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Spring 2018 > Hints > Flashcards

Hints Flashcards

1
Q

Which valve seperates the areas of greatest pressure difference?

A

Mitral

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2
Q

Which valve separates the areas of lowest pressure differences?

A

Tricuspid valve

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3
Q

What vessel lies in the anterior interventricular groove or sulcus?

A

LAD

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4
Q

Which aortic leaflet is the superior one in the parasternal long axis view?

A

the right leaflet

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5
Q

which aortic leaflet is the posterior one in the parasternal long axis view?

A

the noncoronary

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6
Q

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

A

C) Pulmonary artery

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7
Q

The coronary arteries come off the:

A

Sinuses of valsalva

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8
Q

During which phase do the coronaries fill?

A

Early diastole

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9
Q

the best images of the ascending aorta are often obtained from which transducer window?

A

Suprasternal

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10
Q

Name the vessels coming off the arch and most proximal to distal

A

Innominate(proximal)
Left common carotid
left subclavian artery (Distal)

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11
Q

What cardiac pathology is associated with bicuspid aortic valves?

A

Coarctation of the aorta

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12
Q

which window do you use to look for the secondary finding in bicuspid valves?

A

Suprasternal arch

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13
Q

where do most aortic coarctations occur?

A

the aortic isthmus ( after takeoff of the left subclavian artery)

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14
Q

from the apical 4ch view where are the pulmonary veins located?

A

rt and lt lower(inferior) pulmonary veins

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15
Q

from the apical 4ch view how do you rotate the transducer to obtain the apical LAX?

A

Counterclockwise 120 degrees

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16
Q

Where is the coronary sinus located?

A

Posterior AV groove

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17
Q

TO visualize the coronary sinus in the apical 4ch view you should tilt the transducer”

A

Posterior

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18
Q

where is the chiari network located?

A

in the right atrium

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19
Q

what portion of the pulmonary venous PW Doppler represents atrial systole? /

A

a wave

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20
Q

at what temperature is it unsafe to use a TEE probe?

A

40-45 degrees celcius

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21
Q

which has the fastest intrinsic rates?

A

SA node

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22
Q

What is the absolute refractory state?

A

that period when a muscle cell is not excitable- from phase 1 until phase 3;

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23
Q

what is the relative refractory period?

A

is during phase 3 and the muscle cell might contract if the stimulus is strong

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24
Q

What is the Frank - Starling law

A 
(length- tension relationship)
Incrased volume (preload) = increased contractability

Increased myocardial fiber length= Increased tension (rubber band theory)

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25
Q

Acute AI is __________ because we shift up the starling curve

A

Hypercontractile

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26
Q

Chronic Ai is ____________ when we drop off the end

A

Failure

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27
Q

echo findings for preload

A

Dilatation

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28
Q

echo findings for afterload

A

Hypertropy

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29
Q

which study does not allow for the calculation of ejection fraction?

a) 2D echo
b) cardiac angio
c) chest Xray
d) cardiac nuclear study

A

Chest xray

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30
Q

how do you eliminate aliasing on PW spectral Doppler?

A

switch to continuous wave doppler

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31
Q

What does VTI x CSA equal?

A

Doppler stroke volume

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32
Q

Inhalation of amyl nitrite causes?

A

decreased afterload

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33
Q

Mitral valve velocity during inspiration

A

Decreases

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34
Q

Isovolumetric timing with the ECG after the R wave=

A

Isovolumetric contraction

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35
Q

Isovolumetric timing with the ECG after the T wave=

A

Isovolumetric relaxation

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36
Q

what is the duration of the IVRT and IVCT

isovolumetric relaxation and contraction time

A

70 msec

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37
Q

on the wiggers diagram when is the mitral valve open?

A

4-1

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38
Q

the duration of isovolumetric relaxation time will increase with

A

bradycardia

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39
Q

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

a) Ao valve is open and mitral valve is open

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40
Q

Which is the correct order for the cardiac cycle

A

Mechanical diastole, electrical diastole, electrical systole, mechanical systole

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41
Q

what is the normal pressure in the pulmonary artery?

A

25/10

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42
Q

Normal atrial pressures are about ___ mmHG in the right atrium and ____ mmHG in the left atrium

A

6, in the right

10 in the left

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43
Q

The right sided pressures are approximately _________ of the left sided pressures

A

1/5th

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44
Q

where is the O2 saturation the lowest?

