Set 9 Flashcards
What is a basic rule regarding thrombus in the ventricles?
A basic rule is that thrombus does not form on a ventricular wall that moves normally
Approximately 40% of acute myocardial infarctions will produce a left ventricular mural thrombus
Most thrombi of this type form between the 6th-10th days after infarction and are found in the left ventricular apex
How does a right ventricular infarction appear on a 2D echo image?
In autopsy series, right ventricular infarctions account for up to 70% of inferior myocardial infarctions but are clinically recognized in only 3% of these cases.
Right ventricular free wall akinesia is the most sensitive echo indicator of a right ventricular infarction
Other less specific findings include right ventricular dilatation, tricuspid regurgitation, and paradoxical septal motion
In 2D echo, how do the findings produced by ischemic cardiomyopathy differ from those caused by viral cardiomyopathy?
A dilated, hypocontractile left ventricle may appear in both cases.
In ischemic cardiomyopathy, the right ventricle is often unaffected and there may be some wall segments moving differently than others.
In viral cardiomyopathy, the right ventricle is often dilated and hypocontractile
What is the role of Doppler in ischemic heart disease?
Doppler examination is important in assessing the complications of myocardial infarctions, particularly ischemic mitral regurgitation, flail. Mitral valve with severe regurgitation, and ventricular septal defects
Right ventricular infarctions may be accompanied by tricuspid regurgitation, although this sign is not specific for such infarctions.
Name 5 cardiac problems that penetrating wounds to the heart might cause
- Myocardial rupture
- Traumatic ASD or VSD
- Valvular disruption
- Pericardial effusion
- Coronary artery trauma
In cases of penetrating wounds to the heart, what is the problem with the presence or absence of pericardial effusions?
The problem with the presence or absence of pericardial effusions is that 50% to 75% of patients with cardiac trauma will NOT have an effusion.
Patients with gunshot wounds were the ones with pericardial effusions, only 25% of the time.
Absence of a pericardial effusions does not mean the heart is not involved (especially in gunshot wounds)
What is a myxoma?
A myxoma is a benign tumor composed of mucopolysaccharide (mucous) cells.
Most myxomas have a soft, gelatinous appearance. Some are multilobulated and others are more encapsulated.
What are the most likely locations for cardiac myxomas?
In 75% of cases, cardiac myxomas form in the left atrium.
The right atrium is the next most common location, following by the left and right ventricles.
Multiple myxomas occur in approximately 5% of patients
What percentage of cardiac myxomas recurs?
5-14% of cardiac myxomas recur after resection. Recurrence is usually near the original tumor site but may also involve other intracardiac sites.
What symptoms and physical findings are associated with a left atrial myxoma?
In left atrial myxoma, symptoms are related to obstruction of the mitral orifice.
Symptoms include dyspnea, fatigue, weakness, and a diastolic murmur
Which other cardiac abnormality does the symptoms and physical findings of a left atrial myxoma mimic?
The symptoms and physical findings of a left atrial myxoma mimic those of a patient with rheumatic mitral stenosis
What is the most common primary malignant cardiac tumor?
The most common primary malignant cardiac tumor is a sarcoma.
These tumors account for about 25% of all primary cardiac tumors and are second only to myxomas in frequency.
Sarcomas have varying histologic features and may take the form of an angiosarcoma (the most common histologic type), a rhabdomyosarcoma, or a fibrosarcoma
What is the most common benign cardiac tumor seen in children?
Rhabdomyomas are the most common benign cardiac tumor seen in children. These tumors, which are derived from cardiac muscle cells, are frequently multiple, are intracavitary, and/or intramyocardial and may obstruct cardiac inflow or outflow.
Fibromas are the second most common cardiac tumor seen in children and are often intramyocardial.
Name 5 technical maneuvers that can differentiate a cardiac mass from an artifact during echo
To differentiate a cardiac mass from an artifact, the examiner can:
- Decrease the overall transmit gain and time gain compensation (TGC) controls
- Use multiple cardiac windows (all masses should be documented in two or more echo views)
- Change the depth of view, thereby possible changing the position of range artifacts
- Switch to a higher frequency transducer to improve resolution
- Inject contrast material, which may help identify masses by outlining the lesion
If you see a mobile mass in the inferior vena cava extending into the right atrium what should you be suspicious that this patient might have?
