III. Echocardiography Flashcards
Transespohageal Echo is used to guide ____ surgery.
Cardiac
(Diagnostic, therapeutic purposes)
Two types of echocardiography
- TEE (transesophageal echo)
- TTE (transthoracic echo)
Which echo can be used in SV, awake, or crashing patient?
TTE
Echocardiography is an ultrasound of the ____.
Heart
What does Echocardiography allow us to assess:
- Cardiac valve area and functionality.
- Abnormal communication between left and right heart
- Valve leakage (regurgitation)
- Calculate cardiac output and ejection fraction
- Cardiac Tissue
- Velocity of Blood Flow
Echocardiography uses ____ or ____ Doppler
Pulse
Continuous
Ultrasound Waves are either ____, ____, or ____.
- Absorbed
- reflected
- Scattered
____ (located within the probe) transmit and receive ultrasound Waves.
Peizoelectric crystals
Ultrasound technology used within echocardiography converts ____ energy into ____, which is then received by the probe, ultimately creating an observable ____.
- electrical
- sound (waves)
- picture
When viewing a 2D transthoracic echo (TTE) of the heart, what chamber will most superior in the scan?
Most inferior?
- RV (it is closest to the chest surface due to heart’s rotation in the chest)
- LA (furthest away from chest surface)
Heart Anatomy Review Picture
Transthoracic Echo (TTE) is noninvasive/invasive.
Noninvasive
TTE is used for the evaluation of (5 things)
- 4 chamber view
- Heart strength
- Valve condition
- Pericardium
- Aorta
TTE may be able to detect (6 things):
- MI (along with EKG & Cardiac Enzymes)
- Hypertrophy
- Infiltration
- Strength of heart
- Tumors
- Vegetation
TTE may have decrease accuracy due to (3 things):
- Obesity (extra tissue will attenuate the signal and decrease quality)
- COPD
- Chest Wall deformity
Information obtained from TTE
- Glonbal and regional LV function
- Global RV function
- Gross valvular abnormalities
- Diastolic function and volume status
- Effusion/Tamponade
- Dynamic obstruction
Echocardiographic view comprises two things:
- Echocardiographic window (what you are looking through)
- A cross-section.
What are the three different TTE windows?
- Parasternal (4th ICS):long axis, short axis
- Apical Window (Apex of LV): 4 chamber view, 2 chamber view
- Subcostal (just under Xyphoid Process): 4 chamber view
Any 2D view of the heart (other than “donut view” short axis), gives you a view of what two walls of the heart?
- Anteroseptal Wall
- Inferolateral Wall (posterior wall)
Parasternal Long Axis (PLAX) TTE view shows what:
- Anterior septum
- Posterior wall (inferior lateral)
- Mitral valve
- Aortic leaflets
Parasternal Short Axis (PSAX) shows what 4 things:
- Size and filling of LV (Intravascularly full vs volume depleted)
- Ventricular wall thickness
- Global function of LV
- Regional Function
TTE
What view is this?
Short Axis
Left Cusp is on right
Right cusp on lower edge
Noncoronary on the left
What is the intention of short axis view?
view of aortic valve
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.
pulmonary valve
Aortic valve has how many cusps (leaflets)?
3
TTE
What view is this?
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
TTE: Apical 4 Chamber View
Good for viewing what?
- global LV function
- mitral valve function (Dz)
- Apex of heart
- RV valve function & TAPSE
universal metric of LV function
Ejection Fraction
What is the major way of quantifying RV function?
TAPSE (Tricuspid Annular Plane Systolic Excursion)
What landmark is the pointer on?
Tricuspid Annulus
The RV motion can be described as:
up & down swinging motion
TAPSE
(measurement & definition)
≥1.6cm
A measurement of the distance traversed by the Tricuspid Annulus between systole and diastole
what TAPSE major is very poor
<1.0
A “five” chamber view involves tilting the image plane superiorly to show the base of the ____ and the ____.
aortic valve
left ventricular outflow tract
TTE
What view is this?
Apical Two Chamber (A2C)
What is the A2C good for evaluating?
- Anterior and Inferior LV
- Mid portion of Mitral Valve
What view is this?
Subcostal View
What is the Subcostal View good for?
- RV View (size, function, thickness)
- Effusion (visible between ventricle and liver superiorly)
- Intra-Atrial septum
- IVC
Normal LV myocardium is generally less than ____ thick at end-diastole, and will eject approximately ____ or more of the blood volume in the LV.
12mm
60%
The ____ view and the ____ view are often the most useful for assessing left ventricular myocardial function.
apical four chamber
mid-ventricle short axis
Probe with ultrasound tip transducer placed down esophagus
TEE
T/F: TEE has Improved image quality vs. TTE
TRUE
TEE
Decreased/Increased distance the ultrasound wave has to travel compared to TTE
Decreased
TEE
Decreased ____ leads to improved signal strength
attenuation
TEE or TTE
Requires team, takes longer, requires sedation or GA, has increased risks
TEE
TEE risk of perforation
1:10,000
TEE gives good views of:
Aorta, Plum. Art., Valves, Atria and Ventricles, Septum’s, Coronary Art., and Pericardium
TEE vs TTE
Additionally used in hemodynamically unstable and critically ill pt.
