Exam #3 Flashcards
what type of exams will always include suprasternal notch (aka aortic arch views) ?
PEDIATRIC echocardiographic examinations
patient placement for suprasternal notch views?
supine
neck extended
can place a pillow under shoulders to help patient with better neck extension.
have patient turn their head to the right will move the chin out of the way to make room for the placement of transducer
Suprasternal long axis… where is transducer placed?
at the suprasternal notch
the index is directed towards patient’s head at 12 o clock and angled inferior towards the heart
suprasternal long axis view - can rotate a tad to 1o’clock to see everything you need (tracy’s advice)
structures demonstrated in suprasternal notch
ascending thoracic aorta, aortic arch, descending thoracic aorta, brachiocephalic artery, left common carotid artery, left subclavian artery, right pulmonary artery
innominate artery AKA
brachiocephalic artery
what are TECHNICALLY the first arteries to branch off the aorta
the RIGHT and LEFT coronary arteries!
they branch from the very base of the aorta
What is the first artery to branch off the aortic ARCH
brachiocephalic artery or innominate artery
The Subcostal 4-chamber view is BEST for what?
InterATRIAL septum evaluation
RV size and function
RV free wall measurements
Is Doppler successful for a subcostal 4-chamber view? Why or why not?
No, because the view is perpendicular to the heart. In Doppler, we want parallel views to detect patterns of blood flow.
what does ASD, VSD, and PFO stand for and how can you evaluate them?
ASD: Atrial Septum Defect
VSD: Ventricular Septum Defect
PFO: Patent Foramen Ovale
IVC ______ with inhalation.
IVC ______ with exhalation.
collapses with inhalation
expands with exhalation
Here’s a situation… you notice that the IVC is dilated… you have the patient do a “sniff” test and notice that the IVC remains dilated and fixed throughout the respiratory cycle. What can you infer here?
That the patient has elevated right heart pressures.
From what view can you also evaluate the abdominal aorta?
The IVC/Hepatic Vein View
(Subcostal)
What is the diameter of a normal abdominal aorta?
1-3 cm
From the IVC/Hepatic Vein view, how can you view the abdominal aorta?
Rotate the transducer counterclockwise toward PATIENTS FEET
Should the patient hold inspiration (hold their breath) during a IVC/Hepatic Vein View?
No. Just perform the “sniff test.”
Subcostal SAX View, rotation?
12 o clock. Sweep to see pap, MV, and Aortic valve views.
Subcostal 4 chamber view, rotation?
3 o clock toward patient left shoulder. Hold transducer right of midline, away from stomach on softer portion of abdomen.
For IVC/Hepatic Vein view, rotation?
Obtain Subcostal SAX view, then once at aortic level, point probe more toward right, past aortic valve level, the hepatic vein and IVC can be seen to enter the RA.
Evaluate IVC respiratory variations at this view.
What views are frequently NOT a part of adult echos but SHOULD be?
Suprasternal notch view
What view is ALWAYS included in a pediatric exam?
Suprasternal notch view
Difference between suprasternal notch and subcostal patient positioning?
subcostal: supine, legs bent, feet flat.
suprasternal: supine, neck extended, pillow under shoulders to help patient with neck extension, turn patient head to right so you don’t bop them in the head with transducer.
suprasternal notch view, what structures?
ascending thoracic aorta, aortic arch, descending thoracic aorta, brachiocephalic (innominate artery), left common carotid artery, left subclavian artery, right pulmonary artery.
what is coarctation
narrowing of descending aorta (usually pediatrics)
what is significant aortic insufficiency?
leaks on the aortic valve
in what victims would you usually find aortic dissection (common in MVA’s)
car accident victims, damage
Does taking a deep breath and holding it (such as when performing a subcostal view on the patient) decrease or increase intrathoracic pressure?
DECREASES!!!!!!!
Would the subcostal 4-chamber view be a good view for doppler? why or why not
NO because the long axis of the heart is at a 45 degree angle (perpendicular) - successful doppler needs to run PARALLEL to blood flow
How to go from a subcostal 4-chamber view to subcostal SAX?
Rotate the probe from 3 o’clock to noon (counterclockwise)
How to go from a subcostal SAX view to a IVC/hepatic vein view?
After obtaining the SAX aortic valve view, point the probe more towards the right, past the aortic valve level, and the hepatic veins and IVC can be seen to enter the RA.
How to achieve the abdominal aorta view?
Achieve a SAX Subcostal view (noon) and then rotate toward 6 o’clock (patient’s feet).
Normal abdominal aorta is how many cm?
1-3 cm
For the long axis view at the suprasternal notch, the transducer is placed
at the suprasternal notch, directed at patient’s head at 12 o’clock. Angle inferior toward heart. Can rotate a little toward 1 o’clock.
Structures demonstrated at the Suprasternal Notch View:
Ascending AND Descending Thoracic Aorta, Aortic Arch, CBS or the (Brachiocephalic, Left Common Carotid, and Left Subclavian Artery, and the Right Pulmonary Artery
what is marfans syndrome
it is a disease in which connective tissue becomes weak
resulting in aortic dilation, aneurysm formation, aortic dissection, aortic regurgitation and mitral valve prolapse
(from google)
If you can’t see the ascending AND descending aorta in the Suprasternal Notch view, rotate the transducer from its regular _____ o’clock to _______o’clock.
12 o’clock to 1 o’clock
Suprasternal short axis view
From Suprasternal Long Axis, rotate to 3 o’clock or 90 degrees clockwise toward patient left shoulder
Structures demonstrated in Suprasternal Short-Axis view
Aorta in short axis, right pulmonary artery in long axis anterior to left atrium
These views are very useful when evaluating Doppler velocities with a non-imaging probe for aortic valvular stenosis
Suprasternal views
