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Grad Cert Ultrasound University of Melbourne > Transthoracic Echocardiography Examination > Flashcards

Transthoracic Echocardiography Examination Flashcards

1
Q

What are the four standard TTE windows?

A
  • Parasternal short axis (PSAX)
  • Parasternal Long Axis (PLAX)
  • Apical View (A)
  • Subcostal/Subxiphoid (Subx)
Acoustic windows used for TTE
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2
Q

what is the iHeartScan examination and what does it involve?

A

iHeartScan is also known as Haemodynamic Echocardiography Assessment in Real Time.

It relies on pattern recognition in 2D and colour doppler. It does not include spectral doppler, or the suprasternal window.

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3
Q

What are the four movements of an ultrasound probe?

A
  • Translation (sliding/sweeping) - Movement of the probe over the skin while maintaining 90deg angle to skin. Sliding is translation along the long axis. Sweeping is translation along the short axis.
  • Heel-toe (rocking) - Rocking along the long axis of the probe.
  • Rotation - Moving the probe around it’s long axis.
  • Angulation (tilting/fanning) - Rocking along the short axis of the probe.
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4
Q

Where is the parasternal window located?

A

The aim of the Parasternal window is to have the right ventricle next to the probe.
This is usually achieved by placing the probe in the left fourth intercostal space just lateral to the sternal border.

The location may vary depending on patient position and cardiac location. It is often seen in the 5th intercostal space in patients that are supine, have hyperinflated lungs or unfolded aortas.

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5
Q

What is the optimum positioning of the patient for a Left Parasternal window view?

A

Left lateral at an angle of 45deg - 90deg.

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6
Q

What causes make the parasternal window most likely to be unobtainable?

A
  • Hyper-inflated lungs from PEEP or airway disease.
  • Air in the chest post cardiac surgery (air in the mediastinum will usually resolve 12-24hrs post surgery).
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7
Q

What should be visible in PLAX?

A
  • RV - Right Ventricle (next to probe)
  • ASW - Anterior Septal Wall
  • MV - Mitral Valve
  • AV - Aortic Valve
  • Ao - Aorta (ascending)
  • LV - Left Ventricle
  • AML - Anterior Mitral Leaflet
  • PML - Posterior Mitral Leaflet
  • LA - Left Atrium
  • PW - Posterior Wall
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8
Q

What is the best way to find the PLAX view?

A
  • Locate the 4th intercostal space just lateral of the sternum (May need to move to 5th).
  • Aim the probe index marker towards the right shoulder (dissect R clavicle w/ scan plane).
    • The probe may need to be rotated clockwise due to rib alignment differences.
    • The LV should be horizontal on the screen.
  • The correct PLAX view has both AV and MV in the same view.
  • If the TV is visible, angulate up towards the head to visualise the LV. Once MV and LV both visible, angle/rotate to show both LV and LVOT.
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9
Q

What examination depth should be used for PLAX?

A

Standard depth is 14-16cm, however initially should be set to maximum to note any distant structures e.g. pericardial effusions.

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10
Q

How can the PLAX RVIT view be obtained?

A

Obtain standard PLAX window, then angle down towards the right hip.
This will provide a view of the Right Ventricle Inflow Tract (RVIT) and the Tricuspid Valve.

Some rotation may be necessary.

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11
Q

What view is shown in this cardiac image and what are the structures shown?

A

PLAX view at level of RVI. This shows the RV, RA, TV and CS. The IVC may be visualised posterior to the RA.

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12
Q

how is the PSAX view obtained?

A
  • Obtain a PLAX view.
  • Rotate the transducer 90deg until the index marker aims toward the L shoulder.
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13
Q

What view is shown in the in this cardiac image and what are the structures?

A

PSAX view at AV level. This provides a view of the RV inflow/outflow tract, as well as the RA, TV, RV, PV, PA.

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14
Q

What view is best for visualising the interatrial septum (IAS)?

What can be assessed from this view?

A

PSAX view at the level of just below the aortic valve. The IAS is just below the Aortic Valve.

This view allows assessment of the relative filling pressures of the two sides of the heart.

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15
Q

What is the view that obtained this cardiac image called and what is shown?

A

PSAX view at basal LV level. This shows the RV and LV bases, and the MV made up of the AMVL and PMVL.

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16
Q

What view obtained the following image and what structures are shown?

A

This is the PSAX view at the mid papilliary LV level.

The structures are the moderator band, RV, LV, Septal wall (inferoseptal)

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17
Q

Where is the apical window located on the body?

A

The apical window is found at approximately the 5th intercostal space at the mid clavicular line when the pt is supine.

