Echo Parameters Flashcards
1
Q
Normal RA volume for men
A
25 +/- 7 mL/m2
2
Q
Normal RA volume for women
A
20.5 +/- 6mL/m2
3
Q
How is RA size measured?
A
Dedicated apical 4C to measure RA volume by single plane area-length
4
Q
HTN causes dilation of what portion of the aorta?
A
distal aortic segments, little effect on SoV
5
Q
What coronary cusps are seen in PS long axis view?
A
RCC above NCC
6
Q
What aortic annular axis (minor or major) is measured in PS long axis
A
Minor
7
Q
What part of the cardiac cycle do you measure aortic annulus and LVOT diameter? How to measure?
A
Mid-systole
inner -edge to inner-edge
8
Q
What part of the cardiac cycle do you measure SoV, aortic root, STJ? How to measure?
A
End-diastole
leading edge to leading edge
9
Q
What is the concern with IVC diameter in athletes?
A
Does not correlate well with RAP, they typically have dilated IVC with normal collapse
10
Q
When should you measure IVC?
A
End expiration and end diastole using M-mode
11
Q
How does RV EF compare to LVEF?
A
RVEF is normally smaller than LVEF, but RV EDV is larger than LV EDV, so stroke volume is similar.
RV EF is slightly higher in women compared to men.
12
Q
Normal RV EF
A
> /= 45%
13
Q
Normal RV fractional area change?
A
> /= 35%
14
Q
Normal TAPSE?
A
1.8 or greater
15
Q
Normal RV base diameter? mid?
A
Normal = 41mm for base
Normal = 35mm for mid
16
Q
Normal Tissue doppler-derived tricuspid lateral annular systolic velocity
A
> 9.5cm/s
17
Q
Normal RIMP (PW)
A
<0.43
18
Q
Normal RIMP (TD)
A
<0.54
19
Q
Normal LV EDV volume for men/women?
A
Men <74 mL/m2
Women < 61mL/m2
20
Q
Normal LV ESV volume for men/women?
A
Men 31 mL/m2
Women 24 mL/m2
21
Q
Regional wall motion 4 grade scheme?
A
- Normal or hyperkinetic
- Hypokinetic or reduced thickening
- Akinetic or absent/negligible thinning
- Dyskinetic or systolic thinning/stretching
22
Q
The current generation of fully sampled matrix array transducers typically containes how many crystals?
A
3,000 piezoelectric crystals
23
Q
What causes stitch artifact?
A
Any sort of non-regular movement during a multibeat acquisition: respiration, arrhythmia, patient/operator movement, esophageal motility
24
Q
What LAA filling velocity is associated with CVA?
A
<20cm/s
25
What tricuspid leaflet has the longest radial length?
Anterior
26
Methemoglobinemia suspected if? Consequences? Treatment?
Cyanosis, low SpO2, normal pO2
Circulatory collapse, neurologic depression, death
Methylene blue
27
Coronary cusp closest to atrial septum on TEE?
NCC
28
Why is the RCA most at risk for air embolization during surgery?
It is the most anterior when a patient is supine and air floats.
29
What should you do if a patient needs intraop TEE but has an esophageal stricture?
Epicardial echo
30
Intraoperative TEE is useful in LVAD placement because ?
Evaluation of AI, as this may make LVAD ineffective
31
Most specific criterion for severe MR?
EROA >0.4cm2 or VC > 7mm
32
What happens to ESV and EF in a hypovolemic patient?
Decreased ESV, increased EF
33
EF on TEE is higher or lower while on cardiopulm bypass?
Either: tends to be underfilled, so EF is higher but metabolic changes/transient ischemia can cause decreased as well
34
Hoe to get PHT from DT?
PHT = DT x 0.29
35
MVA using PHT?
MVA = 220/PHT
36
How to estimate PADP with PI?
PADP = 4[PV (EDP)]2 + RAP
Use PV END-DIASTOLIC PRESSURE, not early peake diastolic.
37
PAWP by Vp?
PAWP = 4.6 + 5.27(E/Vp)
38
What is Vp? Normal?
Flow propagation velocity.
Rate at which RBCs reach the LV apex from the MV leaflet during early diastole. Measure of LV relaxation (diastolic function).
