Set 1 Flashcards
What is the most common associated defect with Ventricular Septal Defects?
Pulmonic stenosis (PS) with VSDs
What is the most common associated defect with a Sinus Venosus Atrial Septal Defect?
Partial Anomalous Pulmonary Venous Return
What is the most common associated defect with Ebstein’s Anomaly?
Secundum ASDs with Ebstein’s Anomaly
What is the most common associated defect with Bicuspid Aortic Valves?
Coarctation of the aorta with Bicuspid Aortic Valves
How do you assess the right atrial pressure based on the size and collapsibility of the inferior vena cava (IVC)?
Right atrial pressure based on the size and collapsibility of the IVC uses the following criteria based on the 2010 ASE RV Guidelines:
3 mmHg = normal IVC (<2cm) & collapses (>50%)
8 mmHg = intermediate
15 mmHg = dilated (>2cm) & no collapse (<50%)
What is the name of the valve of the coronary sinus?
Thesbian valve
In which chamber would you see a chiari network?
Chiari networks are seen in the right atrium as fine strands of tissue similar to chordae of the mitral and tricuspid valves
When is the left ventricular volume the largest?
The left ventricular volume is largest at end diastole (when we measure it)
When is the left atrium volume the largest?
The left atrium volume is largest at end systole.
What is the dimensionless index for evaluating aortic stenosis?
The dimensionless index is a ratio of he LVOT velocity and the peak velocity across the aortic valve
What is the cutoff value for severe AS when using the dimensionless index?
The cutoff value for severe AS when using the dimensionless index is < 0.25
When a patient has aortic regurgitation, what is the equation for calculating Left Ventricular End Diastolic Pressure (LVEDP)?
LVEDP = Diastolic BP - the end diastolic AR gradient
How many scallops is the mitral valve divided into and what are their names?
The mitral valve is divided into 6 scallops (segments)
Anterior 1, 2, & 3
Posterior 1, 2, & 3
When a patient has an aortic aneurysm, at which point (size) do you need a surgical consult?
When aortic aneurysms are larger than 5cm, its time for a surgical consult
What happens to the mitral inflow pattern in a normal patient when you have them perform a Valsalva maneuver?
The normal mitral inflow pattern maintains the E/A ratio (E>A) following a Valsalva maneuver, but the velocities are LOWER
When a patient has pulmonary regurgitation, what is the equation for calculating Pulmonary Artery End Diastolic Pressure (PAEDP)?
PAEDP = RAP + end diastolic PR gradient
RA pressure is obtained by looking at the IVC size and collapsibility like you do for TR and pulmonary pressures
In the parasternal short axis view, at the level of the mitral valve and papillary muscle, how many segments is the left ventricle divided into?
The left ventricle is divided into 6 segments at the level of the mitral valve and papillary muscle.
Name the ventricular segments seen in the parasternal short axis view
The ventricular segments are the:
- Anterior
- Anteroseptal
- Inferoseptal
- Inferior
- Inferolateral
- Anterolateral
(Anterior is on top and then proceeds to the left)
In the apical four chamber view, which 2 walls of the left ventricle are seen?
In the apical four chamber view, the inferoseptal and anterolateral walls of the left ventricle are seen
In the apical 2 chamber view, which 2 walls of the left ventricle are seen?
In the apical 2 chamber view, the anterior and inferior walls of the left ventricle are seen
Which walls of the left ventricle are seen in the parasternal and apical long axis views?
The anteroseptal and inferolateral walls of the left ventricle are seen in the parasternal and apical long axis views
Which two aortic valve leaflets are seen in the parasternal and apical long axis views?
The right and non coronary leaflets are seen in these views. The right leaflet is on top (superior) and the non coronary is on the bottom (inferior)
Where is the coronary sinus located in the parasternal long axis view?
The coronary sinus lies in the posterior atrioventricular (AV) groove. This groove is located between the left atrial and the left ventricular walls and lies posterior to the mitral valve. In the parasternal long axis view, the coronary sinus can sometimes be seen as a small echo free circle
In the PLAX where is the coronary sinus located in relation to the descending aorta?
