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Echo Review
ARDMS Review Questions
582
Health Care
Professional
06/24/2014

Additional Health Care Flashcards

 


 

Cards

Term
What two chambers form the most anterior aspect of the heart?
Definition
The right ventricle and right atrium.
Term

By looking at the spectral Doppler tracing below, how much AI is present?

 

[image]

Definition
Mild because the slope does not appear steep and the window is not filled in.
Term
What area of the heart is not covered by the pericardium?
Definition
The base of the heart which is formed by the left atrium where the four pulmonary veins enter.
Term
Name the two layers of tissue that compose the pericardium.
Definition

Visceral (inner serous) layer

and

Parietal (outer fibrous) layer

Term

Name the layers of the heart walls from outer to inner.

Definition
  1. Epicardium which is also the visceral layer fo the serous pericardium.
  2. Myocardium which is the muscle layer.
  3. Endocardium which is the intimal or epithelial layer which also forms the valves.
Term
Deoxygenated blood from the superior and inferior vena cava empties into the?
Definition
Right Atrium
Term
Name the two atrioventricular valves.
Definition

Mitral valve and tricuspid valve.

Term
Name the muscular ridges that line the right atrium, anterior and lateral walls of the heart.
Definition
Pectinate Muscles
Term
Name the two semi-lunar valves.
Definition
Aortic and pulmonic valves.
Term
The main coronary arteries arise from the?
Definition

Right and left coronary cusps of the aortic valve.

 

The coronary cusps are located in the region of the sinuses of Valsalva in the proximal ascending aorta.

Term
The bulging areas of the ascending aorta that are adjacent to each of the coronary cusps forms the?
Definition
Sinuses of Valsalva
Term
Name the fold of tissue that guards the inferior vena cava.
Definition
Eustachian valve
Term
The two divisions of the right ventricle are?
Definition
  1. Posteroinferior inflow portion - This portion of the right ventricle contains the tricuspid valve.

   2.  Anterosuperior outflow portion - This portion

        of the RV contains the origin of the pulmonary

        trunk, and can also be called the conus

        arteriosus, or infundibulum.

Term
The chordae tendinae are the attachment of the mitral and tricuspid valves to the?
Definition
Papillary muscles
Term
The absence of the pulmonary veins entering the left atrium is known as?
Definition

TAPVR or Total Anomalous Pulmonary Venous Return.  The findings for this anomaly is the convergence of all the pulmonary veins to form a venous sinus superior to the left atrium.  Other findings include enlargement of the right and left ventricles, right ventricular hypertrophy, and a patent foramen ovale or atrial septal defect.

Term
The m-mode tracing diplayed below indicates a wall motion abnomality involving the?
Definition
Interventricular septum.
Term

The muscle bundles that line the walls of the right and left ventricles are the?

Definition
Trabeculae carnae
Term
What is the name of the small, fibrous, nodule located at the center of each of the aortic valves cusps?
Definition

Arantius nodule

 

The Arantius nodules aid in the support of the cusps.

Term
When there are two ostiums in the right coronary sinsus, one of the ostiums typically gives rise to the right coronary artery, what structure arises from the other ostium?
Definition

The conus artery.

 

If the consus artery does not come off the coronary sinus, it is the first branch off of the right main coronary artery.

Term
What is the potential importance of the conus artery?
Definition
The conus artey may act as an alternate route of collateral arterial circulation.
Term
Name the walls of the heart on the short axis view below.
Definition

1. Interventricular septum

2. Anterior wall               

3.Lateral wall                 

4. Posterior wall             

5. Inferior wall               

Term

The right interior oblique view that is obtained during a heart catheterization is similar to what view on the echocardiogram?

Definition
Apical two chamber view.
Term
The naturally occurring shunt between the aorta and the pulmonary artery in fetal circulation is referred to as?
Definition
Ductus arteriosus
Term
What are the names of the pulmonic valve cusps?
Definition

1. Anterior pulmotic valve cusp

2. Right pulmomic vavle cusp  

3. Left pulmonic valve cusp     

 

Term
What are the names of the tricuspid valve leaflets?
Definition

1. Anterior tricuspid vavle leaflet   

2. Septal tricuspid valve leaflet     

3. Posterior tricuspid valve leaflet 

Term
When performing an echocardiogram on a patient with suspected cardiac temponade, diastolic collapse may noted on the?
Definition
Right ventricle.
Term
An inflammation that affect the cardiac valves, and inner lining is?
Definition
Endocarditis
Term
What portion of the heart is continuous with the interventricular septum?
Definition
The antrior aortic root wall.
Term

What portion of the heart is a continuation of the anterior mitral valve leaflet?

 

Definition
The posterior aortic root wall.
Term
What are the possible cardiopulminary complications associated with mitral stenosis?
Definition

1. Atrical fibrillation (40-50% of patients with symptomatic mitral stenosis have atrial fibrillatin).

        2. Mitral insufficiency

3. Left atrial enlargement

4. Systemic emboli

5. Pulminary hypertension

6. Endocarditis

7. Dialated right ventricle

8. Right ventricular hypertrophy

9. Tricuspid insufficiency 

                                   

                      

    

                      

                          

Term
List the vessels that typically arise from the aortic arch.
Definition

1. Left subclavian artery

2. Brachiocephalic or innominate artery

3. Left common carotid artery

 

(Please note that there are variations from the normal anatomy).

