Exam #3

Question 1

what type of exams will always include suprasternal notch (aka aortic arch views) ?

Answer 1

PEDIATRIC echocardiographic examinations

Question 2

patient placement for suprasternal notch views?

Answer 2

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

Question 3

Suprasternal long axis… where is transducer placed?

Answer 3

at the suprasternal notch

Question 4

the index is directed towards patient’s head at 12 o clock and angled inferior towards the heart

Answer 4

suprasternal long axis view - can rotate a tad to 1o’clock to see everything you need (tracy’s advice)

Question 5

structures demonstrated in suprasternal notch

Answer 5

ascending thoracic aorta, aortic arch, descending thoracic aorta, brachiocephalic artery, left common carotid artery, left subclavian artery, right pulmonary artery

Question 6

innominate artery AKA

Answer 6

brachiocephalic artery

Question 7

what are TECHNICALLY the first arteries to branch off the aorta

Answer 7

the RIGHT and LEFT coronary arteries!

they branch from the very base of the aorta

Question 8

What is the first artery to branch off the aortic ARCH

Answer 8

brachiocephalic artery or innominate artery

Question 9

The Subcostal 4-chamber view is BEST for what?

Answer 9

InterATRIAL septum evaluation
RV size and function
RV free wall measurements

Question 10

Is Doppler successful for a subcostal 4-chamber view? Why or why not?

Answer 10

No, because the view is perpendicular to the heart. In Doppler, we want parallel views to detect patterns of blood flow.

Question 11

what does ASD, VSD, and PFO stand for and how can you evaluate them?

Answer 11

ASD: Atrial Septum Defect
VSD: Ventricular Septum Defect
PFO: Patent Foramen Ovale

Question 12

IVC ______ with inhalation.
IVC ______ with exhalation.

Answer 12

collapses with inhalation
expands with exhalation

Question 13

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?

Answer 13

That the patient has elevated right heart pressures.

Question 14

From what view can you also evaluate the abdominal aorta?

Answer 14

The IVC/Hepatic Vein View
(Subcostal)

Question 15

What is the diameter of a normal abdominal aorta?

Answer 15

1-3 cm

Question 16

From the IVC/Hepatic Vein view, how can you view the abdominal aorta?

Answer 16

Rotate the transducer counterclockwise toward PATIENTS FEET

Question 17

Should the patient hold inspiration (hold their breath) during a IVC/Hepatic Vein View?

Answer 17

No. Just perform the “sniff test.”

Question 18

Subcostal SAX View, rotation?

Answer 18

12 o clock. Sweep to see pap, MV, and Aortic valve views.

Question 19

Subcostal 4 chamber view, rotation?

Answer 19

3 o clock toward patient left shoulder. Hold transducer right of midline, away from stomach on softer portion of abdomen.

Question 20

For IVC/Hepatic Vein view, rotation?

Answer 20

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.

Question 21

What views are frequently NOT a part of adult echos but SHOULD be?

Answer 21

Suprasternal notch view

Question 22

What view is ALWAYS included in a pediatric exam?

Answer 22

Suprasternal notch view

Question 23

Difference between suprasternal notch and subcostal patient positioning?

Answer 23

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.

Question 24

suprasternal notch view, what structures?

Answer 24

ascending thoracic aorta, aortic arch, descending thoracic aorta, brachiocephalic (innominate artery), left common carotid artery, left subclavian artery, right pulmonary artery.

Question 25

what is coarctation

Answer 25

narrowing of descending aorta (usually pediatrics)

Question 26

what is significant aortic insufficiency?

Answer 26

leaks on the aortic valve

Question 27

in what victims would you usually find aortic dissection (common in MVA’s)

Answer 27

car accident victims, damage

Question 28

Does taking a deep breath and holding it (such as when performing a subcostal view on the patient) decrease or increase intrathoracic pressure?

Answer 28

DECREASES!!!!!!!

Question 29

Would the subcostal 4-chamber view be a good view for doppler? why or why not

Answer 29

NO because the long axis of the heart is at a 45 degree angle (perpendicular) - successful doppler needs to run PARALLEL to blood flow

Question 30

How to go from a subcostal 4-chamber view to subcostal SAX?

Answer 30

Rotate the probe from 3 o’clock to noon (counterclockwise)

Question 31

How to go from a subcostal SAX view to a IVC/hepatic vein view?

Answer 31

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.

Question 32

How to achieve the abdominal aorta view?

Answer 32

Achieve a SAX Subcostal view (noon) and then rotate toward 6 o’clock (patient’s feet).

Question 33

Normal abdominal aorta is how many cm?

Answer 33

1-3 cm

Question 34

For the long axis view at the suprasternal notch, the transducer is placed

Answer 34

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.

Question 35

Structures demonstrated at the Suprasternal Notch View:

Answer 35

Ascending AND Descending Thoracic Aorta, Aortic Arch, CBS or the (Brachiocephalic, Left Common Carotid, and Left Subclavian Artery, and the Right Pulmonary Artery

Question 36

what is marfans syndrome

Answer 36

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)

Question 37

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.

Answer 37

12 o’clock to 1 o’clock

Question 38

Suprasternal short axis view

Answer 38

From Suprasternal Long Axis, rotate to 3 o’clock or 90 degrees clockwise toward patient left shoulder

Question 39

Structures demonstrated in Suprasternal Short-Axis view

Answer 39

Aorta in short axis, right pulmonary artery in long axis anterior to left atrium

Question 40

These views are very useful when evaluating Doppler velocities with a non-imaging probe for aortic valvular stenosis

Answer 40

Suprasternal views