The coronary sinus is located anterior to the descending aorta. If the coronary sinus is dilated, it may be mistaken for the descending aorta
How would you angle to view the coronary sinus in the apical 4 chamber view?
From the apical 4 chamber view you would angle posterior in order to visualize the coronary sinus, which is located posterior to the mitral annulus
Why is it important to know the location of the coronary sinus and the descending aorta?
The coronary sinus and the descending aorta are important landmarks that can help differentiate pericardial effusions from pleural effusions:
Pericardial: lie posterior to the coronary sinus and anterior to the descending aorta
Pleural: lie posterior to the descending aorta in the PLAX
What would cause the coronary sinus to become dilated?
The coronary sinus dilated due to:
increased pressure in the right atrium (as in severe tricuspid regurgitation)
or
increased flow into the coronary sinus in some congenital malformations (as in Persistent Left Superior Vena Cava (PLSVC)
Name the three major coronary arteries
The three major coronary arteries are the right, left anterior descending (LAD), and circumflex arteries. The latter two arteries branch from the left main coronary artery (which is not considered a major artery because it is very short)
Where are the coronary arteries located on the surface of the heart?
The coronary arteries are located on the outer, epicardial surface of the heart as follows:
The right coronary artery (RCA) arises from the right aortic root sinus, follows the right atrioventricular junction, and descends along the posterior interventricular groove.
The left anterior descending coronary artery (LAD) follows the anterior interventricular groove. The circumflex coronary artery (Circ) courses along the left atrioventricular junction.
Name the cardiac walls supplied by the right coronary artery
Inferior wall
Inferoseptal
Right ventricular apex
Right ventricular free wall
Name the cardiac walls supplied by the left anterior descending artery
Anterior wall
Anteroseptal
Left ventricular apex
Name the cardiac walls supplied by the circumflex artery
Anterolateral wall
Inferolateral wall
While scanning a 43 year old man with a history of an old myocardial infarction, you notice that the anterior cardiac walls is akinetic. Which coronary artery is most likely to have been involved in the infarction?
The left anterior descending (LAD) coronary artery, which supplies blood to the anterior cardiac walls is most likely to have been involved. This artery also supplies the anterior portion of the ventricular septum and the left ventricular apex
In the apical four chamber view of another patient, the distal ventricular septum and left ventricular apex are hypocontractile. Which coronary artery is most likely to be diseased?
The left anterior descending (LAD) coronary artery is the most likely choice.
In some patients with distal septal hypocontractility the proximal portion of the septum moves normally because it is supplied by the right coronary artery.
What are the normal systolic and diastolic pressures (mean) in the right atrium?
Right atrial pressures (mean) = 6 mmHg
What are the normal systolic and diastolic pressures in the right ventricle?
Right ventricular pressures = 25/5 mmHg
What are the normal systolic and diastolic pressures in the pulmonary artery?
Pulmonary artery pressures = 25/10 mmHg
What are the normal systolic and diastolic pressures (mean) in the left atrium?
Left atrial pressures (mean) = 10 mmHg
What are the normal systolic and diastolic pressures in the left ventricle?
Left ventricular pressures = 120/7 mmHg
What are the normal systolic and diastolic pressures in the aorta?
Aortic pressures = 120/80 mmHg
When is the pressure in the left ventricle at its lowest?
The left ventricle pressure is lowest in early diastole, just after the mitral valve opens.
After that, the left ventricular pressure rises as the chamber fills in diastole
What is the normal mean pulmonary artery wedge pressure?
The normal mean pulmonary artery wedge pressure is 10 mmHg, which equals the left atrial pressure.
The PA wedge pressure is NOT the same as the PA pressure.
How is the pulmonary wedge pressure determined?
A Swan-Ganz catheter is positioned in the pulmonary artery and a small balloon is inflated at the catheters tip.
The balloon is then floated and wedged into a smaller pulmonary artery
A pressure reading is obtained distal to the balloon
The inflated balloon prevents the tip of the catheter from sensing the pulmonary pressure, and the left atrial pressure is recorded as it is reflected across the pulmonary bed.
