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Echo > TEE > Flashcards

TEE Flashcards

1
Q

TEE TECHNIQUE

Atrial pacing is a technique thats used with TEE. Atrial pacing can be used to evaluate which cardiac disease?

A

CAD

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2
Q

TEE TECHNIQUE

Which medication can be administered with a TEE exam for stress evaluation?

A

DOBUTAMINE

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3
Q

TEE TECHNIQUE

Another TEE technique is to detect a shunt. What medication is given for shunt evaluation?

A

SALINE CONTRAST

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4
Q

TEE TECHNIQUE

How should the patient be positioned for a TEE exam?

A

LLD with head of the bed raised to 30 degrees to prevent aspiration

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5
Q

TEE TECHNIQUE

What is the frequency transducer used in TEE exam?

A

TEE probes are usually higher 5-7MHz while TTE probes are 2-7MHz

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6
Q

TEE TECHNIQUE

what can be viewed in a DTG view?

A

Long axis view of LV

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7
Q

TEE TECHNIQUE

what can be viewed in a TG view?

A

short axis view basal and mid levels, long axis view of LV, RVIT, 2CH

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8
Q

TEE TECHNIQUE

At what temperature is it unsafe to use a TEE probe?
a) 20-25° C
b) 25-30° C
c) 30-40° C
d) 40-45° C

A

D -
if its over 40C, it’ll overheat and cause damage to digestive organs

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9
Q

TEE TECHNIQUE

what can be viewed in a high esophageal view?

A

long and short axis views of the aortic arch

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10
Q

List the advantages of TEE

A
  • higher resolution imaging;

can see….
- small vegetation
- smaller structures and valves
- thrombus
- atria and atrial appendage thrombus
- prosthetic valves

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11
Q

List the disadvantages of TEE (in other words, what are the risks & downfalls of doing a TEE?)

A
  • requires sedation
  • TRUE APEX IS NOT WELL VISUALIZED
  • associated with administered meds, airway compromise, vasovagal reaction, esophageal perforation
  • electrical/temp hazard
  • infection from a dirty probe
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12
Q

list the indications for a TEE (in other words, why would someone need to do a TEE?)

A
  • endocarditis
  • congenital heart dz
  • wall motion abnormalities
  • thrombus formation of embolism source
  • valvular stenosis/regurg
  • prosthetic valve assessment
  • aorta pathology (dissection)
  • pericardial dz
  • intraoperative monitoring
  • suboptimal TTE exam
  • chest trauma patients
  • pre and post surgical assessment
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13
Q

list the contraindications of a TEE exam (in other words, why cant someone do a TEE? - think serious medical conditions)

A
  • tumors of the mouth, esophagus, or stomach
  • esophageal pathology- stricture, diverticula, varices
  • gastric bleeding
  • severe dysphagia
  • cervical spine disorders that prevent cervical flexion
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14
Q

TEE IMAGES

What view is this? Label the image.

A

ME Long Axis

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15
Q

What view is this? Label the image.

A

ME RVOT view

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16
Q

What view is this? Label the image.

A

ME AV SAX (Base of Heart)

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17
Q

What view is this? Label the image.

A

ME AV SAX (Base of Heart)

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18
Q

What view is this? Label the image.

A

TG SAX (basal level)

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19
Q

What view is this? Label the image.

A
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20
Q

What view is this? Label the image.

A

TG SAX (Mid LV)

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21
Q

What view is this? Label the image (walls)

A

TG SAX (Mid LV)

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22
Q

What view is this? Label the image.

A

ME 4CH

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23
Q

What view is this? Label the image.

A

ME 4CH

this image shows a typical 4 chamber with MR

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24
Q

What view is this? Label the image.

A

ME 5CH

25
Q

What view is this? Label the image.

A

ME 5CH

26
Q

What view is this? Label the image.

A

ME 2 CH

27
Q

What view is this? Label the image. What is the red arrow pointing to?

A

ME 2CH; red arrow pointing to the LAA

28
Q

What view is this? Label the image. What is the blue arrow pointing to?

A

Basal View (LAA); blue arrow pointing to coumadin ridge

29
Q

What view is this? Label the image.

A

Basal View (LAA)

30
Q

What view is this? Label the image. What is the red arow pointing to?

A

ME BICAVAL VIEW

31
Q

What view is this? Label the image.

A

ME Bicaval View

32
Q

What kind of study is done in this image? Is there a shunt?

A

Bubble study (saline bubbles are a form of contrast useful in assessing shunt flow); no shunt

33
Q

What view is this? Label the image.

A

TG 2CH

34
Q

What view is this? Label the image.

A

TG LAX RVOT

35
Q

What view is this? Label the image.

A

TG LAX (left heart)

36
Q

What view is this?

A

TG SAX descening aorta

37
Q

What view is this?

A

TG SAX descening aorta

38
Q

What view is this?

A

TG LAX descending aorta

39
Q

What is the arrow
pointing to? What is the asterisk on?

A

LUPV; LAA

40
Q

Label this TEE image.

A
41
Q

Label this TEE image.

