the rv inflow and pulmonary inflow increases.
Pulsus paradoxus.
Echo free space posterior to Descending Aorta, is called?
Pleural effusion
Microbables contrast agent size
5 micros
Characteristic of False lumen in Ao Dissection?
Convex
Small in Ascending and Aortic Root
Larger in Descending Ao
Cobweb 100%
Higt risk of Thrombus
the false lumen compress in systole
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Pulsus Paradoxus, Cardiac Tamponade
Excessive Bublle Destruction in the near field. (Apex) during contraste study
SWIRLING
Solution:
Decrease MI
Increase contrast dose
MOVe the focus
The physiologic consecuences of fluid in the pericardial space depend on:
the volume
Th rate of fluid accumulation (time)
How much the respiratory Variation in diastolic filling has to be in order to be considerate Cardiac Tamponade?
> 25%
Autoinmune Tissue Disorder that can cause aneurysms of the Ao and it’s characterized by Effacement of the sinutubular junction and enlargment of the sinusus of Valvasa, in adition to Dilation of the Ao. is called?
Marfan Syndrome
Dessises of the Aorta?
Dilatation
Aneurysmsn
dissection of the aorta
Intramural Hematoma
Penetraring Ulcer
Name the anatomy
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Restrictive Cardiomyopathy
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Contrast study showing Apical Hypertrophy C
Common feature of all Hypertophy CMP patterns?
Normal thickness of the Basal Posterios Lv Wall
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Dilated coronary sinus
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LV non-compacted miocardial with contrast
Pattern and Degree of the Hypertrophy Cardiomyopathy? classification
Septal or sigmoidel predominat
Reversal Septal contour
Apical HCM
Neutral HCM
Pandiastolic Filling Restriction?
Tamponade
The blood goes during the whole diaslote
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Mind and apical Hypertrophy with Aneurysm
Biphasic Filling Restriction?
Constrictive Pericarditis
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Subvalvular Aortic Stenosis. look how the leaflet flutter
What are the Differential Diagnosis of HCMP?
HTN
Aortic Stenosis
Athletes heart
Subaortic Stenosis
LV noncompaction
Cardiac Amyloidosis
How does the microbubles can be administrated?
Dilution (most common) 1vias of contrast in 9 cc saline
Infusion
Bolus
What organs control the pressure of the heart chambers?
the pericardium
Caracteristic of the Hypertrophy cardiomipathy
Asimetric Hypertophy of the LV >1,5cm
Diastolic disfunction
sistolic preserve
LA enlargment
Dinamic LVOT obstruction
How is the E’ signal TDI in Constritive Pericarditis?
Normal, but the mitral inflow signal is a restrictive pattern E wave bigger than A wave
pericardium that extends posterioly to LA, between the four pulmonary veins?
oblique sinus
Types of Cardiomyopathy?
Dilated
Hypertrophic
restrictve
when Peripartum Cardiomyopathy happend
During the final month of pregancy and after 5 month of delivery
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D reversal in Constrictive Pericarditis.
its tipical to see you a Swave in cardiac tamponade
Obove which number Aneurysms can be considered?
Above 50% of it’s regular meassure
Inflamation of the pericardium?
pericarditis
tipical finfind in HTN heart Desiase?
Atrail enlargment
LV hypertrophy
Dilated Ascending Aorta
AV esclerosis
MVC Mitral valve calcificacion
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pulsed alternate
indication of Diastole disfunction
Types of Aneurysm?
Succular
Fusiform (most common)
what is the main difference between Eccentric or Concentric hypertrophy and Hypertrophy cardiomeopathy?
In concentric hypertrophy the thickness increases because the myocitis are add parallel or in series but in Hypertropy CDM are disorganized
Dilated cardiomyophaty is caracterized by
Impared LV contractility
Reduce cardiac output
Eleveted LVEDP
Risk of factor for Aortic dissection
HTN
Atherosclerosis
How to diagnosis pericarditis?
At least 2 criterias?
ST elevation
Chest Pain (like IM)
New or increased Pericardial Effusion
Pericardial rub on auscultation
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Aneurysms of the ascending aorta
it’s causing a compression of the RA
