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Questions Flashcards

1
Q

Frequency is defined as:

A

Number of times particles vibrate each second in the direction of wave propagation

  • Inverse of period
  • Unit = Hz or 1/sec
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2
Q

Normal range of ultrasound used in imaging

A

1-30 MHz

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3
Q

1 MHz

A

= 1 million Hz or 10^6 Hz

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4
Q

As an ultrasound wave travels through the human body, the type of tissue that results in the fastest loss of its strength is?

A

Lung

Due to numerous air interfaces

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5
Q

A positive Doppler shift indicates that the reflector is moving?

A

So that the angle between the transmitted beam and the direction of motion is >90 degrees.

If <90 degrees, then direction of motion is away from the beam

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6
Q

What is harmonic imaging?

A
  • Uses ultrasound reflections that have twice the frequency of the transmitted waves.
  • Transmitted wave = fundamental ultrasound signal and the return ultrasound = harmonic signal.
  • Harmonic generated in the tissue from within the body, beyond the body wall, which leads to a reduction in distortion and scattering
  • Harmonic only crosses through body wall once
  • Side lobes produced by original fundamental ultrasound do not produce harmonics, so side lobe artifacts and reverberations are less likely with harmonic imaging
  • Improves resolution
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7
Q

Laminar flow:

A

smooth flow where highest velocity is along the central axis of the vessel and gradually decreases toward the walls

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8
Q

When are ascending aorta linear artifacts most likely to occur?

A

When the ascending aorta diameter exceeds that of the left atrium

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9
Q

Range ambiguity

A

Occurs when echoes from deep structures created by a first pulse arrive at the transducer after the second pulse has been emitted

Can cause echoes from distant structures to appear closer to the transducer

Resolve by changing depth

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10
Q

A mirror-image artifact in two-dimensional echocardiography develops when:

A

A structure is located in front of a highly reflective surface, which produces near total reflection of the ultrasound beam.

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11
Q

Ring-down artifact vs Comet Tail

A
  • Ring down caused when a central fluid collection is trapped by a ring of air bubbles
  • Region of a bright reflector created, behind which a solid streak or a series of parallel bands radiates away
  • Comet tail is due to reverberations off of a bright reflector
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12
Q

Refraction

A

Results in side-by-side double imaging

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13
Q

Shielding v Shadowing v Ghosting

A

Shielding: presence of a bright beam of ultrasound artifact that obscures the visualization of tissue beyond this point.

Shadowing: attenuation of ultrasound beyond a bright reflector that obscures the visualization of ultrasound

Ghosting: color Doppler that is distorted beyond anatomic borders because of multiple reflections.

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14
Q

Tricuspid leaflets visualized by plane

A

4 chamber: Anterior and Septal

RV Inflow-Outflow: Posterior and Septal

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15
Q

LV Volume calculations assume LV is an:

A

Ellipse

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16
Q

What LV parameter is not affected by preload?

A

End systolic diameter

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17
Q

A soft first heart sound is caused by:

A

AV block

With a long PR interval the mitral and tricuspid leaflets float into a semi-closed position because of the long period between atrial contraction and ventricular activation.

The degree to which the mitral valve leaflets are separated when ventricular activation closes the mitral valve is an important determinant of the loudness of the mitral component of the S1.

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18
Q

A loud first heart sound is caused by:

A

Mitral stenosis

  • Leaflets can’t float closer together so they can slam shut
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19
Q

LV calculations yield a smaller LV volume than contrast angio because:

A

1) LV calculations underestimate the true length of the LV

2) Contrast fills the trabeculations of the LV, yielding a larger volume

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20
Q

Normal longitudinal and radial strain values

A

Longitudinal (apex to base): 20%

Radial (wall thickening in short axis): 40%

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21
Q

ASE endorsed method for calculating LV EF

A

modified Simpson’s method (biplane method of disks)

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22
Q

Pulmonary systolic primary variables

A

S1: Atrial relaxation
S2: LA pressure

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23
Q

C Sept

A

3 = decreased risk of SAM post MV repair

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24
Q

PISA Area

A

2 pi r^2

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25
Q

Large Ar wave in pulmonary vein tracing due to:

A

Mitral stenosis

Obstruction to flow through MV during atrial contraction results in large backward wave

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26
Q

Pericardial Tamponade

A
  • Systolic inversion of RA
  • Late diastolic collapse of RV
  • RESTRICTIVE mitral pattern
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27
Q

Normal Mitral Flow Variable

A

E wave: 60
A wave: 60
DT: <100

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28
Q

Hodgkins on TEE appears as:

A

Anterior mediastinal mass

  • Causes decreased LV filling
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29
Q

