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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.

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2
Q

Dilated CMO (aka: congestive CMO) is the most common CMO.

T or F ?

A

T

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3
Q

Hypertrophic Cardiomyopathy (HCMO) etiology

A

idiopathic

genetic/gene mutations cause the heart muscle to grow abnormally thick

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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

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5
Q

4 Infiltrative Disorders associated with restrictive cardiomyopathy.

A
  1. amyloidosis: *most common. Extracellular deposition of amyloid protein in multiple organ systems *Uniform “sparkling”, “ground glass” granular myocardial appearance
  2. sarcoidosis: multisystem granulomatous disease causing progressive heart failure *about 25% of cases and occurs in twice as many females
    as males
  3. 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.
  4. Goucher disease: missing an enzyme that breaks down lipids. Lipids start to build up in certain organs such as your spleen and liver.
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6
Q

Uniform “sparkling”, “ground glass” granular myocardial appearance describes dilated cardiomyopathy.

T or F

A

F

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7
Q

Restrictive/Infiltrative Cardiomyopathy is the __________common of all types of cardiomyopathy.

A

least

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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

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9
Q

List 4 storage disorders associated with restrictive cardiomyopathy.

A
  1. 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.
  2. Danon disease: a metabolic disorder (glycogen storage
    disease); X-linked; associated with CM, muscle weakness,
    intellectual disability; LV hypertrophy with depressed EF
  3. Oxalosis- a metabolic disorder; causes kidney stones; renal
    failure-Thickening of bilateral walls with speckling
  4. 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.
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10
Q

Reduced systolic function; decreased EF, < 30% describes which type of cardiomyopathy?

A

dilated CM

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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

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12
Q

List 4 causes of Dilated Cardiomyopathy:

A
  1. idiopathic *most common primary etiology
  2. ethyl alcohol *most common secondary etiology
  3. CAD
  4. chemotherapy
  5. postpartum
  6. viral
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13
Q

List 4 signs/symptoms that a patient with hypertrophic cardiomyopathy will present with.

A
  1. CP
  2. syncope
  3. dyspnea
  4. fatigue
  5. arrhythmia
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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

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15
Q

List 4 conditions associated with SAM:

A
  1. Hypertrophic cardiomyopathy
  2. Left ventricular hypertrophy
  3. Infiltrative cardiomyopathies with septal involvement
  4. Hypercontractile states
  5. Mechanical causes
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16
Q

What is SAM?

A

Systolic anterior motion of MV leaflet

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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

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18
Q

Amyloidosis is the most common infiltrative disorder.

T or F

A

T

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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

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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

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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

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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

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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.

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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)

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25
Q

Formula for LA volume *Biplane method

A

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.

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26
Q

AS etiologies

A
  • degenerative/calcification *most common
  • congenital (uni-, bi-, quadricuspid) *BAV - 2:1 male to female occurance
  • Rheumatic
  • SVAS (supra valvular AS)
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27
Q

MVA equation

A
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28
Q

PISA method

A
  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!
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29
Q

Explain Doppler assessment of MS: 4 steps

A
  • 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
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30
Q

A ______________ VSD is located posteriorly and inferiorly beneath the posterior tricuspid valve.

A

Subvalvular

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31
Q

List 4 processes that can change the shape of the Left Atrium

A
  1. Atrial fibrillation
  2. Mitral valvular disease
  3. Hypertensive heart disease
  4. High cardiac output states
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32
Q

________________________ created a diagrammatic representation of the cardiac cycle in 1915.

A

Dr. Carl Wiggers

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33
Q

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?

A

T

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34
Q

__________________ is located at the center of the atrial septum and is the most common type of ASD.

A

Ostium secundum

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35
Q

After birth the foramen ovale becomes the ___________.

A

Fossa ovalis

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36
Q

_______________ sits low in the atrial septum and may involve a cleft mitral valve.

A

Ostium primum

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37
Q

The left atrial appendage and mitral annulus are located in the more muscular portion of the left atrium. T or F?

A

T

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38
Q

__________________ sits high in the atrial septum and is associated with a PAPVR and TAPVR.

A

Sinus venosus

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39
Q

A ______________ VSD is located in the right ventricular outflow tract inferior to the Pulmonary valve.

A

Supracristal

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40
Q

The ______________ is the large opening between the coronary sinus and left atrium

A

Coronary sinus

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41
Q

The mid-portion of the IAS is known as the ____________________

A

fossa ovalis

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42
Q

LA structural ____________ is the complex process that results in changes in LA size, shape, and architecture.

A

remodeling

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43
Q

The most common VSD is the membranous. T or F?

A

T

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44
Q

The IVS is divided into Three regions. List those regions.

A
  1. Inlet
  2. Trabecular
  3. Infundibular
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45
Q

Cor triatriatum is a normal type of heart structure. T or F?

A

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.

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46
Q

A Membranous VSD had the appearance of “Swiss Cheese.” T or F?

A

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.

