Hints Flashcards
Which valve seperates the areas of greatest pressure difference?
Mitral
Which valve separates the areas of lowest pressure differences?
Tricuspid valve
What vessel lies in the anterior interventricular groove or sulcus?
LAD
Which aortic leaflet is the superior one in the parasternal long axis view?
the right leaflet
which aortic leaflet is the posterior one in the parasternal long axis view?
the noncoronary
from the left parasternal window which of the following are you most likely to get accurate velocity measurements?
a) LVOT
b) Mitral stenosis
c) Pulmonary artery
d) mitral regurgitation
C) Pulmonary artery
The coronary arteries come off the:
Sinuses of valsalva
During which phase do the coronaries fill?
Early diastole
the best images of the ascending aorta are often obtained from which transducer window?
Suprasternal
Name the vessels coming off the arch and most proximal to distal
Innominate(proximal)
Left common carotid
left subclavian artery (Distal)
What cardiac pathology is associated with bicuspid aortic valves?
Coarctation of the aorta
which window do you use to look for the secondary finding in bicuspid valves?
Suprasternal arch
where do most aortic coarctations occur?
the aortic isthmus ( after takeoff of the left subclavian artery)
from the apical 4ch view where are the pulmonary veins located?
rt and lt lower(inferior) pulmonary veins
from the apical 4ch view how do you rotate the transducer to obtain the apical LAX?
Counterclockwise 120 degrees
Where is the coronary sinus located?
Posterior AV groove
TO visualize the coronary sinus in the apical 4ch view you should tilt the transducer”
Posterior
where is the chiari network located?
in the right atrium
what portion of the pulmonary venous PW Doppler represents atrial systole? /
a wave
at what temperature is it unsafe to use a TEE probe?
40-45 degrees celcius
which has the fastest intrinsic rates?
SA node
What is the absolute refractory state?
that period when a muscle cell is not excitable- from phase 1 until phase 3;
what is the relative refractory period?
is during phase 3 and the muscle cell might contract if the stimulus is strong
What is the Frank - Starling law
(length- tension relationship) Incrased volume (preload) = increased contractability
Increased myocardial fiber length= Increased tension (rubber band theory)
Acute AI is __________ because we shift up the starling curve
Hypercontractile
Chronic Ai is ____________ when we drop off the end
Failure
echo findings for preload
Dilatation
echo findings for afterload
Hypertropy
which study does not allow for the calculation of ejection fraction?
a) 2D echo
b) cardiac angio
c) chest Xray
d) cardiac nuclear study
Chest xray
how do you eliminate aliasing on PW spectral Doppler?
switch to continuous wave doppler
What does VTI x CSA equal?
Doppler stroke volume
Inhalation of amyl nitrite causes?
decreased afterload
Mitral valve velocity during inspiration
Decreases
Isovolumetric timing with the ECG after the R wave=
Isovolumetric contraction
Isovolumetric timing with the ECG after the T wave=
Isovolumetric relaxation
what is the duration of the IVRT and IVCT
isovolumetric relaxation and contraction time
70 msec
on the wiggers diagram when is the mitral valve open?
4-1
the duration of isovolumetric relaxation time will increase with
bradycardia
during the cardiac cycle this event never happens
a) Ao valve is open &mitral valve is open
b) Ao valve is open &mitral valve is closed
c) Ao valve is closed &mitral valve is open
d) Ao valve is closed &mitral valve is closed
a) Ao valve is open and mitral valve is open
Which is the correct order for the cardiac cycle
Mechanical diastole, electrical diastole, electrical systole, mechanical systole
what is the normal pressure in the pulmonary artery?
25/10
Normal atrial pressures are about ___ mmHG in the right atrium and ____ mmHG in the left atrium
6, in the right
10 in the left
The right sided pressures are approximately _________ of the left sided pressures
1/5th
where is the O2 saturation the lowest?
coronary sinus
the O2 saturation in the pulmonary veins is ________ and ___________ in the arteries
95% and 75%
Best cath technique for LV function
LV angiogram
What is PCW (pulmonary capillary wedge) measuring?
