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TEE Flashcards

1
Q

Normal Systolic LVID

A

Men: 32.4 +/- 3.7 mm
Women: 28.2 +/- 3.3 mm

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2
Q

Normal Diastolic LVID

A

Men: 50.2 +/- 4.1 mm
Women: 45 +/- 3.6 mm

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3
Q

Normal LVEDV

A

Men: 74 mL/m^2
Women: 61 mL/m^2

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4
Q

Normal LVESV

A

Men: 31 mL/m^2
Women: 24 mL/m^2

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5
Q

Relative Wall Thickness

A

(2 x PWT)/LVIDd

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6
Q

Concentric hypertrophy

A

RWT >0.42

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7
Q

Eccentric hypertrophy

A

RWT <0.42

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8
Q

Ejection Fraction

A

(EDV - ESV)/EDV

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9
Q

RV free wall thickness

A

End-diastole

<0.5 cm

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10
Q

RV dimensions

A

RVD1 (TV annulus): 2-2.8 cm
RVD2 (mid-ventricle): 2.7-3.3 cm
RVD3 (long axis): 7.1-7.9 cm

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11
Q

LA dimension

A

Men: 3-4 cm
Women: 2.7-3.8 cm
Volume: <34 mL/m^2

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12
Q

RA volume

A

Men: 25 +/- 7 mL/m^2
Women: 21 +/- 6 mL/m^2

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13
Q

Aortic Regurgitation

When to replace valve?

A
  1. Severe, symptomatic AR
  2. Asymptomatic patients with
    - Dilated heart (EDD >70 mm)
    - Decreased EF (<55%)
    - Dilated aortic root (>50-55 mm)
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14
Q

Aortic Regurgitation

Pressure Half Time (PHT)

A

Mild: >500 ms
Moderate: 200-500 ms
Severe: <200 ms

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15
Q

Aortic Regurgitation

Deceleration Slope

A

Mild: <2 m/s
Moderate: 2-3 m/s
Severe: >3 m/s

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16
Q

Aortic Regurgitation

Descending Aorta Flow Reversal

A

Mild: Early brief
Moderate: Intermediate
Severe: Holodiastolic

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17
Q

Aortic Regurgitation

Vena Contracta width

A

Mild: <3 mm
Moderate: 3-6 mm
Severe: >6 mm

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18
Q

Aortic Regurgitation

AR Jet/LVOT width

A

Mild: <25%
Moderate: 25-64%
Severe: >64%

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19
Q

Aortic Regurgitation

Regurgitant Volume

A

Mild: <30 mL
Moderate: 30-59 mL
Severe: >59 mL

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20
Q

Aortic Regurgitation

Regurgitant Fraction

A

Mild: 20-30%
Moderate: 30-49%
Severe: >49%

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21
Q

Aortic Regurgitation

EROA

A

Mild: <0.1 cm^2
Moderate: 0.1-0.29 cm^2
Severe: >0.29 cm^2

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22
Q

Aortic Stenosis

Modified Gorlin Equation

A 
AVA = CO / MG^(1/2)
AVA = CO / PG
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23
Q

Aortic Stenosis

Peak Velocity

A

Aortic Sclerosis: = 2.5 m/s
Mild: 2.6-2.9 m/s
Moderate: 3-4 m/s
Severe: >4 m/s

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24
Q

Aortic Stenosis

Mean Gradient

A

Mild: <20 mmHg
Moderate: 20-40 mmHg
Severe: >40 mmHg

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25
Q

Aortic Stenosis

AVA

A

Mild: >1.5 cm^2
Moderate: 1-1.5 cm^2
Severe: <1 cm^2

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26
Q

Aortic Stenosis

Indexed AVA

A

Mild: >0.85 cm^2/m^2
Moderate: 0.6-0.85 cm^2/m^2
Severe: <0.6 cm^2/m^2

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27
Q 
Aortic Stenosis
Velocity Ratio (Dimensionless Index)
A

Mild: > 0.5
Moderate: 0.25-0.5
Severe: <0.25

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28
Q

LV Fractional Shortening

A

(LVEDd - LVESd) / LVEDd

Normal >25%

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29
Q

LV Fractional Area Change

A

(EDA - ESA) / EDA

Normal >40-45%

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30
Q

Ejection Fraction

A

(EDV - ESV) / EDV

Normal >55%

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31
Q

Simplified Bernoulli’s Equation

A

P = 4v^2

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32
Q

Dp/Dt

A

32/Dt
Normal >1200 mmHg/s
Abnormal <800 mmHg/s
Independent of afterload, dependent on preload

