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echo exam Flashcards

1
Q

Nyquist limit equation

A

1/2* PRF

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2
Q

Axial resolution equation

A

1/2 * SPL

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3
Q

Doppler equation

A

deltaF=Vcostheta2Ft/c

delta F = Fr - Ft
V is velocity of blood
2 is number of doppler shifts
c is speed of sound through soft tissue:1540m/s

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4
Q

Relative speed of u/s in different media

A

bone>tendon>muscle>blood=liver>soft tissue>fat>lung>air

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5
Q

Determinants of velocity

A

stiffness (up)

density (down)

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6
Q

velocity determination (medium or source)

A

medium

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7
Q

wavelength determined by..

A

source and medium

same with SPL

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8
Q

strength and seconds determined by

A

source

frequency, amplitude, etc

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9
Q

temp above which PZT is dead

A

curie temp

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10
Q

acoustic impedance eqn

A

z = density * velocity

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11
Q

matching layer thickness

A

1/4 * wavelength

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12
Q

PZT thickness

A

1/2 * wavelength

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13
Q

quality factor eqn

A

= Resonant frequency/bandwidth

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14
Q

Backing material affects on SPL, BW, sensitivity, intensity, DF

A 
dampens crystal
decreases SPL => improves axial resolution
increases BW => decreases QF
decreases sensitivity
decreases intensity
decreases DF
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15
Q

what determines resonant frequency in PULSE WAVE DOPPLER

A

RF = Velocity/2xThickness (both of the PZT crystal)

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16
Q

equivalent of temporal resolution

A

frame rate ~PRF

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17
Q

Functions of receiver

A
  1. Amplification (gain)
  2. Compensation (time gain compensation)
  3. Compression
  4. Demodulation
  5. Rejection
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18
Q

power related to amplitude

A

proportional to amplitude squared

ie: doubling amplitude would increase power by 4 times

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19
Q

intensity related to amplitude

A

proportional to amplitude squared

ie: doubling amplitude would increase power by 4 times

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20
Q

synonyms for axial resolution

A

LARRD (longitudinal, axial, radial, range, depth)

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21
Q

synonyms for lateral resolution

A

LATA (lateral, angular, transverse, azimuthal)

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22
Q

what is duty factor

A

% of time probe is emitting pulses (CWD=100%)

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23
Q

different types of myocardium with dobutamine stress

A

stunned, hibernating, ischemic, scar

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24
Q

difference between stunned and hibernating myocardium (with dobutamine)

A

hibernating myocardium has biphasic response to dobutamine (salvageable and needs revascularization)

stunned keeps improving with dobutamine (newly reperfused myocardium)

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25
Q

Common frequencies of echo machines

TTE vs TEE

A

Echo machines operate between 2-10MHz

most common is 5-7MHz with TEE probes

TEE higher than TTE=> better spatial resolution

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26
Q

attenuation coefficient

and how itā€™s used

A

1/2*frequency

*path length gives you how much it attenuates over distance

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27
Q

spatial peak temporal average max limit for focused and unfocused beams

A

100mW/cm2 max for focused beams

1W/cm2 max for unfocused

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28
Q

near field length equation

A

radius of transducer squared/wavelength

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29
Q

Risk factors for SAM after MVR (8 things)

A
  1. c sept dist <2.5cm
  2. narrow lvot < 2cm
  3. MA angle <120 degrees
  4. AL/PL ratio<1.3 (measured with valve closed at beginning of systole)
  5. basal sept hypertrophy >1.5cm
  6. Anterior leaflet >2cm (measured end diastole open)
  7. posterior leaflet >1.5cm (measured end diastole open)
  8. EDD< 4.5cm
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30
Q

Predictors of failed MVR for ischemic MR (5 things)

A
  1. annulus diameter>4cm
  2. tethering height>10mm
  3. tethering area>1.6cm2
  4. PL angle> 45 degrees
  5. LVEDd>6cm
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31
Q

with HOCM:

criteria mandating surgery

criteria with worse prognosis (2 things)

A

peak gradient > 50mmHg: surgical myectomy recommended

Wall thickness > 30mm and peak instantaneous gradient > 30mmHg associated with worse survival

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32
Q

LV noncompaction criteria

what is LV noncompaction

A

hypertrabeculated/poor function/dysrhythmias

Jenni criteria:

1. ratio of NC:C > 2:1 at end systole
2. Mid to apical inferior and lateral LV
3. color flow within recesses
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33
Q

Load independent measures of systolic function (4 things)

A
  1. end systolic elastance
  2. preload recruitable stroke work
  3. strain rate
  4. preload adjusted max power
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34
Q

Normal LV wall thickness (M/F)

what view?

