Right Heart Flashcards

Question

_RV Wall Thickness Measurement_ \_\_\_\_\_\_\_, ________ and _______ should be excluded

Answer 1

Trabeculae papillary muscles epicardial fat

Answer 2

RV: **thin** compacta, heavily **trabeculated** cavity LV: **thicker** compacta

Answer 3

RV: Crescentric with triangular LV: Truncated ellipse

Answer 4

RV: 75 +/- 13 (49 – 101) LV: 66 +/- 12 (64 – 109)

Answer 5

RV: **2-5** LV: **7 - 11**

Answer 6

RV: * Systolic: 25 ( 15 – 30) * Diastolic: 4 (1 – 7) LV: * Systolic: 130 (90 – 140) * Diastolic: 8 (5 – 12)

Answer 7

RV: \> 40 - 45 LV: \> 50

Answer 8

RV: **Longitudinal** LV: **Circumferential and Longitudinal**

Answer 9

**RCA conus branch & LAD branch**

Answer 10

RCA marginal branches

Answer 11

**PDA (posterior descending artery)**

Answer 12

sternocostal

Answer 13

Diaphragmatic

Answer 14

**4V² + RAP** \***RAP** decided by 3/8/15 method \***V** = peak TR velocity jet

Answer 15

3 mmHg (5 mmHg) normal

Answer 16

8 mmHg (6/10 mmHg) intermediate

Answer 17

8 mmHg (10-15 mmHg) intermediate

Answer 18

15 mmHg (15-20 mmHg) Increased

Answer 19

**Cor Pulmonale** is an increase in bulk of the right ventricle of the heart, generally caused by chronic diseases or malfunction of the **lungs**. This condition can lead to heart failure

Answer 20

Chronic bronchitis emphysema

Answer 21

High blood pressure in the blood vessels of the lungs (**pulmonary hypertension**)

Answer 22

* **cystic fibrosis:** **a genetic disorder that affects mostly the lungs, but also the pancreas, liver, kidneys, and intestine**. Long-term issues include difficulty breathing and coughing up mucus as a result of frequent lung infections * **pulmonary embolism** * **pneumoconiosis**: a disease of the lungs due to inhalation of dust, characterized by inflammation, coughing, and fibrosis * **muscular dystrophy:** Muscular dystrophy is **a group of diseases that cause progressive weakness and loss of muscle mass**. In muscular dystrophy, abnormal genes (mutations) interfere with the production of proteins needed to form healthy muscle. There are many kinds of muscular dystrophy \***Loss of lung tissue after lung surgery or certain chest-wall disturbances can produce cor pulmonale as well**

Answer 23

**T**ricuspid **A**nnular **P**eak **S**ystolic **E**xcursion TAPSE is measured as the displacement of the lateral tricuspid annulus toward the apex during systole **= RV Longitudinal Systolic Function** **\***By using M-mode, it measures between end-**diastole** and **peak systole.** **In presence of severe TR and normal contractility TAPSE is increased**. In presence of mildly reduced contractility (and severe TR) TAPSE is within the normal range. If _TAPSE is reduced this means that RV longitudinal function is severely impaired._

Answer 24

The right ventricular myocardial performance index and tricuspid annulus motion are used in the assessment of _global right ventricular function_ In pulmonary hypertension, _S’ wave assessment may be used for therapeutic efficacy evaluation_. Longitudinal strain reduction indicates an increased risk of vascular events, while an increased value of myocardial performance index is a predictor for a survival in pulmonary hypertension. A decreased S’ wave velocity is associated with limited pulmonary vascular flow in patients with pulmonary embolism

Answer 25

the maximum velocity achieved by the lateral tricuspid annulus during systole = **systolic excursion velocity.** It is a useful index to assess right ventricular function.

Answer 26

S’ is an index that has been shown to correlate with _RV ejection fraction_, and with outcomes in people with RV dysfunction- pulmonary hypertension, pulmonary embolus, and cardiogenic shock.

