echocardiography

Question 1

how is epss an indirect measurement for systolic function

Answer 1

Lv dimensions are proportional to the diastolic left ventricular volume, and the maximal diastolic excursion of the mitral valve is proportional to itral stroke volume, the ratio of the two dimensions will be proportional the the ejection fraction

Question 2

How does the aortic valve opening on M mode change with DCM

Answer 2

The aortic valve opening is normally quick, forming a box-shaped profile. In DCM, due to reduced forward flow, there is gradual closure of the valve, which results in more coffin-like shape

Question 3

What is the descent of the base ?

Answer 3

Old unused measurements look at the descent of the heart base towards the apex as an assessment of systolic function. Measurements >10mm are normal.

Question 4

How do you determine stroke volume of the LV with VTI

Answer 4

Measure the VTI of the LVOT, times this by the cross-sectional area of the LVOT

Question 5

Show the formula for calculating stroke volume with VTI

Question 6

IF you have cyclical (every other) variation of VTI (high->low->high-> low) this can be an indication of what form of pulse and dysfunction

Answer 6

Pulsus alternans - sign of advanced ventricular systolic dysfunction

Question 7

what assumption does LV stroke volume using VTI assume?

Answer 7

That there is no aortic insufficiency

Question 8

What is a major source of error when calculating VTI?

Answer 8

Not accurately measuring the orifice area. As the measurement for stroke volume using VTI requires the square of the radius of the LVOT, the error can be amplified exponentially.

Question 9

How can you assess systolic function through dP/dt

Question 10

What is a B-bump on M-mode of the mitral valve an indicator of ?

Answer 10

This is associated with elevated LA pressure, which in turn reflects a LV end-dyastolic pressure, typically exceeding 20mmHg. This can add validity to an assessment of diastolic dysfunction when associated with pseudonormal mitral inflows

Question 11

Describe the findings of pulmonary vein flow profiles in a normal individual.

Answer 11

Normal pulmonary vein flow occurs in both systole and diastole, and there is a brief retrograde flow that corresponds to atrial contraction (A-wave)

Question 12

what changes do you see to pulmonary flow profiles with diastolic dysfunction?

Answer 12

You see increasingly prominent A-flow reversal and decrease in systolic flow the more progressive the diastolic dysfunction becomes

Question 13

What ancillary imaging can be used to determine if a mitral inflow profile is normal or pseudonormal?

Answer 13

Tissue Doppler imaging, pulmonary vein profiles

Question 14

How may a Valsalva manoeuvre help identify abnormal relaxation when you have a pseudonormal profile?

Answer 14

During Valsalva, flow into the left heart is reduced, and left atrial and ventricular diastolic pressure is decreased, resulting in a reduction in the E-wave velocity and reversal of the pseudonormal E/A ratio to reveal a pattern of abnormal relaxation.

Question 15

How can the colour M mode of mitral inflows assess diastolic function?

Answer 15

The velocity of propagation (Vp) can be measured from the slope of the leading edge of the colour M mode profile. lower the VP the more significant the diastolic dysfunction

Question 16

How is colour M-mode Vp affected by preload?

Answer 16

It is relatively preload indipendent

Question 17

what is MPEI

Answer 17

Myocardial performance indexx. It is a unitless number that reflects global left ventricular systolic and diastolic performance. It is defined as the ratio of the isovolumetric times (IVRT and IVCT) to ejection times; MPI=(AVCO-ET)/ET
AVCO is the period between the start of IVCT and end of IVRT. ET is the time between the start of the LV outflow to the end. Increasing values suggest worsening ventricular performance.

Question 18

What are secondary echo findings in DCM ?

Answer 18

1) LV dilation
2) LA dilation
3) pulmonary hypertension
4) Tricuspid regurgitation
5) right ventricular dilation/dysfunction
6) A-fib

Question 19

Distinguishin restrictive and constrictive pericarditis is challenging with no measurement/feature 100% discriminatory. Which two echo measurements are the most accurate in differentiating the two conditions?

Answer 19

Two of the more reliable discriminators are;
1) E-wave amplitude of mitral valve inflow
a. With constrictive, there is usually an exaggerated variation >25% of E-wave amplitude with the respiration cycle
2) Mitral valve annular velocities
a. E’ are significantly higher (>20cm/sec) in constrictive pericardis, compared to restrictive where they are often <10cm/sec)