A

coronary sinus

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45
Q

the O2 saturation in the pulmonary veins is ________ and ___________ in the arteries

A

95% and 75%

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46
Q

Best cath technique for LV function

A

LV angiogram

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47
Q

What is PCW (pulmonary capillary wedge) measuring?

A

Left atrial pressure

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48
Q

To determine AS where are catheters placed?

A

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

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49
Q

TIssue harmonic imaging results in ?

A

thicker valve leaflets

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50
Q

Apical swelling of echo contrast-for LVO is caused by

A

high MI

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51
Q

a secondary finding in aoric stenosis is

A

LEft ventricular hypertrophy

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52
Q

In aortic stenosis is pulse pressure wide or narrow?

A

Narrow ( pulse pressure is the difference between systolic and diastolic pressures w
it is wide in AI and narrow in AS)

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53
Q

The best view to diagnose a bicuspid aortic valve is in the parasternal?

A

Short axis systole

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54
Q

what is a common symptom of aortic coarctation?

A

hypertension

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55
Q

What is Takayasu? arteritis?

(aortic arch syndrome

A

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)

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56
Q

Patients BP = 110/84, aortic velocity is 5m/sec. peak LV pressure in this patient is?

A

210mmHG

add the Ao gradient (100mmHG is the velocity is 5m/sec) to the systolic BP

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57
Q

the normal aortic valve area is

A

3-4cm squared

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58
Q

what is the continuity equation

A

Area2= area1 xV1
—————-
V2

*given V1, V2, and A1 calculate A2

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59
Q

when does VTI work better than peak velocities

A

in patients with poor LV function and when moderate to severe AI is present

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60
Q

using the continuity equation when would the severity of AS be underestimated

A

When the LVOT measured too large

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61
Q

what is DImensionless Index (DI)

A

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
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62
Q

Which pressure is obtained during Doppler?

A

peak or peak instantaneous (for AS it’s the highest gradient anytime during systole)

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63
Q

echo gradients are usually _______ than cath gradients

A

higher

peak instantaneous vs. peak to peak

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64
Q

what is Noonan syndrome and what is it most commonly associated with

A

classified as a cardiofacial syndrome with PS, HCM and ASD(30%)

Noonan syndrome = Pulmonic stenosis

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65
Q

does Pulmonic stenosis cause pulmonary hypertension?

A

NO

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66
Q

If unable to obtain PS gradient from the parasternal window where else can you go?

A

Subcostal short axis

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67
Q

What does a Mitral stenosis(MS) murmur equal

A

MS murmur= low frequency “diastolic rumble” with opening snap

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68
Q

which cardiac valve is the second most common to be affected by rheumatic fever disease?

A

aortic

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69
Q

patients with mitral stenosis often develop?

A

atrial fibrillation

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70
Q

with atrial fibrillation mitral stenosis velocity calculations are best performed?

A

averaged over 5-10 beats

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71
Q

in the PSAX view which method is used to assess the MV area?

A

Planimetry

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72
Q

what is the formula to convert deceleration time to pressure half-time

A

Mitral halftime= deceleration time x 0.29

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73
Q

what is the formula to convert deceleration time to mitral valve area

A

Mitral valve area= 759/ deceleration time

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74
Q

for tricuspid stenosis what is the difference in carcinoid vs. rheumatic?

A

carcinoid= fixed body of the leaflets

rheumatic =tethered leaflet tips

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75
Q

which anomaly goes with aortic dissection?

A

Marfan syndrome

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76
Q

what kind of murmur would you hear in a patient with rupture of a sinus of valsalva aneurysm?

A

continuous

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77
Q

what is diastolic “blow”

A

the classic aortic regurgitation murmur

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78
Q

what causes MV preclosure

A

an elevated LVEDP

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79
Q

what is the formula to find LVEDP

A

LVEDP= diastolic BP -end diastolic gradient

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80
Q

antegrade

A

normal flow direction

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81
Q

retrograde

A

flow in opposite direction

*descending aorta diastolic flow reversal

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82
Q

Mild aortic regurgitation has an ________ spectral trace

A

incomplete

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83
Q

how would you calculate pulmonary artery end diastolic pressure

A

Pulmonic insufficiency velocity

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84
Q

what is the formula for Pulmonary artery end diastolic pressure (PAEDP)

A

PAEDP= RAP + EDP (converted from the EDV)

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85
Q

systolic flow reversal of bubbles in the IVC – TR or tamponade

A

TR= post systolic

Tamponade= pre systolic

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86
Q

what is the most common valvular problem associated with carcinoid syndrome

A

Tricuspid regurgitation

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87
Q

CVP (central venous pressure) refers to the

A

IVC pressure close to the RA

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88
Q

Hepatic venous flow reversal indicates_______ TR

A

Severe TR

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89
Q

Given a TR velocity of 4.0m/sec what is the RVSP?

