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Cardiac 1 > Final review > Flashcards

Final review Flashcards

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?

A

both: 18-22mm

23
Q

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

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

What does the LAD supply?

A

anterior IVS, anterior wall and apex

25
Q

What does the RCA supply?

A

inferior IVS, inferior free wall and RV free wall

26
Q

What does the LCx supply?

A

lateral wall, anterolateral wall, inferolateral wall

27
Q

What is one of the most common indications for echo?

What do we assess for?

A

suspected or documented CAD

assessment of systolic wall thickening and endocardial motion, documenting wall motion abnormalities

28
Q

What do 80% of patients have? What can the LAD supply up to 55% of?

A

right dominant coronary artery

55% of the LV (block can cause sudden cardiac death)

29
Q

How is the wall motion score calculated?

A

the sum of individual segment scores over the # of segments visualized

30
Q

What is cardiac output defined by?

A

SV x HR

-resting adult puts out 5-6L/min

31
Q

What is fractional shortening?

A

it is a rough estimate of LV systolic function, normal rate is 25-45%

32
Q

What is LV mass an important RF for?

A

important RF and strong predictor of cardiovascular events

33
Q

How is LV mass calculated?

A

converting volume to mass by multiplying the volume of myocardium by the density

34
Q

When does LV mass vary?

A

with gender, age, body size, obesity and world region

-is always higher in men compared to women

35
Q

What is concentric hypertrophy?

Clinical examples?

A

increased LV mass, increased relative wall thickness

- LV pressure overload: AO stenosis and high BP

36
Q

What is eccentric hypertrophy?

Clinical examples?

A

increased LV mass with normal relative wall thickness

- aortic regurgitation (chronic volume overload)

37
Q

What is concentric remodeling?

Clinical examples?

A

normal LV mass and increased relative wall thickness

- hypertensive heart disease

38
Q

What is the most commonly used measure of cardiac function?

A

LV EF

  • % of blood leaving the heart in each contraction
    men: 52-72%, women: 54-74%
39
Q

Explain what preload is

A

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
Q

Describe what ventricular compliance is

A

defined as the ratio of change in volume/change in pressure

high afterload = thick walls
high preload = thin walls

41
Q

Describe the Frank Starling mechanism

A

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
Q

What does the Frank Starling mechanism ensure?

A

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
Q

What is inotropy?

A

force of contraction/contractility of the ventricle

44
Q

Describe what afterload is

A

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
Q

Describe what TDI is

A

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
Q

What is TDI primarily used for?

A

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

47
Q

Describe the Bernoulli effect

A

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
Q

What is strain rate?

A

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
Q

What is the difference between strain and strain rates

A

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
Q

What is speckle tracking?

What is it important for clinically?

A

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
Q

What are the advantages of speckle tracking over TDI?

A

faster data acquisition
direct measure of strain
multiple simultaneous measurements
offline analysis

52
Q

What is normal end diastolic LV volume for men and women?

A

men: 62-150ml
women: 46-106ml

53
Q

What is normal end systolic LV volume for both men and women?

A

men: 21-61ml
women: 14-42ml

Cardiac 1 (1 decks)

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