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33
Q

Velocity of Circumferential Shortening (VCF)

A

FS/LVET

Normal 1.09 +/- 0.3 circ/s

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34
Q

End Systolic Elastance

A
  • Plot series of end-systolic points under various loading conditions
  • Steeper slope = better systolic function
  • Load independent
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35
Q

Preload-Recruitable Stroke Work

A
  • Stroke work = area under pressure-volume loop
  • Plot stroke work as function of end-diastolic volume
  • Steeper slope = better systolic function
  • Load independent
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36
Q

Preload Adjusted Max Power

A

=Stroke Work / (EDV)^2
=Stroke Work / (EDA)^(3/2)
-Load independent

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37
Q

Systolic Mitral Annular Velocity (Sm)

A
  • S’ velocity lateral annulus
  • Normal >8 cm/s
  • Abnormal <5 cm/s
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38
Q

Strain Rate

A

= (v1-v2) / x
Dimensionless
Exempt from influence of translation
Load independent

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39
Q

Load Independent Measures of Systolic Function

A
  • End-systolic elastance
  • Preload recruitable stroke work
  • Preload adjusted max power
  • Strain rate
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40
Q

MAPSE

A

Normal 12 +/- 2 mm

Abnormal <8 mm

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41
Q

Myocardial Performance Index (MPI)

A

(ICT + IRT) / ET
Normal 0.39 +/- 0.05
Abnormal >0.5

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42
Q

Mitral valve annulus diameter

A

ME long axis view
Mid-diastole
29 +/- 4 mm

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43
Q

Mitral Regurgitation

Ajet/Aatria

A

Mild: <20%
Moderate: 20-40%
Severe: >40%

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44
Q

Mitral Regurgitation

Vena Contracta

A

Mild: <3 mm
Moderate: 3-6.9 mm
Severe: >7 mm

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45
Q

Mitral Regurgitation

MR Jet Area

A

Mild: <4 cm^3
Moderate: 4-10 cm^3
Severe: >10 cm^3

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46
Q

Mitral Regurgitation

Pulmonary Vein Flow

A

Mild: Normal
Moderate: Blunted S
Severe: S reversal

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47
Q 
Mitral Regurgitation
Regurgitant Fraction (RF)
A

RF = RV / SV(MV)
Mild: <30%
Moderate: 30-49%
Severe: >50%

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48
Q 
Mitral Regurgitation
Regurgitant Volume (RV)
A 
RV = SV(MVinflow) - SV(LVOT)
RV = EROA / VTI(MR)
Mild: <30 cc
Moderate: 30-59 cc
Severe: >60 cc
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49
Q

Mitral Regurgitation

EROA

A 
EROA = RV / VTI(MR)
EROA(PISA) = Q(MRPisa) / V(MRpeak)
Mild: < 0.2 cm^2
Moderate: 0.2-0.39 cm^2
Severe: >0.4 cm^2
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50
Q

Mitral Regurgitation

CWD Strength

A

Mild: Faint
Moderate: Moderate, partial
Severe: Very dense, holosystolic

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51
Q

Mitral Regurgitation

PISA Radius

A

If Valias = 40 and V(MRpeak) ~500 cm/s
Mild: <4 mm
Moderate: 4-10 mm
Severe: >10 mm

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52
Q

SAM Risk Factors

A
  • LV EDD <45 mm
  • Aortomitral angle <120
  • C-sept distance <25 mm
  • AL/PL <1.3 (valve closed)
  • Basal septum >15 mm
  • LVOT <2 cm
  • AL length >2 cm (valve open)
  • PL length >1.5 cm (valve open)
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53
Q

Mitral Stenosis

MVA by PHT

A

MVA = 220 / PHT

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54
Q

Mitral Stenosis

MVA by Deceleration Time

A

MVA = 759 / DT

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55
Q

Mitral Stenosis

Mean Gradient

A

Mild: <5 mmHg
Moderate: 5-10 mmHg
Severe: >10 mmHg

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56
Q

Mitral Stenosis

PHT

A

Normal: 40-70 ms
Mild: 70-150 ms
Moderate: 151-219 ms
Severe: >220 ms

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57
Q

Mitral Stenosis

MVA

A

Normal: >2.5 cm^2
Mild: 1.6-2.5 cm^2
Moderate: 1-1.5 cm^2
Severe: <1 cm^2

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58
Q

Mitral Stenosis

Peak PA Pressure

A

Normal: 20-30 mmHg
Mild: <30 mmHg
Moderate: 30-50 mmHg
Severe: >50 mmHg

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59
Q

Mitral Stenosis

PISA

A

MVA = {[23.14r^2 x (alpha/180)] * Valias} / Vpeak

60
Q

Aortic Stenosis

Peak Gradient

A

Mild: 20-39 mmHg
Moderate: 40-69 mmHg
Severe: >70 mmHg

61
Q

RV FAC

A

Normal >42-56%

Abnormal <35%

62
Q

RV EF

A

Normal >51.5-64.5%

Abnormal <45%

63
Q

TAPSE

A

Normal 21-27 mm

Abnormal <17 mm

64
Q

RV Isovolumic Acceleration (IVA)