A

72mmHG

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90
Q

what is the formula for RSVP

A

RSVP= TRgradient + RAP

RSVP=4(v)squared + RAP

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91
Q

in the absence of pulmonic stenosis the RVSP should equal

A

the pulmonary artery pressure

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92
Q

the vena contracta might be seen in which type of cardiomyopathy?

A

Dilated

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93
Q

what of the 4 parts of an MR jet

A
  1. zone of convergence
  2. Vena contracta (greater than or equal to 0.7 cm= severe MR)
    3, Jet size (turbulence)
  3. Downstream effect (pulm venous flow reversal)
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94
Q

when does the Coanda Effent happen

A

with wall hugging jets.

May underestimate jet sized

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95
Q

if you suspect Severe MR where else should you look?

A

Pulmonary vein

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96
Q

Pulmonary venous systolic flow reversal =?

A

severe MR

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97
Q

the greatest source of error in measuring PISA is with

A

radius of the flow convergence

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98
Q

Which of the following is used in echo to measure dP?dt?

A

Mitral regurgitation

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99
Q

dP/dT measurement of mitral regurgitation assesses what?

A

LV systolic function

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100
Q

what is the formula for left atrial pressure(LAP)

A

LAP= systolic BP- MR gradient

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101
Q

what does the pressure waveform for MR look like

A

late systolic jump in LA pressure

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102
Q

what is Marfan disease

A

Congenital connective tissue disease causing aortic dilatation and mitral valve prolapse(MVP)

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103
Q

in Marfan syndrome why does aortic dissection and MVP occur?

A

decreased fibrillin

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104
Q

what is Ehlers-Danlos

A

connective tissue disease

look for MVP, dilate AO and dissection

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105
Q

Severe aortic aneurysms are greater than

A

5.0cm

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106
Q

when do you not diagnose a MVP

A

from the apical 4 chamber view

in the presence of a large pericardial effusion

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107
Q

what are two types of endocarditis?

A

Libman-sachs (systemic lupus erythematous)

Marantic (non bacterial) now called NBTE
nonbacterial thrombotic endocarditis
seen in patients with metastatic disease

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108
Q

patients with a history of IV drug abuse may present with:

A

tricuspid endocarditis

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109
Q

can you tell old vs new vegetations

A

no

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110
Q

in order to be seen by 2D vegetations need to be at least?

A

3mm

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111
Q

mechanical valves are durable but need

A

blood thinners

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112
Q

what is the name of the most common Caged ball valve

A

Starr edwards

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113
Q

what is the name of the most common Caged disc valve

A

Beall

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114
Q

what is the name of the most common Tilting disc valve

A

Bjork -shiley

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115
Q

what is the name of the most common bileaflet( bidisc, bi popper)

A

ST Jude (bi leaflet valve)

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116
Q

autografts use the

A

patients own tissue

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117
Q

what is the name of the dual valve surgery for congenital AS

A

Ross procedure

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118
Q

a mitral valve prosthesis has what kind of artifact

A

acoustic shadowing

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119
Q

the normal pressure half time for mitral prosthetic valve is

A

<170msec

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120
Q

which cardiomyopathy is autosomal dominant?

A

Hypertrophic

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121
Q

what is the ratio for assessing asymmetric hypertrophy

A

1.3:1

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122
Q

LVOT obstruction causes the aortic valve to

A

close mid systole

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123
Q

what does it mean if the mitral inflow shows A wave greater than E wave

A

abnormal relaxation

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124
Q

does Inderal (beta blocker) increase SAM?

A

no , it decreases heart rate, reduces SAM with exercise

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125
Q

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?

A

left ventricular infarct

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126
Q

Global longitudinal strain in patients with HOCM is typically?

A

-10%

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127
Q

what does strain measure

A

the deformation within the myocardium

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128
Q

Chagas disease can cause

A

Cardiomyopathy
posterior and apical thinning
septum usually normal

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129
Q

what are the echo signs of congestive carioimyopathies

A 
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)
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130
Q

what is the cause of a B- notch

A

increased LVEDP

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131
Q

what is the 2D post transplant appearance

A

double atria

  • might have 2 Pwaves on ECG
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132
Q

Amyloid and sarcoid are what type of cardiac abnormalities?