A
42
Q

NAME all views and DEGREES in the ME position

A

ME 4CH= 0
ME mitral comm = 60
ME 2CH= 90
ME LAX= 120
ME AV SAX= 60

43
Q

NAME all views and DEGREES in the 2 ME views & 4 TG views

A

ME RVIT/OT= 60
ME bicaval = 120
_______________________________________________________________________
TG Apical SAX = 0
TG mid-pap SAX = 0
TG basal SAX = 0
TG LV 2CH = 90

44
Q

TEE- normal variants

What view is this? what structures are shown in this image that can be misdiagnosed for pathology?

A

bicaval view;
**eustachian valve; *chiari network **

45
Q

TEE- normal variants

What view is this? what structures are shown in this image that can be misdiagnosed for pathology?

A

bicaval view; crista terminalis

46
Q

TEE- normal variants

What view is this? what structures are shown in this image that can be misdiagnosed for pathology?

A

4CH; moderator band

47
Q

TEE- normal variants

What view is this? what structures are shown in this image that can be misdiagnosed for pathology?

A

LAX aortic valve; lambls excresences

48
Q

TEE normal variants

What view is this? what structures are shown in this image that can be misdiagnosed for pathology?

A

Basal view (LAA); coumadin ridge

49
Q

what is a coumadin ridge?

A

A prominent muscle ridge formed between LAA and
the atrial insertion of the LUPV

50
Q

TEE TEST QUESTION - 1

The Doppler tracing was acquired on TEE imaging. This signal is most consistent with?

A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Mitral regurgitation
E. Tricuspid regurgitation

A

B

EXPLANATION:

This is a CW Doppler tracing (note velocity scale) with a maximum velocity of about 4 m/s and with flow occurring in diastole, directed toward the transducer, consistent with aortic regurgitation.

Aortic stenosis, mitral regurgitation, and tricuspid regurgitation have a similar velocity, but all occur in systole.
Mitral stenosis would be a lower velocity diastolic signal, usually directed away from the transducer from a mid- TEE 4 chamber view.

This tracing was obtained in a patient with a bicuspid aortic valve where the aortic regurgitant jet was directed posteriorly

51
Q

TEE TEST QUESTION - 2

You are asked to quantify mitral regurgitation severity in a patient with mitral valve prolapse, and the adjacent color Doppler image is obtained. To complete your evaluation, based on the image provided, you recommend?

a. Record mitral inflow Doppler signal
b. Color Doppler interrogation of pulmonary veins
c. Adjust Doppler baseline
d. Measure medial to lateral diameter of isovelocity hemisphere

A
52
Q

TEE TEST QUESTION - 3

In the image provided name the labelled structures:
a.
b.
c.
d.
e.

A
53
Q

TEE TEST QUESTION - 4

In the image provided name the labelled structures:
a.
b.
c.
d.
e.

A
54
Q

TEE TEST QUESTION - 5

You are asked to evaluate a patient with a history of a bioprosthetic aortic valve and suspected aortic regurgitation. The following image is obtained from a mid-esophageal long-axis view at 130⁰ .

Which additional imaging view of the aortic valve would aid in visualizing the regurgitant jet?

a. High-esophageal short-axis view
b. Transgastric long-axis view
c. Mid-esophageal 4 chamber view
d. Deep gastric short-axis view

A
55
Q

TEE TEST QUESTION - 6

A TEE is ordered in a patient in whom a type A aortic dissection is suspected. Imaging of the distal ascending aorta is hindered by:

a. Ultrasound attenuation in the far-field
b. Interposition of the trachea
c. Ring-down, or near field clutter artifact
d. Anatomic constraint of esophagus for the TEE probe

A

B

56
Q

TEE TEST QUESTION - 7

You are called urgently to the operating room to aid in cardiovascular imaging in a patient after coronary bypass grafting surgery who has been just taken off the cardiopulmonary bypass pump. The anesthesiologist has noted new ST segment elevation on the electrocardiogram monitor. You note heterogeneity in the wall motion in the indicated area (arrows) and conclude:

a. Left anterior descending artery distribution ischemia
b. Cardiogenic shock and global myocardial ischemia
c. Left circumflex artery distribution ischemia
d. Right coronary artery distribution ischemia

A
57
Q

TEE TEST QUESTION - 8

A TEE is performed to evaluate for endocarditis. After recording the transgastric view, in the probe is withdrawn back into the esophagus. In this position, there is resistance to further withdrawal of the probe. The next step would be to:

a. Withdraw the probe
b. Retroflex the probe
c. Rotate the probe
d. Advance the probe

A
58
Q

TEE TEST QUESTION - 9

A 66-year-old man presents with dyspnea. Electrocardiography demonstrates newly diagnosed atrial fibrillation, and a TEE is ordered to evaluate for left atrial appendage thrombus before direct current cardioversion. What abnormality is identified in the left atrial appendage?

a. Reverberation artifact
b. Left atrial appendage thrombus
c. Atrial appendage trabeculation
d. Spontaneous echo contrast

A
59
Q

TEE TEST QUESTION - 10

A male with previous mitral valve replacement underwent transesophageal echocardiogram for shortness of breath. #D full volume color Doppler from a slightly rotated surgeon’s atrial view was obtained. The finding indicated by the arrow is best described as which of the following?

a. Aortic regurgitation
b. Lateral paravalvular regurgitation
c. Medial paravalvular regurgitation
d. Prosthetic mitral stenosis
e. Prosthetic mitral valve regurgitation

A

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