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Cardiac 1 > Final review > Flashcards

Final review Flashcards

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1
Q

What is Doppler used for in echo?

A

hemodynamic assessment of the heart
velocity and pressure measurements
recognition of normal and abnormal BF through the heart
assessment of myocardial tissue velocities

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2
Q

Describe pulsed wave Doppler in echo

A

PW detects flow at specific locations, aliasing can occur with PW
-aliasing occurs when the Doppler shift exceeds 1/2 the PRF (wrapping around the tracing)

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3
Q

Describe continuous wave Doppler in echo

A

CW detects flow along the entirety of the beam, good for measuring high velocities
no aliasing

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4
Q

Explain Colour Doppler in echo

A

form of PW, images of flow are angle dependent and we need to be as parallel to flow as possible
- turbulent flow will show as bright mosaic of colours = aliasing

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5
Q

Explain what TDI is

3 versions

A

tissue doppler imaging, has 3 versions
1- colours are overlaid on the 2D image
2- same volume box on a cursor line and obtains a spectral tracing (most common)
3- obtaining a colour m-mode

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6
Q

What is TDI used for

A

assessing diastolic function/dysfunction of the LV and systolic function of the RV

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7
Q

What is the typical colour Doppler scale setting?

A

50-70 m/s

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8
Q

What are the clinical assessments that use colour Doppler?

A

valvular regurgitation and stenosis, intracardiac shunts, and outflow tract obstructions

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9
Q

P= 4v^2

What is this equation and what is it used for?

A

the simplified Bernoulli equation
- it is used to calculate pressure gradients between chambers/areas of narrowing
P= pressure gradient, V= velocity

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10
Q

Where is a colour doppler tracing for the LV inflow obtained?

A

AP4 with the colour box placed over the LA and half of the LV
-flow is towards the probe during diastole

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11
Q

What is LV inflow spectral doppler tracings used for?

A

a measure of diastolic function, captures the velocities of diastolic flow from the LA to the LV
- is a biphasic wave form, looks like the M-mode tracing of the mitral valve

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12
Q

Where is the colour doppler tracing of the RV inflow found?

A

AP4, colour box covers entire RA and half the RV, flow is towards the probe (antegrade)

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13
Q

Where is the sample volume box placed for the spectral tracing of the RV inflow?
Describe the waveform obtained

A

placed at the ventricular side near the TV valve leaflet tips
antegrade flow during diastole, with lower velocities than the LV

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14
Q

Where is the LA filling/pulmonary veins spectral tracing obtained?
Describe the waveform

A

AP4 with PW cursor at least .5cm within the right superior pulmonary vein
- biphasic, systolic and diastolic velocities are recorded

(is an assessment of diastolic function)

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15
Q

Where is the spectral tracing for the LVOT and AoV obtained?

Describe the waveform

A

AP5 or AP3, PW cursor is placed .5-1.0cm away from AoV in the LVOT
- monophasic, laminar, retrograde flow during systole

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16
Q

In regards to the LVOT spectral tracing, what does a narrow band of velocities at any instant in time during acceleration reflect?
What does deceleration look like?

A
  • uniformity of blood flow velocity

- spectral broadening

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17
Q

Where is the LV V1 VTI traced?

A

in the LVOT spectral tracing, is used to calculate SV

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18
Q

What is the normal 2D measurement for the IVS and PW in diastole, for both men and women?

A

men: 6-10mm
women: 6-9mm

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19
Q

What is the normal 2D measurement for LVIDd, for both men and women?

A

men: 42-58mm
women: 38-52 mm

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20
Q

What is the normal 2D measurement for LVIDs, for both men and women?

A

men: 25-40mm
women: 22-35mm

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21
Q

What is the normal 2D measurement for the LA, for both men and women?

A

men: 30-40mm
women: 27-38mm

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22
Q

What is the normal 2D measurement for the LVOT, for both men and women?

Study These Flashcards
A

both: 18-22mm

23
Q

What is the normal 2D measurement for the aortic root, and ascending aorta, for both men and women?

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A 
AO root
men: 31-37mm
women: 27-33mm
Ascending ao
men: 26-34mm
women: 23-31mm
24
Q

What does the LAD supply?