Left atrial pressure
To determine AS where are catheters placed?
one in the LV and one in the Ao or
one in the LV and “pulled back across the AoV
or
one catheter with two separate sensors
TIssue harmonic imaging results in ?
thicker valve leaflets
Apical swelling of echo contrast-for LVO is caused by
high MI
a secondary finding in aoric stenosis is
LEft ventricular hypertrophy
In aortic stenosis is pulse pressure wide or narrow?
Narrow ( pulse pressure is the difference between systolic and diastolic pressures w
it is wide in AI and narrow in AS)
The best view to diagnose a bicuspid aortic valve is in the parasternal?
Short axis systole
what is a common symptom of aortic coarctation?
hypertension
What is Takayasu? arteritis?
(aortic arch syndrome
Narrowing anywhere along the aorta
occurs more in young women from asia
-there is fibrosis of the arch and descendingAo of unknown etiology.
in advanced states multiple coartations may occur (look for supravalvular AS)
Patients BP = 110/84, aortic velocity is 5m/sec. peak LV pressure in this patient is?
210mmHG
add the Ao gradient (100mmHG is the velocity is 5m/sec) to the systolic BP
the normal aortic valve area is
3-4cm squared
what is the continuity equation
Area2= area1 xV1
—————-
V2
*given V1, V2, and A1 calculate A2
when does VTI work better than peak velocities
in patients with poor LV function and when moderate to severe AI is present
using the continuity equation when would the severity of AS be underestimated
When the LVOT measured too large
what is DImensionless Index (DI)
a ratio of the LVOT and AS velocities or VTI
- used when the LVOT cannot be accurately measured, or in the setting of LV dysfunction
Which pressure is obtained during Doppler?
peak or peak instantaneous (for AS it’s the highest gradient anytime during systole)
echo gradients are usually _______ than cath gradients
higher
peak instantaneous vs. peak to peak
what is Noonan syndrome and what is it most commonly associated with
classified as a cardiofacial syndrome with PS, HCM and ASD(30%)
Noonan syndrome = Pulmonic stenosis
does Pulmonic stenosis cause pulmonary hypertension?
NO
If unable to obtain PS gradient from the parasternal window where else can you go?
Subcostal short axis
What does a Mitral stenosis(MS) murmur equal
MS murmur= low frequency “diastolic rumble” with opening snap
which cardiac valve is the second most common to be affected by rheumatic fever disease?
aortic
patients with mitral stenosis often develop?
atrial fibrillation
with atrial fibrillation mitral stenosis velocity calculations are best performed?
averaged over 5-10 beats
in the PSAX view which method is used to assess the MV area?
Planimetry
what is the formula to convert deceleration time to pressure half-time
Mitral halftime= deceleration time x 0.29
what is the formula to convert deceleration time to mitral valve area
Mitral valve area= 759/ deceleration time
for tricuspid stenosis what is the difference in carcinoid vs. rheumatic?
carcinoid= fixed body of the leaflets
rheumatic =tethered leaflet tips
which anomaly goes with aortic dissection?
Marfan syndrome
what kind of murmur would you hear in a patient with rupture of a sinus of valsalva aneurysm?
continuous
what is diastolic “blow”
the classic aortic regurgitation murmur
what causes MV preclosure
an elevated LVEDP
what is the formula to find LVEDP
LVEDP= diastolic BP -end diastolic gradient
antegrade
normal flow direction
retrograde
flow in opposite direction
*descending aorta diastolic flow reversal
Mild aortic regurgitation has an ________ spectral trace
incomplete
how would you calculate pulmonary artery end diastolic pressure
Pulmonic insufficiency velocity
what is the formula for Pulmonary artery end diastolic pressure (PAEDP)
PAEDP= RAP + EDP (converted from the EDV)
systolic flow reversal of bubbles in the IVC – TR or tamponade
TR= post systolic
Tamponade= pre systolic
what is the most common valvular problem associated with carcinoid syndrome
Tricuspid regurgitation
CVP (central venous pressure) refers to the
IVC pressure close to the RA
Hepatic venous flow reversal indicates_______ TR
Severe TR
Given a TR velocity of 4.0m/sec what is the RVSP?
