Final Flag questions Flashcards
1
Q
What is cardio myopathy?
A
disease of myocardium
Cardiomyopathy is a disease of the heart muscle that makes it easier for your heart to pump blood to the rest of your body. Cardiomyopathy can lead to heart failure.
2
Q
Dilated CMO (aka: congestive CMO) is the most common CMO.
T or F ?
A
T
3
Q
Hypertrophic Cardiomyopathy (HCMO) etiology
A
idiopathic
genetic/gene mutations cause the heart muscle to grow abnormally thick
4
Q
Sarcoidosis is multisystem granulomatous disease; involves the heart in about 25% of cases and occurs in twice as many females as males
T or F ?
A
T
5
Q
4 Infiltrative Disorders associated with restrictive cardiomyopathy.
A
- amyloidosis: *most common. Extracellular deposition of amyloid protein in multiple organ systems *Uniform “sparkling”, “ground glass” granular myocardial appearance
-
sarcoidosis: multisystem granulomatous disease causing progressive heart failure *about 25% of cases and occurs in twice as many females
as males - Hurler syndrome: lack an enzyme that the body needs to digest sugar. As a result, undigested sugar molecules build up in the body, causing progressive damage to the brain, heart, and other organs.
- Goucher disease: missing an enzyme that breaks down lipids. Lipids start to build up in certain organs such as your spleen and liver.
6
Q
Uniform “sparkling”, “ground glass” granular myocardial appearance describes dilated cardiomyopathy.
T or F
A
F
7
Q
Restrictive/Infiltrative Cardiomyopathy is the __________common of all types of cardiomyopathy.
A
least
8
Q
_______________ is a hereditary factor associated with infiltrative/restrictive CM and typically occurs early in life.
Characteristics are: excessive glycogen storage in tissues; heart becomes enlarged and heavily thickened; and is autosomal recessive.
A
Pompes
9
Q
List 4 storage disorders associated with restrictive cardiomyopathy.
A
-
Farby disease: a rare genetic disease with a deficiency of
an enzyme called alpha-GAL. A lipid storage disorder that
is X-linked and affects mainly males. -
Danon disease: a metabolic disorder (glycogen storage
disease); X-linked; associated with CM, muscle weakness,
intellectual disability; LV hypertrophy with depressed EF -
Oxalosis- a metabolic disorder; causes kidney stones; renal
failure-Thickening of bilateral walls with speckling - Hemochromatosis: causes your body to absorb too much iron from the food you eat. Excess iron is stored in your organs, especially your liver, heart and pancreas.
10
Q
Reduced systolic function; decreased EF, < 30% describes which type of cardiomyopathy?
A
dilated CM
11
Q
An iron storage disease that affects multiple organ and tissue systems which may result in tissue damage and organ malfunction (the iron is stored within the cardiac cell rather than extracellular) is ______________________.
A
Hemochromatosis
12
Q
List 4 causes of Dilated Cardiomyopathy:
A
- idiopathic *most common primary etiology
- ethyl alcohol *most common secondary etiology
- CAD
- chemotherapy
- postpartum
- viral
13
Q
List 4 signs/symptoms that a patient with hypertrophic cardiomyopathy will present with.
A
- CP
- syncope
- dyspnea
- fatigue
- arrhythmia
14
Q
When discussing dynamic LVOT obstruction traits
Hydrodynamic drag forces (____________?_______________ ) describes the reduction in fluid pressure that results when a fluid flows through a constricted section (or choke) of a pipe.)
A
Venturi effect
15
Q
List 4 conditions associated with SAM:
A
- Hypertrophic cardiomyopathy
- Left ventricular hypertrophy
- Infiltrative cardiomyopathies with septal involvement
- Hypercontractile states
- Mechanical causes
16
Q
What is SAM?
A
Systolic anterior motion of MV leaflet
17
Q
_____________ is a rare, genetic, recessive disease originates from mutations in the “coding” of the mitochondria.
Both parents must have the dominant trait for a 25% chance of passing to offspring.