A

Infiltrative

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133
Q

what is hemochromatosis

A

an iron disorder in which the body simply loads too much iron

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134
Q

Amyloidosis involves _______ ______ . some may describe is as

A

abnormal proteins

some may describe is as a translucent waxy protein build up on the myofibrils

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135
Q

what is the term ground glass appearance related to

A

infiltrative endocarditis

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136
Q

a restrictive cardiomyopathy has which of the following?

a. increased afterload
b. decreased LV compliance
c. increased preload
d. decreased LA pressure

A

b. decreased LV compliance

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137
Q

what are the types of cardiomyopathies

A

Normal
Congestive (dilated)
Hypertrophic
Restrictive

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138
Q

a typical ejection fraction in a dilated cardiomyopathy patient might be? or for HCM patient

A

15-25%

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139
Q

The majority of ventricular filling occurs during?

A

the first third of diastole

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140
Q

what are the names of the filling patterns

A

normal
abnormal relaxation
normalization (pseudonormalization)
restrictive

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141
Q

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

a pseudonormal pattern

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142
Q

in elderly patients(>60) the A wave is _________ than the E wave

A

normally higher or equal to

143
Q

how does the normal Doppler waveform differs from flow at the mitral leaflet tips

A

E and A are reversed at these two sample sites

144
Q

how would you determine if a patient has constrictive versus restrictive disease?

A

MV inflow with respiration variation

145
Q

In constrictive pericarditis does the E wave increase or decrease with inspiration?

A

Decrease

146
Q

what is the order of excitation

A
  1. SA node
  2. AV node
  3. bundle of his
  4. Bundle branches
  5. Purkinje fibers
147
Q

Name the three layers of the pericardium

A
  1. fibrous pericardium: thick outer sac
  2. Serous Parietal: bound to fibrous pericardium smooth, “ the wall of a cavity”
  3. Serous Visceral: bound to epicardium, smooth” toward the organ”

pericardial fluid is found in between the two serous layers

148
Q

A pericardial effusion can often be seen in patients with:

A

renal failure

149
Q

what is the murmur of a pericardial effusion?

A

Friction rub

150
Q

what is the pericardial effusion criteria

A 
small= posterior fluid <1cm
med= anterior &amp; posterior 1-2 cm
large= Surrounding the heart >2cm
151
Q

when should you measure pericardial effusions during systole or diastole?

A

during diastole

152
Q

what is the importance in identifying the coronary sinus vs the AO

A

to differentiate between pericardial and pleural effusions

153
Q

where does the oblique sinus of the pericardium lie

A

Posterior to the LA in the PLAX view-

area between the two sets of the pulmonary veins)

154
Q

what to do if tamponade is suspected?

A

Immediate interpretation

155
Q

what is Beck’s triad (for Tamponade)

A

a. elevated venous pressure
b. hypotension
c. quiet heart.

156
Q

the most sensitive way to diagnose cardiac tamponade is?

A 
respiration variation
(in transvalvular flow >25%)
157
Q

what cardiac condition would prevent diastolic right ventricular collapse?

A

Pulmonary hypertension

158
Q

In tamponade what happens to hepatic veins diastolic and systolic flow during expiration?

A

S &D wave are still present but diminished

159
Q

what other pericardial abnormality also causes impaired ventricular filling?

A

constrictive pericarditis

160
Q

A huge, dilated PA, severe TR and RV enlargement best describe?

A

Pulmonary hypertension

161
Q

what is Eisenmenger syndrome

A

Reversal of a long standing left to right shunt from PHTN. shunt is no right to left

162
Q

SAX LV in PHTN stays flattened while in RV volume overload

A

rounds some in systole

163
Q

what is represented with a decreased A wave and a flying W

A

Pulmonary hypertension by Mmode

164
Q

with small pulmonary emboli the heart may be

A

normal

165
Q

with large pulmonary emboli the RV/RA will

A

dilate, PHTN or RV systolic dysfunction may be present

166
Q

Given tricuspid regurgitation with 60mmHG gradient grade the severity of pulmonary hypertension

A

severe

167
Q

what are the 2010 ASE right heart RAP guidelines

A 
3mmHG= normal IVC and collapses with a sniff
8mmHg= intermediate- unable to sniff or IVC collapses <20%
15mmHg= dilated(>2.1cm) &amp; doesn't collapse 50%
168
Q

the size of an aneurysm during systole:

A

increases

169
Q

the most common (mechanical) complication of an MI

A

aneurysm formation

170
Q

which of the following occurs first in the setting of severe mitral regurgitation due to flail leaflet?