72mmHG
what is the formula for RSVP
RSVP= TRgradient + RAP
RSVP=4(v)squared + RAP
in the absence of pulmonic stenosis the RVSP should equal
the pulmonary artery pressure
the vena contracta might be seen in which type of cardiomyopathy?
Dilated
what of the 4 parts of an MR jet
- zone of convergence
- Vena contracta (greater than or equal to 0.7 cm= severe MR)
3, Jet size (turbulence) - Downstream effect (pulm venous flow reversal)
when does the Coanda Effent happen
with wall hugging jets.
May underestimate jet sized
if you suspect Severe MR where else should you look?
Pulmonary vein
Pulmonary venous systolic flow reversal =?
severe MR
the greatest source of error in measuring PISA is with
radius of the flow convergence
Which of the following is used in echo to measure dP?dt?
Mitral regurgitation
dP/dT measurement of mitral regurgitation assesses what?
LV systolic function
what is the formula for left atrial pressure(LAP)
LAP= systolic BP- MR gradient
what does the pressure waveform for MR look like
late systolic jump in LA pressure
what is Marfan disease
Congenital connective tissue disease causing aortic dilatation and mitral valve prolapse(MVP)
in Marfan syndrome why does aortic dissection and MVP occur?
decreased fibrillin
what is Ehlers-Danlos
connective tissue disease
look for MVP, dilate AO and dissection
Severe aortic aneurysms are greater than
5.0cm
when do you not diagnose a MVP
from the apical 4 chamber view
in the presence of a large pericardial effusion
what are two types of endocarditis?
Libman-sachs (systemic lupus erythematous)
Marantic (non bacterial) now called NBTE
nonbacterial thrombotic endocarditis
seen in patients with metastatic disease
patients with a history of IV drug abuse may present with:
tricuspid endocarditis
can you tell old vs new vegetations
no
in order to be seen by 2D vegetations need to be at least?
3mm
mechanical valves are durable but need
blood thinners
what is the name of the most common Caged ball valve
Starr edwards
what is the name of the most common Caged disc valve
Beall
what is the name of the most common Tilting disc valve
Bjork -shiley
what is the name of the most common bileaflet( bidisc, bi popper)
ST Jude (bi leaflet valve)
autografts use the
patients own tissue
what is the name of the dual valve surgery for congenital AS
Ross procedure
a mitral valve prosthesis has what kind of artifact
acoustic shadowing
the normal pressure half time for mitral prosthetic valve is
<170msec
which cardiomyopathy is autosomal dominant?
Hypertrophic
what is the ratio for assessing asymmetric hypertrophy
1.3:1
LVOT obstruction causes the aortic valve to
close mid systole
what does it mean if the mitral inflow shows A wave greater than E wave
abnormal relaxation
does Inderal (beta blocker) increase SAM?
no , it decreases heart rate, reduces SAM with exercise
61 year old male with IHSS and a resting gradient of 144mm Hg admitted to the hospital with chest pain. the next day the resting gradient was 15 mmHg. What happened?
left ventricular infarct
Global longitudinal strain in patients with HOCM is typically?
-10%
what does strain measure
the deformation within the myocardium
Chagas disease can cause
Cardiomyopathy
posterior and apical thinning
septum usually normal
what are the echo signs of congestive carioimyopathies
Multichamber enlargement Globally impaired LV contractility B notch on mitral valve Mmode reduced aortic root excursion thrombus may be present Small pericardial effusion Increased Epoint to septal separation(>7mm) Reduced mitral valve excursion (double diamond on Mmode)
what is the cause of a B- notch
increased LVEDP
what is the 2D post transplant appearance
double atria
- might have 2 Pwaves on ECG
Amyloid and sarcoid are what type of cardiac abnormalities?