Term
The "hockey stick" appearance is associated with what cardiac abnormality?
Definition

Mitral stenosis

 

The "hockey stick" appearance is also known as diastolic doming of the mitral valve leaflets.

Term

The portion of the aorta known as the isthmus is formed by the joining of the descending aorta and the? 

 

Definition
Aortic arch
Term
Which one of the coronary arteries is the major blood supply to the right ventricle?
Definition

The acute marginal branch.

 

The acute marginal artery branches off of the right coronary artery.

Term
A moderator band is a structure that is typiaclly seen in the?
Definition

Right ventricle

 

Teh moderator band is a muscle that crosses from the lower interventricular septum to the anterior papillary muscle.

Term
For Mitral Stenosis, What is the formula for Pressure Half Time?
Definition
Initial Peak divided by 1.4 = Pressure Half Time
Term
For Mitral Stenosis, Which is the best Doppler Method?
Definition
Pressure Half Time
Term
How do you calculate Mitral Valve Area?
Definition
MVA=220 divided by Pressure Half Time
Term
What is the simplified method for MVA?
Definition
MVA=759 divided by decel. time
Term
What is considered normal MVA?
Definition
4.0-6.0 cm squared
Term
What is considered moderate MS for MVA?
Definition
1.0-1.5 cm squared
Term
When is the Continuity Equation an inaccurate way to determine MVA?
Definition
When there is moderate-severe MR or severe AI
Term
How do you calculate the peak pressure gradient for MS?
Definition
Measure the peak velocity & put into the Bernoulli Equation
Term
Which is the most common method used for MS?
Definition
Mean Pressure Gradient
Term
What is considered moderate for mean pressure gradient of MS?
Definition
5-12 mmHg
Term
What is the Cascade of Ischemia?
Definition
It is the order of events after the myocardium has been denied oxygen.
Term
What is the most accurate 2D method used to determine MVA?
Definition
Planimetry
Term
What are the 6 methods used for quantifying MS?
Definition

Pressure Half Time

Continuity Equation

Peak Gradient

Mean Gradient

Planimetry

P.I.S.A 

Term
What is the Wilkins Scoring?
Definition
It is used to determine if surgery is to be suggested for the mitral valve.
Term
If the Wilkins Score is 8 or less, what does it indicate?
Definition
There is a possibility of a good outcome.
Term
Using Wilkins Score, what score would suggest surgery and what score could mean a high death rate?
Definition

9-surgery suggested

12- high death rate 

Term
What will be seen with severe MR?
Definition
"S" wave reversal of the pulmonary vein tracing
Term
What will acute, severe MR look like?
Definition
"V" shaped waveform
Term
Where does a mural thrombus most commonly occur?
Definition
Apex-in areas of akinesis
Term
With MR, where is the jet width measured at?
Definition
the Vena Contracta
Term
What is the term used when severe MR hugs the wall & may still reach the most posterior aspect of the LA & fills the pulmonary veins?
Definition
Coanda Effect
Term
How do you perform P.I.S.A for MR?
Definition

1. Angle to get biggest P.I.S.A

2. Zoom on P.I.S.A

3.Change nyquist limit (lower baseline, bottom # should be 30-40)

4. Freeze & Scroll back for largest P.I.S.A

5. Measure leaflet level to peak

6. Put into formula 

 

Term
For EROA, what is considered moderate?
Definition
30-39 mm squared
Term
What does EROA stand for?
Definition
Effective Regurgitant Orifice Area
Term
What are the 2 most common locations for a true aneurysm?
Definition
apical inferior & posterior areas
Term
How can you tell the difference between a true aneurysm & a pseudoaneurysm?
Definition

True- Has wider neck; buldging

Pseudo- Has small neck 

Term
With papillary muscle dysfunction, 60% occur with which wall?
Definition
anterior wall
Term
Which areas are most commonly involved with Acute VSD?
Definition
basal septum or apical septum
Term
Which artery is affected with RV infarction?
Definition
RCA-proximal portion
Term
What occurs after an infarction?
Definition

*Myocardium becomes akinetic (happens within hrs)

*Myocardium thins (happens over time)

*Myocardium becomes more echogenic (happens over time) 

Term
Define Stroke Volume.
Definition
The amount of blood pumped out of the heart with each contraction or  beat.
Term
What is the formula for Stroke Volume?
Definition
EDV-ESV= SV
Term
What is Afterload?
Definition
The force the ventricle must eject blood against
Term
What is preload?
Definition
Initial stretching of the myocytes prior to contracting
Term
What is the amount of blood ejected by a ventricle in one minute?
Definition
Cardiac Output
Term
What is the calculation for cardiac output?
Definition
Stroke Volume x Heart Rate
Term
What is Cor Pulmonale?
Definition
Right heart failure due to pulmonary disease
Term
What is the formula for cardiac index?
Definition
Cardiac Output divided by BSA
Term
What is muscular synchronicity?
Definition
Correct timing of the ventricular & atrial systole which is essential to produce a maximum cardiac output
Term
What can cause muscular dyssynchronicity?
Definition

