TEE 2 Flashcards
What is the equation for obtaining Fractional area change?
FAC = (EDA-ESA)/EDA
Name the ways EEF are estimated?
- Normal = >55
- Mild 45-54
- Moderately 35-44
- Moderate Severe 25-34
- Severe <25
The LV is divided into 17 segments, how is each one qualitativley rated for thickening during systole?
- 1 = Normal = 30% thickening
- 2 = Mild hypokinesis = 10 - 30%
- 3 = Severe hypokinesis = < 10%
- 4 = Akinesis = no thickening
- 5 = Dyskinesis = Thinning w/ paradoxical motion
What is a suggestive of myocardia ischemia?
-An increase in the scale of 2 or more regions
In assessment of diastolic function what does he PWD E wave correspond with?
Early passive diastolic flling
In assessment of diastolic function what does he PWD A wave correspond with?
Atrial contraction filling
A mild form of diastolic dysfunction results in what?
-impaired relaxation pattern
What causes an impaired relaxation pattern?
- Decreased peak E-A velocity
- Prolonged E wave decelartion
Advanced diastolic dysfunction causes what?
-restrictive pattern
What causes a restrictive pattern?
- Increased peak E-A velocity
- Decreased E wave deceleration
What is pseudonormal pattern?
-As diastolic dysfunction progresses from mild to severe there are periods when pattern appears normal
How is normal diastolic function identified?
- Positive waves during systole and diastole
- Negative wave during atrial contraction
Mitral valve prolapse is present when a portion of the leaflet moves to the _______ side during ________
- Atrium
- Systole
When is flail present?
- choradae tendenae is ruptured
- Leaflet is oscillating in LA during systole
How is mitral regurge severity rated?
1-4 scale with 1 being mild and 4 severe
What are the 2 causes of functional Mitral Regurge?
- Dilation of Annulus
- Papillary muscle displacement
What causes the annulus dilation and papillary displacement in functional MR?
-Wall motion abnormalities from CAD and LV dilation
What type of MR is common and requires surgery?
Myxomatous degeneration
Myxomatous degeneration is caused by what?
-Elongated, redundant leaflets that prolapse into LA during systole
What is the most common form and easiest to fix of Myxomatous degeneration?
-Prolapse of middle scallop of posterior leaflet
What type of MR is causes thickening and shortening MV leaflets?
Rheumatic
Rheumatic MR is ________ to repair and usually requires ________ valve
Difficult, Prosthetic
What does promixal isovelocity surface area do?
-Quantify MR with echo, using CFD, CWD
Proximal isovelocity surface area is commonly applied to _______ MR and not accurate for _________ MR
- Central
- Eccentric
ROA of less than 0.2 cm² is considered _______ while ROA of 0.4 cm² is considered ________.
Mild
Severe
Mitral stenosis is almost always caused by what?
Rheumatic heart disease
What is considered severe and moderate Mitral stenosis?
- Severe <1 cm²
- Moderate 1-1.5 cm²
In what 2 ways con Mitral Stenosis be measures
- Planimetry
- Pressure half time
Rate at which pressure gradient decreases across stenotic valve is directly related to what? and is called what?
- severity of stenosis
- Pressure half time
The severity of aortic regurge is measured how?
- Size of regurgitant jet on CFD
- Depth it extends into LV
Evaluation of Aortic Stenosis is based on what?
- 2D valve appearance
- Doppler velocity measurement of flow through valve
Severity of aortic stenosis can be made by what 3 ways?
- Trasaortic gradients
- Planimetry
- Aortic valve area (AVA) by continuity equation
Transaortic gradients be calculated using what by what?
- Simplified bernouli equation
- CWD
During aortic valve planimetry, what finding is considered significant?
-Aortic valve area of less than 1 cm²
What is the continuity equation?
Same amount of flow passes through the AV and LVOT w/ each stroke
How is TR graded and what is it based on?
- Semiquantitative 1-4 scale
- Size or reguritant jet
Significant TR is caused by what?
annular dilation secondary to right heart failure
Tricuspid stenosis is _________ seen and is due to ________.
Rarely
rheumatic heart disease
Pulmonic stenosis is usually ________ and rare in adult
Congenital
When looking at the left atrium what is being looked for?
- Size (normal less than 5 cm)
- Masses (Afib)
A variable sized fold of tissue at the junction of the IVC and the RA is called what?
-Eustachian valve
What is a chiari network?
-Fine filamentous mobile strands in the RA
What parts of the aorta can be blocked by the trachea?
- Distal ascending
- Proximal arch
Normal inside diameter of ascending aorta? Aortic arch? Descending aorta?
- 3.5 cm
- 3.0 cm
- 3.0 cm
3 common abnormalities of the aorta detected by TEE
- Atherosclerosis
- Aneurysm
- Dissection
Normal thickness of aorta intima layer
- < 2mm
How are aortic aneurysms classified?
- Location
- shape (diffuse or saccular)
How are aortic dissections classified?
- Type A = Ascending (surgical emergency)
- Type B = Non-Ascending (treated medically)
Measuring stroke volume w/ TEE requires what 2 measurements? Taken when and where?
- Velocity profile
- Area which flow occurs
- both Must be measured at same location at same time in cardiac cycle
What view is used to monitor for ischemia?
TG mid SAX
Beside ischemia, what other problem may cause wall motion abnormalities?
-Hypovolemia
Air in the heart is easily seen in TEE as what?
-Hyperdense or white