Infiltrative
what is hemochromatosis
an iron disorder in which the body simply loads too much iron
Amyloidosis involves _______ ______ . some may describe is as
abnormal proteins
some may describe is as a translucent waxy protein build up on the myofibrils
what is the term ground glass appearance related to
infiltrative endocarditis
a restrictive cardiomyopathy has which of the following?
a. increased afterload
b. decreased LV compliance
c. increased preload
d. decreased LA pressure
b. decreased LV compliance
what are the types of cardiomyopathies
Normal
Congestive (dilated)
Hypertrophic
Restrictive
a typical ejection fraction in a dilated cardiomyopathy patient might be? or for HCM patient
15-25%
The majority of ventricular filling occurs during?
the first third of diastole
what are the names of the filling patterns
normal
abnormal relaxation
normalization (pseudonormalization)
restrictive
If a patient has a normal MV inflow but the pulmonic veins showed a decreased S wave and D wave consider that they might have
a pseudonormal pattern
in elderly patients(>60) the A wave is _________ than the E wave
normally higher or equal to
how does the normal Doppler waveform differs from flow at the mitral leaflet tips
E and A are reversed at these two sample sites
how would you determine if a patient has constrictive versus restrictive disease?
MV inflow with respiration variation
In constrictive pericarditis does the E wave increase or decrease with inspiration?
Decrease
what is the order of excitation
- SA node
- AV node
- bundle of his
- Bundle branches
- Purkinje fibers
Name the three layers of the pericardium
- fibrous pericardium: thick outer sac
- Serous Parietal: bound to fibrous pericardium smooth, “ the wall of a cavity”
- Serous Visceral: bound to epicardium, smooth” toward the organ”
pericardial fluid is found in between the two serous layers
A pericardial effusion can often be seen in patients with:
renal failure
what is the murmur of a pericardial effusion?
Friction rub
what is the pericardial effusion criteria
small= posterior fluid <1cm med= anterior & posterior 1-2 cm large= Surrounding the heart >2cm
when should you measure pericardial effusions during systole or diastole?
during diastole
what is the importance in identifying the coronary sinus vs the AO
to differentiate between pericardial and pleural effusions
where does the oblique sinus of the pericardium lie
Posterior to the LA in the PLAX view-
area between the two sets of the pulmonary veins)
what to do if tamponade is suspected?
Immediate interpretation
what is Beck’s triad (for Tamponade)
a. elevated venous pressure
b. hypotension
c. quiet heart.
the most sensitive way to diagnose cardiac tamponade is?
respiration variation (in transvalvular flow >25%)
what cardiac condition would prevent diastolic right ventricular collapse?
Pulmonary hypertension
In tamponade what happens to hepatic veins diastolic and systolic flow during expiration?
S &D wave are still present but diminished
what other pericardial abnormality also causes impaired ventricular filling?
constrictive pericarditis
A huge, dilated PA, severe TR and RV enlargement best describe?
Pulmonary hypertension
what is Eisenmenger syndrome
Reversal of a long standing left to right shunt from PHTN. shunt is no right to left
SAX LV in PHTN stays flattened while in RV volume overload
rounds some in systole
what is represented with a decreased A wave and a flying W
Pulmonary hypertension by Mmode
with small pulmonary emboli the heart may be
normal
with large pulmonary emboli the RV/RA will
dilate, PHTN or RV systolic dysfunction may be present
Given tricuspid regurgitation with 60mmHG gradient grade the severity of pulmonary hypertension
severe
what are the 2010 ASE right heart RAP guidelines
3mmHG= normal IVC and collapses with a sniff 8mmHg= intermediate- unable to sniff or IVC collapses <20% 15mmHg= dilated(>2.1cm) & doesn't collapse 50%
the size of an aneurysm during systole:
increases
the most common (mechanical) complication of an MI
aneurysm formation
which of the following occurs first in the setting of severe mitral regurgitation due to flail leaflet?
dilated right ventricle
what type of MI causes Papillary muscle rupture?
inferior MI
what are the characteristics of a true aneurysm
Wide base
walls composed of myocardium
low risk of free rupture
what are the characteristics of a pseudoaneurysm
narrow base
walls composed of thrombus and pericardium
high risk of free rupture
the most common location for pseudoaneurysms is:
inferior basal, not apical
does the wall of a pseudoaneurysm contain endocardium
no, its a rupture across both endo and myocardium
what information do you need pre op in a patient with a LV aneurysm?
movement of the other walls
color Doppler in ischemic disease can be good for?