A
Friedreich’s Ataxia
*associated with HCM
18
Q
Amyloidosis is the most common infiltrative disorder.
T or F
A
T
19
Q
Dynamic LVOT obstruction; “dagger-shaped” CW profile; mitral regurgitant (accompanying SAM) with posteriorly directed jet; relaxation abnormality / diastolic dysfunction describe which type of CM?
A
obstructive hypertrophic CM
20
Q
Conditions that decrease preload, lower afterload, and increase contractility generally increase LVOT gradient (and the systolic murmur).
T or F
A
T
*Provocative maneuvers that influence LVOT gradient in HCM i.e Valsalva, Amyl nitrite
21
Q
True idiopathic and familial forms of dilated cardiomyopathy are relatively rare.
T or F
A
T
*Secondary causes of dilated cardiomyopathy are more common = ethyl alcohol
22
Q
In cases of severe dilated cardiomyopathy, the increased EPSS (increased E-point to septal separation) is indicative of increased left ventricular systolic function.
T or F
A
T
23
Q
Hypertrophic Cardiomyopathy (HCMO) treatment
__________ is a potential complication of alcohol septal ablation
A
heart block
*Heart block occurs when the electrical signals from the top chambers of your heart don’t conduct properly to the bottom chambers of your heart. There are three degrees of heart block. First degree heart block may cause minimal problems, however third degree heart block can be life-threatening.
24
Q
What is ASH?
A
asymmetric septal hypertrophy
*Normally IVS/LVPW ratio is 1/1 or 1
ASH is classified by a IVS/LVPW ratio > or = 1.3/1.0 or 1.3
ex: if the IVS = 1.8 and LVPW = 1.1, the IVS/LVPW ratio = 1.8/1.1 = 1.6 (ASH)
25
Formula for LA volume \*Biplane method
LA volume = (0.85 × A1 × A2)/L
\*A1 = LA area from 4C
\*A2 = LA area from 2C
\*L is the shortest of the two lengths measured in the
apical two- and four-chamber views.
26
AS etiologies
* degenerative/calcification \***most common**
* congenital (uni-, bi-, quadricuspid) \*BAV - 2:1 male to female occurance
* Rheumatic
* SVAS (supra valvular AS)
27
MVA equation
28
PISA method
1. Align direction of flow with insinuation beam
2. Zoom view & variance off
3. Change baseline/Nyquist limit low in direction of jet
4. Measure radius \*Make sure AoV is closed!
29
Explain Doppler assessment of MS: 4 steps
* Acquire pressure halftime with CW
* Acquire mitral valve area by measuring: peak E velocity & deceleration time
* Calculate pressure halftime by **DT (deceleration time) x 0.29**
* Calculate **MVA by 220/PHT**
30
A ______________ VSD is located posteriorly and inferiorly beneath the posterior tricuspid valve.
Subvalvular
31
List 4 processes that can change the shape of the Left Atrium
1. Atrial fibrillation
2. Mitral valvular disease
3. Hypertensive heart disease
4. High cardiac output states
32
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ created a diagrammatic representation of the cardiac cycle in 1915.
Dr. Carl Wiggers
33
The American Society of Echocardiography has established LA volume as the standard method for LA size assessment, regardless of whether it was obtained by the method of discs or the biplane area-length method. T or F?
T
34
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is located at the center of the atrial septum and is the most common type of ASD.
Ostium secundum
35
After birth the foramen ovale becomes the \_\_\_\_\_\_\_\_\_\_\_.
Fossa ovalis
36
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ sits low in the atrial septum and may involve a cleft mitral valve.
Ostium primum
37
The left atrial appendage and mitral annulus are located in the more muscular portion of the left atrium. T or F?
T
38
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ sits high in the atrial septum and is associated with a PAPVR and TAPVR.
Sinus venosus
39
A ______________ VSD is located in the right ventricular outflow tract inferior to the Pulmonary valve.