Normal: >55cm/s in young, >45cm/s in middle-aged and elderly
39
E/e' is directly proportional to what?
LAP.
LAP = 1.9 + 1.24(E/e') or 4 + E/e'
E/e' medial>15 = elevated LAP
E/e' lateral>12 = elevated LAP
40
Peak to peak gradient equation?
P2P = (LVSP + LAP) - SBP
LVSP can be calculated by peak MR velocity using bernoulli
41
P1/2t of severe AI?
<200
42
What would preclude ASD closire?
Elevated PVR
43
How to calculate PVR on echo?
```
PVR = change in pulmonary pressure/pulmonary flow
PVR = MPAP-LAP/pulmonary flow (Qp)
```
MPAP = PADP + 1/3(PASP-PADP)
Answer in woods units, normal 1-2
44
RVSP equation using VSD?
RVSP = SBP - 4(V-VSD)2
*no need for RAP if VSD used
RVSP - PS gradient = PASP
45
LAP equation
LAP = LVSP - (pressure change using Vmr jet)
46
Mean aortic gradient is about __%of peak gradient?
60%
47
E wave deceleration time that would point towards restrictive (G III)?
<160ms
48
What atrial reversal velocity would indicate elevated LVEDP? What about AR-a duration?
>35cm/s.
The atrium is contracting, which propels blood into atrium (A wave on MV inflow) and backwards into PV (no valves). The higher the LVEDP, the more blood that will be pushed backwards and the higher the AR wave will be.
if AR duration is >30ms longer than a wave (AR-a), this also implies LVEDP is elevated.
49
How does inspiration affect ventricular interdependence?
Ventricular interdependence refers to diastolic filling of one ventricle at the expense of the other.
In constriction, inspiration leads to decreased systemic vein pressure, which leads to increased SV-RA-RV gradient, leading to increased RV filling and decreased LV filling.
So you will see increased HV forward flow during inspiration and increased retrograde flow with expiration.
This will occur in BOTH constriction and tamponade
50
When doe flow across the AV occur?
Only during ET, whether normal or abnormal.
Systole consists of IVCT and ET. TR/MR will be holosystolic, AS will start later because it will not happen during IVCT.
51
Triphasic MV inflow is consistent with what diagnosis?
Cor triatrium, can present similar to MS.
52
How do you calculate LAV index?
LAV = 0.85 x (A1xA2/L)
LAVindex = LAV/BSA
53
How to differentiate tamponade from constriction using E:A ratio?
Constriction does not impede early diastolic filling, so E>A. Tamponade impedes diastolic filling, so A>E.
54
Tissu doppler filters are used to excllude __ velocities.
high
55
What is strain rate?
The change in velocity between two points divided by their distance.
56
Subendocardial fibers are __ and mid-myocardial fibers are __.
1. Longitudinal, this is why the detection of subendocardial disease uses global longitudinal strain.
2. Circumferential
57
GLS is dependent on __, __, and __.
Vendor, age, and gender.
58
Tell me about radial strain rates.
Positive radial strain rates represent active contraction. So negative strain rates are either relaxation (if during diastole) or hypokinetic/dyskinetic (if during systole).
59
How would you define subclinical LV dysfunction?
GLS reduction in 15% compared to baseline.
60
In asymmetric septal HCM, the tissue doppler e':
Has an inverse relationship with septal thickness. You can use this to differentiate HCM from athlete's heart.
61
HgbA1c correlates with
E/e', so elevated A1c is associated with diastolic dysfunction, even if asymptomatic.
62
What change in US contrast led to improved LV opacification?
Using higher-molecular weight gases instead of room air.
63
Allergy to __ is a contraindication to Optison.
blood products
64
__ is a contraindication to all contrast agents.
ASD, though can be used with PFO
65
What is contractility?
How can you measure this?
Systolic function independent of loading conditions. So if EF changes with constant HR, conduction velocity, preload, and afterload: contractility has changed.
Can measure with systolic strain rate (always) or LV dP/dT (if MR present but not severe)
66
What is the most reliable measure of RV function?
None are reliable, though 3DE is up and coming.
67
Wall stress is proportionate to __.
transmural pressure and chamber size.
68
How do you define a WMA?
