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From Flashcardlet big > Echo questions > Flashcards

Echo questions Flashcards

1
Q

What is diastolic heart failure

A

defined as a condition in which filling of the LV is impeded resulting in symptoms of low cardiac output, elevated LV filling pressure or both.

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2
Q

What are 4 phases of diastole

A

Isovolumetric relaxation time (IVRT)–closure AV to open of MV
Rapid ventricular filling (E wave velocity) MV opens, accumulating blood from LA LV increasing LVP
Diastasis (slope of filling)
Atrial contraction

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3
Q

What are patterns that diastolic dysfunction can present itself

A

impaired relaxation–reduced LV relaxation rate but relatively normal compliance and filling pressure

Pseudo normal—combined pattern of abnormal relaxation and restrictive physiology.

Restrictive–profound abnormalities of LV relaxation, compliance and mardedly increased filling pressure

Normal filling pattern

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4
Q

List 4 echocardiographic grades of diastolic dysfunction

A

Grade 1: abnormal relative E < A
Grade 2: Pseudonormal relaxation E > A
Grade 3: reversible restrictive filling E&raquo_space; A
Grade 4: fixed restrictive filling E&raquo_space;>A
Components of mitral valve inflow pattern
E = early wave represents early diastolic left ventricular phase
A (Atrial) - late diastolic ventricular filling phase associated with left atrial contraction
AT = accerleration time occurs from the onset of mitral diastolic time to the peak of the E wave
DT = deceleration time occurs from the peal of the E wave to the end of the early mitral flow

Normal is 1-2:

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5
Q

Phil Jones 5 measurements of Diastolic dysfunction

A
  1. Transmitral E wave deceleration time
  2. Isolvolumic relaxation time
  3. transmitral E:A ratio
  4. Ratio of transmitral A wave duration to pulmonary atrial reversal wave duration
  5. Pulmonary vein S:D ratio
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6
Q

What 4 tests are on the echo are you going to ask for when it comes to diastolic dysfunction

A

Transmitral doppler flow
check for DT
E and A ratio (if E < A then you have a problem)
Pulmonary Vein Flow Dopper
A blunted pulmonary vein flow pattern is found in diastolic dysfunction
Tissue Doppler imaging
displays the velocities of the myocardium during contraction and relaxation
Color M mode transmitral flow

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7
Q

Dr. Mcarthry diastolic dysfunction

A

Tissue Doppler imaging - reduction in the ventricular myocardial E’ relaxation velocity, reversal of the E’:A’ ratio (mirroring the mitral E:E ratio) and a E:E’ ratio greater than 15 are also indicators.

The presence of left atrial dilation is usually seen and reflects chronic elevation in filling pressures which accompanies diastolic dysfunction.

LV hypertrophy is also usually present.

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8
Q

What is “E”

A

This is deceleration time from peak to baseline

If > 24 ms is impaired relaxation

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9
Q

What is IVRT

A

Isolcolumetric relaxation time

if > 90ms its impaired relaxation

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10
Q

What are features of diastolic dysfunction

A

Elevated filling pressure (LVEDP > 16mm Hg) or PCWP * Done in Cath
Rate of LV myocardial relaxation is reflected by monoexpoentioal course of LV pressure fall, assuming (R = 0.97). to amonoexponential pressure decay.
Tau is a time constant that is widely accepted invasive measure of the rate of LV relaxation.
T > 48 ms
Isovolumetric relaxation time
Diastolic trans-mitral valve blood flow (E wave = early diastolic filling A = atrial contraction
E wave > A wave 1.5 to 1.0 ratio
If E to A < 1.0 then stiff heart and take long to relax
Really high E to A ratio > 2.0

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11
Q

What test can evaluate diastolic dysfunction

A

Brain Natriuretic peptide levels can be predictive.

If really high > 900s then both
if 500 think systolic
if low then 300s then systolic

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12
Q

describe diastolic filling issues

A

Changes in the passive component of diastole (shift of end-diastolic pressure-volume relationship (EDPVR). A left ward/upward shifted EDPVR (decreased ventricular capacitance results in a need for increased filling pressure to achieve filling volumes necessary for the heart to generate a normal stroke volume and blood pressure.

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13
Q

What is principle for Dopppler in diastolic heart failure

A

Pulse-waved Doppler tracing of mitral inflow are frequently used to study LV filling.

The normal filling velocity in early diastole is 1m/s if active relaxation is slowed early inflow is slower and loast for a longer duration.

This is responsible for the E/A reversal seen in pt.

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14
Q

What is Tissue Doppler

A

Newer, sophisticated technique to evaulate LV filling dynamics
directly measure the velocity of myocardial displacment as the LV expands in diastole.

The tissue velocity measured durning early filling (E-prime) can be considered a surrogate marker for tau

The ratio of of peak early transmitral flow velocity (E) to the peak early myocardial tissue velocity E-prime) is frequently cited as convincing evdience of myocardial diastoluc dysfunction.

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15
Q

What is an advantage of a Valsalva maneuver for assessing diastolic function

A

In cardiac patients a decrease of >50% in the E/A ratio is highly specific for increased LV filling pressure.

A smaller magnitude of change does not always indicated normal diastolic function.

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16
Q

What is Isovolumic relation time

A

when myocardium relaxation is impaired, LV pressure falls slowly, which results in a longer time before it drops the LA pressure.

Therefore, mitral opening is delayed and IVRT is prolonged.

