Final Flag Questions Flashcards
1
Q
A vasodilator that exhibits an extremely short half-life and increases blood flow in coronary territories utilized during a Pharmacological Stress Echo is _____________ (similar to adenosine).
A
dipyridamole
2
Q
What does SBSE stand for?
A
spine bicycle stress echo
3
Q
_______________= Heart Rate x Systolic BP / 100
A
double products
Pressure Rate Product (PRP), also known as the double product (DB), is used in exercise physiology to measure the stress put on the cardiac muscle based on the number of times the heart needs to beat per minute and the arterial blood pressure that pumps against.
4
Q
*1979 marked the first use of cross sectional echocardiography with bicycle exercise to describe ______________.
A
reversible segmental pathology
5
Q
Infusion pump
starting rate is ___ mcg/kg/min
at 3 min increased to ___ mcg/kg/min
at 6 mim increase to ____ mcg/kg/min
at 12 min increase ___ mcg/kg/min
A
5
10
20
40
6
Q
Exercise stress – ___% of maximum heart rate sustained for 1 minute
A
90
7
Q
Pharmacologic stress- ___% of maximal heart rate sustained for 1 minute.
A
85
8
Q
Digital image acquisition – Triggered by _________
A
QRS complex
9
Q
During DSE, if the THR is not achieved, a sixth dose of up to 50 mcg/kg/min can be administered with _____.
Additional doses of 0.25-0.5 mg of _____ may be repeated 1 minute interval (max 2.0 mg)
A
atropine sulfate 0.5 mg
atropine
10
Q
WMSI equation
A
WMSI (wall motion score index) = sum of all wall motion scores/number of segments visualized
11
Q
- Most common cardiac tumor in infants and children
- many are diagnosed within a year of life and greater than 90% are diagnosed by the age 15
A
Rhabdomyoma
- noncancerous (benign) tumor
- typically grows in myocardium in LV/RV as clusters
- The most common type of cardiac tumors seen in infants and children
12
Q
- a fatty infiltration of the interatrial septum sparring the fossa ovalis (gives dumb-bell shape)
- most prevalent in elderly and/or obese patients
- usually asymptomatic and found incidentally *appear echogenic
A
LHIS (lipomatous hypertrophy of the interatrial septum
13
Q
- most common valvular tumor
- believed to originate from a small thrombus that attaches and grow into a sense, mobile mass
- highly mobile and life-threatening
- 95% found in left heart especially AoV
- strongly associated with systemic emboli (stroke)
*resemble chordae tendineae
A
papillary fibroelastoma
14
Q
- second most common benign tumor in children
- bulky tumor that is frequently embedded in the myocardial wall of the ventricles or the IVS
- typically presents during childhood
- heart transplant may be indicated if children with a vary large mass - causing obstruction and leading to HF
A
fibroma
15
Q
The heart is removed, the tumor is removed, and the heart is put back into the patient
procedure?
A
autoplanstation
16
Q
List 4 ways that nonprimary tumors can involve the heart.
A
- direct extension
- metastatic spread of disease
- production of biologically active substances
- side-effects related to treatment of the primary tumor
17
Q
Most common malignant primary cardiac tumor
A
angiosarcomas
18
Q
Most common secondary malignant tumor
&
frequent original location in order
A
cardiac carcinoma
- lung
- lymphoma
- breast
- leukemia
- stomach
- melanoma
19
Q
Most common primary cardiac tumor in adults
A
myxoma
20
Q
Most common primary malignant cardiac tumor in adults
A
- angiosarcoma - begins in RA or pericardium
- Rhabdomyosarcoma
*Note: A carcinoma forms in the skin or tissue cells that line the body’s internal organs, such as the kidneys and liver. A sarcoma grows in the body’s connective tissue cells, which include fat, blood vessels, nerves, bones, muscles, deep skin tissues and cartilage.
21
Q
List 4 of the most common non primary cardiac tumors.
A
- lung carcinoma
- lymphoma
- breast carcinoma
- leukemia
22
Q
Nonprimary cardiac tumors are______ more common than primary cardiac tumors.
A
20 times
23
Q
A
24
Q
Nonprimary cardiac tumors most often involve the ________ but also may invade the ________. They rarely appear as intracardiac masses.