<50% wall thickening or <5mm excursion
69
5 year mortality of postinfarct patient with mild LV dysfunction and ESV <95mL?
10%
70
5 year mortality of postinfarct patient with mild LV dysfunction and ESV >95mL?
30%
71
How would decreased preload affect strain?
Decreased preload would decrease strain due to decreased LV cavity size.
Decreased HR (increased filling) and decreased afterload (decreased impedance) would increase strain.
72
LV mass equation?
LV mass = 1.04([LVd+IVS+PW]3 - LVd3) -13.6
hypertrophy >131 men, >100 women
73
What anomalies are associated with subaortic membrane?
PDA, PS, coarctation of Ao, and VSD
74
How to differentiate constriction from restriction via e'?
MEDIAL e' >8cm/s heavily favors constriction over restriction. <6cm/s favors restriction.
75
What will you see on HV doppler in constriction?
HV end-diastolic reversal velocity/flow flow velocity >0.8
76
Pulmonary inflow pattern. What are the S1, S2, and D waves related to?
S1: LA relaxation
S2: Stroke volume and PA pressure
D: LV relaxation
77
How do you estimate PCWP in atrial fibrillation?
E/e' >11, MV DT <150ms, and PV diastolic velocity <220ms are all associated with elevated filling pressures.
78
If large V-wave on Cath and no MR on echo?
LA has lost reservoir function. Severe loss of LA compliance.
79
LVEDP given AI?
End diastolic AI velocity can be used to determine LVEDP if systolic DBP is known.
LVEDP = DBP - LVEDP
80
WHat are the components of the Wilkins score?
Leaflet mobility, leaflet calcifications, leaflet thickening, subvalvular thickening
81
Most likely to give a false negative on stress echo?
Isolated LCx disese. Sensitivity of stress echo increases as the number of vessels involved increases.
82
Myxoma characteristics?
Usually in the LA and attached to the atrial septum by a narrow stalk
83
Fibroma characteristics?
almost always single and located in the ventriculary myocardium, commonly the ventricular septum.
84
Fibroelastoma characteristics?
well-circumscribed oval mass that is often attached to the leaflet of a valve by a narrow stalk
85
Indications for PV balloon valvuplasty?
Peak gradient >60, mean >40 or symptomatic with peak gradient>50.
86
Effective orifice area indexed to BSA fro PPM in aortic position? severe?
PPM <0.85, severe <0.65
87
Risk factors for coronary obstruction during TAVR?
LM height >10mm above aortic annulus
Female (83% were women)
Small aortic root diameter
88
Mitral clip inclusion criteria?
A2-P2
Copatation length between 2mm and 11mm
Flail gap <10mm and flail width <15mm
89
Before releast of mitral clip, what should sonographer do?
Ensure proper clip capture
Measue MV gradient to ensure no MS (must be <6mmHg)
planimeter MVA (should be >2.0cm2)
Importantly, once above is performed mitral clip release does not need to be performed under echo guidance. Every other step should be.
90
Contraindication to LAA occlusion?
Valvular Afib
91
Most common potential complication of Watchman?
Serious pericardial effusion
92
What defines LVOT obstruction?
Peak instantaneous gradient of >30mmHg, and >50mmHg meet the conventional threshold for surgical or percutaneous intervention
93
What defines success in alocohol septal ablation?
Reduction in gradient by at least 50%, Myocardial contrast echo is important to define vascular distribution of septal wall.
ASA should be avoided if septal wall thickness >30mm
94
Contraindication to mitral clip?
MVA <4.0cm2
95
What defines success of MV valvuloplasty?
Increase in MVA by 50%.
96
thinning of the anterior, basal septum is highly specific for what disease?
Cardiac sarcoidosis
97
What is the definition of chemo-induced cardiac toxicity?
Reduction in EF by 10% with EF <53%.
*GLS is not currently in the definition, but >15% drop may predict a reduction in LVEF
98
Septal thickness in HCM that is an indication for ICD?
30mm
99
RVOT diameter to make you think of ARVC?
3.6cm or greater
100
Apical HCM measurement?
Apical thickness >15mm. End-diastolic dimension usually normal. Important to note that no LVOT obstruction/SAM occur in isolated apical HCM
101
Most important predictor of mortality in amyloidosis?
Increased LV wall thickness. >15mm predicts CHF and death.