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17
Q

What are main indicators of abdnormal relaxation

A

IVRT

Isvolumetric or early diastolic annulur motion or LV strain

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18
Q

Main indicators of reduced operating compliance

A

DR of Mitral E velocity
A-wave transit time
ratio of VEDP to LV end-diastolic volume

surrogates of of increased LVEDP
mitral A-wave duration
reduced A prime
and prolonged Ar during in pulmonary venous flow

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19
Q

What are indicators of early diastolic LV and LA pressures

A

E/eprime ration

DR of mitral E velocity in patients withe decpressed EF

20
Q

What are the standard 2D echo views

A 
Parasternal long axis
Parasternal short axis 
Apical 4 chamber
Apical five chamber
apical long axis two chamber view
subcostal 
suprasternal 
right parasternal view
21
Q

What is a grading system for aortic atheroma

A

Grade 1: normal
Grade 2: intimal thickening
Grade 3 Protrudes < 5 mm into aortic lumen, irregular, sessile
Grade 4: protrudes > 5 mm into aortic lumen, irregular, sessile
Grade 5: mobile atheroma of any size

4 and 5 are associated with stroke

22
Q

What are TEE findings of ischmic MR

A

Central MR
Dilated LV
MItral annulus dilated
posterior and apical displaced papillary muscle
decreased posterior medial annular angle (could be papillary muscle)
Tethering of mitral leaflet

23
Q

How do you identify true and false lumen during dissection

A 
True
	smaller
	Expands during systole 
	color prominent
False
	larger
	expands during diastole
	color less prominent 
	clot/smoke present
24
Q

What are the images for TTE

A

Parasternal
Apical
Subcostal
Suprasternal

25
Q

What are quantitative features of severe IMR

A

EROA (mm2) > 30

Regurg volume > 60

+ enlargement of cardiac chambers/vessels

26
Q

List quantitative features of severe TR

A

EROA (mm2) > 40mm2

> 45ml/beat of R vol

RV, RA, and Inferior vena cava dilation

27
Q

What are quantitative findings for severe primary MR

A

EROA (mm2) > 40

R vol > 60

LV and LA enlargement

28
Q

List quantitative features of secondary MR

A

EROA (mm2) = > 20

R vol > 30

29
Q

List qualitative features of severe MR

A

fail leaflet/ruptured papillary muscle/large coaptation defect
central jet or eccentric jet adhering, swiring, and reaching the posterior wall of the left atrium
large flow convergence zone

Semi-quantitative 
	> 7 mm vena contracta
	systolic pulmonary vein flow reversal 
	E-wave dominant > 1.5
	TVI mitra/TVI aortic > 1.4
30
Q

List qualitative features of AR

A

abnormal/fail/large coaptation defect
large central jet, variable in eccentric jets
Dense CW
Holodiastolic flow reversal in descending aorta (EDV > 20 cm)

Semiquantitative
> 6 mm vena contracta width (mm)
Pressure half-time < 200 ms

31
Q

List qualitative features of TR

A

abnormal fail/large coaptation defect
very large central jet or eccentric wall

Semiquantiative
> 7 vena contracta 
systolic hepatic vein flow reversal 
E-wave dominant > 1 m/s 
PISA radius > 9 mm
32
Q

What are TTE pericardial compression signs

A

LV septal displacement with respiration

Increased mitral inflow with expiration and reduction with inspiration

33
Q

What are risk factors for esophageal injury in pt undergoing TEE

A 
Previous esophageal injury 
throacic aortic aneurysm 
prlonged steroid use
large LA
advanced age 
previous thoracic irradiation
34
Q

What is normal thickening of myocardium with contraction

A

> 40% wall thickening with systole

35
Q

What is hypokinetic

A

< 30% wall thickening with systole

36
Q

Define Akinetic and dyskinetic wall motion on echo

A

Akinetic < 10% wall thickening

Dyskinetic–segmental outward motion during systole (usually some thickening)

37
Q

What are tamponade findings on echo

A

IVC dilation
invagination of the RA wall in diastole
expiratory collapse of the RV

38
Q

Echo signs consistent with pericardial constriction

A

thickened perciardium > 6 mm
ventricular interaction: idicates a fixed peridcardial space with leftward septal shit (septal bounce)
decreased mitral inflow with inspiration
decreased pulmonic inflow with inspiration
increased TV inflow during inspiration
diastolic hepatic venous flow reversal with expiration

39
Q

What is the significance of color on the colour-mapping Doppler

A

Blue Color represents flow away from the probe

Red color presents flow towards the probe

40
Q

What is modified Bernoulli equation

A

Using this equation two difference pressure gradients can be calculated across a cardiac valve

Change in Pressure = 4V2 (squared)

a peak gradient : which is calculated from peal velocity
mean gradient: which is calculated from the mean velocity

41
Q

What are two major assumptions of doppler-calculated gradients

A

All measurements assume linear flow—valvular stenosis produced trubulent flow

All measurements assume ultrasound beam is parallel to the direction of blood.

42
Q

What is continuity equation

A

Based on the principle of conservation of mass, hence the flow of blood across the outflow tract of a chamber must be the same as the flow of blood across the valve of that chamber

Volume of blood flow = cross-sectional area (A) X velocity of blood

43
Q

How can you measure Pulmonary artery systolic pressure by echocardiography

A

Use a modified Bernoullie equation

RVSP = 4 V2 + JVP

assuming there is no pulmonary stenosis, RVSP also represents the pulmonary artery systolic pressure (normally less then 25)

44
Q

Define vena contracta

A

narrowest segment of regurgitant flow stream and typically occurs just beyond the reguritant orifice

45
Q

What are echo risk factors for SAM

A 
Septum > 15mm
Small LV cavity
Hyperdynamic LVEF 65% 
Aorto mitral angle < 120 
Short coaptation-septal distance< 25 mm
Too small annuloplasty ring
Excessive height of posterior leaflet post repair
46
Q

What is diastolic dysfunction

A

limitation of the ventricle to fill to normal end-diastolic volume without an abnormal increase in end-diastolic pressure at rest or during exercise

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