A
pericardium
myocardium
25
Structures that may be mistaken for an Abnormal Cardiac Mass found in
AoV
Lambl's excrescence
nodules of Arantius
26
The most common primary cardiac tumors in adults, in order of frequency, are:
myxoma
pericardial cyst
lipoma
papillary fibroelastoma
angiosarcoma
27
List 2 **extra cardiac** pericardial malignant masses.
**angiosarcoma**
**Mesothelioma** - a cancer caused by asbestos. It most commonly occurs in the linings of the lungs or the abdomen.
28
What is this?
**Angiosarcoma** (malignant)
are malignant sarcomas of vascular endothelial cell origin. Endothelial cells make up the lining of vessels. Angiosarcomas can occur in any region of the body, although they are most commonly located in the skin, breast, liver, and deep tissue.
may be found in any of the 4 chambers. Large size and rapid/aggressive growth is not unusual.
29
The second most common primsry malignant tumor
rhabdomyosarcoma
30
*Results in cyanosis requiring early intervention to maintain \_\_\_\_\_and \_\_\_\_\_\_\_.*
cyanosis
PFO
PDA
31
Type ?
**AV (atrial-ventricular) discordance**
**&**
**VA (ventricular-arterial) discordance**
**Atrioventricular and ventriculoarterial discordance,** also known as congenitally corrected transposition of the great arteries: **Levo-TGA/l TGA/Corrected TGA**
* ventricles are transposed (RV in LV position becoming arterial ventricle & LV in RV position becoming venous ventricle)
* If no other defects present, heart function normally for 15-20 years
* _eventually systemic ventricle (RV in LV position) will fail_
type 3
32
Qp/Qs \> 1
left to right shunt
33
_Qp:Qs ratio_
ratio \< 1.0 indicates
right to left
34
**a rare congenital abnormality characterized by a mirror-image transposition of both the abdominal and the thoracic organs**
**\*normal heart structually**
situs inversus totalis
35
The heart is displaced to the right due to a
mass (space occupying lesion) in the left chest
dextraposition
36
* Location of the heart is in the right side of the thorax, the left ventricle remaining in the normal position on the left, but lying anterior to the right ventricle
* Most common form of Dextrocardia
* May be associated with atrial- ventricular discordance and ventricular-arterial discordance
dextroversion
37
a condition in which all four of the pulmonary veins are abnormally connected to the right atrium instead of the left atrium. This allows blood high in oxygen to enter the right side of the heart. Blood high in oxygen flows across an ASD, to the left ventricle, allowing some blood with oxygen to reach the body. Without the ASD, blood high in oxygen would not be able to reach the body.
**TAPVD** (Total Anomalous Pulmonary Venous Drainage)
38
In \_\_\_\_\_\_\_, **the heart is positioned on the right side of the chest instead of its normal position on the left side**.
dextrocardia
39
Most common congenital anomaly involving the \_\_\_\_\_\_\_\_
systemic veins
40
\_\_\_\_\_\_\_\_\_ is uncommon, complex anomaly; critical underdevelopment of the left ventricle due to restriction of the LV inflow/outflow as a result of :
* **mitral valve atresia-** inflow reduction; **hypoplasia** or complete closure (atresia)
* **aortic valve atresia** - outflow obstruction, **AV** hypoplasia**/**severe stenosis, or coarctation of aorta
* **hypoplasia of aorta** - outflow obstruction
* Small atrial septal defect typically present
**Hypoplastic Left Heart Syndrome (HLHS)**
**\*point:**
* **MV atresia**
* **AV atresia**
* **hypoplasia of aorta**
41
What is the least common ASD?
sinus venosus
also called:
IVC (inferior vena caval)/SVC (superiro vena caval) septal defect
42
Aortic coarctation typically occur at \_\_\_\_\_\_\_\_\_\_
AO isthmus
43
AV (atrial-ventricular) discordance
&
VA (ventricular-arterial) discordance
AKA: congenitally corrected transposition of the great arteries or
**Levo-TGA**
44
What type of VSD?
* *MOST COMMON TYPE OF VSD IN ADULTS (80%)*
* bordered by TV, AoV, and muscle
* high on the septal wall and closer to the valves and the great vessels
* thinner, more flexible
perimembraneous/membraneous
45
Qp:Qs \< 1.5
size of shunt?
small
46
* Aorta is connected to the RV and the Pa is connected to the LV
* Two parallel circuits exist
* This condition is incompatible with life unless surgically corrected - relying on ASD/VSD/PDA
D-TGA
D-transposition of the great arteries
47
\_\_\_\_\_\_\_\_\_\_\_\_\_ is defined as the process in which a long-standing Lt \> Rt cardiac shunt caused by a congenital heart defect (typically a VSD, ASD or PDA) causes pulmonary hypertension and eventual reversal of the shunt into a cyanotic Rt \> Lt shunt.
