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ECHOCARDIOGRAPHY Flashcards

1
Q

What is echocardiography?

A

A group of applications using ultrasound to interrogate cardiac structures

It utilizes acoustic waves generated by piezoelectric crystals in the ultrasound probe.

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2
Q

What are the main characteristics of ultrasound waves?

A

Frequency, wavelength, velocity, and amplitude

These characteristics define how ultrasound interacts with tissues.

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3
Q

What is the frequency range typically used in echocardiography?

A

2 to 10 MHz

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4
Q

What does the time it takes for ultrasound to return to the probe indicate?

A

The depth of the structures relative to the probe

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5
Q

What is the principle of Doppler ultrasonography?

A

Based on the change between transmitted and receiving frequencies reflecting the speed and direction of moving blood

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6
Q

List some appropriate indications for obtaining an echocardiogram.

A
  • Symptoms possibly related to cardiac etiology
  • Initial evaluation of left-sided ventricular function after acute myocardial infarction
  • Evaluation of cardiac murmur in suspected valve disease
  • Sustained ventricular tachycardia or supraventricular tachycardia
  • Evaluation of suspected pulmonary artery hypertension
  • Evaluation of acute chest pain with nondiagnostic markers
  • Evaluation of known valve disease with change of clinical status
  • Evaluation of suspected endocarditis or tamponade
  • Evaluation of cardiotoxic effects of chemotherapy
  • Evaluation for cardiac injury in chest trauma
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7
Q

What are some uncertain indications for echocardiography?

A
  • Cardiovascular source of embolic event with normal TTE
  • Surveillance of prosthetic valves in clinically stable patients
  • Initial evaluation of systemic hypertension without symptoms
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8
Q

What are inappropriate indications for echocardiography?

A
  • Routine monitoring of stable conditions
  • Not the test of choice for initial evaluation of pulmonary embolus
  • Not for screening asymptomatic hypertensive patients
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9
Q

What are some appropriate indications for Transesophageal echocardiography (TEE)?

A
  • Evaluation of suspected aortic pathology
  • Guidance during percutaneous cardiac procedures
  • Determine mechanism of regurgitation
  • Diagnose/manage endocarditis in high probability patients
  • Persistent fever with an intracardiac device
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10
Q

What are the different modalities used in echocardiography?

A
  • One-dimensional motion mode (M-mode)
  • Two-dimensional (2D) imaging
  • Three-dimensional (3D) imaging
  • Doppler
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11
Q

What is the primary use of 2D echocardiography?

A

Identifying cardiac anatomy and morphology

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12
Q

How does M-mode differ from 2D echocardiography?

A

M-mode transmits a single line of ultrasound and provides better temporal resolution, while 2D provides better spatial resolution

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13
Q

What are the advantages of 3D echocardiography?

A
  • Eliminates geometric assumptions
  • Quantifies volumes of complex structures
  • Views structures from multiple perspectives
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14
Q

What does Doppler measure in echocardiography?

A

Movement of blood in and around the heart based on frequency shifts

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15
Q

Name the three modes of Doppler used in echocardiography.

A
  • Pulsed Doppler
  • Continuous-wave Doppler
  • Color Doppler
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16
Q

What is the purpose of the parasternal long-axis (PLAX) view?

A

Provides information on left ventricular structure and function

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17
Q

How is the parasternal short-axis (PSAX) view obtained?

A

By turning the ultrasound beam approximately 90 degrees clockwise from the PLAX position

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18
Q

What is assessed in the apical views of echocardiography?

A
  • LV size
  • Ejection fraction
  • Wall motion
  • Diastolic function
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19
Q

What is the standard method for measuring left ventricular ejection fraction (LVEF)?

A

LVEF = (End diastolic volume - End systolic volume) / End diastolic volume

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20
Q

What is Simpson’s method in echocardiography?

A

Tracing the LV endocardial border in systole and diastole to compute volumes

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21
Q

What is the Teicholz method used for?

A

Estimating LVEF using dimensions from the PLAX view

22
Q

True or False: Visual estimation of LVEF is commonly used in echocardiography.

23
Q

What technique is increasingly used to assess LVEF accurately?

A

3D echocardiography

24
Q

What does strain imaging assess?