A

Normal 1.4 +/- 0.5 m/s^2

65
Q

TV S’

A

Normal >9.8-16.4 cm/s

Abnormal <9.5 cm/s

66
Q

RV dP/dT

A

15 mmHg/dT
Normal >400 mmHg/s

Very sensitive to loading conditions

67
Q

Tricuspid Annulus

A

ESD 28 +/- 5 mm

EDD 31 +/- 5 mm

68
Q

Tricuspid Regurgitation

Jet Area

A

Mild: <5 cm^2
Moderate: 5-10 cm^2
Severe: >10 cm^2

69
Q

Tricuspid Regurgitation

VC Width

A

Mild: <0.3 cm
Moderate: 0.3-0.69 cm
Severe: >0.7 cm

70
Q

Tricuspid Regurgitation

Hepatic Vein Flow

A

Mild: S dominant
Moderate: S blunting
Severe: S reversal

71
Q

Tricuspid Regurgitation

EROA

A

Mild: <0.2 cm^2
Moderate: 0.2-0.39 cm^2
Severe: >0.4 cm^2

72
Q

Tricuspid Regurgitation

Regurgitant Volume

A

Mild: <30 cc
Moderate: 30-44 cc
Severe: >45 cc

73
Q

Tricuspid Stenosis

Tricuspid Valve Area

A

TVA = 190/PHT

Severe: < 1 cm^2

74
Q

Tricuspid Stenosis

Mean Gradient

A

Mild: <2 mmHg
Moderate: 2-5 mmHg
Severe: >5 mmHg

75
Q

Pulmonic Regurgitation

Severe PR

A

PI Jet Width/PA annulus 0.7
Deceleration time PI trace <260 ms
PHT PI jet <100 ms
Prominent flow reversal in main PA

76
Q

Pulmonic Stenosis

Velocity

A

Mild: <3 m/s
Moderate: 3-4 m/s
Severe: >4 m/s

77
Q

Pulmonic Stenosis

Peak Pressure Gradient

A

Mild: <36 mmHg
Moderate: 36-64 mmHg
Severe: >64 mmHg

78
Q

RV MPI

A

MPI = (IVRT + IVCT) / ET
PW Normal: 0.26 +/- 0.085
PW Abnormal: >0.43

TDI Normal: 0.38 +/- 0.08
TDI Abnormal: >0.54

79
Q

ASD

Ostium Secundum

A
  • Most common ASD
  • Defect in septum primum
  • A/w MVP
80
Q

ASD

Ostium Primum

A
  • Endocardidal cushion defect
  • A/w cleft AV, cleft septal TV leaflet, and cleft anterior MV leaflet
  • A/w Trisomy 21
  • Can be a/w restrictive or non-restrictive VSD
81
Q

ASD

Sinus Venosus

A
  • Located near SVC>IVC
  • SVC sinus venosus a/w anomalous drainage of RUPV
  • IVC sinus venosus a/w Scimitar Syndrome
82
Q

ASD

Coronary Sinus

A
  • Least common ASD

- A/w persistent L SVC

83
Q 
VSD
Type 1 (Outlet, Supracristal)
A
  • Defect just below PV
  • Most likely to be a/w prolapse of RCC and resultant AR
  • Least common VSD
84
Q 
VSD
Type 2 (Membranous, subaortic, conoventricular, malalignment)
A
  • Most common VSD (70%)
  • Located near TV
  • A/w LV septal aneurysms
  • Can be a/w prolapse of RCC
  • A/w TOF
85
Q 
VSD
Type 3 (Inlet, endocardial cushion defect)
A
  • A/w primum ASD
  • A/w Trisomy 21
  • A/w cleft AV leaflets, cleft septal TV leaflet, and cleft anterior MV leaflet
86
Q 
VSD
Type 4 (muscular, trabecular)
A