Masses in the inferior vena cava could be a thrombus but you should be suspicious for renal cell carcinoma until that has been ruled out with further tests.
How does atrial fibrillation affect the mitral valve, as documented by M-mode imaging?
As documented by M-mode imaging, atrial fibrillation affects the mitral valve by causing:
- Irregularity of the length of the diastolic filling periods
- Absence of an A-wave
- Fibrillatory waves on the mitral leaflet during diastole (these waves are best seen on the anterior leaflet)
How does atrial fibrillation affect the left ventricle, as seen by 2D imaging?
The effect of atrial fibrillation on the left ventricle is less obvious on 2D echo than on M-mode imaging but may also include variations in ventricular size as the diastolic filling period changes.
Atrial fibrillation may also cause changes in the amplitude of ventricular contraction, with longer diastolic intervals having more forceful ejections
What are the 3 layers of the pericardium?
Although most echo textbooks only refer to TWO laters of the pericardium, there are 3 anatomic layers.
The serous visceral (covering the outer surface of the heart, the epicardium), the serous parietal which lines the inside of the fibrous pericardium (the parietal or thick outer sac)
How do frequent premature ventricular contractions (PVCs) affect the aortic Doppler spectral trace?
The Doppler spectral trace shows the premature ventricular contractions’ effect on aortic flow. When a premature beat occurs, the diastolic interval is shortened, and little or no flow is seen.
Because a compensatory pause ensues, involving a longer than normal diastole, the next beat will have a higher velocity as a result of the greater ventricular volume
How does atrial flutter affect the mitral valve, as documented by M-mode imaging?
In M-mode imaging, the effect of atrial flutter on the mitral valve is characterized by rapid, course, regular flutter waves or undulations, which correspond to the atrial contractions
What effect does an atrial septal defect have on the cardiac chambers?
The classic L-R shunt flow across the atrial septal defect causes the right atrial and ventricular diastolic volume and the pulmonary blood flow to increase.
In addition to right ventricular dilatation resulting from volume overload, paradoxical wall motion or septal flattening is seen in the parasternal short axis view. The left ventricle is rarely affected.
What is the most common congenital cardiac anomaly?
Ventricular septal defects (20-30% of all defects) are the most common congenital anomaly.
Bicuspid aortic valves are more common in the general populations (1-2%), but are considered a variant of normal unless stenotic.
Which is the most prevalent cyanotic congenital cardiac lesion?
Tetralogy of Fallot is the most prevalent cyanotic congenital cardiac lesions
What are the 3 possible deformities involved in an atrioventricular septal defect?
Atrioventricular septal defects can involve:
- Primum atrial septal defect
- Ventricular septal defect
- Cleft mitral valve
What type of patients are at high risk for having an atrioventricular septal defect?
Patients with Down Syndrome (Trisomy 21) are at high risk for atrioventricular septal defects
What congenital cardiac lesion is commonly associated with pulmonic stenosis?
Pulmonic stenosis is commonly associated with a ventricular septal defect
What congenital cardiac lesion is commonly associated with bicuspid aortic valves?
Bicuspid aortic valve is commonly associated with aortic coarctation
Name and describe the 4 main types of atrial septal defects
The 4 main types of atrial septal defects are:
- Secundum defects - which are located in the mid-septal area and are the most commonly observed type (incidence 70%)
- Primum defects - which are located in the inferior septum, close to the atrioventricular valves, and are the second most commonly observed type type (incidence 20%)
- Sinus venosus defects - which are located near the entrance of the superior vena cava. These defects are also associated with anomalous pulmonary venous return and account for approximately 8% of atrial septal defects
- Coronary sinus defects - which are located in the inferior septum, close to the coronary sinus and account for only 2% of atrial septal defects
What is the main direction of flow across an atrial septal defects?
At normal right and left pressures, the direction of flow across an atrial septal defect is left to right
In color Doppler imaging, what echo view is best for detecting flow across an atrial septal defect?
In color flow Doppler imaging, the best echo view for detecting left to right flow across an atrial septal defect is the subcostal four chamber view.
In this view, shunt flow is parallel to the ultrasound beam, so echo sensitivity is optimal