*Bundle Branch Block

*Chronic Atrial Arrythmias

*Ischemia 

Term
What are 4 factors that affect the contractive state of the myocardium?
Definition

-Ischemia

-Cardiomyopathies

-Stimulation of Sympathetic Nervous System Hormones

-Negative Inotropic Medications 

Term
What is hypokinesis?
Definition
Markedly reduced wall thickening
Term
An absence of wall thickening is also known as what?
Definition
akinesis
Term
What abnormal wall motion is associated with dyskinesis?
Definition
paradoxical movement
Term
What is the fractional amount of blood being pumped out of the ventricle with each contraction?
Definition
Ejection Fraction
Term
What is the formula and normal range for Ejection Fraction?
Definition

Formula: EDV-ESV divided by EDV x 100

Normal Range: 55-75% 

Term

Define Heart Rate.

 

Definition
The number of contractions of heart in one minute
Term
What is affected most by heart rate?
Definition
The amount of filling
Term
What are the 2 normal systolic functions of the heart?
Definition

1. Walls thicken

2. Ventricular chamber size decreases 

Term

Which circulation of the heart transports blood to the alveoli so that blood can exchange CO2 for O2 at the capillary level?

Definition
Pulmonary Circulation
Term
What is the Pulmonary Circulation composed of?
Definition
IVC and SVC, Pulmonary Artery—Right and Left Pulmonary Artery, Pulmonary Capillaries that surround the Alveoli.
Term
What nervous system controls the Pulmonary Circulation?
Definition
The Autonomic Nervous System
Term
Which circulation of the heart supplies oxygenated blood to the rest of the body’s tissues?
Definition
Systemic Arterial Circulation
Term
What is the Systemic Arterial Circulation composed of?
Definition
Aorta and Arterioles
Term
What regulates the Mean or Average Blood Pressure and controls blood flow into organs?
Definition

Arterioles

Term
What are Arterioles made up of?
Definition
Metarterioles and Capillaries
Term
This contains neurons that accelerate heart rate and stroke volume via sympathetic stimulation (SA Node).
Definition
Cardio Accelerator Center
Term
This contains neurons that decrease heart rate and stroke volume via parasympathetic impulses.
Definition
Cardio Inhibitor Center
Term
This contains neurons that control blood vessel diameter via the sympathetic nervous system.
Definition
Vasomotor Center
Term
What are Baroreceptors?
Definition
Pressure sensitive sensory neurons—when pressures fall too low, or rise too high, they send signals to the brain to cause the appropriate nervous system to be activated.
Term
These sense and monitor the pH activity, O2 levels and CO2 levels.
Definition
Chemoreceptors
Term
What hormones increase blood pressure?
Definition
Epinephrine and Norepinephrine, Renin, Antidiuretic Hormone (ADH) and Aldosterone
Term
Which circulation of the heart returns blood from the rest of the body to the right heart and lungs and acts as a capacitor or storage location for blood until it is needed?
Definition
Systemic Venous Circulation
Term
What is the Systemic Venous Circulation controlled by?
Definition
Sympathetic Nervous System and Arterial tone
Term
What are the factors that locally control blood flow?
Definition
Exercise and Digestion
Term
What acts as a pump for blood when one is lying down—supine?
Definition
the Diaphragm
Term
What acts as a pump when one is upright—walking?
Definition
Calf Muscles
Term
Which circulation of the heart provides constant supply of oxygen rich blood to the myocardium under varying conditions or demands?
Definition
Coronary Circulation
Term
What are the 2 main arteries that carry blood to the heart?
Definition
Left Coronary Artery and Right Coronary Artery
Term
What two arteries does the Left Main Coronary Artery bifurcate into?
Definition
Left Anterior Descending (LAD) and Circumflex (LCx)
Term
What artery feeds the Anterior wall?
Definition
Left Anterior Descending (LAD)
Term
What artery feeds the Posterior wall?
Definition
Circumflex (LCx)
Term
What artery feeds the Apical wall?
Definition
Left Anterior Descending (LAD)
Term
What artery feeds the Inferior wall?
Definition
Right Coronary
Term
What artery feeds the Lateral wall?
Definition
Circumflex (LCx)
Term
What artery feeds the Septal wall?
Definition
Left Anterior Descending (LAD)
Term
What does the Circumflex branch into?
Definition
the Obtuse Marginal Branches
Term
What is Autoregulation?
Definition
The ability of the coronary arteries to maintain a constant perfusion pressure by dilating when myocardial O2 becomes too low due to large reduction of flow and oxygen.
Term
What are some factors that DECREASE Coronary flow?
Definition

 - Blockage of the coronary arteries   

 - A decrease in aortic end diastolic pressures           

 - An increase in LV end diastolic pressures  

 - An increase in RA pressures

Term
What is the purpose of the Coronary Veins?
Definition
To drain the heart’s muscle of blood back into the RA
Term
What are the 3 Coronary Veins?
Definition

