Epicardial / Epiaortic Echo

Question 1

Neuro cognitive dysfunction risk factors

Answer 1

•Age
•Systolic HTN
•prior CVA
•female
•DM
•atherosclerosis of ascending aorta:
- old
- HTN
- unstable angina
- COPD
- CVA
- PVD
- elevated Cr
- CABG > 50% risk
- mobile plaque 45% -> CVA

Question 2

Epiaortic Exam — 5 views

Answer 2

• SAX of proximal ascending — STJ to proximal PA
- identify site of cardioplegia, cross clamp, cannulation

• SAX of mid ascending — adjacent to right PA
• SAX of distal ascending — right PA to take off of innominate artery
• LAX of ascending
• LAX of arch — includes all arch vessels

Question 3

Grading Plaque

Answer 3

• Grade 1 — normal intimal thickening
• Grade 2 — severe intimal thickening w/o protruding atheroma
• Grade 3 — atheroma 3 - 5 mm
• Grade 4 — atheroma > 5 mm
• Grade 5 — mobile component

*Grade 3 = 3 - 5 mm …. Grade 5 = anything mobile

Question 4

Epicardial Exam

Answer 4

• AV SAX — pa raster also AV SAX

• AV LAX — suprasternal AV LAX
- CFD and PWD

• LV basal SAX — modified parasternal MV basal SAX
• LV mid SAX — parasternal LV mid SAX (backwards from TEE view)
• LV LAX — parasternal LAX
• LV 2 chamber — modified parasternal LAX (challenging, least useful)