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RCE Guidelines Studying > Echo Stuff > Flashcards

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
Q

What are three echo features of myxomas?

A

-Found in all cavities of the heart (LA 75% of time) and not attached to valves
-narrow stalk
-mobile

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26
Q

How do you differentiate a Papillary Fibroeleastoma from Myxoma?

A

-Small size with stippled edge
-Finger like projections from the tumor

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27
Q

What are two echo features of Angiosarcoma?

A

-Echo dense mass that blurs with the usual tissue margins
-Associated with effusion 90% of time

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28
Q

What is a Lambl’s excrescence?

A

-Forms along closure margins of the valves, greater frequency with age ?degenerative

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29
Q

What is the cut off for mild, mod and severe PPM of AVR?

A

> 0.85
< 0.85
< 0.65

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30
Q

What is cut off for mild, moderate and severe PPM for the mitral valve?

A

> 1.2
< 1.2
< 0.9

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31
Q

What is the formula for RVSP?

A

RVSP = 4(V tr)^2 + RAP

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32
Q

What is formula for PADP?

A

PADP = 4 (V ePR)^2 + RAP

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33
Q

What is formula for mean PA pressure?

A

mPAP = 4(V peak PR)^2 + RAP

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34
Q

What is the W sign in PH?

A

Mmode through RVOT, signifies high RV afterload

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35
Q

What is rule of 60’s for PE?

A

Less then 60msec accel time, less than 60mmHg

In chornic pulmonary htn, the acceleration time shortens to less than 100 msec

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36
Q

Differential for high gradient across mitral prosthetic Valve?

A

-Thrombus
-Vegetation
-Pannus
-PPM
-MR (differentiate with supportive features (PHT, Pulmonary veins)

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37
Q

AVA VTI Continuity Equation

A
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38
Q

Modified Bernoulli Equation

A
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39
Q

MR PISA, ERO, Residual Volume Equation

A
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40
Q

Echo Qp/Qs

A
41
Q

Stroke Volume and Cardiac Output

A
42
Q

Review Echo criteria for CP diagnosis

A
43
Q

Review algorithm for high gradient across mechanical mitral valve?

A
44
Q

Review Diastology Algorithm part 2

A
45
Q

Review Diastology algorithm part 1

A
46
Q

What is restrictive features as per 2016 Diastology guidelines? (6)

A

-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
Q

Review A-F of M Mode of Mitral valve leaflet

A
48
Q

What is this and what does it represent?

A

B Bump

Elevated LVEDP (> 20mmhg)

49
Q

What is shown here?

A

SAM (during systole)

50
Q

What is this?

A

Rheumatic Mitral Stenosis (notice how anterior and posterior mitral leaflets move in unison)

51
Q

What is this?

A

MMode demonstrating MVP

52
Q

What is this?

A

-MVP (Late systolic regurgitation)

53
Q

What is this?

A

LA Myxoma

Echodensity which is prolapsing into the LA

54
Q

What Rhythm is this?

A

Atrial Fibrillation

55
Q

What is shown here ? (MMode through Aortic Valve)

A

HoCM, mid systolic closure of Aortic Valve

56
Q

What is shown here?

A

Constriction- Movement of the IVS with respiration

57
Q

What is shown here?

A

Tamponade: LV End Diastole varies with inspiration (decreases) and Posterior Pericardial Effusion

58
Q

What is shown here?

A

Flying W -> MMode through the RVOT showing that the Pulmonic valve closes/shutters half way through systole indicated Pulmonary Hypertension

59
Q

Diagnosis?

A

CP- Annulus Paradoxus

60
Q

Diagnosis?

A

CP- Diastolic reversal in Hepatic vein in expiration

61
Q

Doppler of LVOT, what is shown here?

A

Pulsus alternans- Severe CMO

61
Q

Doppler of LVOT, what is shown here?

A

Pulsus alternans- Severe CMO

62
Q

What are 5 predictors of embolism in IE?

A

-Large vegetations > 10mm

-Highly mobile vegetations

-Anterior mitral valve leaflet

-Staph aureus

-Delay in appropriate antibiotic therapy

63
Q

What are the variants of HCM morphology? (4)

A

-Reverse Curve Morphologic Variant

-Neutral Septal Morphologic Variant

-Sigmoid Septal Variant

-Apical Variant (Progression to aneurysm)

64
Q

How to differentiate MR from LVOT doppler?