ASE 16 segment models

A

Basal Level: 1-6
Midpap: 7-12
Apex: 13-16

Numbers start at anteroseptal in basal and mid pap. Start anterior in apex. Counted counter clockwise

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30
Q

Carpentier Mitral Valve Dysfunction Classification

A

Type 1: Normal
Type 2: Excessive (a: prolaspse, b: flail)
Type 3: Restrictive

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31
Q

Persistent left SVC associated with:

A

Coronary sinus ASD

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32
Q

Focal depth of ultrasound

A

= Diameter^2/ (4 x wavelength)

A more shallow focal depth will produce a wide beam in the far field

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33
Q

Beam diameter at focal point in an unfocused beam:

A

= 1/2 diameter of the transducer

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34
Q

Most common congenital heart defect observed in adult patients?

A

Bicuspid AV

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35
Q

ASDs and associated findings

A

Ostium Secundum: MR and MV prolapse
Ostium Primum: MR and MV cleft
Coronary Sinus ASD: Persistent left SVC
Sinus Venosus ASD: Anomalous pulmonary vein drainage

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36
Q

Dextroversion
Situs Inversus
Dextrocardia

A

Dextroversion: rightward shift in the cardiac apex without mirror image inversion

Situs Inversus: right to left reversal of thoracic and abdominal viscera

Dextrocardia: mirror image inversion of the heart to the right

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37
Q

Sensitivity in detecting dissection of the aorta

A

CT > TEE = MRI > Aortography

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38
Q

Aortic dissection True v False Lumen

A

TL:
round
expands in systole
laminar flow

FL:
typically larger
smoke

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39
Q

Restrictive Mitral filling pattern

A
  • Cardiac tamponade

- Constrictive pericarditis

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40
Q

MR Values

A

EROA
Mild: 0.4

RF%
Mild: 50%

VC
Mild: 0.7

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41
Q

TR Values

A

VC
Severe: >0.7

TRarea/RAarea
Mild: 16-30%
Mod: 30-60%
Severe: >60%

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42
Q

Unit Conversion

A

1 second = 1,000,000 musec
1 second = 1,000 msec

1 meter = 100 cm
1 meter = 1,000 mm

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43
Q

Propagation Velocity

A

= stiffness/density

Propagation velocity will increase with stiffness of item. However, if given a list, in general more dense items have a higher propagation velocity since they also have much higher stiffness (which outweighs the increase in density)

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44
Q

Pulmonic Valve Leaflets

A

Right, Left, Anterior

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45
Q

Third Order Chordae

A

Attach to ventricular wall (not papillary muscle) and attach to base of posterior leaflet only

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46
Q

Which view of mitral valve passes through the highest or most basal portion of the mitral annulus?

A

Midesophageal long-axis

  • Also good to assess leaflet prolapse
47
Q

Pulse Repetition period vs PRF

A

PRP
- Inverse of pulse repetition frequency
- Time from start of one pulse to start of next
PRP = 13 x depth

PRF
- number of pulses that occur in one second
PRF = 77,000/depth

48
Q

Pressure, intensity, amplitude and power equations

A

Pressure: dB = 20 log (P2/P1)
Intensity: dB = 10 log (I2/I1)
Amplitude: dB = 20 log (A2/A1)
Power: dB = 10 log (P2/P1)

Attenuation coefficient = 1/2 frequency
Total attenuation = AC x depth

20MHz probe with amplitude 1mm, what is amplitude at 8cm depth?

AC = 20/2 = 10
Total Attenuation = 8x10 = -80
* negative because lost amplitude

dB = 20 log (A2/A1) = -80
log (A2/A1) = -4
A2 = A1 x 10^-4
if Amplitude initial (A1) = 1, then
A2 = 1 x 10^-4
49
Q

Angle of refraction

A

Refraction REQUIRES:

1) Oblique angle of incidence
2) Difference in velocity of sound in medium

Snells Law:
(Sin angle transmission)/(Single angle incidence) = V2/V1

If velocity of first medium greater than second medium, then the angle of refraction will be less than angle of incidence

If velocity of first medium lower than second medium, then angle of refraction will be greater than angle of incidence

50
Q

Order of vessels on aorta

A

Celiac
SMA
Renal arteries
IMA

51
Q

Myocardial Performance Index

A

(IVRT+IVCT)/Ejection Time

52
Q

Deceleration Time

A

Normal aging: DT increases with impaired relax
Pseudonormal: DT will decrease as E wave rises and reverts back to normal
Restrictive: DT increases further as E becomes tall and sharp

DT normal = 150-220

53
Q

LV Wall Tension

LV Wall Stress

A

Tension = Pressure x Radius

Stress = Tension/ (2xThickness)
= (Pressure x Radius) / (2 x Thickness)