\*at this point, VSD should not be closed
**Eisenmenger’s syndrome**
48
The most common form of cyanotic congenital heart disease with a prevalence of approximately 8% - 10% of all CHDs.
Tetralogy of Fallot
49
Tetralogy of Fallot 4 features:
PS
RVH
perimembraneous VSD
overriding Aorta of septum
50
What type of ASD?
* *rare*
* *Defect occurs as a true persistence of the embryonic foramen primum*
* *Located between the limbic septum, pars atrioventricularis of the membranous septum and ccoronaray sinus*
ASD in septum intermedium
51
**atrioventricular canal (septal) defect/AVCD/AVSD** has high association with \_\_\_\_\_\_\_\_\_.
Trisomy 21 (Down Syndrome)
\**Abnormal development of**endocardial cushions**resulting in a**primum ASD and membranous VSD***
52
Most common congenital anomaly involving the **systemic veins**
**SVC systemic venous return**
\*Most common form is the left **SVC drains into the RA via the coronary sinus** (Appears as a dilated coronary sinus on PLAX and A4C with inferior angulation)
53
What type of surgical procedure?
* Native pulmonary artery is used to replace aortic valve*
* Indications: Severe aortic stenosis with Hypoplastic aortic annulus*
Ross
54
Most common congenital anomaly of the adult heart affecting approximately 2% of the population
BAV
55
Usually see a difference in blood pressure between arms and legs
What kind of CHD is suspected?
coarctation of Ao
56
* During 3rd or 4th week of fetal life, aorticopulmonary septal forming, spiraling, and division does not occur
* Main pulmonary artery, aorta, and coronary arteries arise from one great vessel out of the base of the heart
* Large malaligned ventricular septum
Truncus arterosus
57
cardiac and chamber development: 7 regions
1. Sinus venosus
2. Primitive atria
3. Atrioventricular canal
4. Primitive ventricle
5. Bulbus cordis
6. Truncus arteriosus
7. Aortic sac and arches
58
6 aortic arches
**1st pair** – persist as components of the maxillary arteries and **external carotid arteries**
2nd pair – persist as stapedial arteries
**3rd pair** - become **the common carotid arteries** and
proximal segment of the internal carotid arteries.
**\*4th pair** – Right becomes the Prox R S**ubclavian**; Left
becomes the **aortic arch** segment between the LCA
and L subclavian A
5th pair – rudimentary
**\*6th pair** – Right becomes **Prox R PA** (distal part
disappears early); L Prox becomes **Prox L PA** and
persists until birth as the **PDA**
59
\_\_\_\_\_\_\_ is a condition in which all four of the pulmonary veins are abnormally connected to the right atrium instead of the left atrium. This allows blood high in oxygen to enter the right side of the heart. Blood high in oxygen flows across an ASD, to the left ventricle, allowing some blood with oxygen to reach the body. Without the ASD, blood high in oxygen would not be able to reach the body.
occurs when absence of the right SVC & absence of hepatic segment of IVC
* blood flows from the IVC to the azygous vein to the left AVC to LA
* hepatic veins drains into the LA
* common atrium
Total Anomalous Pulmonary Venous Return (TAPVR)
60
Interatrial septum complete by
27-37 days/ complete by 5th-6th week post conception
61
Structures unique to fetal circulation
placenta
umbilical vein
ductus venosus
foramen ovali
ductus arteriosus
62
heart forms by day \_\_\_\_\_
50
63
\_\_\_\_\_\_\_ occurs when interruption of the IVC;
* Absence of hepatic segment with azygous vein continuation
* Absence of the abdominal segment with hemiazygous continuation
* **The IVC draining into the LA** occur
Anomalies of IVC systemic venous return
64
_Anomalies of Position Mirror Image Dextrocardia_
\*\*Type 2
AV - conrodance
VA - discordance
**Dextro-TGA/ d-TGA** (_dextro-loop_ occurs)
* **rare**
* creates 2 independent parallel circuits
* patients show cyanosis
* systemic flow: RA-RV-AO-body-RA
* venous flow: LA-LV-PA-lungs-LA
* rely on **PDA, PFO, VSD** to get oxygenated blood
* prostaglandin keeps shunt open
65
_ASD Doppler Assessment_
## Footnote
*\*\*\*From a low parasternal 4ch, apical 4ch, subcostal 4ch view, and subcostal short-axis view, place color-flow map on ____ gate in atrial septum to look for ______ turbulence*
PW
late systole to early diastole
66
_Anomalies of Venous Return:_
***Most common form is the \_\_\_\_\_drains into the RA via the \_\_\_\_\_\_\_***
left SVC
CS
67
**_HLHS_**
## Footnote
***\_\_\_\_\_\_\_\_ may be performed to create a more pronounced communication between the atria; Multistage surgery is required in order for survival (survival rate still low)***
atrial septostomy
68
What type of ASD?
