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PTE Masters + A Practical Approach to Transesophageal Echocardiography > High Yield PTEeXAM Review Part 12 - 14 > Flashcards

High Yield PTEeXAM Review Part 12 - 14 Flashcards

1
Q

How does chamber quantifications change when comparing M-Mode to 2D echo?

A

M mode measures slightly higher LV dimensions as compared to 2D echo for the same LV

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2
Q

The recommended view for RV chamber quantification by TEE is what view?

A

ME 4 chamber view (RV focused)

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3
Q

The recommended view for measurement of the RVOT by TEE is what view?

A

ME RV Inflow Outflow

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4
Q

Mitral Valve Area formula for mitral valve when using PHT is what?

A

MVA = 220 / PHT

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5
Q

What are the mean pressure gradients when evaluating mitral stenosis to determine mild, moderate, and severe?

A

Mild <5 mmHg

Moderate 5- 10 mmHg

Severe > 10 mmHg

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6
Q

MVA formula for mitral valve when using Deceleration time is what?

A

MVA = 760 / Deceleration TIme

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7
Q

How would aortic regurgitation affect Mitral Stenosis evaluation using PHT method?

A

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

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8
Q

How would diastolic dysfunction affect your PHT methods when evaluating for mitral stenosis?

A

Diastolic Dysfunction would increase LVEDP which would decrease your PHT

You would therefore underestimate your mitral stenosis with diastolic dyfunction

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9
Q

What phase is at the arrow in the photo?

A

M mode Vp Late atrial contraction

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10
Q

When should left atrial size be measured in relation to the cardiac cycle?

A

End-Ventricular Systole when it achieves its greatest dimension

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11
Q

When would you want to measure left atrial dimensions?

A

Quantify and follow response to therapy in diastolic dysfunction

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12
Q

What resolution(s) does the focal point have?

A

Best Lateral and Elevational Resolution

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13
Q

How will the focal point change when you increase the beam diameter?

A

Deeper focal point

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14
Q

What are the vena contracta cutoffs for TR grading?

A

Mild ?

Mod ?

Severe > 7mm

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15
Q

What are the vena contracta cutoffs for MR?

A

Mild < 3 mm

Mod 3-7 mm

Severe > 7 mm

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16
Q

What are the vena contracta cutoffs for AI?

A

Mild < 3 mm

Mod 3-6 mm

Severe > 6mm

17
Q

How does systolic flow reversal in the pulmonary veins on PWD affect your decision to deem severe MR or not?

A

Positive (+) Systolic flow reversal = Severe MR

Negative (-) systolic flow reversal does not rule out Severe MR because of false positives

  1. The jet can be pointed away
  2. The LA can be dilated
  3. Atrial Fibrillation (Blunting)
18
Q

the vena contracta is independent of what two things when looking at MR?

A

Independent of flow and rate

19
Q

What is the narrowest portion of the MR jet when you measure vena contracta “Equivalent to”?

A

Regurgitant Orifice Area

20
Q

Where is the vena contracta of MR best measured?

A

ME LAX

  • Highest “Axial Resolution”
  • Perpendicular to the jet
  • Zoom mode
  • Narrow sector
  • Minimum depth

Perpendicular to the scan plane

21
Q

How do you calculate dP/dT Calculation for the LV?

A
  1. Optimize MR jet
  2. CWD on MR jet
  3. 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

22
Q

Normal FAC values of the RV are greater than What %

What is abnormal?

A

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.

23
Q

Normal values for fractional shortening are “A” %

Normally, the a FAC is > “B” %

A

FS = > 30%

FAC > 50%

24
Q

How does FAC correlate to EF?

A

FAC 10% –> 15% EF

FAC 20% –> 29% EF

FAC 30% –> 42% EF

FAC 40% –> 54% EF

FAC 50% –> 66%

FAC 60% –> 75%

25
Q

What mitral leaflet scallop is closes to the left atrial appendage?

A

P1 scallop

26
Q

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?

A

MR occurs during isovolumetric contraction because LV pressure exceeds LA pressure

Aortic Outflow (Aortic Stenosis) starts after IVCT is over and ejection starts

27
Q

In the CWD profile of AR jet, the time interval indicated by the Boled Arrow is the the:

A

Pressure half time

28
Q

Name 3 other causes of holo-diastolic reversal of flow in the abdominal aorta other than severe AI.

A
  1. PDA
  2. Aortic Dissection
  3. Aortic Aneurysm
29
Q

The ultrasound modality with the highest thermal index (TI) i.e. the ability to raise the body tissue temperataure is:

A

Pulse Wave Doppler

30
Q

How does the Reynolds number change when you increase the diameter?

A

Increase the Reynolds number

Less chance of turbulent flow

31
Q

During catheterization, when do they measure peak AV gradients during the “Pull back”?

A
  1. LVOT
  2. Sino-tubular Junction
32
Q

When using continuity equation, what is the biggest form of error when quantifying AV area?

A

Diameter at Point A

(Because the measurement is squared)

33
Q

When you put CWD across the aortic valve, how does that pressure compare to the gradient obtained in cath lab?

A

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
34
Q

What does S1 wave correlate to?

S2?

D?

A?

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)

35
Q

What will affect S1 wave pulmonary venous waveform?

A

Atrial Relaxation in early systole

36
Q

What will affect S2 wave pulmonary venous waveform?

(3)

A

RV stroke volume

LA compliance

Descent of MV annulus which lowers LA pressure

37
Q

Tissue doppler signals have:

  1. What amplitude?
  2. What velocity?
A

Amplitude = High

Velocity = Low

38
Q

What is tenting height and when would it be applicable?

A

Used for ischemic MR

- Measures severity of leaflet restriction

39
Q

Which of the following is the most common location of a papillaray fibroelastoma?

A

Aortic Valve

PTE Masters + A Practical Approach to Transesophageal Echocardiography (55 decks)

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