A

6-9mm for women
6-10mm for men

(TG mid short axis)

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35
Q

Normal RV wall thickness

36
Q

Normal LVIDd and LVIDs

What view?

A

LVIDd greater than 5.4/5.5cm enlarged (peak of R wave)
LVIDs greater than 4.0cm is enlarged

ME 2 chamber

37
Q

TV annular dilation

what view?

what axis does it dilate?

A

TV dilation is greater than 4.0cm at end diastole

ME 4 chamber

TV dilates in septal/lateral plane

38
Q

MV annular dilation

what view?

what axis does it dilate?

A

MV dilation is greater than 4.0cm at end diastole

ME long axis

MV dilates in A/P plane

39
Q

VAD map goals

40
Q

E and Vp predict LAP

A

E/Vp > 2.5 indicates PCWP >15mmHg

41
Q

Normal LV FS, FAC, EF

what views?

A

FS normal>25% (m mode of TG mid SAX)

FAC normal >35% (TG mid SAX)

LVEF normal >53%

42
Q

LV dp/dt

how to calc?

normal values?

A

LV Dp/dt from 1-3m/s of MR jet (calc pressure gradients)

normal >1000mmHg/s

43
Q

SWMA grading

A 
grade 1 normal; radial shortening >30%
grade 2 mild hypokinesis; 10-30%
grade 3 severe hypokinesis <10%
grade 4 akinesia
grade 5 dyskinesis
44
Q

modified bernoulli eqn

when to use?

if you used it, overestimate or underestimate degree of stenosis?

A

If V1>1.5m/s canā€™t use simplified Bernoulli (would overestimate degree of stenosis)

modified: delta P = 4[(V2)2 - (V1)2]

45
Q

Katz plaque grading

which are associated with poor outcomes?

A

grade 1 < 2mm
grade 3: 3-5mm
grade 5 is anything mobile

grade 4 and 5 associated with adverse neurologic outcomes

46
Q

Ebsteinā€™s valve criteria (index and true measure)

A

septal leaflet > 0.8cm/m2 from annulus or >20mm in adults

47
Q

Wave properties determined by source, medium or both

A

time (sec) by source

strength by source

velocity by medium (stiffness same direction/density opposite direction)

length by both

48
Q

what is Vp?

what does it measure?

How is it measured?

Normal?

A

Vp is propagation velocity of early mitral inflow measured with CFD over M mode; 4cm into LV

measurement of diastolic function

normal > 50cm/sec

49
Q

LV mpi equation

what does it measure?

whatā€™s normal and abnormal?

A

LV myocardial performance index

Measures Systolic/diastolic fxn

=(IVRT+IVCT)/ET

<0.35 is normal
>0.5 abnormal (LOWER IS BETTER)

50
Q

RV mpi equation

what does it measure?

whatā€™s normal and abnormal?

A

RV myocardial performance index

Measures Systolic/diastolic fxn

=(IVRT+IVCT)/ET

> 0.55 is bad with TDI
0.4 bad by CWD

51
Q

Stages of hypoplastic left heart surgery

A
  1. Norwood:
    a. atrial septectomy
    b. RVOT and PV attached to Neo-aorta along with small native aorta
    c. ligate main PA
    d. ligate PDA
    e. either sano (RV to main PA) or BT shunt (R innominate to RPA)
  2. bidirectional glen (ligate shunt and SVC to RPA)
  3. Fontan (IVC to RPA) sometimes fenestration in IVC to RA
52
Q

Difference between sano and BT shunt

A

Part of Norwood procedure for HLH (1st stage)

sano (RV to main PA)

BT shunt (R innominate to RPA)

53
Q

Diastology with age

A

impaired relaxation: E/A decreases and eā€™ decreases

54
Q

complications with TEE

GI perf incidence

A

Complication of TEE is 1 in 500

1 in 5000 for GI perf

55
Q

prosthetic severe AS cutoffs (7 things)

A
  1. AT>100ms
  2. AT/ET>0.4
  3. peak velocity>4m/s
  4. mean gradient>35mmHg
  5. CFD: tombstone:bad; triangle:good
  6. dimensionless index<0.25
  7. EOA<0.8cm2
56
Q

percentage of normal prosthetic valves that have trace to mild regurg

A

10% have trace to mild regurg

57
Q

prosthetic mitral stenosis (5 things)

