High Yield PTEeXAM Review Part 12 - 14 Flashcards
How does chamber quantifications change when comparing M-Mode to 2D echo?
M mode measures slightly higher LV dimensions as compared to 2D echo for the same LV
The recommended view for RV chamber quantification by TEE is what view?
ME 4 chamber view (RV focused)
The recommended view for measurement of the RVOT by TEE is what view?
ME RV Inflow Outflow
Mitral Valve Area formula for mitral valve when using PHT is what?
MVA = 220 / PHT
What are the mean pressure gradients when evaluating mitral stenosis to determine mild, moderate, and severe?
Mild <5 mmHg
Moderate 5- 10 mmHg
Severe > 10 mmHg
MVA formula for mitral valve when using Deceleration time is what?
MVA = 760 / Deceleration TIme
How would aortic regurgitation affect Mitral Stenosis evaluation using PHT method?
Severe A.I. will lead to an underestimation of Mitral Stenosis using PHT method
Why?
Severe A.I. –> Rapid increase in in LV pressure. rapid increase will decrease your PHT and result in an overestimation of the mitral valve area
How would diastolic dysfunction affect your PHT methods when evaluating for mitral stenosis?
Diastolic Dysfunction would increase LVEDP which would decrease your PHT
You would therefore underestimate your mitral stenosis with diastolic dyfunction
What phase is at the arrow in the photo?
M mode Vp Late atrial contraction
When should left atrial size be measured in relation to the cardiac cycle?
End-Ventricular Systole when it achieves its greatest dimension
When would you want to measure left atrial dimensions?
Quantify and follow response to therapy in diastolic dysfunction
What resolution(s) does the focal point have?
Best Lateral and Elevational Resolution
How will the focal point change when you increase the beam diameter?
Deeper focal point
What are the vena contracta cutoffs for TR grading?
Mild ?
Mod ?
Severe > 7mm
What are the vena contracta cutoffs for MR?
Mild < 3 mm
Mod 3-7 mm
Severe > 7 mm
What are the vena contracta cutoffs for AI?
Mild < 3 mm
Mod 3-6 mm
Severe > 6mm
How does systolic flow reversal in the pulmonary veins on PWD affect your decision to deem severe MR or not?
Positive (+) Systolic flow reversal = Severe MR
Negative (-) systolic flow reversal does not rule out Severe MR because of false positives
- The jet can be pointed away
- The LA can be dilated
- Atrial Fibrillation (Blunting)
the vena contracta is independent of what two things when looking at MR?
Independent of flow and rate
What is the narrowest portion of the MR jet when you measure vena contracta “Equivalent to”?
Regurgitant Orifice Area
Where is the vena contracta of MR best measured?
ME LAX
- Highest “Axial Resolution”
- Perpendicular to the jet
- Zoom mode
- Narrow sector
- Minimum depth
Perpendicular to the scan plane
How do you calculate dP/dT Calculation for the LV?
- Optimize MR jet
- CWD on MR jet
- Two points from 1-3 m/sec Then calculate the slope here!
Divide 32 mmHg / Time it takes to get from 1 to 3 m/sec
Normal = ~>1200 - 1600
Normal FAC values of the RV are greater than What %
What is abnormal?
Remember this is the percentage of area change not the RV ejection fraction. Normal FAC values are greater than 35%.
Anything below 35% is abnormal.
Normal values for fractional shortening are “A” %
Normally, the a FAC is > “B” %
FS = > 30%
FAC > 50%
How does FAC correlate to EF?
FAC 10% –> 15% EF
FAC 20% –> 29% EF
FAC 30% –> 42% EF
FAC 40% –> 54% EF
FAC 50% –> 66%
FAC 60% –> 75%
What mitral leaflet scallop is closes to the left atrial appendage?
P1 scallop
If you place a CWD in DEEP TG 5 chamber or TG LAX, you could get MR jet and AS jet in same plane.
What differentiates them?
MR occurs during isovolumetric contraction because LV pressure exceeds LA pressure
Aortic Outflow (Aortic Stenosis) starts after IVCT is over and ejection starts
In the CWD profile of AR jet, the time interval indicated by the Boled Arrow is the the:
Pressure half time
Name 3 other causes of holo-diastolic reversal of flow in the abdominal aorta other than severe AI.
- PDA
- Aortic Dissection
- Aortic Aneurysm
The ultrasound modality with the highest thermal index (TI) i.e. the ability to raise the body tissue temperataure is:
Pulse Wave Doppler
How does the Reynolds number change when you increase the diameter?
Increase the Reynolds number
Less chance of turbulent flow
During catheterization, when do they measure peak AV gradients during the “Pull back”?
- LVOT
- Sino-tubular Junction
When using continuity equation, what is the biggest form of error when quantifying AV area?
Diameter at Point A
(Because the measurement is squared)
When you put CWD across the aortic valve, how does that pressure compare to the gradient obtained in cath lab?
CWD gradient > Cath gradient due to pressure recovery
- Decreased in blood velocity in ascending aorta and increase in pressure resulting in a lower peak gradient across the AV
What does S1 wave correlate to?
S2?
D?
A?
Systolic wave which has an early-systolic component (S1)
A larger mid- and late-systolic component (S2)
Followed by a diastolic component (D)
During atrial contraction, there is slight flow reversal (Ar)
What will affect S1 wave pulmonary venous waveform?
Atrial Relaxation in early systole
What will affect S2 wave pulmonary venous waveform?
(3)
RV stroke volume
LA compliance
Descent of MV annulus which lowers LA pressure
Tissue doppler signals have:
- What amplitude?
- What velocity?
Amplitude = High
Velocity = Low
What is tenting height and when would it be applicable?
Used for ischemic MR
- Measures severity of leaflet restriction
Which of the following is the most common location of a papillaray fibroelastoma?
Aortic Valve
