POC Echo

Question 1

Name the four main POC Echo views

Answer 1

Right parasternal short axis at LV papillary; Right parasternal short axis view at heart base; Right parasternal 4 chamber long axis view; Right parasternal LV outflow tract view

Question 2

What two ways can a global assessment of left ventricular contractility be assessed?

Answer 2

Qualitative “eyeball” assessment or quantitative assessment by fractional shortening or ejection fraction

Question 3

Fractional shortening equation (%FS):

Answer 3

(LVIDd - LVIDs / LVIDd) x 100

Question 4

What is the normal %FS range?

Answer 4

28-45% in dogs
30-50% in cats

Question 5

FS% below ____ is suggestive of severe myocardial systolic failure?

Answer 5

Below 20%

Question 6

FS% above ____ is considered hyperdynamic LV function

Answer 6

Above 55%

Question 7

Especially in human ICUs, most if not all patients with septic shock experience what kind of LV changes?

Answer 7

LV hypokinesis and LV dilation

Question 8

Sepsis induced myocardial depression is a global (systolic and diastolic) biventricular dysfunction that can be

Answer 8

Reversible

Question 9

Normal fractional area change

Answer 9

30-60%

Question 10

Normal ejection fraction

Answer 10

55-75%

Question 11

Normal intra-cardiac pressures of RA, LA, RV, LV

Answer 11

5, 10, 25, 125

Question 12

Simplified Bernoulli equation and what it tells you

Answer 12

Pressure gradient = 4x V2

Estimation of pressure from velocity
As the speed of a moving fluid increases, the pressure within the fluid decreases

Question 13

In human ICUs, the two most common causes of right heart failure secondary to primary lung disease

Answer 13

Massive pulmonary embolism, ARDS

(other causes include sepsis, high levels of PEEP and increased pulmonary vascular resistance due to chronic lung disease)

Question 13

Common acquired causes of right-sided heart failure in the dog? (5)

Answer 13

Heartworm disease
Other causes of pulmonary hypertension
Neoplasia
Valvular heart disease
Cardiomyopathy

Question 13

Young dog congenital diseases that cause RV dysfunction?

Answer 13

Pulmonic stenosis
Tricuspid valve dysplasia

Question 14

What is TAPSE?

Answer 14

Tricuspid Annular Systolic Excursion

A technique assessing RV function
Obtained in MMode in left-sided apical four chamber view
Measures the distance moved by the TV annulus from end diastole to end systole

TAPSE is reduced with RV systolic dysfunction

Question 15

Why does positive pressure ventilation result in decreased preload and subsequently decreased aortic velocities?

Answer 15

Decreases venous return during inspiration

Question 16

Studies in humans have shown that magnitude of respiratory variation of _________________________ measured by pulse wave Doppler at the aortic annulus is superior to static measurements of LV end diastolic area to predict fluid responsiveness.

Answer 16

peak aortic velocity

Question 17

In one study of humans with septic shock, an aortic pulse variation of >____ predicted a fluid responsive state.

Answer 17

> 12%

Question 18

A fluid responsive animal will have an obviously small caudal vena cava with >______ respiratory fluctuation

Answer 18

> 50-60%

Question 19

An animal with severely elevated RA pressures will have a dilated vena cava that fluctuates <________ with respirations

Answer 19

<25-30%

And is usually accompanied by dilated hepatic veins and ascites, +/- GB halo sign