Study These Flashcards
A

anterior IVS, anterior wall and apex

25
What does the RCA supply?
inferior IVS, inferior free wall and RV free wall
26
What does the LCx supply?
lateral wall, anterolateral wall, inferolateral wall
27
What is one of the most common indications for echo? | What do we assess for?
suspected or documented CAD | assessment of systolic wall thickening and endocardial motion, documenting wall motion abnormalities
28
What do 80% of patients have? What can the LAD supply up to 55% of?
right dominant coronary artery | 55% of the LV (block can cause sudden cardiac death)
29
How is the wall motion score calculated?
the sum of individual segment scores over the # of segments visualized
30
What is cardiac output defined by?
SV x HR | -resting adult puts out 5-6L/min
31
What is fractional shortening?
it is a rough estimate of LV systolic function, normal rate is 25-45%
32
What is LV mass an important RF for?
important RF and strong predictor of cardiovascular events
33
How is LV mass calculated?
converting volume to mass by multiplying the volume of myocardium by the density
34
When does LV mass vary?
with gender, age, body size, obesity and world region | -is always higher in men compared to women
35
What is concentric hypertrophy? | Clinical examples?
increased LV mass, increased relative wall thickness | - LV pressure overload: AO stenosis and high BP
36
What is eccentric hypertrophy? | Clinical examples?
increased LV mass with normal relative wall thickness | - aortic regurgitation (chronic volume overload)
37
What is concentric remodeling? | Clinical examples?
normal LV mass and increased relative wall thickness | - hypertensive heart disease
38
What is the most commonly used measure of cardiac function?
LV EF - % of blood leaving the heart in each contraction men: 52-72%, women: 54-74%
39
Explain what preload is
is the volume of blood in the ventricles at end diastole (right before ventricular contraction) - the initial stretch of the myocytes prior to contraction - increase in preload increases the active muscle tension
40
Describe what ventricular compliance is
defined as the ratio of change in volume/change in pressure high afterload = thick walls high preload = thin walls
41
Describe the Frank Starling mechanism
increasing venous return > increases the ventricular preload > increases the SV - the more a normal ventricle is stretched/filled by the increased venous return, the greater the volume that is ejected during the NEXT contraction
42
What does the Frank Starling mechanism ensure?
it ensures that the outputs of both ventricles are matched over time - increased RV output increases the venous return to the LV > FS mechanism operates to increase the output of the LV
43
What is inotropy?
force of contraction/contractility of the ventricle
44
Describe what afterload is
it is the load in which the ventricle much contract against to eject blood (the pressure the ventricle must overcome to eject) -greater the AO pressure, the greater the afterload on the LV
45
Describe what TDI is
TDI records velocities within the myocardium itself, has 3 versions: most common is placing the sample volume box along the cursor line and obtaining a spectral waveform based on high amplitude, low velocity signals from the myocardium
46
What is TDI primarily used for?
assessing diastolic function and dysfunction of the LV, and systolic function of the RV
47
Describe the Bernoulli effect
it is the dorp in pressure at a stenosis due to high flow speed (if flow energy increases, pressure energy drops) - pressure energy is converted to flow energy upon entry of the stenosis, and is converted back to pressure energy when it exits
48
What is strain rate?
provides data on relative timing of the myocardial motion and peak systolic and diastolic strain rates -measures the rate of change in length normalized to an original length
49
What is the difference between strain and strain rates
strain: fractional change in length, unitless measure reported as a positive or negative % strain rate: rate of change in strain with units of 1/second
50
What is speckle tracking? | What is it important for clinically?
tracking the motion of bright spots in the myocardium, is a measure of deformation of a materal - in patients with a normal EF but with an underlying disease, we can see changes in each segment before LV function declines (useful for chemo patients)
51
What are the advantages of speckle tracking over TDI?
faster data acquisition direct measure of strain multiple simultaneous measurements offline analysis
52
What is normal end diastolic LV volume for men and women?
men: 62-150ml women: 46-106ml
53
What is normal end systolic LV volume for both men and women?
men: 21-61ml women: 14-42ml

Cardiac 1 (1 decks)

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