A

-MR is longer than LVOT

-MR is higher velocity that LVOT

-MR shape is less late peaking

65
Q

What are 4 criteria for Diastolic Dysfunction?

A

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
Q

What supports Grade 1 Diastolic dysfunction (Impaired relaxation, normal LA Pressure)

A

E/A < 0.8 + E < 50 cm/s

67
Q

What supports Grade III diastolic dysfunction?

A

E/A > 2 (High LA filling pressure)

68
Q

What supports Grade II diastolic dysfunction?

A

-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
Q

What happens to E and A with Valsalva?

A

Both E and A decrease

70
Q

What happens to E and A with Valsalva in Grade 2 diastolic dysfunction?

A

E/A goes from reduced to > 1

71
Q

What Deceleration time is associated with poor survival in Atrial Fibrillation?

A

DT < 130 msec

72
Q

How to differentiate between pathologic and functional obstruction using acceleration time in Aortic Valve Prosthetic valves?

A

-Jet Acceleration time > 100msec -> pathologic

< 100msec -> functional obstruction (Regurgitation, PPM, normal prosthesis)

73
Q

What is the formula for Dimensionless Index?

A

DVI = LVOT Velocity / Prosthetic Velocity

74
Q

How to use DVI to differentiate between pathologic Aortic Prosthetic Valve stenosis vs/ functional obstruction?

A

DVI < 0.25 -> pathologic

DVI > 0.3 -> functional obstruction

75
Q

What is high velocity for prosthetic Aortic valve but AT < 100ms and indexed EOA < 0.65? What if indexed EOA > 0.85?

A

iEOA < 0.65 -> Severe PPM

iEOA > 0.85:
-If MG > 20 -> Pathologic Regurgitation
-If MG < 20 -> normal

76
Q

What happens if you use Pressure Half Time method for mitral prosthesis

A

It significantly over estimates EOA

77
Q

How to differentiate between mitral prosthetic stenosis vs. functional obstruction for Mitral prosthetic valve?

A

-Use Pressure Half time

If PHT > 130 msec -> pathologic obstruction

If PHT < 130 msec -> PPM, Tachycardia, High flow, Functional obstruction

78
Q

Name 3 CV symptoms of Cardiac masses, and 3 systemic

A

-CV: Embolism, Arrhythmia, HF

-Systemic: Fever, Fatigue, Weight loss

79
Q

Where is Angiosarcoma usually located and what is it usually associated with?

A

RA

Associated with pericardial effusion

Cytology is universally negative

80
Q

What are 2 hallmarks of atrial myxomas?

A

-In the left or right atrium attached to the IAS

81
Q

What is most common benign pediatric cardiac neoplasm?

A

Rhabdomyoma

82
Q

What systemic syndrome is associated with myxomas? What about rhabdomyomas?

A

Myxoma: Carney Complex (Autosomal Dominant)

Rhabdomyomas: Tuberous Sclerosis

83
Q

Name 5 masses usually attached to valves

A

-Endocarditis

-Thrombus

-Papillary Fibroelastoma

-Lambl’s excrescences

-Non bacterial thrombotic endocarditis

84
Q

2 scenarios where you can’t use bernouli equation + RAP for PASP estimation?

A

-RVOT obstruction/PV stenosis

-Wide Open TR as velocity is typically low flow

85
Q

What is RV enlargement measurement in basal diameter in Apical 4 chamber?

A

> 41 mm

86
Q

What is this?

A

Cleft Mitral Valve

87
Q

How to diagnose Coronary Sinus ASD?

A

Left arm saline bubble injection to uncover Left sided SVC

88
Q

What is this on PLAX?

A

Membranous VSD

89
Q

What is this on PSAX?

A

Subarterial VSD?

90
Q

What is this seen on PSAX ?

A

Inlet VSD

91
Q

What is this seen on PSAX at level of aortic valve?

A

Subarterial VSD

92
Q

How to calculate RVSP in the setting of a VSD? (Or any Right to left shunt)

A

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
Q

What is shown here?

A

3 sign with Aortic Coarctation

94
Q

What is shown here?

A

PW through abdominal aorta -> shows antegrade extension of diastolic flow associated with Aortic Coarctation

95
Q

Review VSD anatomy

A
96
Q

Review VSDs on Echo

A
97
Q

What S/D ratio is consistent with high LA pressure?

A

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