Exam 1

Question 1

LAD feeds

Answer 1

Apical cap
Apical Septum
Apical Lateral
Mid Anterior Lateral
Basal Anterior Lateral
Apical Inferior
Apical Anterior
Mid Anterior
Basal Anterior
Mid Anterior Septum
Basal Anterior Septum

Question 2

RCA feeds

Answer 2

Mid Inferior Septum
Basal Inferior Septum
Mid Inferior
Basal Inferior
Mid Inferior Lateral
Basal Inferior Lateral

Question 3

Circumflex feeds

Answer 3

Apical Lateral
Mid Anterior Lateral
Basal Anterior Lateral
Mid Inferior Lateral
Basal Inferior Lateral

Question 4

Right and Left Dominance

Answer 4

RCA gives rise to the Posterior Descending Artery in 80%
Circumflex gives rise to the Posterior Descending Artery in 20%

Question 5

Ischemia

Answer 5

Deficient oxygen supply to the myocardium resulting in transient or reversible injury to the myocardium
-caused by partial occlusion of a coronary artery due to atherosclerotic plaque

Question 6

Ischemia on Echo

Answer 6

normal wall motion at rest (partial occlusion does not prevent oxygenation of the heart muscle)
abnormal wall motion with stress or exercise

Question 7

Infarction

Answer 7

Irreversible injury to the myocardium due to prolonged ischemia
-caused by acute thrombotic total occlusion at the atherosclerotic plaque (plaque ruptures and clots)

Question 8

Infarction on Echo

Answer 8

acute infarction demonstrates abnormal wall motion at rest; unaffected segments are hyperkinectic

Question 9

Post reperfusion echo

Answer 9

PCI (percutaneous coronary intervention = angioplasty/stent)
CABG (Coronary Artery Bypass Graft Surgery)
Echo performed several days after to assess effectiveness
Assess systolic and diastolic function and wall segments

Question 10

Echo 4 to 6 weeks post MI

Answer 10

-checking status of infarcted segments
-looking at actual extent of infarction
-evaluates for reduced global function and ventricular dilation

Question 11

Hibernating myocardium

Answer 11

border myocardium that is chronically ischemic but not infarcted and could benefit from PCI or CABG
-identified with dobutamine stress test (wall motion improves with small amounts)

Question 12

Development of MI complications

Answer 12

-MR due to infarct of segment and pap muscle
-Ventricular septal defect due to necrosis then rupture of a focal area of IVS
-Pericardial effusion seen 2-4 days post MI
-Right Ventricular Infarction associated with inferior LV infarct
-LV aneurysm due to extensive damage of thinned dyskinetic walls
-LV thrombus due to akinetic walls and stasis of blood
-Acute/End stage ischemic cardiomyopathy from severe LV dysfunction and dilation due to acute multi vessel or prox event

Question 13

Delineating aneurysms

Answer 13

Aneurysm creates distinct outpouching of an area of the ventricle
-thin layer of myocardium
-wide neck
-ruptures early
-smooth transition from normal to thin wall

Question 14

Chronic pulmonary hypertension on echo

Answer 14

-concentric RVH
-PSM and D shaped LV in systole and diastole
-RAE
-PV mmode: reduced a wave and mid systolic closure
-Eventual RV systolic dysfunction
-Eventual RVE
-Enlarged PA, IVC, Coronary Sinus

Question 15

acute pulmonary emboli on echo

Answer 15

-immediate RVD
-RV systolic dysfunction
-significantly elevated pulmonary pressures and resistance
-dagger shaped TR

Question 16

Symptoms of PE

Answer 16

SUDDEN ONSET OF:
-SOB
-sharp chest pain
-cough with possible hemoptysis
-rapid HR
-sweating
-signs of cyanosis