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Echo Boards > Mixed > Flashcards

Mixed Flashcards

1
Q

TEE absolute contraindications

A

1) perforated viscus
2) symptomatic esophageal stricture
3) esophageal tumor
4) esophageal perforation or laceration
5) esophageal diverticulum
6) active upper GI bleed

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2
Q

To optimize 3D echo temporal resolution

A

Decrease volume size: width (lateral and elevation planes) and depth (axial plane)
Decrease scan line density
Multi-beat acquisition

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3
Q

To optimize 3D echo spatial resolution

A 
Change frequency (?increase)
Change focus
Put gain in mid range
Put compression in mid range
Get image in near field
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4
Q

Major Duke criteria

A

2 for endocarditis:

1) positive blood culture
- positive blood culture with typical organisms
- persistently positive blood culture
- single positive blood culture for Coxiella burnetii or positive IgG titers
2) endocardial involvement
- vegetation
- abscess
- new partial dehiscence of prosthetic valve
- new valvular regurgitation

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5
Q

Area length method

A 
For LA volume
= (8 x A1 x A2) / 3 x pi x L
A1 = area apical 4 chamber
A2 = area apical 2 chamber
L = shortest length btw apical 2 and apical 4
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6
Q

Mitral inflow and pulmonary flow tracing changes with increasing LA pressures

A 
increase E
shorten deceleration time
increase E/A
decrease S wave velocity (pulm vein systole)
decrease S/D ratio
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7
Q

Threshold for concentric hypertrophy/remodeling

A

Relative wall thickness >0.42

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8
Q

Threshold for hypertrophy

A

> 95ml/m2 for women

>115ml/m2 for men

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9
Q

Wall motion score

A

= sum score for segments / #segments visualized

like an average wall motion abnormality score

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10
Q

Fractional shortening =

A

= (LVEDD-LVESD)/LVEDD x100

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11
Q

Normal value for fractional shortening

A

> 18%

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12
Q

4 grade wall motion scoring

A

1: normal or hyperdynamic
2: hypokinetic
3: akinetic
4: dyskinetic or aneurysmal

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13
Q

LV relative wall thickness

A

= (2 x post wall thickness) / LVEDD

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14
Q

dilated cardiomyopathy M mode finding

A

E point septal separation >10mm

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15
Q

Mild aortic stenosis

A

AVA >1.5cm2
MG <20mmHg
Vel <3cm/sec

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16
Q

Mod aortic stenosis

A

AVA 1-1.5cm2
MG 20-39mmHg
Vel 3-3.9cm/sec

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17
Q

Severe aortic stenosis

A

AVA <=1cm2
MG >=40mmHg
Vel >=4cm/sec

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18
Q

Surgical repair ascending aorta indications

A

> =5.5cm

>=5cm if FH dissection, >=0.5cm/yr growth rate

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19
Q

Mod-sev AI echo surveillance

A

q1yr

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20
Q

Mild AI echo surveillance

A

q3yr

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21
Q

PHT in AI

A

<200msec if acute

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22
Q

Vena contracta for AI severity

A

<0.3cm: mild AI

>=0.6cm: severe AI

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23
Q

Surgery for asymptomatic chronic AI

A
  • EF <=50%
  • Undergoing other surgery
  • LVESD >50mm or >25mm/m2
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24
Q

Severe mitral stenosis

A

MVA 1.0 - 1.5cm2
Mean grad 5-10mmHg
PHT >150msec
PASP >30mmHg

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25
Q

Progressive mitral stenosis

A

MVA > 1.5cm2

Mean grad <5mmHg

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26
Q

PHT from DT

A

PHT = 0.29 x DT

27
Q

half velocity

A

V1/2 = Vmax/1.4

28
Q

Wilkins score

A 
Balloon valvuloplasty if <8
1 mild - 4 severe
- mobility
- thickening
- calcification
- sub valv thickening
29
Q

Class I recs for surgery for mitral regurgitation

A
  • Sx chronic severe primary MR and LVEF >30%

- ASx chronic severe primary MR and LVEF 30-60% and/or LVESD >=40mm

30
Q

Tricuspid leaflets seen

A

A4C: septal and anterior
Parasternal long: septal and anterior
Parasternal short: posterior and (septal vs anterior)

