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Echo Stuff Flashcards

1
Q

What is abnormal Longitudinal strain?

A

> -18% (like -17% onwards)

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2
Q

Name 9 criteria for Severe AR?

A

-Diastolic flow reversal in Ascending Aorta
-LVEDD > 65
-Reduced LVEF
-PHT < 200 msec
-Rvol > 50%
-RF > 60%
- VC > 65% in PS Long
- ERO > 0.3
-VC > 0.60

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3
Q

What are three features of Rheumatic mitral stenosis?

A

-thickening predominant at leaflet tips
-doming of the mitral leaflets in diastole which leads to the hockey stick sign
-Thickened chordae

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4
Q

Name 5 ways to assess MS severity?

A

-Planimetry: Tend to over measure, limited by image quality

-MG:

-Continuity equation: MVA = (Pi)(LVOT radius)^2 x VTI LVOT / VTI MVA

-PHT: MVA / SqRt

-PISA: (Pi)(r)2 x Aliasing Velocity x angle / Mitral Valve Velocity

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5
Q

How do you derive MVA by PHT?

A

MVA = 220/PHT

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6
Q

Name two things that will shorten PHT

A

-AR
-High LVEDP

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7
Q

Name something that will lengthen PHT?

A

Early post PMBC

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8
Q

How do you derive PHT?

A

0.29 x DT

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9
Q

How do you derive MVA by PISA?

A

MVA = (2(pi)(r^2) x (Alias Velocity)) / Vmax

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10
Q

What are the 4 components of the Wilkins score? What score is good?

A
  • Valve mobility
  • Valve thickening
  • Valve calcification
  • Subvalvular thickening
  • < 8
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11
Q

What is the Carpentier classification?

A

-Type 1: Normal leaflet motion
-Type 2: Increased Leaflet mobility
-Type 3: Decreased Leaflet mobility

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12
Q

Name 3 characteristics of jet area that indicate severe MR?

A
  • Jet > 10 cm^2
  • > 40% LA area
  • Jet swirling in the LA
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13
Q

4 indicators of Severe MR?

A
  • VC > 0.7
    -ERO > 0.4 cm^2
    -RF > 50%
    -RVol 60 cc
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14
Q

How to calculate ERO?

A

PISA = 2(Pi)(R^2) x Aliasing Velocity

ERO = PISA/MR velocity

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15
Q

What are two doppler parameters to indicate severe MR?

A

-E wave > 1.2 cm
-Dense triangular CW wave

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16
Q

What are 4 etiologies of Pulmonic regurgitation?

A

-Carcinoid
-Endocarditis
-Rheumatic
-Secondary Pulm Htn

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17
Q

What is the key hemodynamic principle in Constriction?

A

-Dissociation of intrathoracic and intrapericardial pressures with inspiration and expiration

-The negative intrathoracic pressure pulls wedge pressure below LV diastolic

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18
Q

What are 6 features of constriction on echo?

A

-MV/TV inflow by 25/40%
-Septal bounce > 8mm septal e prime
-Abnormal septal flattening with variation
-Pulmonary and hepatic vein reversal in diastole
-Plethoric IVC
-Thickened Pericardium

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19
Q

What are the 3 grades of diastolic dysfunction?

A
  1. Reduced relaxation with normal filling pressure
  2. Filling pressure starts to elevate
  3. Increased filling pressures
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20
Q

Diastology: E/e prime cut off

A

> 14

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21
Q

Septal and Lateral e velocity

A

< 7 and < 10 cm/s

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22
Q

TR velocity

A

2.8 m/s

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23
Q

LA volume for DD

A

34

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24
Q

What are three reasons that you can’t measure Diastology?