    - Coronary Sinus      

    - Anterior Right Ventricular Veins                             

    - Thesbian Veins

Term
How many Cardiac Veins are there?
Definition
4
Term
Name the 4 Cardiac Veins.
Definition

                 - Small Cardiac Vein    

                 - Middle Cardiac Vein                   

                 - Great Cardiac Vein                           

                 - Coronary Sinus

Term
Where is the Coronary Sinus located?
Definition
Posterior part of the Coronary Sulcus or AV Groove
Term
Where are the Anterior Right Ventricular Veins located?
Definition
in the Anterior Right Ventricular Free Wall
Term
What are Thesbian Veins?
Definition
Tiny venous outlets that drain the Myocardium directly into the RA and Ventricle.
Term
True/False. With expiration, preload pressures are increased.
Definition

        FALSE — Inspiration increased. Expiration decreased

Term
What is the main fuel of the heart?
Definition
Fatty Acids
Term
What are the Major Determinants of Myocardial Oxygen Requirements?
Definition

         - Ventricular Wall Tension

         - Contractility

         - Stress Hormones

         - Drugs

         - Heart Rate

Term
What coronary artery supplies the SA Node?
Definition
Right Coronary Artery
Term
True or False? The esophagus is located between the pharynx and the stomach.
Definition
TRUE
Term
List the medical personnel that must be in the room for a TEE procedure.
Definition
Physician, nurse and sonographer.
Term
True or False? A patient must be monitored by a pulse oximeter during a TEE?
Definition
TRUE
Term
What percentage of TEEs results in death?
Definition
<.01%
Term
Which structure is more anterior, the trachea or the esophagus?
Definition
TRACHEA
Term
Which of the following is not a reason to perform a TEE? A. mitral valve abnormalities B. Aortic root dissection C. Congenial defects D. flu symptoms
Definition
D. flu symtoms
Term
When would an outpatient be able to leave after a TEE?
Definition
Must have a driver, gag reflex must have returned, normal B/P and HR must be cleared by the nurse.
Term
How long must a patient be NPO for a TEE?
Definition
Four hours prior to the exam
Term
What must you be concerned with when performing a TEE on a patient with a recent CVA?
Definition
Dysphagia
Term
What medication(s) during TEEs are given to patients in order to reduce anxiety?
Definition
Valium, Demerol and Morphine can be given to reduce anxiety.
Term
What are the names (2) of the substances that eliminate the gag reflex used in TEE procedures?
Definition
Cetacaine, viscous lidocaine
Term
What is versed?
Definition
Induces short term amnesia also known as conscious sedation. Used in TEE to sedate patients
Term
What is used to make sure the gag reflex is gone before performing a TEE?
Definition
Tongue depressor
Term
State the absolute contraindications for a TEE?
Definition
Inability to swallow, esophageal varies, tumors or strictures, gastrointestinal bleeding, unwilling patient
Term
What is the ideal position for a patient having a TEE?
Definition
Left Lateral Position
Term
True or False? TEE is low frequency ultrasound.
Definition
False
Term
True or False? A bite block should be used at all times, even if the patient has already removed his/her dentures.
Definition
False, a bite block is not necessary if the patient does not have any teeth.
Term
What is the most common cause for tricuspid stenosis?
Definition
Rheumatic Fever
Term
What is normal tricuspid valve area?
Definition
>7cm2
Term
When is a commisurotomy most likely to be performed on the TV?
Definition
mean gradient>4mmHg
Term
When is the RV impaired due to TS?
Definition
TV area measures <1.5 cm2
Term
When does pedal edema occur with TS?
Definition
Mean gradient of 10mmHg
Term
What must the Doppler of Tricuspid Valve E wave measure in order to confirm the presence of TS?
Definition
>.7 m/sec
Term
While performing an echo you realize the patient’s TR velocity reaches a proximal 1/3 of the RA, what is the amount of TR present?
Definition
Moderate (2+)
Term
What is the only way severe TR can be verified?
Definition
Use Color and PW. Look for flow reversal in the IVC and hepatic veins during systole. PW hepatic vein to show flow reversal of the “s” wave above the baseline.
Term
What does RVSP stand for?
Definition
Right Ventricular systolic pressure
Term
If the IVC completely collapses how many mmHg would you add to get your RVSP?
Definition
+5mmHg
Term
If the IVC is dilated with a partial collapse how many mmHg would you add to get your RVSP?
Definition
+15mmHg
Term
What formula is used to estimate RVSP?
Definition
4(TR velocity)(squared)+IVC=RVSP
Term
If TR is present in a patient that has had an MI would the RVSP be overestimated or underestimated?
Definition
Underestimated
Term
What is the most common cause of pulmonic stenosis?
Definition
congenital
Term
What type of murmur is heard with pulmonic stenosis?
Definition
S.E.M. (systolic ejection murmur)
Term
How is a Rt sided murmur different from a Lt sided murmur?
Definition
Rt sided murmurs increase with inspiration
Term
What is seen on M-Mode with a patient that has severe pulmonary stenosis? (be specific)
Definition
increased A dip/wave >7mm
Term
Using a peak gradient of 4 m/s, estimate the severity of the pulmonary stenosis.
Definition

4(4*4)=64mmHg

moderate P.S.