54
Q

Fractional Shortening

A

= (LVEDd-LVESd)/LVEDd

55
Q

Mitral Flow Changes with Acute Heart Rejection

A

RESTRICTIVE PICTURE

  • Decreased IVRT
  • Increased E wave velocity
  • Shortened E wave DT
  • Decreased E wave PHT
  • Decreased tissue doppler
56
Q

RV Pressure v Volume Overload and Septum

A

RV Pressure Overload:
- Paradoxical septal motion during systole (septum flattens)

RV Volume Overload
- Paradoxical septal motion during late diastole (period of highest RV volume)

57
Q

Constrictive Pericarditis

A
  • Normal systolic function
  • Restrictive mitral inflow profile
  • Normal LV wall thickness
  • Normal LV diameter
  • DILATED left atrium due to chronic pressure overload
58
Q

Chiari network association

A
  • PFO

- Interatrial septal aneurism

59
Q

Nyquist Limit

A

Maximal DOPPLER SHIFT that can be measured and determines max velocity that can be measured

IT IS NOT the max velocity that can be measured

NL = 1/2 PRF

60
Q

Stunned v Hibernating Myocardium

A

Stunned: Newly reperfused myocardium that has impaired wall motiion that reverses following resolution of reperfusion injury

Hibernating: viable mycardium that appears dysfunctional and has little reserve (improves with low dose dobutamine but deteriorates with high dose dobutamine)

61
Q

Myocardial Contrast Echo

A
  • Injection of contrast into aorta root and watching perfusion of myocardium

Can distinguish:
- Acutely ischemic myocardium (RWMA with no perfusion) from stunned myocardium (RWMA with perfusion)

62
Q

Myocardial PET imaging

A
  • The gold standard for determining myocardial viability
  • NH3 = marker of perfusion
    18F-fluorodeoxyglucose = marker of metabolism

Normal: Normal perfusion and metabolism
Scar: Decreased perfusion and metabolism
Hibernating: Decreased perfusion, normal metabolism

63
Q

LVH, values

A

Normal: 0.6 - 1.1 cm
Mild: 1.2 - 1.4 cm
Moderate: 1.2 - 2 cm
Severe: >2 cm

64
Q

Restrictive Cardiomyopathy

A
  • Thick RV and LV walls
  • Normal EF
  • Dilated IVC
65
Q

Chronic HTN

A
  • Concentric LVH
  • AV sclerosis
  • MV annular calcification
  • Aortic root dilation
  • LA enlargement
  • Impaired relaxation
66
Q

What type of transducer can create multiple focal zones per scan line?

A

Phased array transducers

  • Will increase lateral resolution
67
Q

Which valve is least likely to be effected by endocarditis?

A

Pulmonic Valve

68
Q

Complications of Mitral Repair

A
    • LV rupture (most common, but rare)
  • Circumflex damage
  • Left or Non-coronary AV cusp damage
  • SAM of the Anterior mitral leaflet
  • Conduction delay
69
Q

What method of determining MS valve area is not affected by AI or MR?

A

PISA

Continuity equation for use in MS will be affected by MR or AI since there is are then different volumes of flow through MV and AV and continuity equation is assuming identical flow through both of these valves

70
Q

What methods of determining AS are not affected by decreased EF or MR?

A

Continuity Equation
- compares LVOT and AV stroke volumes which would remain the same in decreased EF or with MR

AND

VTI lvot / VTI av

  • Should be similar so = 1

Mild AS: >0.5
Mod AS: 0.25-0.5
Severe AS: 0.25

As AS worsens, VTI of AV grows, but VTI of LVOT remains the same

71
Q

TAPSE, values

A

Normal: 20-25

Decreased RV function <16

72
Q

AI Slope

A

Moderate AI: 200-300cm/sec

Severe: >300

73
Q

Maximum spatial peak temporal average intensity for ultrasound beams

A

100 mW/cm^2

74
Q

Calculating axial resolution from frequency

A

If frequency of probe 5MHz and pulse contains two cycles, then

axial res = 1/2 x SPL

SPL = (cycles)x(1540m/s)/(frequency)
= 1/2 x (2 x 1540)/5x10^6 cycles/s

75
Q

Endocardial Wall Thickening, Grading

A

Normal: >30%
Mild HK: 10-30%
Severe: <10%

76
Q

Q factor

A

Describes quality of ultrasound

= Resonant Frequency/Bandwidth

77
Q

Which scallop of mitral valve is most likely to develop myxomatous degeneration, annular dilation and regurgitation?

A

P2

78
Q

TR Jet/RA area

A

Trace: 60%

79
Q

Half layer thickness

A

Thickness of tissue required to reduce intensity by half

80
Q

What are piezoelectric crystal made of?