-Located more inferior and posteriorly

87
Q

Tetralogy of Fallot

A
  • VSD (membranous)
  • Overriding aorta
  • Pulmonary obstruction
  • RVH
  • A/w R aortic arch (25%) and coronary artery abnormality
88
Q

Ebstein’s Anomaly

A
  • Large, sail-like anterior TV leaflet
  • Apically displaced septal TV leaflet
  • Atrialization of RV
  • Dilated RV with severe volume overload 2/2 TR
  • A/w ostium secundum ASD
  • A/w WPW syndrome, atrial and ventricular arrhythmias
89
Q

Diastology

Vp

A

Normal >45-50 cm/s

  • Measure 4 cm into LV
  • Dependent on preload
  • E/Vp >2.5 predicts PCWP >15 in pts with EF <55%
90
Q

Diastology
Grade 0
Normal

A

e’ >10 cm/s

91
Q

Diastology
Grade 1
Impaired Relaxation

A

e’ <10 cm/s

E/e’ <8
E/A <0.8
DT >200 ms
ARdur-Adur <30 ms

92
Q

Diastology
Grade 2
Pseudonormal

A

e’ <10 cm/s

E/e’ 9-12
E/A 0.8-1.5
DT 160-200 ms
ARdur-Adur >30 ms

93
Q

Diastology
Grade 3
Restrictive

A

e’ <10 cm/s

E/e’ >13
E/A >2
DT <160 ms
ARdur-Adur >30 ms

94
Q

Diastology

Predictors of Increased Filling pressures

A

E/E’ >15
IVRT/Te-e’ <2
E/Vp >2.5 predicts PCWP >15 (if EF <55%)
ARdur - Adur >30 ms

95
Q

Diastology (Updated)

Normal

A

Mitral E/A ratio >0.8
Average E/e’ <10
Peak TR velocity <2.8
LA volume index <34

96
Q

Diastology (Updated)

Grade 1

A

Mitral E/A ratio <0.8
Average E/e’ <10
Peak TR velocity <2.8
LA volume index normal or increased

97
Q

Diastology (Updated)

Grade 2

A

Mitral E/A ratio >0.8 to <2
Average E/e’ 10-14
Peak TR velocity >2.8
LA volume index >34

98
Q

Diastology (Updated)

Grade 3

A

Mitral E/A ratio >2
Average E/e’ >14
Peak TR velocity >2.8
LA volume index >34

99
Q

Wavelength

A

Length of single cycle
(trough to trough, or peak to peak)
wavelength=velocity/F

100
Q

Spatial Pulse Length

A

Length of entire pulse

SPL = Wavelength x # cycles in pulse

101
Q

Axial (LARD) Resolution

A

Ability to discern 2 separate objects front to back
1/2 SPL
Smaller SPL = better axial resolution
Longitudinal, axial, radial, range, depth

102
Q

Period

A

Amount of time needed to complete single cycle

time for trough to trough or peak to peak

103
Q

Pulse Duration

A

Amount of time needed to complete entire pulse

PD = Period x # cycles in pulse

104
Q

Pulse Repetition Period

A

Amount of time needed to go from beginning of 1 one pulse to beginning of next pulse
Pulse Duration + Listening Time

105
Q

Pulse Repetition Frequency

A

1/Pulse Repetition Period
# pulses/second
Helps determine Nyquist limit
Proportional to frame rate

106
Q

Temporal Resolution

A

Ability to accurately image moving structures at a particular instance in time
Increased PRF = better temporal resolution

107
Q

Nyquist Limit

A

Maximum Doppler shift that can be measured without aliasing occurring
= 1/2 PRF

108
Q

Frequency

A 
# cycles/second
1/period
F=v/wavelength
109
Q

Power

A

Amount of work US beam can do (transducer output)

110
Q

Intensity

A

Power/unit area

Determines bioeffects of US

111
Q

Amplitude

A

Difference between average and max values of an acoustic variable
Higher amplitude = stronger sound pulse
Power & Intensity proportional to Amplitude^2

112
Q

Lateral (LATA) Resolution

A

Ability to determine 2 separate objects side by side
Determined by beam width (narrower is better)
Lateral, angular, transverse, azimuthal

113
Q

Elevational Resolution

A

Ability to determine 2 separate objects along y-axis

Determined by beam height

114
Q

Gain/Amplification

A

Amplification of returning US signal

Post-processing function

115
Q

Time (Depth) Gain Compensation

A

Compensates for attenuation that occurs with increasing depth
Changes gain in horizontal position

116
Q

Lateral Gain Compensation

A

Changes gain in vertical position
Compensates for attenuation
Corrects enhancement artifact