A

dilated right ventricle

171
Q

what type of MI causes Papillary muscle rupture?

A

inferior MI

172
Q

what are the characteristics of a true aneurysm

A

Wide base
walls composed of myocardium
low risk of free rupture

173
Q

what are the characteristics of a pseudoaneurysm

A

narrow base
walls composed of thrombus and pericardium
high risk of free rupture

174
Q

the most common location for pseudoaneurysms is:

A

inferior basal, not apical

175
Q

does the wall of a pseudoaneurysm contain endocardium

A

no, its a rupture across both endo and myocardium

176
Q

what information do you need pre op in a patient with a LV aneurysm?

A

movement of the other walls

177
Q

color Doppler in ischemic disease can be good for?

A

Ventricular septal defect, because you can use PW and CW Doppler for detecting MR

178
Q

what do you look for in a patient with Kawasaki disease?

A

coronary artery aneurysms

179
Q

what is the IVS motion in a patient with left bundle branch block (LBBB)

A

dyskinetic or paradoxical

180
Q

from where do the coronaries originate?

A

in the L and R aortic sinus of valsalva

181
Q

what is meant by “right dominant”

A

when the right coronary gives rise to the posterior descending artery” (85%) of the time

182
Q

which coronary supplies the interatrial septum?

A

right (also usually supplies the SA and AV nodes)

183
Q

which coronary artery feeds the inferoseptal wall

A

right coronary artery

184
Q

in multivessel disease what is better stress echo or nuclear stress exams

A

stress echo

185
Q

what are the indications for a stress echo

A

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

186
Q

what would be a contraindication to performing a stress test on an athlete with chest pain

A

unstable angina

187
Q

in a pharmacological stress test what may be given at peak dose if the target heart rate is not reached

A

Atropine

188
Q

what does it mean when the 2D image appears to have three atria

A

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

189
Q

name the types of Atrial septal defects

A

Secundum
Primum
Sinus venosus
Coronary sinus

190
Q

what is the most common type of ASD?

A

Secundum

191
Q

Partial anomalous pulmonary venous return is seen in which type of ASD

A

sinus Venosus

192
Q

what is the best view to diagnos a sinus venosus ASD

A

Modified subcostal four chamber

193
Q

what is the best view to demonstrate a ASD

A

Subcostal 4 chamber view

194
Q

what is the standard echo view for contrast studies of an ASD

A

apical 4chamber

195
Q

how many beats to see contrast on the left side in a patient with an ASD

A

<5BEATS

EQUAL TO OR > 5 BEATS FOR PULM SHUNT

196
Q

Where should contrast be injected in order to diagnose a persistent left superior vena cava?

A

left arm

197
Q

what is the most common venous malformation and has a dilated coronary sinus

A

Persistent Left superior vena cava

198
Q

what are endocardial cushion defects (AV septal) associated with

A

Down syndrome

199
Q

what are the types of Ventricular septal defects

A

Membranous (perimembranous)
Muscular
Subvalvular
infundibular

200
Q

which is the most common type of VSD

A

Perimembranous

201
Q

what is the supracristal locatione

A

high near the aortic and pulmonic valves

202
Q

where are the inlet locations

A

subvalvular low near the mitral and tricuspid valves

203
Q

what is the classic VSD murmur

A

Loud holosystolic murmur (LSB) (loudest with small VSDs)

204
Q

what is the formula for calculating RVSP from VSD velocities

A

RSVP= systolic BP- VSD gradient

RSVP= SBP- 4(v)squared

205
Q

what congenital abnormality has a displaced TV

A

Ebsteins

206
Q

if a large PDA is not corrected what might develop?

A

Eisenmenger syndrome

207
Q

what are the 4 tetralogy of Fallot defects

A

Perimembranous VSD(large)
overriding aorta
Pulmonary stenosis (often Infundibular)
right ventricular hypertrophy

208
Q

what is a helpful technique in identifying LV myocardial noncompaction during an echocardiogram?

A

echocardiographic contrast agent

209
Q

what part of the heart is most likely to be affected by cardiac contusion?

A

right ventricle

210
Q

what might be the first indication of metastatic cardiac disease?

A

Pericardial effusion

211
Q

which cardiac chamber is most likely involved with metastatic tumors?

A

right atrium

212
Q

the most common benign tumor on the aortic valve is

A

Papillary fibroelastoma

213
Q

Myxomas symptoms mimic

A

Mitral stenosis symptoms

214
Q

LA myxomas are usually attached where?