Supracristal
40
The ______________ is the large opening between the coronary sinus and left atrium
Coronary sinus
41
The mid-portion of the IAS is known as the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
fossa ovalis
42
LA structural ____________ is the complex process that results in changes in LA size, shape, and architecture.
remodeling
43
The most common VSD is the membranous. T or F?
T
44
The IVS is divided into Three regions. List those regions.
1. Inlet
2. Trabecular
3. Infundibular
45
Cor triatriatum is a normal type of heart structure. T or F?
F
\*\*note: Cor triatriatum is a congenital heart defect where the left atrium or right atrium is subdivided by a thin membrane resulting in three atrial chambers.
46
A Membranous VSD had the appearance of "Swiss Cheese." T or F?
F
\*membranous - (**most common**)-located below the AoV at the level of the LVOT
\***muscular/trabecular** - (may be multiple)-located in different regions of the septum “Swiss cheese”
\***Subvalvular** (atrioventricular canal, posterior, inlet) – located posteriorly and inferiorly beneath the posterior tricuspid valve
\***Supracristal (subplmonic, outlet**) – located in the right ventricular outflow tract inferior to the Pulmonary valve.
47
AoV peak vel = _____ increase symptoms and mortality
\>4m/s
48
grade III MR - jet is \_\_\_\_\_\_\_
* moderate to severe: MR jet 1/2 way into the LA
49
list different methods of calculating MS
- planimetry
- pressure half time
- deceleration time method
- PISA
- continuity equation
50
Describe the type of murmur associated with MS.
low-pitched, diastolic rumble with an opening snap
51
_What does PISA stand for?_
52
**Left ventricular diastolic dysfunction (DD)** is defined as the inability of the ventricle to fill to a normal end-diastolic volume, both _during exercise as well as at rest,_ while left atrial pressure does exceed \_\_\_\_\_\_\_\_
12 mmHg
\*Normal LAP: 8-10 mmHg
53
What are the causes of DD?
* **HTN** \*main cause
* **CAD**: ischemia, myocardial fibrosis
* **DM** (Diabetes mellitus): hyperglycemia \***coexistent CAD & HTN**
* **HCM** (hypertrophic cardiomyopathy): fibrosis, afterload, myocardial disarray (Myocardial disarray, also known as myocyte disarray, is **a term to describe the loss of the normal parallel alignment of myocytes (the muscle cells of the heart)**. Instead, the myocytes usually form circles around foci of connective tissue)
* **RCM** (restrictive cardiomyopathy): fibrosis, direct cellular injury, infiltration
54
abnormal relaxation without increased LV end-diastolic filling pressure (decreased **E/A ration \<0.75**)
diagnosis?
mild diastolic dysfunction
55
abnormal relaxation with increased LV end-diastolic filling pressure **(E/A 0.75 to 1.5**, deceleration time \> 140 ms, _plus_ 2 other Doppler indices of elevated end-diastolic filling pressure)
moderate or “psedonormal”
56
advanced reduction in compliance, (i.e. markedly increased stiffness) with restrictive filling (**E/A ration of \> 1.5, deceleration time \< 140 ms**, and Doppler indices of elevated LV end-diastolic filling pressure)severe
severe
57
4 stages of diastole
1. **isovolumetric relaxation**
2. **rapid early LV filling**
3. **slow LV filling** = **diastasis** (In [physiology](https://en.wikipedia.org/wiki/Physiology), **diastasis** is the middle stage of [diastole](https://en.wikipedia.org/wiki/Diastole) during the cycle of a [heartbeat](https://en.wikipedia.org/wiki/Cardiac_cycle), where the initial passive filling of the heart's ventricles has slowed, but before the atria contract to complete the active filling)
4. **atrial contraction**
58
What happens during stage 3?
stage 3: diastasis (slow LV filling)
after initial filling of blood
**Pressures in LV & LA equalize**; Blood transfer slowed due to equalizing pressures
59
myocardial tension primarily determined by \_\_\_\_\_.
