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DMST 367 Echo 3 > Thrombus and SOE ASYNC > Flashcards

Thrombus and SOE ASYNC Flashcards

1
Q

What is Cardiac Thrombus?

A

Coagulation of blood within the heart, appearing as echo dense mass with defined margins, commonly due to stasis or turbulent blood flow

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2
Q

What is the three points of Virchow’s Triad? (In terms of thrombus risk factors)

A
  1. Abnormal walls
  2. Abnormal blood flow
  3. Abnormal blood constituents
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3
Q

What causes the thrombus risk factor of abnormal walls? 7

A

Endothelial injuries such as
1. Atherosclerosis
2. MI
3. Trauma
4. Inflammation
5. Hypertension
6. Smoking
7. Increase in cholesterol

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4
Q

What causes thrombus risk factors of abnormal blood flow? 2

A

Hemodynamic changes such as
1. Stasis of blood
2. Turbulent flow

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5
Q

What causes thrombus risk factors of abnormal blood constituents? 4

A

Hypercoagulability from things like
1. Prolonged bed rest
2. MI
3. A fib
4. Prosthetic valves

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6
Q

What is spontaneous echo contrast also referred to as?

A

Smoke

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7
Q

What is spontaneous echo contrast a precursor to?

A

Thrombus

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8
Q

Spontaneous echo contrast can be sometimes be seen when?

A

With normal patients with good vis

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9
Q

What are three cardiac thrombus locations?

A
  1. LV thrombus
  2. LA thrombus (LAA thrombus)
  3. RT heart thrombus (RA, RV, PA)
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10
Q

What does this image represent?

A

Spontaneous echo contrast

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11
Q

What are some thrombus echo features?

A
  1. Echogenic mass
  2. Protruding vs Mural
  3. Mobile vs sessile
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12
Q

What can be said about the echogenic features of thrombus?

A
  1. Older thrombus becomes more echogenic
  2. Acute thrombus may be the same echogenicity of adjacent myocardium
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13
Q

What can be said about the protruding and mural features of thrombus echogenicity?

A

Protruding more acute and more at risk for embolus

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14
Q

What can be said about mobile echogenic thrombus?

A

More at risk for embolus

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15
Q

MIs commonly involve what?

A

APEX

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16
Q

Most thrombi form near what?

A

APEX

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17
Q

Blood flow velocity is lowest near what?

A

Apex

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18
Q

What kind of blood will clot?

A

Stagnant blood

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19
Q

Thrombus formation with MI location is where?

A
  1. Anterior LAD (30%)
  2. Inferior RCA (5%)
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20
Q

When does thrombus normally happen?

A

2 weeks post MI

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21
Q

In terms of embolization of thrombi, when will it normally happen?

A

1-3 months post MI

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22
Q

What is the frequency of embolization of thrombi?

A

10%

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23
Q

What increases the risk for embolization?4

A
  1. Protruding
  2. Large size
  3. Mobile
  4. Adjacent to hypermobile segment
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24
Q

What does LV thrombus requires for viewing?

A
  1. 2 views for visualization
  2. High frequency probe and zoom
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25
Q

What does this image represent?

A

LV thrombus

26
Q

What does these images represent?

A

Laminar vs protruding thrombus

27
Q

When is Apical LV thrombus suspected?

A

Apical thickness > septal thickness

28
Q

What should we be suspicious of, when looking at the apical LV for thrombus?

A

Akinetic Anterior/ septal walls, this indicates older thrombus

29
Q

What do we use as a contrast agent when looking for apical LV thrombus?

A

Colour doppler and a low colour scale

30
Q

What is LV contrast enhancement used for?

A

To help visualize LV where visibility is poor

31
Q

In terms of LV contrast, Microbubbles opacify what?

A

The LV cavity or myocardium

32
Q

What does this image represent?

A

LV contrast enhancement

33
Q

What does protruding thrombus indicate?

A

Recently formed thrombus

34
Q

Protruding thrombus may be less echogenic than what?

A

Laminar thrombus

35
Q

Protruding thrombus is more mobile than what?

A

Laminar thrombus

36
Q

Protruding thrombus has a higher risk for what?

A

Embolization

37
Q

What does thrombus protrudes into what?

A

LV cavity

38
Q

We use colour doppler to do what in terms of thrombus?

A

Exclude artifact

39
Q

Color doppler with a lower colour scale will no do what?

A

Fill in the area of the thrombus

40
Q

What does this image represent?

A

Using colour doppler to discern between thrombus and not

41
Q

LA thrombus requires what to form?

A

Homeostasis to form

42
Q

What is the LAA (LA appendage)?

A

Horn like projection extending anteriorly (piglet ear)

43
Q

Where is the LAA best seen?

A

In A2C and PSAX

44
Q

Where is the most common site of LA thrombus formation?

A

LAA

45
Q

What does this image represent?

A

LAA

46
Q

What does this image represent?

A

Thrombus in PSAX and TEE LAA

47
Q

What does this image represent?

A

TEE thrombus in the LAA

48
Q

What does this image represent?

A

LAA thrombus expelled into LA

49
Q

What is the best thing to use to assess thrombi?

A

TEE

50
Q

The LA is located where in both parasternal and apical windows with TEE?

A

Parasternal and apical windows

51
Q

The majority of atrial thrombi form where?

A

In the LLA which is best seen with TEE

52
Q

In the presence of A- FIB, an embolic stroke is assumed to come from where?

A

LA appendage, the other likely source is the carotid bulb

53
Q

What is the standard procedure before elective cardioversion or interventional, electrophysiology studies?

A

TEE for LA thrombus

54
Q

How common is RT heart Thrombi?

A

Rare - Occasionally with severe RV enlargement

55
Q

RT heart thrombi is most likely to come from where?

A

A DVT upstream and get trapped in the TV or RV trabeculae

56
Q

What do we call it when a DVT travels upstream and gets trapped in the TV or RV trabeculae?

A

Migratory thrombus

57
Q

Thrombus in the right heart might be attached to what?

A

Indwelling catheters or pace wires

58
Q

What does this image represent?

A

RT heart Thrombi

59
Q

What does this image represent?

A

Right atrial thrombus

60
Q

What does this image represent?

A

Pulmonary artery thrombus

61
Q

What does these images represent?

A
  1. RA wall clot with PE
  2. Pacer wire clot

DMST 367 Echo 3 (27 decks)

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