A

interatrial septum

215
Q

when is the LA volume the highest?

A

End systole

216
Q

when is the LV volume the highest?

A

End diastole

217
Q

the left atrial pressure matches the pressure of what other area?

A

Pulmonary capillary wedge (PCW)

218
Q

How is the PCW pressure determined?

A

Swan Ganz catheter

219
Q

whose responsibility is it to obtain and informed consent prior to TEE?

A

the physician

220
Q

how many segments of a wall have to be affected before calling a WMA?

A

1 segment

221
Q

with PAPVR the pulmonary veins drain into the RA due to what kind of ASD?

A

Sinus venosus ASD

222
Q

with what anomaly does the chordae tendinae insert into a single papillary muscle?

A

congenital mitral stenosis (parachute MV)

223
Q

Restricted VSDs are will be __________ in velocity equal to or larger than

A

High, 4m/s

224
Q

large VSDs will be _____ in velocity, about __________

A

low, 2m/s

225
Q

How far does the insertion of the TV have to be from the MV to confirm the Dx of ebstein’s anomoly

A

10mm

226
Q

what does the mustard procedure correct?

A

redirect blood flow at the atrial level in pts with transposition of the great vessels) TGV

227
Q

what does the ROSS (pulmonary autograft) procedure correct?

A

done for AS (usually congenital)
it moves the PV into the AV(moving the coronaries)
-homograft in PV position

228
Q

what does the Fontan Procedure correct?

A

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

  1. Glenn: Hook SVC directly to the RPA
  2. Fontan: Hook IVC to MPA
229
Q

On 2D what is the difference between a pacemaker wire and a catheter?

A

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)

230
Q

Name the two layers of the epicardium

A

Visceral and parietal

231
Q

The Venturi effect can be associated with which cardiovascular?

A

Hypertrophic

232
Q

What is the Venturi effect?

A

(Modification of Bernoulli’s principle)

Law of conservation of energy means that when the velocity of fluid increases the pressure decreases.

233
Q

If you are doing an echo on a supine patient who becomes short of breath what should you do first?

A

Sit the patient upright

234
Q

What do you do first for an apneic patient after giving sedation?

A

Check their airway

235
Q

Why do an IVC sniff test?

A

To check for elevated RA pressures

236
Q

What type of shunt causes cyanosis in newborns

A

Right to left shunts

237
Q

What is a “pressure drop”?

A

Same as a gradient across valves

238
Q

What valve is the least likely to be affected in rheumatic heart disease?

A

Pulmonic

239
Q

In the cath lab the gorlin formula is used to calculate:

A

Valvular areas

240
Q

Mitral valve velocity should not be affected by:

A

Gender

241
Q

Which valve is most likely to regurgitate in normals?

A

Tricuspid

242
Q

What are the causes of acute mitral regurgitation?

A

Endocarditis
Ruptured chordae
Papillary muscle dysfunction
Prosthetic valve dysfunction

243
Q

With what disease should you not rely on M mode for quantifying left ventricular EF?

A

Apical infarction

244
Q

Where do the coronaries drain?

A

Into the coronary sinus

245
Q

An MI of the inferior wall involves which coronary artery?

A

Right coronary artery

246
Q

LV mass (weight) remains normal in chronic:

A

mitral stenosis

247
Q

which syndrome fits with AR, Ao dilatation, Ao dissections and Ao aneurysms?

A

Marfan syndrome

248
Q

how does switching to a lower frequency transducer affect aliasing?

A

aliasing will occur at higher velocities

249
Q

what are Lamb’s Excrescences

A

they are thin filiform strands (fronds) that form on the edges of valve leaflets

250
Q

high angulation of an M mode transducer beam equals

A

pseudo bicuspid aortic valve

251
Q

what is the structure under the arch?

A

right pulmonary artery

252
Q

what is the primary effect of long standing aortic regurgitation?

A

decreased ejection fraction

253
Q

which standard 2D TTE view typically allows viewing of the LAA?

A

apical 2 chamber view

254
Q

what causes a pericardial knock?

A

abrupt cessation of early diastolic inflow (classic in constrictive pericarditis) similar in timing to very loud S3

255
Q

why follow chronic AI patients?

A

check left ventricular size

256
Q

what accompanies bicuspid aortic valves?

A

coarctation of the aorta(50% of coarcts have a bicuspid valve)

257
Q

given TR and the RA pressure what can you calculate?

A

right ventricular systolic pressure

258
Q

what is the best way to determine the severity of mitral regurgitation?