It determines passive tension and passive stiffness
Titin
\*cellular indices for CHF (congestive heart failure) patients
60
What is LAVI ?
**LAVI = LA Volume / BSA**
**Left Atrial Volume Index (LAVI)** has been found to correlate with mortality from cardiovascular disease and may be measured at the **end-ventricular systole, when the LA is at its maxim size.**
61
_How to Analyze DD_
diastolic function cannot be evaluated with patients with the following conditions:
* AFib
* HCM
* restrictive CM
* sinus tachycardia
* moderate - severe MR
* severe AR
* MS
* heart transplant
62
_Myocardial Performance Index (TEI)_
equation
TEI Index = (IVCT + IVRT) / LVET
63
The normal LAVi is \_\_\_\_\_\_
16-34 mL/m2
64
The pulmonary vein S-wave decreases and the D-wave increases when the LAP increases and LA compliance decreases.
T or F ?
T
65
What is AR (atrial reversal wave) and its normal value?
150ms
* AR is created by atrial contraction \*corresponds with the **P wave** on ECG
66
_Doppler Parameters DD Normal Population_
E/A ratio
normal young/adult
1-2
67
_Doppler Parameters DD Normal Population_
E/A ratio
grade 1 (impaired)
\< 1.0
68
_Doppler Parameters DD Normal Population_
E/A ratio
Grade 2 (psedonormal)
1-1.5
\*reverses with valsalva
69
_Doppler Parameters DD Normal Population_
E/A ratio
grade 3 (restrictive/reversible)
\>1.5
70
_Doppler Parameters DD Normal Population_
E/A ratio
grade 4 (restrictive, irreversible)
1.5-2.0
\***Doppler values similar to grade 3 except not change with Valsalva maneuver**
71
In an adult, the volume of RV is larger than the volume of LV, whereas RV mass is about one sixth that of the LV.
T or F ?
T
72
What are the 3 structures unique to RV?
* **supraventricular crest** (crista supraventricularis)
* moderator band
* prominent trabeculamtions
73
What doe the diagram represent?
TR
74
What doe the diagram represent?
MR & TR
75
What doe the diagram represent?
AR & PR
76
What doe the diagram represent?
AS & PS
77
What doe the diagram represent?
MS & TS
78
What is McConnell sign?
McConnell's sign is **a distinct echocardiographic feature of acute massive pulmonary embolism**. _It is defined as a regional pattern of right ventricular dysfunction, with akinesia of the mid free wall and hyper contractility of the apical wall._
The McConnell’s sign is defined as relative **hyperkinesis of the apex** of the right ventricle (RV) relative to the RV free wall in the setting of RV strain. (aka enlargement
McConnell's sign is considered as a specific sign of APE
79
A large pulmonary embolism may lead to chronic Cor pulmonade
T or F ?
**F**
**A large pulmonary thromboembolism (blood clot) may lead to acute cor pulmonale.**
80
What are the 2 surfaces of RV?
**1. Sternocostal surface**
**2. Diaphragmatic surface**
81
4 types of foreign bodies that may be possible for patients
* **Pacemaker** / defibrillator wires
* Central venous **catheters** including dialysis catheters
* _Extracorporneal membrane oxygenation catheters_ (**ECMO**)
* Atrial septal defect occluder devices
82
Chronic bronchitis and emphysema are types of …
COPD (chronic obstructive pulmonary disease)
83
Pulmonary embolism (PE) is common and often fatal
US -250,000 annually
Undiagnosed: _____ mortality
30%
84
What is TAPSE ?
**T**ricuspid **A**nnular **P**eak **S**ystolic **E**xcursion
84
What is TAPSE ?
**T**ricuspid **A**nnular **P**eak **S**ystolic **E**xcursion
85
Cor pulmonale may also be caused by lung diseases, such as \_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_and \_\_\_\_\_\_\_\_\_.