Term
Using a peak gradient of 4.5 m/s estimate the severity of PS
Definition

4(4.5*4.5)=81 mmHg

Severe PS

Term
What is the most common cause of pulmonary insufficiency?
Definition
PHTN
Term
What type of murmur is heard at the LSB when severe PI is present?
Definition
Graham Steele
Term
In a patient with systemic hypertension what valve should we assess and why?
Definition
AV, use color to assess and look for AI if dilated
Term
What is the most common cause of PHTN?
Definition
idiopathic
Term
What is a common 2D finding in a patient with severe PHTN?
Definition

"D" sign

due to flattening of IVS

Term
What is seen on M-Mode that shows significant PHTN is present?
Definition
"flying W"
Term
A PI waveform has a maximum velocity of 1.8 m/s.  Calculate the mean PA pressure.
Definition
4(1.8*1.8)= 12.96 mmHg
Term
If a patient has an acceleration time of 87 msec and has a dilated IVC with partial collapse, calculate the RVSP.
Definition
79-(.45*87)=30.85mmHg+15=45.85mmHg
Term
What is Cor Pulmonale?
Definition
RV heart failure due to pulmonary disease.
Term
T or F   The weakest echoes or scatters (chambers) will appear grayish on screen.
Definition

False

The weakest echoes appear black on screen (the blood filled chambers)

Term
T or F   The largest, brightest white echo on screen is the pericardium.
Definition
True
Term
Where is the transducer placed on the body to obtain a PLAX?
Definition
LSB, 3rd ICS
Term
Where should the orient marker be when obtaining a PLAX?
Definition
towards the patients Rt shoulder
Term
What structure should not be visualized in the PLAX?
Definition
Apex
Term
From the PLAX the RV tilt is obtained by aiming the beam in what direction?
Definition
inferior and medial
Term
Which TV leaflets are seen in the RV tilt?
Definition
posterior and anterior
Term
Which chamber is the moderator band found in?
Definition
RV
Term
What two walls are seen in the Apical 2 chamber?
Definition
anterior and inferior
Term
What non-cardiac structure is seen in the subcostal long axis?
Definition
Liver
Term
This is a fetal remnant that is occasionally seen in the RA as thin strands.
Definition
Chiari Network
Term
Name the only view that the TV posterior leaflet can be visualized.
Definition
RV tilt
Term
Beginning with an Apical 4 how do you move the transducer to obtain an Apical 2?
Definition
Rotate transducer approximately 90° counterclockwise
Term
What is the difference between the PLAX and the Apical Longaxis (3 chamber)?
Definition
The apex is seen in the apical longaxis (3 chamber)
Term
What is the subcostal long axis great for evaluating?
Definition

1) ASD's

2) evaluating pericardial fluid

Term
If the apex is seen in the PLAX, how is the probe wrongly positioned?
Definition

The probe is either too low or too lateral.

Term

What is the name for the “smoke” that is seen with DCM?

Definition
Spontaneous Contrast
Term
What are the two things that the patient’s outcome or longevity depend on?
Definition
a.How good the RV systolic function is

b.The amount of MR/TR and the resultant secondary pulmonary hypertension that is present.
Term

What can be seen by PW doppler in a patient with DCM?

Definition
V1(LVOT) velocity is decreased
Term

Why is the V1(LVOT) velocity decreased with DCM?

Definition
There is a decrease in systolic pressures in the LV chamber and a decrease in cardiac output.
Term
What calculations can be performed with DCM?
Definition
-MR—dP/dT

-TR—RVSP

-Modified Simpsons—EF

-Contrast—rule out thrombus

-Diastolic Function
Term
What is the treatment for Ischemic Cardiomyopathies?
Definition
Pacemaker—for arrhythmia
Term
When does a Peripartum Cardiomyopathy develop?
Definition
the last month of pregnancy or within 5 months postpartum
Term
Who’s most likely to develop a Peripartum Cardiomyopathy?
Definition
Women older than 30 yrs, twin pregnancy, women of African descent or family history of peripartum cardiomyopathy
Term
What is the usual time frame for recovery of a Peripartum Cardiomyopathy?
Definition
6 months
Term
What causes a Toxic Cardiomyopathy?
Definition
- heavy drinking for more than 15 yrs

- cancer treating agents
Term
What is the treatment for a Toxic Cardiomyopathy?
Definition
Abstinence
Term

What can be misdiagnosed as either a DCM or HCM and why?