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47
Q

AoV peak vel = _____ increase symptoms and mortality

A

>4m/s

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48
Q

grade III MR - jet is _______

A
  • moderate to severe: MR jet 1/2 way into the LA
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49
Q

list different methods of calculating MS

A
  • planimetry
  • pressure half time
  • deceleration time method
  • PISA
  • continuity equation
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50
Q

Describe the type of murmur associated with MS.

A

low-pitched, diastolic rumble with an opening snap

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51
Q

What does PISA stand for?

A
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52
Q

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 ________

A

12 mmHg

*Normal LAP: 8-10 mmHg

53
Q

What are the causes of DD?

A
  • 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
Q

abnormal relaxation without increased LV end-diastolic filling pressure (decreased E/A ration <0.75)

diagnosis?

A

mild diastolic dysfunction

55
Q

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)

A

moderate or “psedonormal”

56
Q

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

57
Q

4 stages of diastole

A
  1. isovolumetric relaxation
  2. rapid early LV filling
  3. slow LV filling = diastasis (In physiology, diastasis is the middle stage of diastole during the cycle of a heartbeat, 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
Q

What happens during stage 3?

A

stage 3: diastasis (slow LV filling)

after initial filling of blood

Pressures in LV & LA equalize; Blood transfer slowed due to equalizing pressures

59
Q

myocardial tension primarily determined by _____.

It determines passive tension and passive stiffness

A

Titin

*cellular indices for CHF (congestive heart failure) patients

60
Q

What is LAVI ?

A

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
Q

How to Analyze DD

diastolic function cannot be evaluated with patients with the following conditions:

A
  • AFib
  • HCM
  • restrictive CM
  • sinus tachycardia
  • moderate - severe MR
  • severe AR
  • MS
  • heart transplant
62
Q

Myocardial Performance Index (TEI)

equation

A

TEI Index = (IVCT + IVRT) / LVET

63
Q

The normal LAVi is ______

A

16-34 mL/m2

64
Q

The pulmonary vein S-wave decreases and the D-wave increases when the LAP increases and LA compliance decreases.

T or F ?

65
Q

What is AR (atrial reversal wave) and its normal value?

A

150ms

  • AR is created by atrial contraction *corresponds with the P wave on ECG
66
Q

Doppler Parameters DD Normal Population

E/A ratio

normal young/adult

67
Q

Doppler Parameters DD Normal Population

E/A ratio

grade 1 (impaired)

68
Q

Doppler Parameters DD Normal Population

E/A ratio

Grade 2 (psedonormal)

A

1-1.5

*reverses with valsalva

69
Q

Doppler Parameters DD Normal Population

E/A ratio

grade 3 (restrictive/reversible)

70
Q

Doppler Parameters DD Normal Population

E/A ratio

grade 4 (restrictive, irreversible)

A

1.5-2.0

*Doppler values similar to grade 3 except not change with Valsalva maneuver

71
Q

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 ?

72
Q

What are the 3 structures unique to RV?

A
  • supraventricular crest (crista supraventricularis)
  • moderator band
  • prominent trabeculamtions
73
Q

What doe the diagram represent?

74
Q

What doe the diagram represent?

75
Q

What doe the diagram represent?

76
Q

What doe the diagram represent?

77
Q

What doe the diagram represent?

78
Q

What is McConnell sign?

A

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
Q

A large pulmonary embolism may lead to chronic Cor pulmonade

T or F ?

A

F

A large pulmonary thromboembolism (blood clot) may lead to acute cor pulmonale.

80
Q

What are the 2 surfaces of RV?

A

1. Sternocostal surface

2. Diaphragmatic surface

81
Q

4 types of foreign bodies that may be possible for patients

A
  • Pacemaker / defibrillator wires
  • Central venous catheters including dialysis catheters
  • Extracorporneal membrane oxygenation catheters (ECMO)
  • Atrial septal defect occluder devices
82
Q

Chronic bronchitis and emphysema are types of …

A

COPD (chronic obstructive pulmonary disease)

83
Q

Pulmonary embolism (PE) is common and often fatal

US -250,000 annually

Undiagnosed: _____ mortality

84
Q

What is TAPSE ?

A

Tricuspid Annular Peak Systolic Excursion

84
Q

What is TAPSE ?

A

Tricuspid Annular Peak Systolic Excursion

85
Q

Cor pulmonale may also be caused by lung diseases, such as ______, __________, _________and _________.

A
  • 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
Q

About _____of patients diagnosed with cor Pulmonale have COPD

A

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
Q

Cor Pulmonale, or pulmonary heart disease, occurs in _____of patients with chronic obstructive pulmonary disease (COPD)

88
Q

RVSP – Right Ventricular Systolic Pressure Equation

A

4V2 + RAP

*RAP decided by 3/8/15 method

*V = peak TR velocity jet

89
Q

RV Structure

_______ surface?

A

sternocostal

90
Q

Which wall?

red

yellow

A

red: anterior free wall
yellow: inferior free wall

91
Q

Which wall?

red

green

yellow

A
  • red: anterior
  • green: lateral
  • yellow: inferior
92
Q

Which wall?