31
Q

Severe TS

A

Mean grad >5-7mmHg (end expiration)
PHT >= 190msec
TVA <= 1.0cm2

32
Q

Severe TR

A

ERO > 40mm2

RV >45ml

33
Q

Mild MR

A

ERO <0.2cm2
RV <30cc
RF <30%
VC <0.3cm

34
Q

Severe non ischemic MR

A

ERO >=0.4cm2
RV >=60cc
RF >=50%
VC >0.7cm

35
Q

Severe ischemic MR

A

ERO >0.2cm2

RV >=30cc

36
Q

Severe pulmonic stenosis

A

Vmax >4m/sec

37
Q

Indications for pulmonary valvotomy

A
  • Sx and peak grad >=50mmHg or mean grad >=30mmHg

- ASx and peak grad >=60mmHg or mean grad >=40mmHg

38
Q

Echo surveillance for ASx PS

A

q2yrs for peak grad >30mmHg, otherwise q5yrs

39
Q

Acceleration time

A

For prosthetic valves

>100msec = pathologic obstruction

40
Q

DVT (DI) for aortic valves (native and prosthetic)

A

<0.25 highly suggests pathologic obstruction

41
Q

Aortic Patient prosthesis mismatch (PPM)

A

measure indexed EOA
>0.85: none
0.66-0.85: moderate
<=0.65: severe

42
Q

Mitral valve prosthesis E velocity interp

A

> =0.19msec: prosthesis dysfunction

43
Q

Mitral valve prosthesis VTI ratio

A

> =2.2: prosthesis dysfunction

44
Q

Mitral valve prosthesis PHT

A

> =130msec highly suggestive of obstruction

45
Q

Mitral PPM

A

Indexed EOA
>1.2: none
0.91-1.20: moderate
<=0.9: severe

46
Q

Suspect prosthetic mitral stenosis

A

E velocity >1.9m/sec
Mean grad >=6mmHg
DI>=2.2
PHT >=130msec

47
Q

Suspect prosthetic mitral regurg

A

E vel >1.9m/sec
Mean grad >=6mmHg
DI >=2.2
PHT <130msec

48
Q

ERO cut offs AI

A

Mild <0.1
Mod 0.1 - 0.29
Sev >0.3

49
Q

Rergurg vol cut offs AI

A

Mild <30cc
Mod 30-59cc
Sev >60cc

50
Q

Regurg fraction cut offs AI

A

Mild <30
Mod 30-49
Sev >50
PHT <250

51
Q

Jet width cut offs AI

A

Mild <25% LVOT
Mod 25-64%
Sev >65%

52
Q

Jet area cut offs AI

A

Mild <5
Mod 5-59
Sev >60

53
Q

Vena contracta cut offs AI

A

Mild <3
Mod 3-6
Sev >6

54
Q

VARC2

A

AI severity post TAVR
Mild <10% circumferential extent
Mod 10-29%
Severe >=30%

55
Q

Normal stroke volume index

A

32-58cm3/m2

56
Q

Simplified MR ERO

A

= (PISA radius)2 / 2

57
Q

LVOT gradient

A

= 4 (MR vel)2 + LAP - SBP

58
Q

Magnificent 4 in diastology

A

1) E’ velocity: >7-10 abnormal
2) E/e’ (nml EF) and E/A (dec EF): E/e’ >2.8m/sec abnormal
3) TR velocity: >2.8m/sec abnormal
4) LAVI: >34ml/m2 abnormal

59
Q

See an L wave?

A

put grade II diastolic dysfunction

60
Q

dP/dt

A

an index of myocardial contractility
= 32,000 / (time in msec to get from 1m/sec to 4 m/sec)
nml >1200
abnml <1000

61
Q

goal MI with contrast

62
Q

transverse sinus

A

recess around great arteries

63
Q

E/e’ suggestive of increased filling pressure

A

septal E/e’ >15

64
Q

PVR estimate

A

peak TR/RVOT VTI >=0.175 correlates with PVR >2 Woods units

Echo Boards (4 decks)

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