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PTE Masters > Rescue TEE > Flashcards

Rescue TEE Flashcards

1
Q

What is the criteria for determining hypovolemia in the transgastric short axis TEE view of the LV in terms of:

  1. End diastolic diameter?
A

< 2.5 cm

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2
Q

What is the criteria for determining hypovolemia in the transgastric short axis TEE view of the LV in terms of:

1. End diastolic area?

A

End diastolic area <55 cm2

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3
Q

What is the normal end-diastolic diameter of the LV in the TEE TG SAX view?

A

3.7 - 5.3 cm

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4
Q

In the TEE TG SAX view, what defines small amount of pericardial fluid?

A

< 0.5 cm (100-200) - Small

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5
Q

In the TEE TG SAX view, what defines moderate amount of pericardial fluid?

A

0.5 cm - 2 cm (200 - 500 mL) Moderate

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6
Q

In the TEE TG SAX view, what defines large amount of pericardial fluid?

A

>2 cm (>500 mL) Large

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7
Q

What is better for evaluating intrapericardial clot and posterior/loculated effusions?

(TTE vs. TEE)

A

TEE > TTE

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8
Q

What is a specific sign of pericardial tamponade?

A

RV Diastolic collapse

Pericardial Pressure >> RV Pressure

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9
Q

What is the sensitivity, specificity and Positive predictive value to atrial compression for cardiac tamponade?

A

Sensitivity = 95%

Specificity = 82%

PPV.= 50%

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10
Q

What is the Specificity and Sensitivity for detecting pulmonary embolism via TEE?

A
  1. Specificity = 95% (If you see thrombus = It’s probably PE)
  2. Sensitivity = 46% (If you don’t see thrombus, you can’t say it’s not a PE)
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11
Q

What are the associated signs of a PE that can help lean towards a diagnosis of PE if you don’t see a clot?

  • Comment on RV
  • Chamber sizes
  • What’s dilated?
  • Comment on the IVC
  • Valve changes?
  • Specific sign?
A
  1. RV Hypokinesis
  2. RV enlargement
  3. Small LV
  4. Flattening of the Intraventricular septum or paradoxical septal motion
  5. Dilated PA
  6. Dilated RA
  7. Distended IVC with loss of respiratory variation
  8. Tricuspid Insufficiency
  9. McConnell’s Sign
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12
Q

What is McConnell’s Sign?

What is associated with?

A

Regional wall motion abnormalities sparing the RV apex

Associated = Massive PE with poor prognosis

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13
Q

McConnell sign better seen on TTE or TEE?

A

TTE > TEE

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14
Q

What is the basic equation for Blood Pressure?

A

BP = CO x SVR

BP = HR x SV x SVR

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15
Q

What is stroke volume equal to?

A

End-Diastolic Area - End-Systolic Area

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16
Q

What TEE findings for Low SVR?

A
  1. Adequate End Diastolic area (EDA)

- Normal = 3.7 - 5.3 cm

  1. Hyperdynamic wall thickening
  2. Reduced End-Systolic Area (ESA)
17
Q

What is the equation for SVR?

A

[(MAP - CVP) / CO] x 80

18
Q

SVR normal values?

A

700 - 1600 dynes/sec/cm5

19
Q

SV = CO / HR

What is the other TEE equation to determine SV?

A

Cross Sectional Area x Velocity Time Interval

CSA @ LVOT

VTI @ Mitral Valve Inflow

20
Q

What are the key differences between a Low SVR state and Hypovolemia (alone) on TEE TG SAX views?

A

Low SVR

- EDA normal (3.7 - 5.3 cm) or adequate

  • End Systolic Area reduced
  • Hyperdynamic Wall thickening

Hypovolemia

- ED Diameter <2.5

End Diastolic area < 55 cm2

21
Q

If you have a patient who has adequate TG Basal SAX contractility but has poor TG SAX and TG Apex contractility, what can be the diagnosis?

A

Takotsubo Cardiomyopathy

AKA

  • Apical Ballooning Syndrome
  • Broken Heart Syndrome
  • Stress/Ampulla Cardiomyopathy
22
Q

What is the pathophysiology of Takotsubo Cardiomyopathy?

A

Not known

  • Multivessel Epicardial Spasm (Ex: surprise bday party)
  • Microvascular Spasm
  • Catecholamine induced myocardial stunning
  • Myocarditis
23
Q

What population predominates in aquiring Takotsubo Cardiomyopathy?

A

Post-menopausal women

24
Q

What can a LV Wall motion abnormality in Takotsubo Cardiomyopathy lead to?

A

LVOT Obstruction –> Hypotension and Refractory Heart Failure

25
Q

Takotsubo Cardiomyopathy has was small percent of presenting sign?

A

1-2% present with ACS

26
Q

Prognosis of Takotsubo Cardiomyopathy?

A

>90% recover

>10% have recurrent

27
Q

What specific wall motion abnormalities are associated with Takotsubo Cardiomyopathy?

A

Moderate-Severe Mid Ventricular Dysfunction

Apical Akinesis/Hypokinesis

Basal = Hyperkinetic

28
Q

Takotsubo Cardiomyopathy LVEF average?

29
Q

Is Takotsubo Cardiomyopathy reversible?

30
Q

What is important to remember about regional wall motion abnormalities of Takotsubo Cardiomyopathy?

A

Not confined to a single coronary artery distribution (Some have atypical Takotsubo Cardiomyopathy confined to single coronary)

DIAGNOSIS OF EXCLUSION = THEY NEED A CATH & RULE OUT OTHER CAUSES OF CARDIOMYOPATHY

31
Q

What is Takotsubo Cardiomyopathy Type 1?

A

Takotsubo Type: Apical Akinesis and Basal Hyperkinesia

32
Q

What is Takotsubo Cardiomyopathy Type 2?

A

Reversible Takotsubo

  1. Basal Akinesis and Apical Hyperkinesia
33
Q

What is Takotsubo Cardiomyopathy Type 3?

A

Mid Ventricular Type:
1. Mid Ventricular Ballooning with basal and apical hyperkinesia

34
Q

What is Takotsubo Cardiomyopathy Type 4?

A

Localized type: Any other LV Segmental Ballooning

35
Q

What Takotsubo Cardiomyopathy Type is most common?

A

Type 1:
Apical Akinesis anad Basal Hyperkinesia

PTE Masters (52 decks)

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