A

Deformation of the myocardial segments

25
What are the views included in a comprehensive transthoracic echocardiographic examination?
Parasternal long-axis, parasternal short-axis, apical four-chamber, apical two-chamber, apical three-chamber, subcostal views ## Footnote These views help visualize different structures of the heart for diagnostic purposes.
26
What does myocardial strain along an axis indicate?
It is defined as (L(t) - L0) / L0, where L(t) is the distance between two points in the myocardium at time t and L0 is the initial length. ## Footnote Myocardial strain is vital for assessing heart function.
27
What is the significance of LV relaxation in echocardiographic diastolic assessment?
It identifies LV relaxation and estimates LV filling pressures ## Footnote Impaired relaxation can lead to increased LA pressure and potential pulmonary edema.
28
What is a normal early diastolic filling velocity (e9) for the lateral and septal walls?
Lateral wall: ≥10 cm/s; Septal wall: ≥8 cm/s ## Footnote Values below these thresholds indicate impaired relaxation.
29
What does the E/e9 ratio estimate?
The LV filling pressure ## Footnote A high E/e9 ratio indicates elevated LV filling pressure.
30
How can Doppler echocardiography estimate stroke volumes?
By using measurements of the LVOT and time-velocity integral (TVI) of blood through the LVOT ## Footnote The LVOT area times the TVI equals blood flow through the LVOT.
31
What echocardiographic technique is used to evaluate valvular disease?
2D echocardiography for visualization of valve structure, 3D echocardiography for detailed anatomical evaluation, and Doppler for assessing regurgitation ## Footnote Continuous-wave Doppler is crucial for determining hemodynamic severity of stenotic lesions.
32
What indicators suggest elevated intrapericardial pressure in pericardial effusion?
* Diastolic indentation or collapse of the RV * Compression of the RA for more than one-third of the cardiac cycle * Lack of IVC collapse with deep inspiration ## Footnote These indicators help assess the hemodynamic impact of pericardial fluid.
33
What findings may indicate a cardiac embolic cause in stroke patients?
* Depressed LVEF <40% * LA or LV clot * Intracardiac mass * Mitral stenosis * Significant atherosclerotic disease ## Footnote These findings warrant further investigation for potential embolic sources.
34
What are the classic echocardiographic findings in hypertrophic cardiomyopathy (HCM)?
* Asymmetric septal hypertrophy * Septal wall thickness >1.5 cm * Systolic anterior motion (SAM) of the mitral valve ## Footnote HCM has various phenotypical presentations.
35
What are the common indications for transesophageal echocardiography (TEE)?
* Suspected endocarditis * Assessment of valvular regurgitation * Exclusion of LA appendage thrombus * Suspected aortic dissection * Evaluation of intracardiac shunts ## Footnote TEE provides better visualization of cardiac structures compared to transthoracic echocardiography.
36
What is the purpose of evaluating the mitral valve?
To assess for possible surgical mitral valve repair or percutaneous repair
37
What is an intracardiac shunt?
An abnormal connection between the heart chambers that may not be well seen on transthoracic echocardiography
38
What is assessed in the left atrium (LA) and LA appendage before planned cardioversion?
The presence of thrombus (clot)
39
What is the role of intraoperative evaluation in cardiac procedures?
To assess cardiac structure and function for various procedures like TAVR, MitraClip, LA appendage closure
40
What does contrast echocardiography involve?
Injection of saline contrast or synthetic, gas-filled microbubbles into a systemic vein and imaging the heart using ultrasound
41
Why does saline contrast not cross the pulmonary capillary bed?
Because of its relatively large size
42
What indicates an intracardiac shunt during contrast echocardiography?
Rapid appearance of saline contrast in the left heart
43
What is the significance of synthetic microbubbles in echocardiography?
They are smaller than saline bubbles and can cross pulmonary capillaries to image left heart structures
44
What is the purpose of stress echocardiography?
To image the heart at rest, during exercise or pharmacologic stress, and during recovery
45
What target heart rate is typically achieved during stress echocardiography?
80% of the maximum age-predicted heart rate
46
What standard echocardiography views are used during stress echocardiography?
Parasternal long-axis, short-axis, apical four-chamber, and two-chamber views
47
What information does assessment of wall motion during stress echocardiography provide?
Presence of flow-limiting coronary artery disease
48
What are contraindications for stress testing modalities?
* Acute coronary syndrome * Severe aortic stenosis * LVOT obstruction * Malignant hypertension * Significant arrhythmias
49
What are additional uses of stress echocardiography?
* Assessment of mitral or aortic valve disease * Assessment of suspected exercise-induced diastolic dysfunction
50
What does improvement in LV function with low-dose dobutamine suggest?
Viable myocardium
51
What distinguishes true aortic stenosis from pseudo-aortic stenosis?
Assessment in patients with mild-moderate aortic stenosis at rest and depressed ejection fraction with low cardiac output

Cardiology Secrets (26 decks)

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