Ventricular septal defect, because you can use PW and CW Doppler for detecting MR
what do you look for in a patient with Kawasaki disease?
coronary artery aneurysms
what is the IVS motion in a patient with left bundle branch block (LBBB)
dyskinetic or paradoxical
from where do the coronaries originate?
in the L and R aortic sinus of valsalva
what is meant by “right dominant”
when the right coronary gives rise to the posterior descending artery” (85%) of the time
which coronary supplies the interatrial septum?
right (also usually supplies the SA and AV nodes)
which coronary artery feeds the inferoseptal wall
right coronary artery
in multivessel disease what is better stress echo or nuclear stress exams
stress echo
what are the indications for a stress echo
to aid in the diagnosis of chest pain
to determine the severity and prognosis of CAD
to guide post MI rehab
to evaluate cardiac arrhythmias
to screen high risk or asymptomatic patients with multiple risk factors
what would be a contraindication to performing a stress test on an athlete with chest pain
unstable angina
in a pharmacological stress test what may be given at peak dose if the target heart rate is not reached
Atropine
what does it mean when the 2D image appears to have three atria
patient might have Cor Triatrium
a congenital malformation where there is a membrane above the level of the mitral valve. in severe cases there is supravalvular stenosis
name the types of Atrial septal defects
Secundum
Primum
Sinus venosus
Coronary sinus
what is the most common type of ASD?
Secundum
Partial anomalous pulmonary venous return is seen in which type of ASD
sinus Venosus
what is the best view to diagnos a sinus venosus ASD
Modified subcostal four chamber
what is the best view to demonstrate a ASD
Subcostal 4 chamber view
what is the standard echo view for contrast studies of an ASD
apical 4chamber
how many beats to see contrast on the left side in a patient with an ASD
<5BEATS
EQUAL TO OR > 5 BEATS FOR PULM SHUNT
Where should contrast be injected in order to diagnose a persistent left superior vena cava?
left arm
what is the most common venous malformation and has a dilated coronary sinus
Persistent Left superior vena cava
what are endocardial cushion defects (AV septal) associated with
Down syndrome
what are the types of Ventricular septal defects
Membranous (perimembranous)
Muscular
Subvalvular
infundibular
which is the most common type of VSD
Perimembranous
what is the supracristal locatione
high near the aortic and pulmonic valves
where are the inlet locations
subvalvular low near the mitral and tricuspid valves
what is the classic VSD murmur
Loud holosystolic murmur (LSB) (loudest with small VSDs)
what is the formula for calculating RVSP from VSD velocities
RSVP= systolic BP- VSD gradient
RSVP= SBP- 4(v)squared
what congenital abnormality has a displaced TV
Ebsteins
if a large PDA is not corrected what might develop?
Eisenmenger syndrome
what are the 4 tetralogy of Fallot defects
Perimembranous VSD(large)
overriding aorta
Pulmonary stenosis (often Infundibular)
right ventricular hypertrophy
what is a helpful technique in identifying LV myocardial noncompaction during an echocardiogram?
echocardiographic contrast agent
what part of the heart is most likely to be affected by cardiac contusion?
right ventricle
what might be the first indication of metastatic cardiac disease?
Pericardial effusion
which cardiac chamber is most likely involved with metastatic tumors?
right atrium
the most common benign tumor on the aortic valve is
Papillary fibroelastoma
Myxomas symptoms mimic
Mitral stenosis symptoms
LA myxomas are usually attached where?
interatrial septum
when is the LA volume the highest?
End systole
when is the LV volume the highest?
End diastole
the left atrial pressure matches the pressure of what other area?
Pulmonary capillary wedge (PCW)
How is the PCW pressure determined?