93
Q

Ischemia/infarction should be considered with a diastolic wall thickness of > 7mm

T or F ?

A

F

Ischemia/infarction should be considered with a diastolic wall thickness of < 7 mm or 30% less than adjacent myocardium.

94
Q

Stenosis of ____ or greater is considered to be significant coronary artery disease.

95
Q

LV dilatation causes improper placement of the pap muscle resulting in _____

  1. improper contraction
  2. ischemia
  3. ruptured papillary muscle
  4. tenting
A

4

*tenting: incomplete closure of MV

96
Q

_____ is a surgical treatment option for patients with IHD/MI.

  1. AICD
  2. IABP
  3. LVAD/RVAD
  4. all of the above
A

*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
Q

______ is the gold standard to determine the presence, location, and severity of CAD.

A

cardiac cath

98
Q

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
A

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
Q

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
A

3: usually occurs at rest/sleep/with little exertion

100
Q

Coronary artery ______ causes temporary coronary artery obstruction.

A

spasm

*coronary artery spasm: a sudden tightening of the muscles within the arteries of your heart.

101
Q

There are 6 risk factors for IHD, to include ______

A
  • hyperlipidemia
  • diabetes
  • HTN
  • tobacco use
  • male
  • family history
102
Q

_____ MI is associated with sudden death.

103
Q

_____ MI is subendocardial MI that does not extend the entire thickness of the heart wall.

A

Non-transmural

104
Q

______ is a ST-segment elevation MI and accounts for _____ of all MIs.

105
Q

Methods of Determining Cardiac Perfusion

may be used to evaluate right heart and left heart ventricular ejection fraction, valvular regurgitation and intracardiac shunts

A

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
Q

Papillary muscle dysfunction is most often associated with _______ and results in MR

A

inferior MI

106
Q

Papillary muscle dysfunction is most often associated with _______ and results in MR

A

inferior MI

107
Q

Myocardial hibernation is caused by a chronic hypoperfusion of the myocardium and it is reversible.

T or F ?

108
Q

What is the difference between myocardial hibernation and myocardial stunning?

A

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
Q

What are the complications of MI?

A

DARTH VADER

  • Death
  • Arrhythmia
  • Rupture of: free ventricular wall/septum/pap muscle
  • Tamponade
  • Heart failure
  • Valve disease
  • Aneurysm 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
  • Dressler’s syndrome
  • Embolism
  • Recurrence/MR

*pericardial effusion, pericarditis, cardiogenic shock, L/R ventricular failure, VSD, RV infarction

110
Q

What is Dressler’s syndrome?

A

a type of inflammation of the pericarditis

111
Q

MI Classification System: Clinical

Type 1

A

spontaneous MI due to plaque, rupture, thrombotic occlusion

112
Q

MI Classification System: clinical

Type 2

A

MI due to supply and demand issue

113
Q

MI Classification System: clinical

Type 4a

A

MI associated with PCI (percutaneous coronary intervention)

114
Q

MI Classification System: clinical

Type 4b

A

MI associated with in-stent thrombosis

115
Q

MI Classification System: clinical

Type 5

A

MI associated with CABG: coronary artery bypass graft

116
Q

What is PCI ?

A

Percutaneous coronary intervention (PCI) refers to a family of minimally invasive procedures used to open clogged coronary arteries

117
Q

what are the absolute contraindications for TEE ?

A

esophageal tumor, stricture, fistula, on penetration
active upper GI bleed
perforated bowel or bowel obstruction
unstable cervical spine
uncooperative patient

118
Q

how many TEE views ?

119
Q

name the 4 windows associated with TEE and each depth

A

UE: upper esophageal window 20-25 cm
ME: midesophageal window 30-40 cm
TG: transgastric window 40-50 cm
Desc thoracic Aorta window

120
Q

describe paradoxical embolous

A

passage of a venous thrombus into the arterial system, which can occur with a patient with PFO

121
Q

what are the name of conscious sedation and reversal agents ?

A

sedative: Versed
analgesic: Demerol
reversal agent: Romazicon, Narcan

122
Q

The Transthoracic Echocardiography transducer is a modified Gastroscope.

T or F ?

A

F

Transesophageal not Transthoracic.

123
Q

List 4 things that are important to note as part of your patient history.

A

Swallowing difficulties

allergies

bleeding disorders

current medical conditionsrgies

medications

when did the patient last eat?

124
Q

*AR severity PHT Mild & severe value ?

A

Mild: > 500m/s Severe: < 200m/s

125
Q

What is EROA ?

A

Effective Regurgitant Orifice Area *cross sectional area of VC = the narrowest area of actual flow

126
Q

modified Bernoulli Equation

A

ΔPmax = 4 (Vmax2 –VLVOT2)

127
Q

what is the simplified continuity equation for AVA ?

A

AVA = [(.785)(D LVOT)2] (V LVOT) / (V AoV)

Echo (35 decks)

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