* *rare*
* *Defect occurs as a true persistence of the embryonic foramen primum*
* *Located between the limbic septum, pars atrioventricularis of the membranous septum and ccoronaray sinus*
ASD in the septum intermedium
69
_Aortic Aneurysm_
***List at least 4 etiologies of aortic aneurysms.***
* trauma
* atherosclerosis
* Marfan syndrome
* BAV
* aortitis
* mycotic
70
a 67 year old male present to the ER with severe back pain between the shoulder blades that radiates to the abdomen. echo findings include an intimal flap visualization in the parasternal LAX, Sub DAO, and supra LAX. According to the DeBakey system, this is a _______ dissection.
**Type 1**
DeBakey
type1: AAO, Arch, DAO
type 2: AAO
type 3: DAO (thoracis/abdominal)
71
The motor vehicle accident patient is experiencing severe, ripping pain, that travels from his chest to his back, and he shows some signs of stroke; what is most likely the diagnosis?
1. AO dissection at the aortic isthmus
2. AO dissection off the DAO
3. AO dissection with tamponade
4. AO aneurysm that is on the verge of dissection
1
72
A hollow shape to the chest wall is known as \_\_\_\_\_
1. pectus carinatum
2. pectus excavatum
3. scoliosis
4. straight back
2
**pectus excavatum** - breast bone sinks into the chest
**pectus carinatum** - breast bone protrudes outward abnormally
73
Connective tissue disorders associated with aortic aneurysm are:
Marfan
Ehlers-Danlos
Loeys-Dietz
74
\*\*\*A patient with a history of Marfan syndrome and mild aortic root aneurysm present to the ER with severe chest and upper back pain, SOB, and a different BP on each arm. Echo findings include severe dilatation of the ascending aorta along with an intimal flap that continues up into the arch. What _complications_ may arise?
1. AR
2. MI
3. PE
4. all of the above
4
\*note: false lumen can obstruct coronary artery ostia leading to MI (WMA)
75
aortic dissection
etiology (3)
trauma
HTN
congenital
76
The patient presents with new diastolic murmur, weight loss, CP, hemoptysis, and clubbing of the fingertips; what is most likely the diagnosis?
1. LA myxoma with secondary stenosis
2. LA thrombus with embolization
3. MV endocarditis
4. RA myxoma with TV complications
1
77
Rhabdomyoma is typically associated with \_\_\_\_\_\_
1. arrhythmia
2. LVOTO
3. tuberous sclerosis
4. all of the above
4
78
Papillary fibroelastoma is the most common valvular tumor; in adults, the _____ are usually involved.
1. AOV, LVOT, and AMVL
2. AV valves
3. SL valves
4. TV, RVOT and PV
1
79
According to the ASE 17 segment model, a wall that becomes hypokinetic with stress should receive a score of \_\_\_\_\_
2
## Footnote
\*Note:
normal: 1 (**hyperkinetic**)
hypo: 2
akinetic: 3
dyskinetic: 4
aneurysmal: 5
80
According to the ASE, if less than 50% of the endocardial borders are visualized, contrast agents for endocardial border delineation are recommended.
T or F ?
F
\*less than 80% not 50%
81
The SE software allows the sonographer to capture diastolic beats off of the EKG.
T or F ?