Swan Ganz catheter
whose responsibility is it to obtain and informed consent prior to TEE?
the physician
how many segments of a wall have to be affected before calling a WMA?
1 segment
with PAPVR the pulmonary veins drain into the RA due to what kind of ASD?
Sinus venosus ASD
with what anomaly does the chordae tendinae insert into a single papillary muscle?
congenital mitral stenosis (parachute MV)
Restricted VSDs are will be __________ in velocity equal to or larger than
High, 4m/s
large VSDs will be _____ in velocity, about __________
low, 2m/s
How far does the insertion of the TV have to be from the MV to confirm the Dx of ebstein’s anomoly
10mm
what does the mustard procedure correct?
redirect blood flow at the atrial level in pts with transposition of the great vessels) TGV
what does the ROSS (pulmonary autograft) procedure correct?
done for AS (usually congenital)
it moves the PV into the AV(moving the coronaries)
-homograft in PV position
what does the Fontan Procedure correct?
Classically done for tricuspid atresia (or any ventricle)Hook up the vena cava to PA (SVC AND IVC)
lots of variation and can be a conduit inside or outside the RA cavity.
done in two steps
- Glenn: Hook SVC directly to the RPA
- Fontan: Hook IVC to MPA
On 2D what is the difference between a pacemaker wire and a catheter?
A pacemaker wire goes to the RV apex
Central venous lines stay in the RA ( swan Ganz catheters usually do not go to the RV apex)
Name the two layers of the epicardium
Visceral and parietal
The Venturi effect can be associated with which cardiovascular?
Hypertrophic
What is the Venturi effect?
(Modification of Bernoulli’s principle)
Law of conservation of energy means that when the velocity of fluid increases the pressure decreases.
If you are doing an echo on a supine patient who becomes short of breath what should you do first?
Sit the patient upright
What do you do first for an apneic patient after giving sedation?
Check their airway
Why do an IVC sniff test?
To check for elevated RA pressures
What type of shunt causes cyanosis in newborns
Right to left shunts
What is a “pressure drop”?
Same as a gradient across valves
What valve is the least likely to be affected in rheumatic heart disease?
Pulmonic
In the cath lab the gorlin formula is used to calculate:
Valvular areas
Mitral valve velocity should not be affected by:
Gender
Which valve is most likely to regurgitate in normals?
Tricuspid
What are the causes of acute mitral regurgitation?
Endocarditis
Ruptured chordae
Papillary muscle dysfunction
Prosthetic valve dysfunction
With what disease should you not rely on M mode for quantifying left ventricular EF?
Apical infarction
Where do the coronaries drain?
Into the coronary sinus
An MI of the inferior wall involves which coronary artery?
Right coronary artery
LV mass (weight) remains normal in chronic:
mitral stenosis
which syndrome fits with AR, Ao dilatation, Ao dissections and Ao aneurysms?
Marfan syndrome
how does switching to a lower frequency transducer affect aliasing?
aliasing will occur at higher velocities
what are Lamb’s Excrescences
they are thin filiform strands (fronds) that form on the edges of valve leaflets
high angulation of an M mode transducer beam equals
pseudo bicuspid aortic valve
what is the structure under the arch?
right pulmonary artery
what is the primary effect of long standing aortic regurgitation?
decreased ejection fraction
which standard 2D TTE view typically allows viewing of the LAA?
apical 2 chamber view
what causes a pericardial knock?
abrupt cessation of early diastolic inflow (classic in constrictive pericarditis) similar in timing to very loud S3
why follow chronic AI patients?
check left ventricular size
what accompanies bicuspid aortic valves?
coarctation of the aorta(50% of coarcts have a bicuspid valve)
given TR and the RA pressure what can you calculate?
right ventricular systolic pressure
what is the best way to determine the severity of mitral regurgitation?
Pulmonary venous flow
a patient has an RVSP of 60mm Hg. One year later the RVSP is 30mm Hg. What happened to this patient?
dilated cardiomyopathy
when is mitral pressure halt time not accurate?