A

Pulmonary venous flow

259
Q

a patient has an RVSP of 60mm Hg. One year later the RVSP is 30mm Hg. What happened to this patient?

A

dilated cardiomyopathy

260
Q

when is mitral pressure halt time not accurate?

A

Post valvuloplasty

261
Q

if your patient has a dilated LV and this septum what might be going on with the patient?

A

severe mitral regurgitation

262
Q

which cardiac pathology affects the valves?

A

Carcinoid

263
Q

which pericardial layer is the serous

A

visceral or epicardial

264
Q

cardiac tamponade is rapid filling of fluid

A

causing restrictive diastolic filling

265
Q

beware of normal dropout vs __________ in the apical 4ch view

A

secundum ASD

266
Q

kids with tuberous sclerosis develop what kind of cardiac tumor?

A

rhambomyomas

267
Q

what is meant by automacity?

A

the ability to initiate an electric impulse or beat

intrinsic means pertaining exclusively to a part

268
Q

if you see anechoic dropout of the interatrial septum in the apical 4 ch view what should you do?

A

look in the 4 subcostal 4ch

269
Q

in contras studies an
ancyonotic flow is

and

cyanotic flow is

A

L-R

R-l

270
Q

Peripheral contrast is not useful in

A

AI

271
Q

what does amyl nitrite do to HR?

A

Inreases heart rate

272
Q

what types of cm. might you seen in a pt with aids?

A

dilated CM

273
Q

On 2D what is the difference between a pace wire and a catheter

A

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

274
Q

Name the two layers of the pericardium

A

Visceral and parietal

275
Q

The Venturi effect can be associated with which cardiomyopathy

A

Hypertrophic

276
Q

What is the Venturi effect

A

( modification of Bernoulli’s Principle)

Law of conservation of energy means that when the velocity of fluid increases the pressure decreases

277
Q

If you are doing an echo on a supine or who becomes short of breath what should you do first?

A

Sit the patient upright

278
Q

What do you do first for an apneic patient after giving sedation

A

Check their air way

279
Q

Why do an IVC “sniff” test

A

To check for elevated RA pressures

280
Q

What type of shunt causes cyanosis in newborns

A

Right to left shunt

281
Q

What is a pressure drop

A

Same as a gradient across valves

282
Q

What valve is the least likely to be affected in rheumatic heart disease

A

Pulmonic

283
Q

In the Cath Lab the Gorlin formula is used to calculate

A

Valvular area

284
Q

Which valve is most likely to regurgitate in Normals

A

Tricuspid

285
Q

With what disease should you not rely on M mode for quantifying left ventricular EF

A

Apical infarction

286
Q

Where do the coronaries drain

A

Into the coronary sinus

287
Q

Which coronary supplies the LV apex

A

Left anterior descending

288
Q

And MI of the inferior wall involves which coronary artery

A

Right coronary artery

289
Q

What percentage of normal will have a PFO

A

20 to 30%

290
Q

What 2D finding what do you see in a patient with a PLSVC

A

A dilated coronary sinus

291
Q

A pre-systolic opening of the aortic leaflets is caused by

A

Elevated LVEDP ( end diastolic pressure)

292
Q

Between which heart sound with a murmur of aortic stenosis be heard

A

S1-S2

293
Q

Patients with Ankylosing spondylitis may develop

A

Aortic regurgitation

294
Q

What is kyphosis

A

Exaggerated anterior spinal curvature

Skeletal before Maddie Mae compress PA and cause E hypertension

295
Q

What can cause contrast to dissipate too quickly

A

High Mi

296
Q

What is you Uhl’s anomaly

A

Congenital absence RV myocardium also called parchment heart- may be confused clinically with Ebstein’s

297
Q

Does a PDA increase LV preload

A

Yes when the shunt is left to right

298
Q

Name the three heart muscle layers

A

Epicardium thin outer layer
Myocardium mid wall(thickest)
Endocardium inside

299
Q

Normally how much pericardial fluid is there

A

40 cc

300
Q

All of the following may result in jugular venous distention except:

a) cardiac tamponade
b) pulmonary hypertension
c) hypovolemia
d) constrictive pericarditis

A

Hypovolemia

301
Q

If a patient has Cor Puomonale what condition is most likely to exist?

