Week 4 - Basics of Cardiac Sonography Flashcards

1
Q

What does aliasing in ultrasound mean?

A

Artifact associated with high velocity flow

Doppler shift is so great the flow is displayed inaccurately

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2
Q

What are the different views of an echo?

A

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

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3
Q

What standard views are seen at each window of an echo?

A

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

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4
Q

In a parasternal long axis view of an echo what is the orientation of the screen compared to the structures?

A

Superior (right side of screen) - Aorta

Inferior (left)- Apex

Anterior (top) - RV

Posterior (bottom) - LV

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5
Q

What structures are seen in an echo of a short axis view at apex level?

A

LV apex

RV

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6
Q

What structures are seen in an echo of a short axis view at mid ventricle level?

A

LV papillary muscles

RV

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7
Q

What structures are seen in an echo of a short axis view at mitral valve level?

A

Anterior leaflet

Posterior leaflet

“fish mouth”

RV

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8
Q

What structures are seen in an echo of a short axis view at aortic valve level?

A
  • Aortic cusps (Right coronary, Left coronary, Non-coronary)
  • Coronary arteries
  • LA
  • RA
  • TV
  • RVOT
  • Pulmonic valve
  • Pulmonary artery and bifurcation
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9
Q

What is a TEE?

A

Echo via esophagus and stomach

  • Semi-invasive
  • Transducer on tip of gastroscope
  • 4-7 MHz
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10
Q

What are the advantages of TEE?

A
  • 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
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11
Q

What are the disadvantages of TEE?

A
  • 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
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12
Q

What are the indications of TEE?

A
  • 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)
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13
Q

What are contraindications of TEE?

A
  • 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
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14
Q

What standard equipment is used for a TEE?

A
  • 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
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15
Q

What views change with TEE probe tip manipulation? What about with rotation angle manipulation?

A

Tip: flexion and extension
-look inferiorly and superiorly “Bending”

Rotation Angle: electronic movement of the tip in circle, medial, lateral, anterior, posterior
-“turn”

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16
Q

What are the different windows of a TEE?

A

Upper Esophageal (UE) = 20-25cm

Midesophageal (ME) = 30-40cm

Transgastric (TG) = 40-50cm

Descending Aorta = turn to posterior

17
Q

What are the different views of a TEE?

A

Long axis
Short axis
4 chamber
2 chamber
5 chamber (LVOT)
RVOT

18
Q

What views and structures are seen in the mid esophageal window?

A

Left Ventricle, Right Ventricle, and Mitral Valve

0\* = 4 chamber view 
60-90\* = 2 chamber view 
120-150\* = Long axis view
19
Q

What views and structures are seen in the mid esophageal window?

A

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
20
Q

What views and structures are seen in the transgastric window?

A

LV, RV, MV, TV, IVC

0\* = short axis view 
90\* = long axis view
21
Q

What views and structures are seen in the deep transgastric window?

A

Aortic flow

0* = 4 chamber

22
Q

What views and structures are seen in the descending thoracic window?

A

Aorta

0\* = transverse aorta 
90\* = long aorta
23
Q

Describe post procedure tasks for the patient after a TEE

A
  • 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
24
Q

Describe post procedure tasks for the probe after a TEE

A
  • 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)
25
Q

What TEE window and view is this?

A

Deep Transgastric 4 Chamber

26
Q

What TEE window and view is this?

A

Descending Thoracic Aorta Long Axis View

27
Q

What TEE window and view is this?

A

Descending Thoracic Aorta Short Axis View

28
Q

What TEE window and view is this?

A

Mid Esophageal 2 Chamber

29
Q

What TEE window and view is this?

A

Mid Esophageal 4 Chamber

30
Q

What TEE window and view is this?

A

Mid Esophageal Long Axis View

31
Q

What TEE window and view is this?

A

Transgastric Long Axis View

32
Q

What TEE window and view is this?

A

Transgastric Short Axis View