F
systolic, not diastolic
only systolic frame is needed
82
During the SBSE (supine bicycle SE), the images are captured at \_\_\_\_\_\_\_
REST, IMPOST, and FINAL
83
During the SE\< the 12-lead EKG prep must be exceptional and the electrodes must be placed exactly the same as they would for a resting 12 lead EKG
T or F ?
F
\*placement of the electrodes are slightly different than a standard 12 lead EKG
84
Acquire the peak DSE images during stage IV, then acquire the final images during stage V
T or F ?
F
stage 1-2 - low dose image
stage 5 or sooner - peak image
after infusion stop - final image
85
\****List the six (6) steps in performing a pediatric echo using the "segmental approach."***
**\*Segmental Approach**
1. Determine Cardiac Location and situs (abdominal and atrial situs)
2. Venous Connections
3. Atrioventricular Connections
4. Ventricular Segment
5. Ventricle-Arterial Connections
6. The Great Vessels
\*note:
cardiac orientation (levo-, dextro-, mesocardia)
atrial situs (disposition)
atrioventricular junction
ventricular loop orientation
ventriculoarterial junction
position and relation of the great vessel
86
***4.) 35% of patients with Truncus Arteriosus have DiGeorge Syndrome.***
True
False
T
87
***7.) Dextrocardia or dextroversion may be associated with atrial-ventricular ______________________ and ventricular-arterial \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.***
discordance
discordance
88
***10.) You suspect that your patient may have an anomaly of IVC systemic venous return. You see: absence of hepatic segment with azygous vein continuation, absence of the abdominal segment with hemiazygous continuation, and the IVC is draining into the LA. What might you suspect?***
Interruption of the IVC
89
***16.) _________________ is the term describing a situation where the location of the heart is in the right side of the thorax, the left ventricle remaining in the normal position on the left, but lying anterior to the right ventricle.***
Dextroversion
or dextrocardia
90
***21.) During cardiac development, the heart has \_\_\_\_\_\_\_\_aortic arches.***
6
91
***19.) A malformation of endocardial cushion tissue typically results in anomalous \_\_\_\_\_\_\_\_\_\_\_\_.***
atrioventricular valves
92
***23.) Septation consists of the development of the \_\_\_***1. \_\_\_, ***\_\_\_***2. ***\_\_\_\_, and \_\_\_\_***3. ***\_\_\_\_\_***
1. endocardial cushion
2. Atrioventricular canal
3. Truncoconal region
93
***24.) During cardiac development, the 6th pair of aortic arches becomes the Prox R PA (distal part disappears early) and the L Prox becomes Prox L PA and persists until birth as the \_\_\_\_\_\_\_\_\_\_?***
ductus arteriosus
94
***Describe 4 of the 6 key techniques utilized to diagnose a cardiac mass.***
location, appearance, size , mobility
95
***21.) Eustachian valves and Chiari networks are thin filamentous structures that extend from the region of the ____________________ toward the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.***
IVC
SVC
96
***23.) Transthoracic echocardiography from the apical window is the optimal approach to detection of LV thrombi, with a sensitivity of 92% to 95% and a specificity of 86% to 88%.***
True
False
T
97
***23.) Smaller microbubbles (1-5 ųm diameter) transverse the pulmonary vasculature, allowing left heart chamber and myocardial opacification.***
***1 MM = ____________________ ųm***
1000
98
***24.) For normal 2-D imaging the MI is set at 0.9 – 1.4. However, for contrast imaging the MI is at a lower setting between _________ and ________ avoid bursting of bubble for longevity of visualization.***
0. 4
0. 6
99
***3.) During pregnancy, the increase in ________________________ levels results in vascular vasodilation and decrease in systemic and pulmonary vascular resistance resulting in an increase in blood flow***
hormone
100
***6.) Myocyte ___________ occurs as a normal and controlled part of an organism's growth or development***
apoptosis (death of cell)
101
***16.) ___________________ is a rare form of endocardial fibrosis that is associated with chronic elevation in circulating eosinophils.***
Loffler’s endocarditis
102
***4.) List 4 echo features of Giant Cell arteritis:***
Aortic aneurysm and dissection
Thickened AoV
LV systolic dysfunction (myocarditis)
Pericardial effusion (pericarditis)
\*note:
Giant cell arteritis is an inflammation of the lining of your arteries. Most often, it affects the arteries in your head, especially those in your temples. For this reason, giant cell arteritis is sometimes called temporal arteritis.
