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Cardiology Secrets > ECHOCARDIOGRAPHY > Flashcards

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
Q

What are the views included in a comprehensive transthoracic echocardiographic examination?

A

Parasternal long-axis, parasternal short-axis, apical four-chamber, apical two-chamber, apical three-chamber, subcostal views

These views help visualize different structures of the heart for diagnostic purposes.

26
Q

What does myocardial strain along an axis indicate?

A

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.

Myocardial strain is vital for assessing heart function.

27
Q

What is the significance of LV relaxation in echocardiographic diastolic assessment?

A

It identifies LV relaxation and estimates LV filling pressures

Impaired relaxation can lead to increased LA pressure and potential pulmonary edema.

28
Q

What is a normal early diastolic filling velocity (e9) for the lateral and septal walls?

A

Lateral wall: ≥10 cm/s; Septal wall: ≥8 cm/s

Values below these thresholds indicate impaired relaxation.

29
Q

What does the E/e9 ratio estimate?

A

The LV filling pressure

A high E/e9 ratio indicates elevated LV filling pressure.

30
Q

How can Doppler echocardiography estimate stroke volumes?

A

By using measurements of the LVOT and time-velocity integral (TVI) of blood through the LVOT

The LVOT area times the TVI equals blood flow through the LVOT.

31
Q

What echocardiographic technique is used to evaluate valvular disease?

A

2D echocardiography for visualization of valve structure, 3D echocardiography for detailed anatomical evaluation, and Doppler for assessing regurgitation

Continuous-wave Doppler is crucial for determining hemodynamic severity of stenotic lesions.

32
Q

What indicators suggest elevated intrapericardial pressure in pericardial effusion?

A
  • 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

These indicators help assess the hemodynamic impact of pericardial fluid.

33
Q

What findings may indicate a cardiac embolic cause in stroke patients?

A
  • Depressed LVEF <40%
  • LA or LV clot
  • Intracardiac mass
  • Mitral stenosis
  • Significant atherosclerotic disease

These findings warrant further investigation for potential embolic sources.

34
Q

What are the classic echocardiographic findings in hypertrophic cardiomyopathy (HCM)?

A
  • Asymmetric septal hypertrophy
  • Septal wall thickness >1.5 cm
  • Systolic anterior motion (SAM) of the mitral valve

HCM has various phenotypical presentations.

35
Q

What are the common indications for transesophageal echocardiography (TEE)?

A
  • Suspected endocarditis
  • Assessment of valvular regurgitation
  • Exclusion of LA appendage thrombus
  • Suspected aortic dissection
  • Evaluation of intracardiac shunts

TEE provides better visualization of cardiac structures compared to transthoracic echocardiography.

36
Q

What is the purpose of evaluating the mitral valve?

A

To assess for possible surgical mitral valve repair or percutaneous repair

37
Q

What is an intracardiac shunt?

A

An abnormal connection between the heart chambers that may not be well seen on transthoracic echocardiography

38
Q

What is assessed in the left atrium (LA) and LA appendage before planned cardioversion?

A

The presence of thrombus (clot)

39
Q

What is the role of intraoperative evaluation in cardiac procedures?

A

To assess cardiac structure and function for various procedures like TAVR, MitraClip, LA appendage closure

40
Q

What does contrast echocardiography involve?

A

Injection of saline contrast or synthetic, gas-filled microbubbles into a systemic vein and imaging the heart using ultrasound

41
Q

Why does saline contrast not cross the pulmonary capillary bed?

A

Because of its relatively large size

42
Q

What indicates an intracardiac shunt during contrast echocardiography?

A

Rapid appearance of saline contrast in the left heart

43
Q

What is the significance of synthetic microbubbles in echocardiography?

A

They are smaller than saline bubbles and can cross pulmonary capillaries to image left heart structures

44
Q

What is the purpose of stress echocardiography?

A

To image the heart at rest, during exercise or pharmacologic stress, and during recovery

45
Q

What target heart rate is typically achieved during stress echocardiography?

A

80% of the maximum age-predicted heart rate

46
Q

What standard echocardiography views are used during stress echocardiography?

A

Parasternal long-axis, short-axis, apical four-chamber, and two-chamber views

47
Q

What information does assessment of wall motion during stress echocardiography provide?

A

Presence of flow-limiting coronary artery disease

48
Q

What are contraindications for stress testing modalities?

A
  • Acute coronary syndrome
  • Severe aortic stenosis
  • LVOT obstruction
  • Malignant hypertension
  • Significant arrhythmias
49
Q

What are additional uses of stress echocardiography?

A
  • Assessment of mitral or aortic valve disease
  • Assessment of suspected exercise-induced diastolic dysfunction
50
Q

What does improvement in LV function with low-dose dobutamine suggest?

A

Viable myocardium

51
Q

What distinguishes true aortic stenosis from pseudo-aortic stenosis?

A

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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