Week 4 - Basics of Cardiac Sonography Flashcards
What does aliasing in ultrasound mean?
Artifact associated with high velocity flow
Doppler shift is so great the flow is displayed inaccurately
What are the different views of an echo?
Long Axis: longitudinal plane of the heart
Short Axis: transverse plane of the heart
4 Chamber: coronal plane of the heart
*others = 5 chamber, 3 chamber (same as long axis), and 2 chamber
What standard views are seen at each window of an echo?
Parasternal - long axis, short axis, RV inflow
Apical - 4 chamber, 2 chamber, apical long axis (3 chamber)
Subcostal - 4 chamber, IVC long axis, LV short axis
Suprasternal Notch - aortic arch long axis and short axis
In a parasternal long axis view of an echo what is the orientation of the screen compared to the structures?
Superior (right side of screen) - Aorta
Inferior (left)- Apex
Anterior (top) - RV
Posterior (bottom) - LV
What structures are seen in an echo of a short axis view at apex level?
LV apex
RV
What structures are seen in an echo of a short axis view at mid ventricle level?
LV papillary muscles
RV
What structures are seen in an echo of a short axis view at mitral valve level?
Anterior leaflet
Posterior leaflet
“fish mouth”
RV
What structures are seen in an echo of a short axis view at aortic valve level?
- Aortic cusps (Right coronary, Left coronary, Non-coronary)
- Coronary arteries
- LA
- RA
- TV
- RVOT
- Pulmonic valve
- Pulmonary artery and bifurcation
What is a TEE?
Echo via esophagus and stomach
- Semi-invasive
- Transducer on tip of gastroscope
- 4-7 MHz
What are the advantages of TEE?
- Improved resolution and less artifact than standard echo
- Imaging possible when TTE window not available (chest trauma, OR, lung disease, obesity)
- Ascending aorta
- Good eval of aortic annulus and valve
What are the disadvantages of TEE?
- Invasive complications risks related to intubation (trauma to pharynx, larynx, esophagus, stomach, teeth; aspiration, hoarseness, dysphasia, sore throat, respiratory distress, splenic hilar laceration)
- Conscious sedation risk factor
- Pt anxiety and discomfort
- Costly, additional resources
What are the indications of TEE?
- Source of emboli (thrombus or vegetation)
- Prosthetic valves (regurg, abscess, stenosis)
- Valve disease
- Aortic dissection
- Pre cardioversion for A-Fib (thrombus eval)
- Tumor or mass
- Congenital heart disease (ASD or VSD)
- Ventricular function
- MI complications (VSD or papillary muscle rupture)
- Congestive heart disease (LV thrombus)
- Poor TTE
- Chest trauma
- Intraop (valvuloplasty, CHD repair, LV function, myotomy/myectomy eval of intracardiac air)
What are contraindications of TEE?
- Significant esophageal disease (dysphagia, malignancy, diverticulum, fistulas, strictures, esophageal varcies, active upper GI hemorrhage, recent GE surgery)
- Excessive bleeding (check INR, therapeutic range)
- Impaired respiratory status (pulmonary disease, monitor for sleep apnea)
- Unstable c-spine
- Mediastinal radiation
- Penetrating/blunt chest trauma
- Extreme oropharyngeal muscle weakness (muscular dystrophies, inflammatory myopathy, motor neuron diseases, peripheral neuropathy)
- Uncooperative/unwilling pt
What standard equipment is used for a TEE?
- TEE probe
- Standard monitors (BP, O2, HR)
- Lubrication
- Suction
- O2/nasal cannula and bite block
- Gauze
- Emesis basin
- IV access/supplies
- PPE
- Intubation tray
- Crash cart
- TEE report sheet
- Meds
What views change with TEE probe tip manipulation? What about with rotation angle manipulation?
Tip: flexion and extension
-look inferiorly and superiorly “Bending”
Rotation Angle: electronic movement of the tip in circle, medial, lateral, anterior, posterior
-“turn”
What are the different windows of a TEE?
Upper Esophageal (UE) = 20-25cm
Midesophageal (ME) = 30-40cm
Transgastric (TG) = 40-50cm
Descending Aorta = turn to posterior
What are the different views of a TEE?
Long axis
Short axis
4 chamber
2 chamber
5 chamber (LVOT)
RVOT
What views and structures are seen in the mid esophageal window?
Left Ventricle, Right Ventricle, and Mitral Valve
0\* = 4 chamber view 60-90\* = 2 chamber view 120-150\* = Long axis view
What views and structures are seen in the mid esophageal window?
Mitral valve, Aortic valve, Left atrium, LA appendage, Inter atrial septum
120-150\* = Long axis view 60-90\* = 2 chamber view 0\* = 4 chamber view
What views and structures are seen in the transgastric window?
LV, RV, MV, TV, IVC
0\* = short axis view 90\* = long axis view
What views and structures are seen in the deep transgastric window?
Aortic flow
0* = 4 chamber
What views and structures are seen in the descending thoracic window?
Aorta
0\* = transverse aorta 90\* = long aorta
Describe post procedure tasks for the patient after a TEE
- Check pt mouth/pharynx for bleeding
- Monitor vitals until return to baseline (20-30 min)
- Instructions for the patient — stand precautions regarding sedation and report adverse side effects to physician such as sore throat >2 days, bleeding, painful IV, fever
Describe post procedure tasks for the probe after a TEE
- Container/bag for contaminated probe
- Check probe for signs of bleeding, bites, cracks, tears
- Disinfecting agents and workstation — follow manufactures guidelines (rinsed w/ soap or enzymatic solution, soaked in disinfecting solution 20 min, rinsed per manufactures guidelines, dry and hang on TEE rack)
What TEE window and view is this?
Deep Transgastric 4 Chamber
What TEE window and view is this?
Descending Thoracic Aorta Long Axis View
What TEE window and view is this?
Descending Thoracic Aorta Short Axis View
What TEE window and view is this?
Mid Esophageal 2 Chamber
What TEE window and view is this?
Mid Esophageal 4 Chamber
What TEE window and view is this?
Mid Esophageal Long Axis View
What TEE window and view is this?
Transgastric Long Axis View
What TEE window and view is this?
Transgastric Short Axis View