Post valvuloplasty
if your patient has a dilated LV and this septum what might be going on with the patient?
severe mitral regurgitation
which cardiac pathology affects the valves?
Carcinoid
which pericardial layer is the serous
visceral or epicardial
cardiac tamponade is rapid filling of fluid
causing restrictive diastolic filling
beware of normal dropout vs __________ in the apical 4ch view
secundum ASD
kids with tuberous sclerosis develop what kind of cardiac tumor?
rhambomyomas
what is meant by automacity?
the ability to initiate an electric impulse or beat
intrinsic means pertaining exclusively to a part
if you see anechoic dropout of the interatrial septum in the apical 4 ch view what should you do?
look in the 4 subcostal 4ch
in contras studies an
ancyonotic flow is
and
cyanotic flow is
L-R
R-l
Peripheral contrast is not useful in
AI
what does amyl nitrite do to HR?
Inreases heart rate
what types of cm. might you seen in a pt with aids?
dilated CM
On 2D what is the difference between a pace wire and a catheter
A pace wire goes to the RV apex,
A central venous line goes to the RA ( swan Ganz catheters do not usually go to the RV apex
Name the two layers of the pericardium
Visceral and parietal
The Venturi effect can be associated with which cardiomyopathy
Hypertrophic
What is the Venturi effect
( modification of Bernoulli’s Principle)
Law of conservation of energy means that when the velocity of fluid increases the pressure decreases
If you are doing an echo on a supine or who becomes short of breath what should you do first?
Sit the patient upright
What do you do first for an apneic patient after giving sedation
Check their air way
Why do an IVC “sniff” test
To check for elevated RA pressures
What type of shunt causes cyanosis in newborns
Right to left shunt
What is a pressure drop
Same as a gradient across valves
What valve is the least likely to be affected in rheumatic heart disease
Pulmonic
In the Cath Lab the Gorlin formula is used to calculate
Valvular area
Which valve is most likely to regurgitate in Normals
Tricuspid
With what disease should you not rely on M mode for quantifying left ventricular EF
Apical infarction
Where do the coronaries drain
Into the coronary sinus
Which coronary supplies the LV apex
Left anterior descending
And MI of the inferior wall involves which coronary artery
Right coronary artery
What percentage of normal will have a PFO
20 to 30%
What 2D finding what do you see in a patient with a PLSVC
A dilated coronary sinus
A pre-systolic opening of the aortic leaflets is caused by
Elevated LVEDP ( end diastolic pressure)
Between which heart sound with a murmur of aortic stenosis be heard
S1-S2
Patients with Ankylosing spondylitis may develop
Aortic regurgitation
What is kyphosis
Exaggerated anterior spinal curvature
Skeletal before Maddie Mae compress PA and cause E hypertension
What can cause contrast to dissipate too quickly
High Mi
What is you Uhl’s anomaly
Congenital absence RV myocardium also called parchment heart- may be confused clinically with Ebstein’s
Does a PDA increase LV preload
Yes when the shunt is left to right
Name the three heart muscle layers
Epicardium thin outer layer
Myocardium mid wall(thickest)
Endocardium inside
Normally how much pericardial fluid is there
40 cc
All of the following may result in jugular venous distention except:
a) cardiac tamponade
b) pulmonary hypertension
c) hypovolemia
d) constrictive pericarditis
Hypovolemia
If a patient has Cor Puomonale what condition is most likely to exist?