TEE
TEE allows for calculation of:
- EF and CO (diff. between LV-vol. and LVED vol.)
- Valve area
Able to measure blood velocity
Doppler Echo
what two methods does doppler echo use to measure blood velocity?
- Pulse Wave Doppler
- Continuous Wave Doppler
____ Doppler is best for evaluating valve lesions, CHD, and hemodynamic info
Continuous
Doppler Echo color flow is based on ____
color-wave principle
Doppler color flow is based on what three things?
- Velocity
- Vector
- Turbulence
doppler color
flow towards tranducer
Red
doppler color
away frmo transducer
blue
doppler color
added for variance
color
Doppler Echo
brightness relates to ____
velocity
Doppler Echo
____ change relates to rate of velocity change over time.
Hue
Coronary Artery Pic
doppler photo
What induction agents common for “sedation” echo?
- propofol
- etomidate
- ketamine
TTE
Name this view
Parasternal Long Axis (PLAX)
TTE
name this view
Parasternal Short Axis (PSAX)
Coronary Artery Pic 2
Coronary Artery Spacial Distribution Pic
Systolic HF vs Diastolic HF Pic
Ejection Fraction Equation
EDV - ESV/EDV x 100
Stroke volume equation
SV = EDV - ESV
Heart Failure Chart Pic
HF with preserved EF diagram pic
basic TEE exam video link
https://youtu.be/g7bSARSBwWs
With GA, use ____ first
OG tube
For sedation case, OG not required
This is the so-called “Mercedes - Benz” view of the aortic valve.
Position 1
TTE Short Axis View
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.
Aortic Valve Transverse (Short-Axis) View, (Position 1)
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.
4 Chamber Transverse View (Position 2)
4 Chamber Transverse View (Pos 2)
The ____ and ____are on the left side of the image
right atrium
ventricle
4 Chamber Transverse View (Pos 2)
The ____ is clearly defined in the middle of the screen.
mitral valve
The 2 Chamber Longitudinal View is also known as:
Position 3
2 Chamber Longitudinal View (Pos 3)
The longitudinal orientation presents the very important ____ (right side) and the opposite ____ .
anterior wall
inferior wall
2 Chamber Longitudinal View (Pos 3)
The____ is seen just above the anterior wall.
left atrial appendage
Refers to the pressure gradient that drives coronary blood pressures.
Coronary Perfusion Pressure (CPP)
CPP equation
CPP= DBP-LVEDP
The difference between the diastolic aortic pressure, and the left ventricular end-diastolic pressure.
Myocardial Segment Terminology Pic
Myocardial Segment Terminology Pic 2
Aortic regurgitation is diagnosed best by ____
Color Doppler Imaging
The regurgitant jet occurs during ____ toward the ____ cavity.
diastole
left ventricular
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.
red-yellow
appears as a “doming” of the leaflet opening during diastole in the long axis view.
mitral stenosis
The normal mitral valve has a valve area in excess of ____.
4 cm sq
Symptomatic mitral stenosis readily occurs when the valve area falls ____
<1.4 cm sq.
The hallmark of a ____ is a highly mobile tag of material attached to a portion of the valve.
valvular vegetation
____ is a disorder which demonstrates poor contractility of all segments of the myocardium.
Cardiomyopathy
Cardiomyopathy can be caused by:
- viral
- toxic
- post-partum
- congenital
- extensive multivessel CAD
cardiomyopathy
The left ventricular ejection fraction in cardiomyopathies will often be less than ____.
25%
cardiomyopathy
One of the most visible features is the relatively weak excursion of the diastolic opening of the ____.
mitral leaflets
Anterior wall ischemia is the result of occlusion of the ____.
left anterior descending coronary artery (LAD)
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.
apical two-chamber, short axis and long axis
long axis
Anterior Wall Ischemia
The motion pattern of those ischemic myocardial segments reveals either a ____ or ____- motion compared to the other normally contractile segments
hypo-
akinetic
Inferior wall ischemia is generally caused by occlusion of the ____ or a ____ .
- posterior descending coronary artery (often the distal portion of the right coronary)
- distal part of the left circumflex coronary artery branch
Inferior wall ischemia
One of the most useful views for regional ischemia is the ____.
short axis of the left ventricular myocardium
Pooled air usually originates from the ____, so atrial accumulation is not unusual.
pulmonary veins
A large intracardiac collection of air, termed “pooled air”, usually accumulates in the highest (dependent) portion of the heart during ____.
bypass
AIR
In 4 chamber view there is a prominent ____ accumulation of air.
There is also accumulation along the atrial septal border in the ____.
apical septal-anterior
left atrium
Normal size of aorta
4-5 squared cm