Definition
Athlete’s Heart—added muscle mass
Term
What is the leading cause of heart failure in elderly women?
Definition
Hypertensive Dilated Cardiomyopathy
Term
What is the treatment for a Hypertensive Dilated Cardiomyopathy?
Definition
Medication to treat the hypertension
Term
What is seen by PW Doppler with HOCM?
Definition
Dynamic dagger
Term
What are the provocative maneuvers that can be used with a patient to determine if an obstruction is present?
Definition
- valsalva

- squatting

- standing

- reclining

- Amyl Nitrate
Term
When can Amyl Nitrate not be used?
Definition
If patient has resting gradient of 50mmHg or 3.5m/sec
Term
What are the two pitfalls of HOCM?
Definition
- Aortic Stenosis can coexist with subaortic stenosis—must obtain gradient in both which can be difficult to get V1(LVOT)

- MR coexists with HOCM (due to SAM)—easy to obtain part of any MR flow, and the waveform will look like dagger also.
Term
What are the two different treatments for HOCM?
Definition
- Beta Blockers

- Septal Myectomy

- Pacemaker

- Alcohol Ablation
Term
What is the first line of treatment for HOCM?
Definition
Beta Blockers
Term
What is Alcohol Ablation?
Definition
Procedure where 100% absolute alcohol is injected into one of the branches of the heart artery that feeds the enlarged septum. Alcohol is very toxic to the heart muscle cells—causes it to die and shrink and scar. Blood flow out of the LV is reduced.
Term
What is another name of a Sigmoid Septum seen in elderly patients?
Definition
Catenoid
Term
What causes the patient to develop a “dip and plateau” with Restrictive Cardiomyopathy?
Definition
This is caused by the early diastolic drop followed by a rise in pressures.
Term
With Restrictive Cardiomyopathy what will be seen with the Diastolic Function—Deceleration Time and Pulmonary veins?
Definition
- Deceleration Time: extremely short < 150msec, Mitral inflow—“E” wave is much taller than “A” wave, E to A ratio > 2.2

- Pulmonary veins: S < D
Term
What is the treatment for Sarcoidosis?
Definition
Steroids

Pacemaker—arrhythmias
Term
What is Arrhythmogenic Right Ventricular Disease?
Definition
Rare, but increasingly recognized condition characterized by apparent patchy apoptosis of the right and, to a lesser extent, LV.

a.k.a. Fat Cardiomyopathy
Term
What can be seen with Arrhythmogenic Right Ventricular Disease?
Definition
- SVT and Ventricular arrhythmias

- Right Heart Failure

- Increased risk of perforation of tamponade

- Sudden death is the first sign of ARVC—usually made postmortem
Term
What are the treatments for Arrhythmogenic Right Ventricular Disease?
Definition
- Anti-arrhythmia medications

- Radiofrequency Ablation and Cardioverter-Defibrillators

- Heart Transplant
Term
What is it called when there is a perceived change in the frequency of a sound?
Definition
The Doppler Effect
Term
In Doppler Effect, there must be movement between either the - of the sound or the - of the sound
Definition
emitter ; reflector
Term
What changes as the distance between the sound source and the reflector changes?
Definition
the frequency
Term
True or False. As the distance between the source and the reflector decreases, the frequency increases or becomes higher.
Definition
true
Term
What is the difference between the emitted frequency and the received frequency called?
Definition
The Doppler Shift
Term
Without movement, what cannot change?
Definition
the frequency or the Doppler Shift
Term
In order to determine the Doppler Shift, the transducer frequency has to bounce off--- and is measured by subtracting it from the transmitted frequency.
Definition
Red Blood Cells-moving target
Term
When is the Doppler Shift positive?
Definition
When the returning frequency is higher than the emitted frequency
Term
What color is a positive Doppler Shift on the color Doppler?
Definition
Red
Term
On Spectral Doppler, where is the positive shift positioned?
Definition
Above the baseline
Term
When is the Doppler Shift negative?
Definition
When the returning frequency is lower than the emitted frequency.
Term
What color is a negative shift on color Doppler?
Definition
Blue
Term
On Spectral Doppler, where is a negative shift positioned?
Definition
Below the baseline
Term
What units does the Doppler Shift use?
Definition
Hertz or kHz
Term
What units does velocity use?
Definition
cm/sec or m/sec
Term
What must be known in order to convert from Doppler Shift to velocity?
Definition
The angle must be known
Term
What is Doppler used to measure?
Definition
Speed and direction of blood as it moves through the heart's valves and blood vessels
Term
The doppler equation states that the ---- of the measured velocity will change with the ----of the angle between the ultrasound---- and the ----.
Definition
accuracy---cosine---sound---reflector
Term
What angle are you at when you are parallel to something?
Definition
angle of 0 degrees
Term
What angle are you at when you are perpendicular to something?
Definition
angle of 90 degrees
Term
What is obtained when you have the cosine of a 0 degree angle which is 1?
Definition
The maximum difference between the transmitted and received frequencies
Term
What is obtained when you have the cosine of a 90 degree angle which is 0?
Definition
Zero Doppler Shift with 100% error in representing the velocity of the reflector
Term
Does a Doppler Shift of 0 cm/sec mean that there is no movement of blood? What does it mean?
Definition
No, The angle between the transducer and the reflectors could be 90 degrees.
Term
What is it called when the Spectral Doppler is performed along with color Doppler?
Definition
Color flow duplex imaging
Term
What should always be used when assessing valves with pulsed or continuous wave doppler? Why?
Definition
Color. Color Doppler demonstrates where to place the cursor and sample volume
Term
What are the three anatomy parts of a Doppler spectrum?
Definition
Velocity ,Time ,Amplitude
Term
Does velocity always determine the severity of blood flow?
Definition
No
Term
What must you have in order to determine the time on a Doppler spectrum?
Definition
EKG tracing to note the part of the cardiac cycle the blood is flowing
Term
How is the amplitude shown on Spectral Doppler?
Definition
The brightness of the pixels represents the relative number of RBCs produced at that moment in time
Term
Why do we perform spectral doppler?
Definition
To measure how fast blood flow is moving and to determine the direction
Term
Why do we measure velocities?
Definition
To perform calculations to determine the severity of a flow abnormality
Term
What is used to create the spectral display on the monitor?
Definition
Fast Fourier Transform
Term
How many crystals does pulsed wave Doppler have?
Definition
Only one crystal. It spends time alternating between sending out pulses and receiving returning signals
Term
How many cycles long is each pulse?
Definition
5 to 30 cycles
Term
What is Pulse Repetition Frequency?
Definition
The rate at which the crystal sends out pulses 10 to 30 kHz
Term
When performing PW, there is a small doubled line area on the cursor. What is it called?
Definition
Sample Volume
Term
What is the major benefit of PW Doppler?
Definition
Range Resolution. It can precisely locate and evaluate blood flow
Term
What is the sample volume size for Valves?  Veins?  Tissue?
Definition
Valves 2 mm
Veins 3-4 mm
Tissue 5 mm
Term
What is the shape of the Sample Volume?
Definition
tear drop
Term
What is the major limitation of PW Doppler?
Definition
We are limited in our ability to measure fast blood flow due to the signal-to-noise ratio which is affected by the volume of blood we are sampling
Term
What is it called when the signal "wraps around" the baseline?
Definition
aliasing
Term
What happens when the Doppler Shift exceeds 1/2 of the PRF?
Definition
aliasing will occur
Term
Aliasing depends on the PRF, which changes with both ---- and ----.
Definition
Depth
Frequency of the probe
Term
What can you do to remove aliasing?
Definition
-first, lower your baseline and/or raise your scales
-lower doppler frequency setting
-try another view where you can use a shallower depth
-switch to CW doppler where higher velocities can be measured
Term
How many crystals does Continuous Wave Doppler have?
Definition
Two crystals
Term