103
***10.) During Pregnancy, the metabolic demands by both the maternal and fetal circulation results in an\_\_\_\_\_\_\_\_\_\_\_\_\_\_***
increase in cardiac output and stroke volume
104
***List 3 features of Takayasu arteritis:***
Aortic dilation
AR
Stenosis and occlusion of large vessels
\*autoimmune disease - rare form of vasculitis disease involving inflammation in the walls of the aorta and its main branches
105
***List 4 echocardiographic findings that may be present to indicate the presence of Ankylosing Spondylitis.***
Dilatation of aortic annulus and sinus of Valsalva
AoV thickening and regurgitation
LV systolic dysfunction
MVP
106
***Cardiac toxicity by\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ drugs was recognized early on as a form of heart failure.***
chemotherapeutic
107
***2.) Which is not a complication of a sinus of valsalva aneurysm?***
TR
AR
Endocarditis
MR
MR
108
***An abdominal bruit is a physical finding of an aortic aneurysm***
## Footnote
True
False
T
109
***For a patient with a sinus of valsalva aneurysm, a rupture into the pericardium is almost 100% fatal and unusual.***
True
False
T
110
***List 3 clinical presentations associated with Marfan's Snydrome.***
Asymptomatic
Murmur may be present
Palpitations or tachycardia
111
***_12.) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\__ is a congenital syndrome characterized by a connective tissue disorder.***
_Marfan Syndrome_
112
***Associated congenital anomalies of a sinus of valsalva aneurysm include:***
VSD
ASD
BAV
All are included
all
113
***19.) The rupture of the right coronary sinus into RV is considered a most common finding in a sinus of valsalva aneurysm.***
True
False
T
114
***20.) List the two major classification schools of thought for identification of aortic dissection.***
Stanford
DeBakey
115
\****A malformation of endocardial cushion tissue typically results in anomalous \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.***
primum ASD
membraneous VSD
116
When there is a midline liver, stomach, and gallbladder it is termed
situs ambiguous
117
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is a term that indicates the normal arrangement of the abdominal and thoracic organs.
situs solitus
118
When performing a fetal echo, the interventricular septum and the interatrial septum should be documented in a _____ degree angle from a midsagittal plane, in a normal fetus, dividing the right and left sides of the fetal heart.
45
119
\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is a term describing an abnormally slow fetal heart rate.
In the second trimester the normal heart rate ranges between _120 and 160_ beats per minute. Transient episodes of **bradycardia** commonly occur in the second trimester. Fixed **bradycardia**, _below 110 bpm,_ should be referred for further evaluation for the possibility of heart block
120
During a fetal echo, documentation of the flap of the foramen ovale should be seen in the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
During a fetal echo, documentation of the flap of the foramen ovale should be seen in the **_left atrium_**. The flap is very thin and may be best visualized with real time.
121
*The patient with congenital heart disease requires\_\_\_\_\_\_\_\_\_ to determine **atrial situs and venous connections.***
***The atrioventricular connections, ventricular morphology and position are then determined.***
***Last, the ventriculoaterial connections are determined.***
***This approach aids the sonographer in the identification of most forms of congenital heart disease (CHD).***
***a sequential, segmental approach***
122
**\*\*\*Cardiac Transplant: Echo Features of Rejection (4)**
* increase in LV wall thickness \> 4mm
* **\>10%** decrease in systolic function
* new or sudden change in P.E
* increase in RVSP
* **restrictive filling:**
* **\> 20% decrease in pressure half time from immediate post operative echo,**
* **E/e' \> 8**
* **20 % decrease in IVRT**
123
What is ICE ?
Function and its use?
**Intracardiac Echocardiography** i.e. **AcuNav**
Used for:
* **IAS/LAA closure**
* septal myocardial **ablation**
* **peri-interventional imaging** of: Asc/Desc/Thoracic/Ao/MV
* alternative guiding tool for interventional procedures especially in **pediatric patients**
* **\*Does not require general anesthesia**
Function:
high frequency - **20-30 MHz**
124
_Surgical Techniques used in Cardiac Transplantation_
The recipient's heart is removed and the doctor's heart is placed in the correct anatomical position
**orthotopic (biatrial or bicaval)**
125
_cardiac transplantation_
primary indication (3)
dilated CM
cardiac amyloid disease
CHD
126
**_Surgical Techniques used in Cardiac Transplantation_**
transplantation of the heart from a different species
xenotransplantation
127
the donor heart is placed in the right chest alongside the recipient organ and anastomosed in a way to allow blood to pass through either or both hearts.