Answer 27

RV S’ of more than 10cm/s is considered normal

Answer 28

1. IVCT 2. IVRT \*Note: you can identify by following ECG

Answer 29

IVCT \*increasing sweep speed can help with this

Answer 30

**a newly emerging topic which has a significant role in predicting cardiovascular outcomes, compared to Left ventricular ejection fraction (LVEF)**. LVEF is the most extensively used and investigated cardiac pumping function for many decades \*note: Because GLS normally varies with age, sex, and LV loading conditions, defining abnormal GLS is not straightforward. However, in adults, **GLS \<16%** (sic) is abnormal, **GLS \>18% (sic) is normal**, and **GLS 16% to 18% is borderline**. (Editor’s note: GLS is expressed as a negative number

Answer 31

**R**ight **v**entricular **I**ndex of **M**yocardial **P**erformance aka: Tei index is an index of global RV performance.

Answer 32

**RIMP = (IVCT + IVRT) / ET** IVCT = isovolumic contraction time IVRT = isovolumic relaxation time ET = ejection time

Answer 33

**RIMP = ( TCO - ET) / ET** \*note: TCO – Tricuspid Closure-Open Time. This is the time between the tricuspid valve opening and closing

Answer 34

\< 17 mm \*mean +/- SD = 24 +/- 3.5

Answer 35

\< 9.5 cm/s \*mean SD = 14.1 + 2.3

Answer 36

\< 35 % \*mean SD = 49 +/- 7 % Fractional area change (FAC) is a measurement that provides an estimate of the global RV systolic function. Remember this is a formula to calculate the % of area change within the RV between diastole and systole. The value provided is a percentage but please do not confuse this with the ejection fraction %

Answer 37

mean +/- SD = 1.4 +/- 0.3

Answer 38

mean +/- SD = 4/0 +/- 1.0

Answer 39

The hepatic vein waveform can be reflective on the severity of TR present. The more severe the regurgitation, the more pulsatile the waveform becomes.

Answer 40

opposite less than \*use PW in HV to confirm elevated RAP

Answer 41

1. SA node 2. Eustachian valve: (EV) is located in the superior portion of the inferior vena cava (IVC) and protrudes into the right atrial cavity. It is considered to be a functional valve in the fetus that helps direct oxygenated blood from the IVC toward the foramen ovale, thereby bypassing the pulmonary circulation. An **embryological remnant** of the inferior vena cava (IVC) valve. It is usually absent or inconspicuous and has no known function in the normal adult 3. Thebesian valve: also known as the **valve of the coronary sinus**, is a fold in the right atrium at the opening of the coronary sinus 4. Pectinate muscle 5. Crista Terminalis

Answer 42

Chiari network

Answer 43

The Chiari network is a _congenital remnant_ of the **right valve of the sinus venosus**, which is reabsorbed to varying degrees in utero (in the uterus). **It has been found in 1.3% to 4% of autopsy studies**

Answer 44

a patent foramen ovale (PFO) a greater degree of shunting across the PFO

Answer 45

* **Eustachian valve** * **Chiari network** * **Eustachian ridge** * **Crista terminalis** * **Lipomatous hypertrophy of the atrial septum -** characterized by an infiltration of adipocytes into myocytes of the interatrial septum, sparing the fossa ovalis, which gives a characteristic hourglass-shaped image * **Fatty infiltration of tricuspid annulus**

Answer 46

**E**xtra**c**orporeal (situated outside body) **m**embrane **o**xygenation catheters ## Footnote a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream of a very ill baby. This system provides heart- lung bypass support outside of the baby's body. It may help support a child who is awaiting a heart or lung transplant.

Answer 47

anterior: RCA - acute marginal branch inferior: RCA - PDA

Answer 48

RCA - conus branch

Answer 49

anterior: RCA - acute marginal branch RVOT: RCA - conus branch

Answer 50

lateral wall: RCA - acute marginal branch IVS/moderator band: LAD

Answer 51

**Right Heart Catherization** \*assessment of the venous catheter is accessed from the **left subclavian vein**

Answer 52

**Left heart Cath** \*assessment of the arterial

Answer 53

**angiogram catheter**

Answer 54

* Heart failure * Acute MI * Acute of chronic pulmonary disease * Congenital heart disease * Complications of transplanted heart * Screening for unspecified respiratory disease * Hypotension * Valvular heart disease * Mechanical complications * Endomyocardial fibrosis ハークシュ！ベラボーめ