A

Lead zirconate

81
Q

Axial resolute and SPL

A

Axial resolution = 1/2 x SPL

82
Q

Resonant frequency of crystal, equations

A

Frequency = Velocity/Thickness

Velocity = Stiffness/Density

83
Q

Cos 60

A

0.5

84
Q

Bandwidth

A

Shorter pulse = wider bandwidth

Imaging transducers have wider bandwidth than therapeutics

85
Q

Q factor (quality)

A

Q = Resonant freq/Bandwidth

86
Q

AVA by Aortic valve side

A

AVA = (aortic valve side ^2) x 0.433

87
Q

Pericardial Effusion

A

Mild 2cm

88
Q

If ultrasound probe interrogates vessel at a 60 degree angle,
freq emitted = 10MHz
Returning freq = 10.5MHz
What is velocity of flow?

A

Velocity = (Change in freq/Cos Angle) x (1540/(2xFreq transmitted))

89
Q

Thebesian Valve

A

Fibrous band at the opening of the coronary sinus

  • Can make coronary sinus catheter placement difficult
90
Q

Basal posterior wall

A

Region 4

- NEVER hypertrophied in cardiomyopathy

91
Q

Dobutamine stress, sens and spec?

A

Sens: 85%
Spec: 88%

92
Q

Most load INDEPENDENT measure of systolic function?

A

Dp/Dt

93
Q

Velocity of circumferential shortening

A

= (LVEDd-LVESd)/(LVEDdxET)

ET = ejection time

** Corrects for HR, so it is a HR INDEPENDENT measure

94
Q

Epiarotic scan

A

Aorta most closely located to probe

Azygous vein seen below aorta (triangular in shape)

95
Q

Intensity reflection coefficient

A

= reflected intensity/incident intensity x 100%

= (incident-transmitted)/incident intens x 100%

96
Q

Dampening material (aka backing)

A
  • Decreases the transducer sensitivity to reflected echo
  • Decreases SPL and improves axial resolution
  • Lowers Q factor (better image) by decreasing resonant frequency and increasing bandwidth
97
Q 
Determining factors for:
Wavelength
Frequency CW
Frequency PW
Resonant frequency
A

Wavelength: thickness of piezoelectric crystal

Frequency CW: electrical frequency of the excitation voltage applied to crystal

Frequency PW: thickness of crystal and propagation speed of sound through crystal

Resonant frequency: Velocity/Thickness

98
Q

Focal length

A

= near field length

= (radius transducer^2)/wavelength

99
Q

Refraction artifact v Mirror image

A

Refraction: artifact to the side and slightly lower than original

Mirror Image: artifact below and slightly to side of original

100
Q

Remnant of sinus venosus

A

Chiari network

- Assoc with aneurismal septum and PFO

101
Q

E-point Septal Separation (EPSS)

A
  • Mmode through septum and anterior mitral leaflet to measure maximal distance between two in end diastole
  • Decreased EPSS correlates with decreased EF
102
Q

Rayleigh Scattering

A
  • Scattering that occurs when the wavelength is much larger than the reflector it strikes
  • Responsible for Doppler determination of blood flow velocities
103
Q

Subarterial VSD synonyms

A

= supracristal = conal

104
Q

Blalock-Taussig Shunt

Glenn Shunt

A

B-T Shunt: Right subclavian to PA

Glen: SVC to PA

105
Q

ABSOLUTE TEE Contraindications

A
  • Pt refusal
  • Esophageal perforation
  • Esophageal web, rings, strictures
  • Cervical instability
  • Obstructing esophageal neoplasm
106
Q

Wall Tension

Wall Stress

A

WT = radius x pressure

WS = WT/Wall thicknessx2

107
Q

MVA and PHT, imperfections

A

Decrease PHT and Overestimate MVA

  • Impaired LV compliance
  • Severe AI
  • Severe MR

Increase PHT and Underestimate MVA
- Impaired relaxation

108
Q

Mitral Valve Dilation

A

End systole anterior posterior mid esophageal long axis measurement greater than 3.6cm

109
Q

Intensity and power

A

= amplitude squared

Intensity= watts/cm^2

110
Q

Spatial peak temporal average intensity

A
  • correlates with the heating of tissues

- same as spatial peak temporal peak when using CW ultrasound

111
Q

Crystal focal length

A

Length = (radius^2)/wavelength

Radius= radius of crystal

112
Q

Hypereosinophilic Syndrome

A
  • Systemic disease affecting brain, heart, bone, lungs
  • restrictive dysfunction with normal systolic function AND LV thrombus (normally in apex, but occasionally under posterior mitral leaflet causing MR)
113
Q

Percent of patients who develop SAM after mitral repair?

A

2-16%

114
Q

AI grading, Jet/LVOT diameter

A

65% - severe

TEE (20 decks)

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