What can CW Doppler measure?

Definition
-extremely fast blood flow
-eliminates the problem of aliasing
Term
What is Range Ambiguity?
Definition
It cannot determine exactly where blood flow is being evaluated because it evaluates all blood flow within the beam
Term
What type of CW Doppler can be positioned in an area of interest while the image is displayed?
Definition
Steerable Duplex Imaging
Term
What CW Doppler has a better signal-to-noise ration?
Definition
Non-Imaging CW
Term
What must you have to note the part of the cardiac cycle you are in?
Definition
EKG tracing
Term
What is the relaxation phase for the ventricles called?
Definition
Diastole
Term
What is the contraction phase of the ventricles called?
Definition
Systole
Term
What valves are open when the blood is flowing through them into the ventricles while the semilunar valves are closed?
Definition
A-V valves;
Mitral and Tricuspid
Term
When the sample volume is placed at the location of the LVIT and the RVIT, in what cardiac cycle and where is the flow placement?
Definition
During diastole above the baseline
Term
When the sample volume is placed at the location of the LVOT and the RVOT, in what cardiac cycle and where is the flow placement?
Definition
During systole below the baseline
Term
Laminar blood flow when using PW Doppler will have a ---- center.
Definition
Dark
Term
---- blood flow will be filled in with white in the center.
Definition
Turbulent
Term
When is the pulmonic valve peaked? Why?
Definition
last 2/3 of systole due to being a low resistant bed
Term
What should you see when performing PW on the LVOT flow?
Definition
Closing valve "click"
Term
What other flows are assessed by Pulsed Doppler?
Definition
-Pulmonary Vein flow
-Hepatic Vein flow
-Suprasternal
Term
When does aliasing occur?
Definition
When blood flow exceeds 1/2 the PRF or Nyquist Limit
Term
What shape is Mitral and Tricuspid regurgitation if its chronic? acute?
Definition
chronic- "U" shaped
acute- "V" shaped
Term
What part of the cardiac cycle will tricuspid or mitral regurgitation occur?
Definition
during systole when the valve should be closed
Term
MR is usually between ----m/sec. TR is usually---- than ----m/sec unless PHTN is present
Definition
MR 4-6m/sec
TR lower 3m/sec
Term
What is Aortic and Pulmonic regurgitation shaped like?
Definition
Trapezoid
Term
What cardiac cycle does Aortic and Pulmonic regurgitation occur in?
Definition
Diastole
Term
What is the shape of a severe Mitral Stenosis?
Definition
Trapezoid
Term
What should always be used to get the highest peak velocities?
Definition
CW
Term
What should be used when assessing Aortic Stenosis?
Definition
Several Views should be looked at as well as piedoff
Term
What must be present in order for blood to flow from one place to another?
Definition
energy difference or Pressure Gradient
Term
Blood always flows from an area of ---- pressure to an area of ---- pressure
Definition
high---low
Term
What is potential energy?
Definition
When blood is about to be ejected from the heart (diastole), it isn't actually moving yet
Term
Once blood moves, it is capable of doing work. What is this called?
Definition
Kinetic energy
Term
What part of the Bernoulli Equation do we use? Why?
Definition
Convective acceleration. It deals with obstructions through which blood flow is decreased and pressures are increased
Term
What is the equation for a Simplified Bernoulli Equation?
Definition
4(V2^2-V1^2)
Term
What is the equation for a Modified Bernoulli Equation? When can we use it?
Definition
4(V2)^2. Only when V1 is less than 1.0 m/s
Term
What Mitral Valve leaflet is the larger of the two?
Definition
Anterior leaflet
Term
What are the four associated support apparatus to the Mitral Valve?
Definition
-anterior and posterior leaflets
-annulus-movement dependent on how well the LV function
-chordae-attach pappilary muscles to leaflets
-pappilary muscles (anterolateral and posteromedial
Term
On the Mitral Valve M-Mode, what does the D-E represent?
Definition
The Opening of the Mitral Valve during early diastole
Term
On the Mitral M-Mode, what does the E-F slope represent?
Definition
Early Diastole--Rapid filling-most filling occurs here
Term
On the Mitral M-Mode, what is Diastasis?
Definition
passive filling- some but little filling occurs here
Term
On the Mitral M-Mode, what is the A -wave?
Definition
Atrial systole- Atrial kick- After the "P" wave -late diastole
Term
On the Mitral M-Mode, what does the B-Bump stand for?
Definition
delayed/prolonged closure--increased LVEDP present
Term
What pathology is it when the Mitral Valve leaflets are damaged, so that the valve is unable to open completely resulting in increased LA pressures?
Definition
Mitral Stenosis
Term
What is the most common cause of Mitral Stenosis?
Definition
Rheumatic Heart Disease (Streptococcus B)
Term
Rheumatic Fever is more common among whom? and what age group?
Definition
Third world countries----children
Term
What valve is mostly affected with Rheumatic fever?
Definition
Mitral Valve
Term
When does Mitral Stenosis severity show up in the heart regarding Rheumatic Fever?
Definition
20-25 years later
Term