102
What treatment for AI would not be recommended prior to LVAD? Why?
Mechanical, because of risk of thrombus
103
Definition of RV failure after LVAD?
Implantation of RVAD or 14 days of inotropic support
104
Does negative bubble study exclude PFO?
No, should have them valsalva, as well.
Should be closed at time of LVAD surgery.
105
Acute RV failure during or immediately after LVAD or other cardiac surgery should make you think of __.
RCA air embolism
106
Heartmate II speed range?
6,000 - 15,000
107
HVAD speed range?
1,800 - 4,000
108
For an LVAD, what is a suction event?
When the LVAD decompresses the LV to an abnormally small size. Will cause abnormal septal shift into the LV. Can cause ventricular arrhythmias due to cannula irritation.
109
Best views to interrogate LVAD cannula?
Parasternal long and short axis
110
For LVAD, what needs to be the case for a speed test echo to be performed?
Patient must be on therapeutic anticoagulation, as a thrombus can embolize. Thrombus may form in aortic root if AV continuously closed.
111
How do you differentiate cor triatrium from supravalvular mitral ring?
By the location of the LAA.
If LAA in the distal/MV/apical portion, cor triatrium.
If LAA in basal/PV portion, supravalvular ring.
112
Annual risk of CVA in patient with AF and MS?
7-15%
113
Smallest vegetation that can be detected by TTE? TEE?
TTE 5mm
TEE 1mm
114
How does persistence of vegetation after abx therapy affect outcomes?
It doesn't. Persistence of vegetation after abx therapy without significant regurgitation. Persistence only affects outcomes if the valve continues to degenerate.
115
After healing from endocarditis, what percentage of valves will regain normal structure and function?
<10%
116
How to identify eustachian valve vegetation?
RVOT view or parasternal short axis.
>5mm thick (normal <2mm) with high-frequency motion independent of the underlying structure.
117
MV aneurysm is usually due to __.
Endocarditis and surgical repair is usually indicated due to high rate of perforation.
118
What is a "ghost"?
Tubular, mobile mass in the path of an intracardiac lead following lead extraction. Almost always occurs after removal for infectious reasons and may persist after abx treatment. Prognostic significane is uncertain.
119
How does severe prosthetic mitral regurgitation affect gradients?
Peak gradient increased more than mean gradient.
120
Attenuation is the combined result of __ ,__, and __?
What aims to correct for this?
Ultrasound scattering, absorption, and scattering.
Time gain compensation
121
What controls the strength of a transmitted ultrasound wave?
Pawer control
122
The spatial resolution of an ultrasound image is equal to the:
What is spatial resolution?
Size of a pixel in the relevant direction
Smallest distal between two objects that allows distinction between them.
123
What is temporal resolution?
Temporal resolution is equal to __.
Smallest time between two events that allows distinction between the two.
Temporal resolution is equal to the inverse of the FRAME rate. For example, if frame rate is 20frames/second. Temporal resolution = 1/20 = .05seconds = 50ms
124
The dynamic range of echoes displayed on the screen is adjusted by the __.
Compression control, this control can be used to include or suppress weak echoes.
125
What control can best compensate for image losses due to attenuation?
Gain, which amplifies the return signal.
126
How does filtering eliminate ghosting artifacts?
By removing low-velocity signals.
127
With time gain compensation, the machine __ signal in near field and __ signal in far field.
Decreases near
Increases far
128
What is persistance?
A tool used to smooth out an image. Images are averaged to create this smoothing effect. This comes at the expense of temporal resolution, so increased persistence can cause structures to appear to be moving in slow motion.
129
What is the difference between read and write zoom?
Read zoom simply magnifies an image.
Write zoom improves image resolution by increasing both the line density and number of pixels.
130
What is harmonic imaging?
Imaging that uses ultrasound reflections that have twice (for second harmonic) the frequency of the transmitted waves.
131
How does decreasing depth affect frame rate?
Hoe does reducing sector width affect frame rate?
BOTH will allow increased rape rate.
132
How does echo contrast work?
Added gas-liquid interface of the microbubbles augment reflection.
133
How can you improve shadowing with echo contrast?
Use less contrast.
134
Eustachian valve, crista terminalis, chiari network are all structures that are seen in the __.