A
  1. peak transmitral velocity >2.5m/s
  2. peak gradient of >10mmHg
  3. VTI MV/VTI LVOT > 2.5
  4. EOA < 1.0cm2
  5. PHT > 200ms

*PHT of 220ms overestimates EOA (underestimates degree of stenosis) with prosthetic

58
Q

Patient prostheses mismatch

aortic (including mild and severe)

mitral

A

aortic EOA/BSA mild< 0.85 cm2/m2

aortic EOA/BSA severe<0.65cm2/m2

mitral EOA/BSA < 1.2cm2/m2

59
Q

when is clot risk highest for prosthetic valves

A

clot risk highest in first 6 months

60
Q

Shone complex

A

hypoplastic left sided structures

supravalvular mitral ring and parachute mitral valve

61
Q

Alagille syndrome

A

PS, TOF, VSDs, liver defects

62
Q

RV systolic function measurements (6 things)

abnormal values

A
  1. TAPSE<1.6-1.7cm
  2. FAC <35 (4chamber)
  3. EF<45%
  4. RV Dp/dt<400
  5. free wall strain more positive than -20
  6. sā€™<10
63
Q

Most common sites of intimal tear for dissections

A

70% near sinus of valsalva (1-3cm distal)

30% ligamentum arteriosum (aortic isthmus)

64
Q

LVAD inflow and outflow velocities

A

inflow velocities >1.5m/s shows obstruction

outflow >2m/s shows obstruction

65
Q

TEVAR endoleak classification

A

time: (primary before 30 days and secondary after)

location:		
1 attachment site
2 branch
3 graft defect
4 leaks due to graft wall porosity
66
Q

Severe PR (3 criteria)

A

PHT<100ms

VC>0.6cm

RF>40%

67
Q

Lutembacher syndrome

A

MS and ASD

68
Q

LV mass calculation measurements

A

end diastole: LVID, ILWT, IVST

69
Q

Cardiac MRI

volumes compared to echo

best measure of valve severity

A

RVOL is best quantitative measure of valve regurg severity

CMR volumes are larger than echo derived volumes

70
Q

Mitraclip criteria (9 things)

A
  1. coaptation length >2mm
  2. coaptation depth < 11mm
  3. flail gap < 10mm
  4. flail width < 15mm
  5. no severe MAC or leaflet calcification
  6. leaflet thickness < 5mm
  7. LVEF > 20%
  8. LVEDd < 60mm
  9. MVA > 4cm2
71
Q

TS severe criteria

A

TVA <1cm2

mean gradient > 5mmHg

72
Q

pseudo-AS criteria

why important?

A

Need 0.3cm2 or more increase in AVA with dobutamine stress to be considered pseudo-AS

DO NOT benefit from surgery

73
Q

normal AVA

A

adult is 3-4cm2

74
Q

3d LVOT measurement vs 2d

A

3D LVOT images are bigger than 2D (3 is bigger than 2)

75
Q

Normal washing jets length in mitral position

what about medtronic-hall?

A

<2.5cm in length in mitral position

Medtronic hall 5-6cm

76
Q

Crawford aneurysm classification general rule

A

number goes up, it moves more distal

except 5 is weird

77
Q

frequency affect on rayleigh scattering

A

Rayleigh scattering increases with increasing frequency

COUNTERINTUITIVE

78
Q

Impella measurement

A

AV annulus to inlet portion of device distance is 3.5-4cm

*5 cm with new 5.5 L flow impella (no pigtail)

79
Q

oblique sinus

A

space around LAA

80
Q

transverse sinus

A

space around aorta and PA

81
Q

important Prosthetic valve measurements in aortic position

ross

stented bioprosthetic

stentless bioprosthetic

A

ross: PV annulus, aortic annulus, STJ proximal ascending aorta

stented bio prosthetic: AV annulus

stentless bioprosthetic: AV annulus, STJ, proximal ascending aorta

82
Q

position of IABP

A

1-2 cm distal to left subclavian artery

83
Q

grading paravalvular regur after TAVR

A

<10% circumference : mild
10-29%: moderate
>30%: severe

84
Q

noonan syndrome

A

associated with PS

85
Q

What E wave on MVI velocity consistent with severe MR

echo exam (1 decks)

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