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I&M II > III. Echocardiography > Flashcards

III. Echocardiography Flashcards

1
Q

Transespohageal Echo is used to guide ____ surgery.

A

Cardiac

(Diagnostic, therapeutic purposes)

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2
Q

Two types of echocardiography

A
  1. TEE (transesophageal echo)
  2. TTE (transthoracic echo)
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3
Q

Which echo can be used in SV, awake, or crashing patient?

A

TTE

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4
Q

Echocardiography is an ultrasound of the ____.

A

Heart

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5
Q

What does Echocardiography allow us to assess:

A
  1. Cardiac valve area and functionality.
  2. Abnormal communication between left and right heart
  3. Valve leakage (regurgitation)
  4. Calculate cardiac output and ejection fraction
  5. Cardiac Tissue
  6. Velocity of Blood Flow
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6
Q

Echocardiography uses ____ or ____ Doppler

A

Pulse

Continuous

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7
Q

Ultrasound Waves are either ____, ____, or ____.

A
  • Absorbed
  • reflected
  • Scattered
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8
Q

____ (located within the probe) transmit and receive ultrasound Waves.

A

Peizoelectric crystals

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9
Q

Ultrasound technology used within echocardiography converts ____ energy into ____, which is then received by the probe, ultimately creating an observable ____.

A
  • electrical
  • sound (waves)
  • picture
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10
Q

When viewing a 2D transthoracic echo (TTE) of the heart, what chamber will most superior in the scan?

Most inferior?

A
  • RV (it is closest to the chest surface due to heart’s rotation in the chest)
  • LA (furthest away from chest surface)
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11
Q

Heart Anatomy Review Picture

A
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12
Q

Transthoracic Echo (TTE) is noninvasive/invasive.

A

Noninvasive

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13
Q

TTE is used for the evaluation of (5 things)

A
  1. 4 chamber view
  2. Heart strength
  3. Valve condition
  4. Pericardium
  5. Aorta
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14
Q

TTE may be able to detect (6 things):

A
  1. MI (along with EKG & Cardiac Enzymes)
  2. Hypertrophy
  3. Infiltration
  4. Strength of heart
  5. Tumors
  6. Vegetation
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15
Q

TTE may have decrease accuracy due to (3 things):

A
  1. Obesity (extra tissue will attenuate the signal and decrease quality)
  2. COPD
  3. Chest Wall deformity
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16
Q

Information obtained from TTE

A
  1. Glonbal and regional LV function
  2. Global RV function
  3. Gross valvular abnormalities
  4. Diastolic function and volume status
  5. Effusion/Tamponade
  6. Dynamic obstruction
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17
Q

Echocardiographic view comprises two things:

A
  1. Echocardiographic window (what you are looking through)
  2. A cross-section.
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18
Q

What are the three different TTE windows?

A
  1. Parasternal (4th ICS):long axis, short axis
  2. Apical Window (Apex of LV): 4 chamber view, 2 chamber view
  3. Subcostal (just under Xyphoid Process): 4 chamber view
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19
Q

Any 2D view of the heart (other than “donut view” short axis), gives you a view of what two walls of the heart?

A
  1. Anteroseptal Wall
  2. Inferolateral Wall (posterior wall)
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20
Q

Parasternal Long Axis (PLAX) TTE view shows what:

A
  1. Anterior septum
  2. Posterior wall (inferior lateral)
  3. Mitral valve
  4. Aortic leaflets
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21
Q

Parasternal Short Axis (PSAX) shows what 4 things:

A
  1. Size and filling of LV (Intravascularly full vs volume depleted)
  2. Ventricular wall thickness
  3. Global function of LV
  4. Regional Function
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22
Q

TTE

What view is this?

A

Short Axis

Left Cusp is on right
Right cusp on lower edge
Noncoronary on the left

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23
Q

What is the intention of short axis view?

A

view of aortic valve

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24
Q

Short-Axis View

During a portion of the cardiac cycle, it is possible to briefly see the opening motion of the ____ anterior to the aorta.

A

pulmonary valve

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25
Q

Aortic valve has how many cusps (leaflets)?

A

3

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26
Q

TTE

What view is this?

A

Apical (Apex) Four Chamber (A4C)

if this view was obtained via TEE, rather, L & R would still be the same, but atria and ventricles would be flipped

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27
Q

TTE: Apical 4 Chamber View

Good for viewing what?