* **cystic fibrosis**
* **pulmonary embolism**
* **pneumoconiosis**: a disease of the lungs due to inhalation of dust, characterized by inflammation, coughing, and fibrosis
* **muscular dystrophy:**
\***Loss of lung tissue after lung surgery or certain chest-wall disturbances can produce cor pulmonale as well**
86
About \_\_\_\_\_of patients diagnosed with cor Pulmonale have COPD
85%
Cor Pulmonale : right heart failure, an enlargement of the right ventricle due to high blood pressure in the arteries of the lungs,usually caused by chronic lung disease
87
**Cor Pulmonale**, or **pulmonary heart disease**, occurs in \_\_\_\_\_of patients with chronic obstructive pulmonary disease (COPD)
25%
88
RVSP – Right Ventricular Systolic Pressure Equation
**4V2 + RAP**
\***RAP** decided by 3/8/15 method
\***V** = peak TR velocity jet
89
_RV Structure_
\_\_\_\_\_\_\_ surface?
sternocostal
90
Which wall?
red
yellow
red: anterior free wall
yellow: inferior free wall
91
Which wall?
red
green
yellow
* red: anterior
* green: lateral
* yellow: inferior
92
Which wall?
inferior
93
Ischemia/infarction should be considered with a diastolic wall thickness of \> 7mm
T or F ?
**F**
Ischemia/infarction should be considered with a diastolic wall thickness of \< 7 mm or 30% less than adjacent myocardium.
94
Stenosis of ____ or greater is considered to be significant coronary artery disease.
70%
95
LV dilatation causes improper placement of the pap muscle resulting in \_\_\_\_\_
1. improper contraction
2. ischemia
3. ruptured papillary muscle
4. tenting
4
\*tenting: incomplete closure of MV
96
\_\_\_\_\_ is a surgical treatment option for patients with IHD/MI.
1. AICD
2. IABP
3. LVAD/RVAD
4. all of the above
\*all the surgical options are:
* **CABG:** coronary artery bypass graft
* **IABP**: intra-aortic balloon pump
* **AICD**: automatic implantable cardioverter-defibrillator
* **LVAD**: LV assist device
* **RVAD**: RV assist device
* **heart transplant**
97
\_\_\_\_\_\_ is the gold standard to determine the presence, location, and severity of CAD.
cardiac cath
98
Stable angina pectoris is \_\_\_\_\_\_
Choose the best explanation:
1. rare, usually in younger patients
2. relieved by rest or Nitroglycerin
3. unexpected CP
4. all of the above
**2: predictable, manageable, and effort induced (trigger: emotional stress, hot/cold temperature, large meals, smoking), lasts seconds to minutes (usually \< 5 min), and relieved by rest or Nitroglycerin**
1. _rare, usually in younger patients_ = **variant angia/Prinzmetal's** angina/angina inversa
2. **relieved by rest or Nitroglycerin**
3. _unexpected_ CP - predictable, manageable
99
Unstable angina pectoris \_\_\_\_\_\_\_\_
Choose the best explanation:
1. lasts seconds to minutes
2. is also known as prinzmetal's angina
3. is usually at rest or with little exertion
4. is usually predictable
**3: usually occurs at rest/sleep/with little exertion**
100
Coronary artery ______ causes temporary coronary artery obstruction.
spasm
## Footnote
\***coronary artery spasm**: a sudden tightening of the muscles within the arteries of your heart.
101
There are 6 risk factors for IHD, to include \_\_\_\_\_\_
* hyperlipidemia
* diabetes
* HTN
* tobacco use
* male
* family history
102
\_\_\_\_\_ MI is associated with sudden death.
type 3
103
\_\_\_\_\_ MI is subendocardial MI that does not extend the entire thickness of the heart wall.
Non-transmural
104
\_\_\_\_\_\_ is a ST-segment elevation MI and accounts for _____ of all MIs.