Right ventricular increase
How do cardiac problems cause renal failure, jugular venous pulsations and peripheral edema
Mostly through systolic Failure and low perfusion causing multi system complications
How many weeks until the heart is developed
Six weeks
And enlarged heart on chest x-ray could be all of the following except:
a) pericardial effusion
b) pleural effusion
c) aortic stenosis
d) hypertrophic cardiomyopathy
Pleural effusion
Which embryonic aortic arch(1-6) develops into the transverse arch
Fourth
Persistent fetal circulation
PHTN with right to left shunting across the foramen and ductus
Volume and then walls equal
Preload
Pressure and thick walls equal
Afterload
Oh right sided pressure is elevated with a valsalva maneuver
During the strain phase no
During the release phase yes
What kind of murmur will a patient with a VSD have
Harsh holosystolic
A patient with a secundum ASD has a bubble study it shows all except:
a) bubbles from RA to LA
b) bubbles from RV to LV
c) negative contrast jet in RA
d) bubbles in pulmonary artery
Bubbles from RV to LV
Which clinical finding is associated with a friction rub
Pericardial effusion
Where is the Chiari network located
Right atrium
What causes a left parasternal friction rub
Pericarditis
Aortic regurgitation starts at the
Beginning of IVRT
What is the frequency for a TEE probe versus a TTE probe
TTE probes are usually lower 2-7 MHz, TEE probes are usually 5 to 7 MHz
In the apical four chamber view where would you see reverberation artifact
Apex
Where are most fibroelastomas found
Usually on the valves (mitral and aortic) may be described as frond like (feathery)
Wing can lead to a false diagnosis of pericardial if fusion on M mode except:
a) descending aorta
b) calcified mitral annulas
c) ascites
d) mitral valve prolapse
Mitral valve prolapse
What might you see in a patient with scleroderma
- pulmonary hypertension
2. pericardial effusion
The reason for using ultrasound gel is
To keep air out
How many years are echo records to be kept
Seven
Will ascending aorta dissection cause severe MR
No not severe MR may be mild
What is the most common type of pediatric cardiac tumor
Rhamdomyomas
Why is the SA node the primary pacemaker
The SA node has the fastest intrinsic rate of any cardiac tissue
SA node equals 60 to 70 per minute
AV node equals 50 per minute
Myocardium equals 30 per minute
How does the wave of contraction (depolarization) move
Inside to outside (endocardium to epicardium)
When is the LV pressure the lowest
Early diastole
What are the four defects that make up shone’s syndrome
Supravalvular mitral membrane
Parachute mitral valve
Subaortic stenosis
Coarctation of the aorta
What is the aortic valve doing during the QT interval
The valve is open
If you have a uniformly dilated aortic root which term best describes this
Fusiform
The primary cause for papillary muscle dysfunction is
Apical infarction
Which valve event starts Isovolumic contraction
Mitral valve close
Which valve event ends isovolumic contraction
Aortic opens
Which valve event starts isovolumetric relaxation
Aorta closes
Which valve event ends isovolumic relaxation
Mitral valve open
What is the first heart sound
Closure of the mitral and tricuspid valve
What is the second heart sound
Closure of the aortic A2 and Pulmonic P2 valves
What is the third heart sound
Early diastolic ventricular inflow
What is the fourth heart sound
Atrial contraction
What causes the third heart sound
Rapid early diastolic flow into a stiff noncompliant ventricle
In patients with a fib which heart son would be missing
The fourth it occurs during atrial contraction
Inspiration will ___________ venous return
Increase
Expiration will _________ venous return
Decrease
Standing will decrease
Venous return and stroke volume
Squatting will ____________ venous return, stroke volume and CO ( increases AR, decreases IHSS)
Increase
Hand grip increases ___________________ and decreases
Increases HR, CO, arterial pressure and MR
Decreases AS
Valsalva during strain
Decreases venous return, SV, CO
Increases IHSS
Valsalva during release
Increase venous return, CO and BP
Most murmurs __________during straining
Decrease
Sit up increase
HR, CO and SV
Amyl nitrite inhalation decrease
Peripheral resistance
AR/ MR
Amyl nitrite inhalation increase
HR, forward flow murmurs
In aortic valve stenosis, what changes are seen in the Doppler spectral trace
Increased velocity and turbulence(spectral broadening)
In severe AS, the time from the onset of flow to peak velocity is prolonged
How does the peak AOV gradient correlate with the severity of stenosis
If the CO is normal, a peak AO gradient of more than 100mmHg denotes severe stenosis
If the CO is low, the valve area may be critically small, but the gradient may be as low as 3 m/sec (36 mmHG)
Therefore look at valve area and gradient