A
  • Afib
    -MAC
  • > Moderate MR
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25
What are three echo features of myxomas?
-Found in all cavities of the heart (LA 75% of time) and not attached to valves -narrow stalk -mobile
26
How do you differentiate a Papillary Fibroeleastoma from Myxoma?
-Small size with stippled edge -Finger like projections from the tumor
27
What are two echo features of Angiosarcoma?
-Echo dense mass that blurs with the usual tissue margins -Associated with effusion 90% of time
28
What is a Lambl's excrescence?
-Forms along closure margins of the valves, greater frequency with age ?degenerative
29
What is the cut off for mild, mod and severe PPM of AVR?
> 0.85 < 0.85 < 0.65
30
What is cut off for mild, moderate and severe PPM for the mitral valve?
> 1.2 < 1.2 < 0.9
31
What is the formula for RVSP?
RVSP = 4(V tr)^2 + RAP
32
What is formula for PADP?
PADP = 4 (V ePR)^2 + RAP
33
What is formula for mean PA pressure?
mPAP = 4(V peak PR)^2 + RAP
34
What is the W sign in PH?
Mmode through RVOT, signifies high RV afterload
35
What is rule of 60's for PE?
Less then 60msec accel time, less than 60mmHg In chornic pulmonary htn, the acceleration time shortens to less than 100 msec
36
Differential for high gradient across mitral prosthetic Valve?
-Thrombus -Vegetation -Pannus -PPM -MR (differentiate with supportive features (PHT, Pulmonary veins)
37
AVA VTI Continuity Equation
38
Modified Bernoulli Equation
39
MR PISA, ERO, Residual Volume Equation
40
Echo Qp/Qs
41
Stroke Volume and Cardiac Output
42
Review Echo criteria for CP diagnosis
43
Review algorithm for high gradient across mechanical mitral valve?
44
Review Diastology Algorithm part 2
45
Review Diastology algorithm part 1
46
What is restrictive features as per 2016 Diastology guidelines? (6)
-Mitral E/A > 2.5 -DT of E wave < 150 msec -IVRT < 50 msec -Septal and Lateral E velocities < 5 (but lateral still greater than Septal) -LAE > 50 -E/e' > 14
47
Review A-F of M Mode of Mitral valve leaflet
48
What is this and what does it represent?
B Bump Elevated LVEDP (> 20mmhg)
49
What is shown here?
SAM (during systole)
50
What is this?
Rheumatic Mitral Stenosis (notice how anterior and posterior mitral leaflets move in unison)
51
What is this?
MMode demonstrating MVP
52
What is this?
-MVP (Late systolic regurgitation)
53
What is this?
LA Myxoma Echodensity which is prolapsing into the LA
54
What Rhythm is this?
Atrial Fibrillation
55
What is shown here ? (MMode through Aortic Valve)
HoCM, mid systolic closure of Aortic Valve
56
What is shown here?
Constriction- Movement of the IVS with respiration
57
What is shown here?
Tamponade: LV End Diastole varies with inspiration (decreases) and Posterior Pericardial Effusion
58
What is shown here?
Flying W -> MMode through the RVOT showing that the Pulmonic valve closes/shutters half way through systole indicated Pulmonary Hypertension
59
Diagnosis?
CP- Annulus Paradoxus
60
Diagnosis?
CP- Diastolic reversal in Hepatic vein in expiration
61
Doppler of LVOT, what is shown here?
Pulsus alternans- Severe CMO
61
Doppler of LVOT, what is shown here?
Pulsus alternans- Severe CMO
62
What are 5 predictors of embolism in IE?
-Large vegetations > 10mm -Highly mobile vegetations -Anterior mitral valve leaflet -Staph aureus -Delay in appropriate antibiotic therapy
63
What are the variants of HCM morphology? (4)
-Reverse Curve Morphologic Variant -Neutral Septal Morphologic Variant -Sigmoid Septal Variant -Apical Variant (Progression to aneurysm)
64
How to differentiate MR from LVOT doppler?
-MR is longer than LVOT -MR is higher velocity that LVOT -MR shape is less late peaking
65
What are 4 criteria for Diastolic Dysfunction?