A
  • global LV function
  • mitral valve function (Dz)
  • Apex of heart
  • RV valve function & TAPSE
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28
Q

universal metric of LV function

A

Ejection Fraction

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29
Q

What is the major way of quantifying RV function?

A

TAPSE (Tricuspid Annular Plane Systolic Excursion)

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30
Q

What landmark is the pointer on?

A

Tricuspid Annulus

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31
Q

The RV motion can be described as:

A

up & down swinging motion

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32
Q

TAPSE

(measurement & definition)

A

≥1.6cm

A measurement of the distance traversed by the Tricuspid Annulus between systole and diastole

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33
Q

what TAPSE major is very poor

A

<1.0

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34
Q

A “five” chamber view involves tilting the image plane superiorly to show the base of the ____ and the ____.

A

aortic valve

left ventricular outflow tract

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35
Q

TTE

What view is this?

A

Apical Two Chamber (A2C)

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36
Q

What is the A2C good for evaluating?

A
  • Anterior and Inferior LV
  • Mid portion of Mitral Valve
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37
Q

What view is this?

A

Subcostal View

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38
Q

What is the Subcostal View good for?

A
  • RV View (size, function, thickness)
  • Effusion (visible between ventricle and liver superiorly)
  • Intra-Atrial septum
  • IVC
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39
Q

Normal LV myocardium is generally less than ____ thick at end-diastole, and will eject approximately ____ or more of the blood volume in the LV.

A

12mm

60%

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40
Q

The ____ view and the ____ view are often the most useful for assessing left ventricular myocardial function.

A

apical four chamber
mid-ventricle short axis

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41
Q

Probe with ultrasound tip transducer placed down esophagus

A

TEE

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42
Q

T/F: TEE has Improved image quality vs. TTE

A

TRUE

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43
Q

TEE

Decreased/Increased distance the ultrasound wave has to travel compared to TTE

A

Decreased

44
Q

TEE

Decreased ____ leads to improved signal strength

A

attenuation

45
Q

TEE or TTE

Requires team, takes longer, requires sedation or GA, has increased risks

A

TEE

46
Q

TEE risk of perforation

A

1:10,000

47
Q

TEE gives good views of:

A

Aorta, Plum. Art., Valves, Atria and Ventricles, Septum’s, Coronary Art., and Pericardium

48
Q

TEE vs TTE

Additionally used in hemodynamically unstable and critically ill pt.

A

TEE

49
Q

TEE allows for calculation of:

A
  • EF and CO (diff. between LV-vol. and LVED vol.)
  • Valve area
50
Q

Able to measure blood velocity

A

Doppler Echo

51
Q

what two methods does doppler echo use to measure blood velocity?

A
  1. Pulse Wave Doppler
  2. Continuous Wave Doppler
52
Q

____ Doppler is best for evaluating valve lesions, CHD, and hemodynamic info

A

Continuous

53
Q

Doppler Echo color flow is based on ____

A

color-wave principle

54
Q

Doppler color flow is based on what three things?

A
  1. Velocity
  2. Vector
  3. Turbulence
55
Q

doppler color

flow towards tranducer

A

Red

56
Q

doppler color

away frmo transducer

A

blue

57
Q

doppler color

added for variance

A

color

58
Q

Doppler Echo

brightness relates to ____

A

velocity

59
Q

Doppler Echo

____ change relates to rate of velocity change over time.

A

Hue

60
Q

Coronary Artery Pic

A
61
Q

doppler photo

A
62
Q

What induction agents common for “sedation” echo?

A
  1. propofol
  2. etomidate
  3. ketamine
63
Q

TTE

Name this view

A

Parasternal Long Axis (PLAX)

64
Q

TTE

name this view

A

Parasternal Short Axis (PSAX)

65
Q

Coronary Artery Pic 2

A
66
Q

Coronary Artery Spacial Distribution Pic

A
67
Q

Systolic HF vs Diastolic HF Pic

A
68
Q

Ejection Fraction Equation

A

EDV - ESV/EDV x 100

69
Q

Stroke volume equation

A

SV = EDV - ESV

70
Q

Heart Failure Chart Pic

A
71
Q

HF with preserved EF diagram pic

A
72
Q

basic TEE exam video link

A

https://youtu.be/g7bSARSBwWs

73
Q

With GA, use ____ first

A

OG tube

For sedation case, OG not required

74
Q

This is the so-called “Mercedes - Benz” view of the aortic valve.