A

Right ventricular increase

302
Q

How do cardiac problems cause renal failure, jugular venous pulsations and peripheral edema

A

Mostly through systolic Failure and low perfusion causing multi system complications

303
Q

How many weeks until the heart is developed

A

Six weeks

304
Q

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

A

Pleural effusion

305
Q

Which embryonic aortic arch(1-6) develops into the transverse arch

A

Fourth

306
Q

Persistent fetal circulation

A

PHTN with right to left shunting across the foramen and ductus

307
Q

Volume and then walls equal

A

Preload

308
Q

Pressure and thick walls equal

A

Afterload

309
Q

Oh right sided pressure is elevated with a valsalva maneuver

A

During the strain phase no

During the release phase yes

310
Q

What kind of murmur will a patient with a VSD have

A

Harsh holosystolic

311
Q

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

A

Bubbles from RV to LV

312
Q

Which clinical finding is associated with a friction rub

A

Pericardial effusion

313
Q

Where is the Chiari network located

A

Right atrium

314
Q

What causes a left parasternal friction rub

A

Pericarditis

315
Q

Aortic regurgitation starts at the

A

Beginning of IVRT

316
Q

What is the frequency for a TEE probe versus a TTE probe

A

TTE probes are usually lower 2-7 MHz, TEE probes are usually 5 to 7 MHz

317
Q

In the apical four chamber view where would you see reverberation artifact

A

Apex

318
Q

Where are most fibroelastomas found

A

Usually on the valves (mitral and aortic) may be described as frond like (feathery)

319
Q

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

A

Mitral valve prolapse

320
Q

What might you see in a patient with scleroderma

A
  1. pulmonary hypertension

2. pericardial effusion

321
Q

The reason for using ultrasound gel is

A

To keep air out

322
Q

How many years are echo records to be kept

A

Seven

323
Q

Will ascending aorta dissection cause severe MR

A

No not severe MR may be mild

324
Q

What is the most common type of pediatric cardiac tumor

A

Rhamdomyomas

325
Q

Why is the SA node the primary pacemaker

A

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

326
Q

How does the wave of contraction (depolarization) move

A

Inside to outside (endocardium to epicardium)

327
Q

When is the LV pressure the lowest

A

Early diastole

328
Q

What are the four defects that make up shone’s syndrome

A

Supravalvular mitral membrane
Parachute mitral valve
Subaortic stenosis
Coarctation of the aorta

329
Q

What is the aortic valve doing during the QT interval

A

The valve is open

330
Q

If you have a uniformly dilated aortic root which term best describes this

A

Fusiform

331
Q

The primary cause for papillary muscle dysfunction is

A

Apical infarction

332
Q

Which valve event starts Isovolumic contraction

A

Mitral valve close

333
Q

Which valve event ends isovolumic contraction

A

Aortic opens

334
Q

Which valve event starts isovolumetric relaxation

A

Aorta closes

335
Q

Which valve event ends isovolumic relaxation

A

Mitral valve open

336
Q

What is the first heart sound

A

Closure of the mitral and tricuspid valve

337
Q

What is the second heart sound

A

Closure of the aortic A2 and Pulmonic P2 valves

338
Q

What is the third heart sound

A

Early diastolic ventricular inflow

339
Q

What is the fourth heart sound

A

Atrial contraction

340
Q

What causes the third heart sound

A

Rapid early diastolic flow into a stiff noncompliant ventricle

341
Q

In patients with a fib which heart son would be missing

A

The fourth it occurs during atrial contraction

342
Q

Inspiration will ___________ venous return

A

Increase

343
Q

Expiration will _________ venous return

A

Decrease

344
Q

Standing will decrease

A

Venous return and stroke volume

345
Q

Squatting will ____________ venous return, stroke volume and CO ( increases AR, decreases IHSS)

A

Increase

346
Q

Hand grip increases ___________________ and decreases

A

Increases HR, CO, arterial pressure and MR

Decreases AS

347
Q

Valsalva during strain

A

Decreases venous return, SV, CO

Increases IHSS

348
Q

Valsalva during release

A

Increase venous return, CO and BP

349
Q

Most murmurs __________during straining

A

Decrease

350
Q

Sit up increase

A

HR, CO and SV

351
Q

Amyl nitrite inhalation decrease

A

Peripheral resistance

AR/ MR

352
Q

Amyl nitrite inhalation increase

A

HR, forward flow murmurs

353
Q

In aortic valve stenosis, what changes are seen in the Doppler spectral trace

A

Increased velocity and turbulence(spectral broadening)

In severe AS, the time from the onset of flow to peak velocity is prolonged

354
Q

How does the peak AOV gradient correlate with the severity of stenosis

A

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

Spring 2018 (7 decks)

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