Right atrium
135
Where is the moderator band?
RV
136
Rhabdomyoma
Benign cardiac tumor. Usually small and lobulated with diameter of 2mm-2cm. Usually multiple and are strongly associated with tuberous sclerosis.
137
Common primary cancers that met to the heart?
RCC - IVC to the R heart
Breast- heme/lymph spread, pericardial effusion common
Lung - direct extension, pericardial effusion common
Melanoma - intracavitary/myocardial involvement
Lymphoma - lymphatic spread
Carcinoid - TV and PV
138
Common myxoma symptoms?
Dyspnea, syncope, palpitations, fevers/weight loss (IL-6 production)
139
Fibroelastomas
90% are single and can occur on any valve. Valve dysfunction is rare.
140
Leiomyosarcomas
are derived from smooth muscle tissue and can originate from the cells lining the PV. Usually occur in the LA, as opposed to most other cardiac tumors, terrible prognosis. Usually present in their 30s.
141
Angiosarcoma.
Terrible prognosis, usually metastasized by diagnosis. 3:1 M:F ratio. R>L heart. Can be intracavitary or infiltrative.
142
Synovial sarcoma
Transposition between Ch 18 and X. Malignant primary cardiac tumor, very rare.
143
What is likely if cardiac mass does not opacify at all with echo contrast?
Cyst
144
Chiari network
congenital remnant of sinus venosus. RA, 2-3% prevalence. Usually incidental
145
What is the most common valve-associated tumor?
Papillary fibroelastoma, 85% (though overall third most common tumor after myxoma and lipoma). Can embolize. All symptomatic patients should get surgery, as should those with large or mobile masses (>1cm)
146
What three vitamin/minerals can lead to a reversible CM?
Thiamine (beriberi) - seen in alcoholics, causes high-output failure
Selenium - TPN patients, LV dilation and systolic CHF
Carnitine - TPN, genetic, liver, renal disease. Systolic CHF
147
Echo of hemochromatosis?
Mild LV dilation with decreased systolic function. Normal valves, maybe some mildly increase wall thickness. Usually in late stage of disease, so other organ systems will also be involved.
148
Friedreich's ataxia?
AR disease. Severe, concentric LVH. Global decrease in function. May mimic HCM. Suspect if young patient with neuro/ataxic complaints.
149
Most common echo abnormality in HIV?
Pericardial effusion
150
Most common associated lesion with sinus venosus ASD?
Anomalous R PV connection
151
Describe hallmarks of AVSD?
Cleft anterior MV leaflet, lateral rotation of the LV papillary muscles, TV/MV attached at same level, LV inflow shortened due to absent of AVS (LV inlet:outlet ratio <1). AV "sprung" anteriorly due to no longer being wedged between TV and MV.
152
Other name for outlet VSD? Most common acquired lesion?
Supracristal or Subpulmonary
Aortic regurgitation due to prolapse of the aortic cusp into the VSD.
153
Most common type of VSD associated with coarctation?
Perimembranous.
154
What percentage of small trabecular VSDs in neonates will close spontaneously?
80-90%
155
Direction of atrial level shunting is primarily related to __.
Compliance of the ventricles or the ventricular EDP
156
Most common site of aortic coarctation?
Just opposite the insertion site of the ductus arteriosus (juxtaductal).
157
Valve lesion associated with Noonan?
Pulm stenosis.
158
RAP as determined by JVP?
RAP = JVP * 0.7
159
Primum ASD associated with?
VSD, cleft MV, LVOT obstruction.
160
Holt-Oram congenital heart defect?
Secundum ASD
161
What is the cause of cyanosis in most congenital patients?
Decreased pulmonary blood flow
162
Tricuspid atresia is always seen with __.
Atrial connection to relieve RA overload.
163
Mean gradient for severe TS? PHT for severe severe PS?
Gradient >7mmHg
190
164
Mean gradient for PS? Peak velocity?
Peak gradient >64mmHg
Peak velocity >4m/s
165
Single most prognostic factor in determining pHTN severity?
Presence of pericardial effusion. RV size, function and LV size are also important.
PAP are not too important, just need to determine high vs low.
166
What measure of RV function is not applicable in acute PTE?
RIMP, will be abnormally low (normal).