heterotopic
128
A type of therapy used for patients in end stage LV dysfunction
**CRT** (Cardiac Resynchronization Therapy)
129
Type of TAVR: **self** expanding
Medtronic Core Value
130
\_\_\_\_\_\_\_\_\_\_\_is **a surgical technique in which short, narrow tubes (trochars) are inserted into the abdomen through small (less than one centimeter) incisions**. Through these trochars, long, narrow instruments are inserted. The surgeon uses these instruments to manipulate, cut, and sew tissue
**Laparoscopic surgery**
131
\_\_\_\_\_\_\_\_\_\_is a type of coronary artery bypass graft (CABG) surgery. It takes **a blood vessel from one part of your body** and uses **it to bypass a blocked coronary artery**. Unlike traditional CABG, off-pump surgery doesn’t stop your heart or use a heart-lung bypass machine. Instead, the surgeon stabilizes your beating heart during surgery.
Off-pump bypass surgery
132
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_is performed by placing the ultrasound transducer on the epicardial surface of the heart to acquire 2-dimensional and color flow, and spectral Doppler images in multiple planes.
epicardial echocardiography
133
right heart cath procedures
transseptal procedure
fluoroscopy
acquire LAP via pulmonary capillary wedge pressure
134
Cardiac Transplantation Complications (4)
CAD (graft atherosclerosis)
silent MI
rejection
infection
135
Type of TAVR: **balloon** expandable
Edward Sapien &Saien
136
IVUS contraindications:
severe HTN
acute MI
GI bleeding
ventricular arrhythmia
allergic reaction to radioactive contrast
137
**Mitraclip** System is based on the principle of \_\_\_\_\_\_\_\_\_
edge-to-edge repair
138
Of all the parameters,
\_\_\_\_\_\_\_\_\_\_ is the most used one because it represents the shortening of the **subendocardial fibers**
which are the **first fibers to be affected i**n most cardiopathies.
longitudinal strain
139
systemic lupus erythematosus
echo features:
Libman-Sacks Endocarditis - nonbacterial thrombotic valve mass
stenosis/regurgitation
MVP
PE
140
Systemic HTN Eventually causes Systemic and Diastolic dysfunction and leads to \_\_\_\_\_\_\_\_
CHF
141
Eosinophil counts ____ for ≥ 6 months or younger than 6 months with evidence of organ damage
1500 mm3
142
most common form of amyloidosis
AL (amyloid light chain) amyloidosis
143
!!!
cardiorenal syndrome
144
Lv diastolic dysfunction is a frequent finding in patients with \_\_\_. DD is associated with the development of _____ and increased mortality. ____ is one of the causes of the development of DD.
CKD
CHF
myocardial fibrosis
145
\_\_\_\_\_\_\_\_\_\_ has been linked to a poor prognosis, with a 2-year mortality rates up to 60%
Anthracycline CM
145
\_\_\_\_\_\_\_\_\_\_ has been linked to a poor prognosis, with a 2-year mortality rates up to 60%
Anthracycline CM
146
***\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is a rare form of endocardial fibrosis that is associated with chronic elevation in circulating eosinophils.***
Loffler's endocarditis
147
Chagas CM is caused by \_\_\_\_\_\_\_
Trypanosoma Cruzi
148
Vasculitis of unknown origin, pathology defined by the **triad of small vessel vasculitis, granulomatous inflammation, and necrosis**
Wegener's granulomatosis
149
**CTRCD** (cancer therapy related cardiac dysfunction) – best exemplified (be a typical example of) with _____ used in the treatment of breast cancer
anthracycline
150
***Rare adrenal tumor or tumor along the sympathetic chain (usually intra-abdominal)that produces excessive catecholamines.***
***echo feature?***
**Pheochromocytoma**
echo features:
arrhythmia, CM, AO dissection
151
Long-term cocaine use can lead to **prolonged transmitral deceleration time** and \_\_\_\_\_\_\_\_\_\_\_. Ultimately, cocaine abusers may develop a _________ **with or without heart failure**
concentric LVH
dilated CM
152
cause of dysrhythmia
MI
autonomic nervous system imbalance
electrolyte imbalance
idiopathic
hypothermia
drug
trauma
damage to CNS