STEMI
70%
105
_Methods of Determining Cardiac Perfusion_
## Footnote
may be used to evaluate right heart and left heart ventricular ejection fraction, valvular regurgitation and intracardiac shunts
**Radionuclide angiography (MUGA)**
A **multigated acquisition scan** (also called **equilibrium radionuclide angiogram** or **blood pool scan**) is a noninvasive diagnostic test used to _evaluate the pumping function of the ventricles_ (lower chambers of the heart).
106
Papillary muscle dysfunction is most often associated with _______ and results in MR
inferior MI
106
Papillary muscle dysfunction is most often associated with _______ and results in MR
inferior MI
107
Myocardial hibernation is caused by a chronic hypoperfusion of the myocardium and it is reversible.
T or F ?
T
108
What is the difference between **myocardial hibernation** and **myocardial stunning**?
**Stunned myocardium** is **_viable_** _(workable)_ **_myocardium_** salvaged (recovered) by coronary reperfusion that _exhibits prolonged_ **postischemic dysfunction** after reperfusion.
**Hibernating myocardium** is **ischemic myocardium** supplied by a _narrowed coronary artery_ in which _ischemic cells remain viable_ but _contraction is chronically depressed_
109
What are the complications of MI?
**DARTH VADER**
* **D**eath
* **A**rrhythmia
* **R**upture of: free ventricular wall/septum/pap muscle
* **T**amponade
* **H**eart failure
* **V**alve disease
* **A**neurysm of ventricle
* _true aneurysm_- a bulge in the ventricular wall that persists during diastole and systole with akinesis or dykinesis
* _pseudo-aneurysm_- a narrow perforation of the ventricular free wall with a false chamber
* **D**ressler's syndrome
* **E**mbolism
* **R**ecurrence/MR
\*pericardial effusion, pericarditis, cardiogenic shock, L/R ventricular failure, VSD, RV infarction
110
What is Dressler's syndrome?
a type of inflammation of the pericarditis
111
_MI Classification System:_ Clinical
Type 1
**spontaneous MI** due to plaque, rupture, thrombotic occlusion
112
_MI Classification System:_ clinical
Type 2
MI due to supply and demand issue
113
_MI Classification System:_ clinical
Type 4a
**MI associated with PCI** (percutaneous coronary intervention)
114
_MI Classification System:_ clinical
Type 4b
MI associated with in-stent thrombosis
115
_MI Classification System:_ clinical
Type 5
MI associated with CABG: coronary artery bypass graft
116
What is PCI ?
**Percutaneous coronary intervention (PCI)** refers to **a family of minimally invasive procedures used to open clogged coronary arteries**
117
what are the absolute contraindications for TEE ?
esophageal tumor, stricture, fistula, on penetration
active upper GI bleed
perforated bowel or bowel obstruction
unstable cervical spine
uncooperative patient
118
how many TEE views ?
20-27
119
name the 4 windows associated with TEE and each depth
UE: upper esophageal window 20-25 cm
ME: midesophageal window 30-40 cm
TG: transgastric window 40-50 cm
Desc thoracic Aorta window
120
describe paradoxical embolous
passage of a venous thrombus into the arterial system, which can occur with a patient with PFO
121
what are the name of conscious sedation and reversal agents ?
sedative: Versed
analgesic: Demerol
reversal agent: Romazicon, Narcan
122
_The_ **_Transthoracic_** _Echocardiography transducer is a modified Gastroscope._
T or F ?
F
Transesophageal not Transthoracic.
123
_List 4 things that are important to note as part of your patient history._
Swallowing difficulties
allergies
bleeding disorders
current medical conditionsrgies
medications
when did the patient last eat?
124
\*AR severity PHT Mild & severe value ?
Mild: \> 500m/s Severe: \< 200m/s
125
What is EROA ?
Effective Regurgitant Orifice Area \*cross sectional area of VC = the narrowest area of actual flow
126
modified Bernoulli Equation
ΔPmax = 4 (Vmax2 –VLVOT2)
127
what is the simplified continuity equation for AVA ?
AVA = [(.785)(D LVOT)2] (V LVOT) / (V AoV)