It may be displaced towards the axillary line if pt is rotated to left lateral position.

If the heart is enlarged or the lungs are large (pneumothorax) and displacing the heart the location may be displaced even more laterally and down to the 6th intercostal space.

If the probe is correctly located the apex doesn’t move on the screen. If it is moving go down one more rib space.

Apical window
18
Q

What is foreshortening in reference to the apical window location?

A

When the probe is accidentally placed over the left ventricular wall and closer to the base than it should be.

This will cause the apex to move in the image. Correct this by moving the probe down one rib space.

19
Q

What is the best way to check if the probe index marker is oriented towards the correct side of the pt for the A4C view?

A

Check that the mitral valve with the asymmetric leaflets is on the right of the screen. The smaller of the ventricles (the right) should be on the left of the screen. The moderator band should also be visible in the RV on the left of the screen.

20
Q

How is the Apical 5-chamber view obtained and what extra information does it show over the A4C?

A

The A5C view is obtained by first obtaining an A4C view and then angling the probe towards the head.

The A5C shows the LVOT and AV which are not shown on the standard A4C view.

21
Q

What is the view shown in the following image, and what are the structures shown?

A

This is the A5C view.

22
Q

Which apical view contains a very good view of all the structures in the left ventricle?

A

The Apical Long Axis View (ALAX) is the best LV view.

23
Q

What is the view shown in the following image and what are the structures shown in it?

A

This is the ALAX view showing the LV and LA.

24
Q

How is the subcostal cardiac window obtained?

A

Place the pt supine, ideally with knees bent.
Place the probe immediately inferior to the xiphoid process and angle upward/slightly leftward.

25
Q

What does area of the heart does the subcostal window provide the best doppler angle for?

A

The subcostal window is the best view for assessing pericardial effusions.

26
Q

What is the best view for doppler assessment of the atrial septum?

A

The subcostal four-chamber view (SC4C).

In this view the septum is perpendicular to the beam angle making it reflect the most ultrasound; and most jets will pass across the septum in the direction of the sector of view.

27
Q

What cardiac window is the best choice during CPR or if the lungs are hyperinflated?

A

The subcostal window.

28
Q

What window allows for global view of the pericardial sac in more than one plane?

A

The subcostal window.

It’s ability to clearly visualise the RV free wall allows for the detection of anterior pericardial effusions and signs of tamponade such as chamber collapse.

29
Q

What cardiac view is shown in the following image and what are the structures shown?

A

THe subcostal 4 chamber view (SC4C).

  • RV
  • LV
  • RA
  • LA
  • TV
  • MV
  • Mod
  • Liver
30
Q

How is the Subcostal 5 Chamber (SC5C) view obtained?

A

Obtain the SC4C view and then angulate upwards. Only a small change in angle is required.

31
Q

How are the Subcostal Short Axis (SCSAX) views obtained?

A

Rotate the transducer so that the index marker is pointing up.

32
Q

What is the following cardiac view and what are the structures shown?

A

SCSAX - AV level.

  • Liver
  • LA
  • RA
  • RV
  • PA
  • AV
33
Q

What view is shown in the following image and what are the structures shown?

A

Subcostal Short axis View at Mid Papillary Level
(SCSAX-LV)

  • Liver
  • LV
  • RV
34
Q

What can be seen by angling the probe to the right while in SCSAX view?

A

The liver, IVC, portal veins and RA.

35
Q

How are the portal veins identified in the SCSAX view of the liver?

A

They have increased echogenicity (whiteness) around the venous chambers compared to the hepatic veins draining into the IVC.

36
Q

How can the RA pressure be estimated in the SCSAX view?

A

The measurments of the IVC size and respiratory variability (collapse during respiration).

37
Q

What are the only patients that pulmonary artery pressure can be measured on using IVC measurements?

A

Spontaneously breathing patients.

38
Q

What are the guidelines for RA pressure values based off IVC size and respiratory variability?

A
39
Q

What are two patient types that normally have dilated IVC?

A

Young athletes and ventilated patients.

40
Q

What is the following window view and what are the structures shown?

A

SCSAX - RA Inflow

  • IVC
  • Liver
  • Hepatic Vein
  • RA
  • Tv
41
Q

How is a subcostal view of the descending aorta obtained?

A

Obtain SCSAX and then turn the index marker up to make the imaging plane vertical.
Then angle towards the right side between SAX and the IVC.

42
Q

What view is shown in the following image and what are the structures shown?

A

SCSAX - Descending Aorta

  • Desc Aorta
  • Liver
  • LV

Grad Cert Ultrasound University of Melbourne (7 decks)

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