A

Position 1

TTE Short Axis View

75
Q

this view is used to measure aortic valve area which can be used along with the aortic flow velocity integral from the “deep” transgastric view to determine cardiac output.

A

Aortic Valve Transverse (Short-Axis) View, (Position 1)

76
Q

This is a very important view that can provide a wealth of information and is safer than the transgastric view since the probe remains in the esophagus.

A

4 Chamber Transverse View (Position 2)

77
Q

4 Chamber Transverse View (Pos 2)

The ____ and ____are on the left side of the image

A

right atrium
ventricle

78
Q

4 Chamber Transverse View (Pos 2)

The ____ is clearly defined in the middle of the screen.

A

mitral valve

79
Q

The 2 Chamber Longitudinal View is also known as:

A

Position 3

80
Q

2 Chamber Longitudinal View (Pos 3)

The longitudinal orientation presents the very important ____ (right side) and the opposite ____ .

A

anterior wall
inferior wall

81
Q

2 Chamber Longitudinal View (Pos 3)

The____ is seen just above the anterior wall.

A

left atrial appendage

82
Q

Refers to the pressure gradient that drives coronary blood pressures.

A

Coronary Perfusion Pressure (CPP)

83
Q

CPP equation

A

CPP= DBP-LVEDP

The difference between the diastolic aortic pressure, and the left ventricular end-diastolic pressure.

84
Q

Myocardial Segment Terminology Pic

A
85
Q

Myocardial Segment Terminology Pic 2

A
86
Q

Aortic regurgitation is diagnosed best by ____

A

Color Doppler Imaging

87
Q

The regurgitant jet occurs during ____ toward the ____ cavity.

A

diastole
left ventricular

88
Q

Aortic Regurgitation

From the 4 chamber or apical views, the color signal is primarily displayed as ____, since its direction is toward the transducer and the jet can be distinguished from the mitral diastolic inflow.

A

red-yellow

89
Q

appears as a “doming” of the leaflet opening during diastole in the long axis view.

A

mitral stenosis

90
Q

The normal mitral valve has a valve area in excess of ____.

A

4 cm sq

91
Q

Symptomatic mitral stenosis readily occurs when the valve area falls ____

A

<1.4 cm sq.

92
Q

The hallmark of a ____ is a highly mobile tag of material attached to a portion of the valve.

A

valvular vegetation

93
Q

____ is a disorder which demonstrates poor contractility of all segments of the myocardium.

A

Cardiomyopathy

94
Q

Cardiomyopathy can be caused by:

A
  • viral
  • toxic
  • post-partum
  • congenital
  • extensive multivessel CAD
95
Q

cardiomyopathy

The left ventricular ejection fraction in cardiomyopathies will often be less than ____.

A

25%

96
Q

cardiomyopathy

One of the most visible features is the relatively weak excursion of the diastolic opening of the ____.

A

mitral leaflets

97
Q

Anterior wall ischemia is the result of occlusion of the ____.

A

left anterior descending coronary artery (LAD)

98
Q

The anterior wall contractility is best revealed by ____, ____, and ____ views.

The ____ view actually defines the anterior-septum which is supplied by septal perforators from the left anterior descending artery.

A

apical two-chamber, short axis and long axis

long axis

99
Q

Anterior Wall Ischemia

The motion pattern of those ischemic myocardial segments reveals either a ____ or ____- motion compared to the other normally contractile segments

A

hypo-
akinetic

100
Q

Inferior wall ischemia is generally caused by occlusion of the ____ or a ____ .

A
  • posterior descending coronary artery (often the distal portion of the right coronary)
  • distal part of the left circumflex coronary artery branch
101
Q

Inferior wall ischemia

One of the most useful views for regional ischemia is the ____.

A

short axis of the left ventricular myocardium

102
Q

Pooled air usually originates from the ____, so atrial accumulation is not unusual.

A

pulmonary veins

103
Q

A large intracardiac collection of air, termed “pooled air”, usually accumulates in the highest (dependent) portion of the heart during ____.

A

bypass

104
Q

AIR

In 4 chamber view there is a prominent ____ accumulation of air.
There is also accumulation along the atrial septal border in the ____.

A

apical septal-anterior
left atrium

105
Q

Normal size of aorta

A

4-5 squared cm

I&M II (7 decks)

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