Answer 55

dyspnea: difficult breathing chest pain, tachypnea: abnormally rapid breathing hypotension

Answer 56

COPD (chronic obstructive pulmonary disease)

Answer 57

* Pacemaker / defibrillator wires * Central venous catheters including dialysis catheters * Extracorporneal membrane oxygenation catheters (**ECMO**) * Atrial septal defect occluder devices

Answer 58

* **Heart failure** * **Acute MI** * **Acute of chronic pulmonary disease** * **Screening for unspecified respiratory disease** * **Hypotension** * **Valvular heart disease** * **Mechanical complications** * **Endomyocardial fibrosis** * **Congenital heart disease** * **Complicationsof** * **transplanted heart**

Answer 59

Right Ventricular Systolic Pressure \***RVSP** can be calculated using the simplified Bernoulli equation**: 4V2 + RAP, where V = peak TR velocity jet.**

Answer 60

**Trabeculations** **papillary muscles** **moderator band**

Answer 61

**1. Sternocostal surface** **2. Diaphragmatic surface**

Answer 62

F **A large pulmonary thromboembolism (blood clot) may lead to acute cor pulmonale.**

Answer 63

longitudinal

Answer 64

1. **Visualization of thromboemboli on right side of heart or pulmonary artery** 2. **RV dilation** 3. **RV dysfunction (global or regional)** 4. **Normal or Hyperdynamic LVFX** 5. **Ventricular septal flattening and paradoxical septal motion** 6. **PA dilatation** 7. **Increased TR or PR** 8. **Increased PS pressure**

Answer 65

McConnell's sign is **a distinct echocardiographic feature of acute massive pulmonary embolism**. It is defined as a regional pattern of right ventricular dysfunction, with akinesia of the mid free wall and hyper contractility of the apical wall. The McConnell’s sign is defined as relative **hyperkinesis of the apex** of the right ventricle (RV) relative to the RV free wall in the setting of RV strain. (aka enlargement McConnell's sign is considered as a specific sign of APE [https://blog.5minsono.com/mcconnells-sign/](https://blog.5minsono.com/mcconnells-sign/)

Answer 66

**acceleration time is significantly decreased (\< 60 msec) + TR gradient \< 60 mmHg** The **60/60 sign** in echocardiography refers to the coexistence of a truncated (shortened in duration or extent) RVOT acceleration time (AT \<60 ms) with a pulmonary arterial systolic pressure (PASP) of less than 60 mmHg (but more than 30 mmHg). In the presence of [right ventricular failure](https://radiopaedia.org/articles/right-ventricular-dysfunction?lang=us), it is consistent with an acute elevation in afterload, commonly due to an [acute pulmonary embolism](https://radiopaedia.org/articles/pulmonary-embolism?lang=us). \*note: The **PASP is equivalent to RVSP** in the absence of pulmonary outflow obstruction

Answer 67

during ventricular systole

Answer 68

end of ventricular systole

Answer 69

end of ventricular systole

Answer 70

during the IVCT

Answer 71

1 creates S1 sound at the IVCT

Answer 72

2 at the beginning of systole (end of IVCT)

Answer 73

**3** creates S2 sound at the beginning of IVRT dicrotic notch The dicrotic notch is universally associated with the **closure of the aortic valve** and taken as a marker of the end of systole and the start of diastole in the arteries the result of **a short period of backward flow of blood immediately before the aortic valve closes**

Answer 74

4 the end of IVRT early ventricular diastole

Answer 75

MS \*note: scale: 100 higher = MV

Answer 76

TS \*note: scale: 20

Answer 77

the atrial pressure

Answer 78

AS \*note: shaded area = **PG**

Answer 79

ventricular systolic pressure

Answer 80

the arterial diastolic

Answer 81

T \***V wave** represents the passive filling before the opening of the mitral valve. This will occur directly with T-wave

Answer 82

left subclavian vein

Answer 83

* supraventricular crest (crista supraventricularis) * moderator band * prominent trabeculamtions

Answer 84

longitudinal