The majority of: -Septal E' < 7 cm/s, Lateral E' < 10 cm/s -Average E/e' > 14 -TR Velocity > 2.8 m/s -LAVI > 34
66
What supports Grade 1 Diastolic dysfunction (Impaired relaxation, normal LA Pressure)
E/A < 0.8 + E < 50 cm/s
67
What supports Grade III diastolic dysfunction?
E/A > 2 (High LA filling pressure)
68
What supports Grade II diastolic dysfunction?
-E/A < 0.8 + E > 50 cm/s OR E/A 0.8 - 2 with 2/3 of the following: -Average E/e' > 14 -TR Velocity > 2.8 m/s -LAVI > 34
69
What happens to E and A with Valsalva?
Both E and A decrease
70
What happens to E and A with Valsalva in Grade 2 diastolic dysfunction?
E/A goes from reduced to > 1
71
What Deceleration time is associated with poor survival in Atrial Fibrillation?
DT < 130 msec
72
How to differentiate between pathologic and functional obstruction using acceleration time in Aortic Valve Prosthetic valves?
-Jet Acceleration time > 100msec -> pathologic < 100msec -> functional obstruction (Regurgitation, PPM, normal prosthesis)
73
What is the formula for Dimensionless Index?
DVI = LVOT Velocity / Prosthetic Velocity
74
How to use DVI to differentiate between pathologic Aortic Prosthetic Valve stenosis vs/ functional obstruction?
DVI < 0.25 -> pathologic DVI > 0.3 -> functional obstruction
75
What is high velocity for prosthetic Aortic valve but AT < 100ms and indexed EOA < 0.65? What if indexed EOA > 0.85?
iEOA < 0.65 -> Severe PPM iEOA > 0.85: -If MG > 20 -> Pathologic Regurgitation -If MG < 20 -> normal
76
What happens if you use Pressure Half Time method for mitral prosthesis
It significantly over estimates EOA
77
How to differentiate between mitral prosthetic stenosis vs. functional obstruction for Mitral prosthetic valve?
-Use Pressure Half time If PHT > 130 msec -> pathologic obstruction If PHT < 130 msec -> PPM, Tachycardia, High flow, Functional obstruction
78
Name 3 CV symptoms of Cardiac masses, and 3 systemic
-CV: Embolism, Arrhythmia, HF -Systemic: Fever, Fatigue, Weight loss
79
Where is Angiosarcoma usually located and what is it usually associated with?
RA Associated with pericardial effusion Cytology is universally negative
80
What are 2 hallmarks of atrial myxomas?
-In the left or right atrium attached to the IAS
81
What is most common benign pediatric cardiac neoplasm?
Rhabdomyoma
82
What systemic syndrome is associated with myxomas? What about rhabdomyomas?
Myxoma: Carney Complex (Autosomal Dominant) Rhabdomyomas: Tuberous Sclerosis
83
Name 5 masses usually attached to valves
-Endocarditis -Thrombus -Papillary Fibroelastoma -Lambl's excrescences -Non bacterial thrombotic endocarditis
84
2 scenarios where you can't use bernouli equation + RAP for PASP estimation?
-RVOT obstruction/PV stenosis -Wide Open TR as velocity is typically low flow
85
What is RV enlargement measurement in basal diameter in Apical 4 chamber?
> 41 mm
86
What is this?
Cleft Mitral Valve
87
How to diagnose Coronary Sinus ASD?
Left arm saline bubble injection to uncover Left sided SVC
88
What is this on PLAX?
Membranous VSD
89
What is this on PSAX?
Subarterial VSD?
90
What is this seen on PSAX ?
Inlet VSD
91
What is this seen on PSAX at level of aortic valve?
Subarterial VSD
92
How to calculate RVSP in the setting of a VSD? (Or any Right to left shunt)
RVSP = SBP - 4(Velocity through VSD)^2 Example: SBP is 120mmhg, Velocity through VSD is 5 m/s RVSP = 120 - 4(5)^2 RVSP = 120 - 100 RVSP = 20mmhg
93
What is shown here?
3 sign with Aortic Coarctation
94
What is shown here?
PW through abdominal aorta -> shows antegrade extension of diastolic flow associated with Aortic Coarctation
95
Review VSD anatomy
96
Review VSDs on Echo
97
What S/D ratio is consistent with high LA pressure?
< 1

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