117
Q

Compression

A

Reduces the dynamic range of signals

High compression produces more highly contrasted image, less “shades of grey”

118
Q

Dynamic Range

A

Range of signals that can be processed by the machine
Inverse of compression
# of “shades of grey”

119
Q

Focus

A

Point where US beam is narrowest

Best lateral resolution

120
Q

Doppler Equation

A 
FR-FT = V cos(theta) 2 FT/C
V = velocity of blood flow
Theta = angle between flow and probe
FR = reflected frequency
FT = transmitted frequency
C = speed of US in soft tissue (1540 m/s)
121
Q

Range Ambiguity

A

Inability to discern specific location of Doppler shift

Seen with CWD

122
Q

Mechanical Index

A

Ability of the US beam to produce cavitation (bursting of bubbles) of contrast material
MI = peak negative pressure / (frequency)^(1/2)
Depends on transmitted frequency and pressure of sound wave

123
Q

Tissue Harmonics

A

Small amount of US converted into a harmonic frequency as sound propagates
Occurs at deeper depths
Occurs along main axis

124
Q

Contrast Harmonics

A

Echo contrast material (microbubbles) expand and compress as it interacts with US, creating harmonic frequencies and lighting up cardiac chambers

125
Q

Cavitation

A

Rupture of microbubbles causing a great deal of harmonic frequencies
Occurs with MI >1

126
Q

Resonance

A

Uneven shrinking and compression of microbubbles (expansion>compression) creates new harmonic frequencies
Occurs with MI 0.1-1

127
Q

Acoustic Impedance (Z)

A

Acoustic resistance to sound traveling through a medium
Z = P x V
P = density
V = velocity

128
Q

Resonant Frequency (RF)

A

Most common frequency in a pulse
CWD: RF determined by electrical frequency of voltage
PWD: RF = V/2Thickness

129
Q

Bandwidth (BW)

A

Difference between lowest and highest frequencies in a pulse

Shorter SPL = higher BW

130
Q

5 Functions of US Receiver

A
  1. Amplification
  2. Compensation
  3. Compression
  4. Demodulation
  5. Rejection
131
Q

Demodulation

A

Changes shape of electrical signal to make it recognizable by image screen
Rectification - turns all negative voltages positive
Smoothing - smoothes out signal

132
Q

Rejection (Threshold, suppresion)

A

Very low amplitude signals are ignored as noise

133
Q

Reverberation artifact

A

US ricochets between 2 reflectors creating multiple equally spaced reflections
Ringdown artifact, comet-tail effect

134
Q

Refraction artifact

A

US beam is refracted by reflector, placing object to the side and deeper than true position

135
Q

Side lobes (grating lobes)

A

US beams traveling along side axes reflect off of a reflector, but machine assumes it is traveling along main axis

136
Q

Acoustic Shadowing

A

Very strong reflector doesn’t allow penetration of US

137
Q

Mirror Image artifact

A

US beam reflects off mirror, before hitting true object. Mirror image will be deeper and to the side, and equidistant to mirror as true object

138
Q

Focal Zone

A

Length of near field (Ln)

Ln = r^2/wavelength

139
Q

Q Factor

A

Q Factor = RF/BW

140
Q

Scattering

A

Random redirection of sound in many directions
Occurs when reflector is smaller than or equal to wavelength of US beam
Directed related to frequency

141
Q

Snell’s Law

A

sin(theta[t])/sin(theta[i]) = v2/v1

Used for refraction

142
Q

Duty Factor

A

Amount of time that US machine is producing sound

=PD/PRP x 100%

143
Q

Propagation Speed Artifact

A

Structure placed at incorrect depth because TEE assumes sounds travels at exactly 1540 m/s

144
Q

Enhancement Artifact

A

Occurs when US travels through medium with lower rate of attenuation than surrounding soft tissue
Objects brighter distal to weakly attenuating medium

145
Q

Attenuation Coefficient

A

Frequency/2

146
Q

Aortic Stenosis

Prosthetic valve severe stenosis cutoffs

A 
EOA <0.8 cm^2
AT > 100 ms
AT/ET >0.4
DVI <0.25
MG > 35 mmHg
Peak Vel >4 m/s
147
Q

Mitral Regurgitation

Predictors for failed MVr for ischemic MR

A 
Type IIIb Carpentier motion
Annulus diameter >4 cm
LV diastolic diameter >6 cm
Tethering (tenting) height >10 mm
Tenting Area >1.6 cm^2
Posterior leaflet angle >45 degrees

TEE (1 decks)

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