Besides, rheumatic fever, what are three other causes of Mitral Stenosis?

Definition
-congenital
-M.A.C.
-myxoma
Term
With MS, what is the congenital cause?
Definition
Parachute Mitral Valve-both leaflets attach to one chordae and one pappilary muscle resulting in a parachute appearance
Term
In MS, what happens with M.A.C.?
Definition
Valves become calcified where diastolic flow is impeded.
Term
What does M.A.C. stand for?
Definition
Mitral Annulus Calcification
Term
----% of the patients who have MAC have MR
Definition
50%
Term
Where does MAC usually start?
Definition
Posterior in the posterior wall, infiltrates the anterior leaflet
Term
What is a Myxoma?
Definition
A primary, non cancerous tumor that is most frequently found in the left atrium, attaching to the intra-atrial septum
Term
What are we concerned with a myxoma?
Definition
It can embolize and cause a TIA or STROKE and even cause a heart sound (called a "tumor plop") that sounds like rheumatic mitral stenosis
Term
What does a myxoma mimic?
Definition
Mitral Stenosis
Term
What chamber is a myxoma usually found in?
Definition
Left atrium 80%
Right atrium 20%
Term
What cardiac cycle does Mitral Stenosis occur in?
Definition
Diastole
Term
What heart sound do you hear with Mitral Stenosis?
Definition
-Opening Snap
-Loud S1
-Diastolic rumble
Term
What is the most common EKG findings with Mitral Stenosis? and what is the problem with it?
Definition
-Atrial Arrhythmias-associated with left atrial enlargement
-The problem is clot formation in the atrial appendage
Term
What are the signs and symptoms of Mitral Stenosis?
Definition
-dyspnea
-hoarseness (Ortner's Syndrome-enlarged LA presses on the pharyngeal nerve)
-Paroxysmal Nocturnal Dyspnea
-hepatic congestion and enlargement as increased pulmonary pressures backup into liver
-fatigue
-hemoptysis (pink or bloody, frothy, sputum) Spitting up blood
Term
What is the Normal Mitral Valve Area when the Mitral Valve opens completely?
Definition
4-6 cm^2
Term
The MV becomes stenotic when the area is less than----
Definition
2 cm^2
Term
What is the valve area in critical MS?  What is recommended by this time?
Definition
- 1.0 cm^2
- surgery is strongly indicated- patients become symptomatic
Term
What happens due to the MV not being able to open up?
Definition
LA pressures increases causing LAE
Term
When LA pressures rise above 18mmHg what does it cause? above 10mmHg?
Definition
-pedal edema
-pulmonary edema
Term
What is hyperplasia?
Definition
protective mechanism in pulmonary capillary constriction. It is an attempt to prevent pulmonary edema.
Term
What happens when the Pulmonary Artery pressures (pulmonary hypertension) increases?
Definition
It can lead to RV Failure
Term
What are some 2D findings with Mitral Stenosis?
Definition
-doming of the leaflets during diastole (hockey stick/ comma sign)
-thickened leaflets with reduced opening during diastole
-both anterior and posterior leaflets move anteriorly in diastole
-decreased MV orifice- 1.0cm^2-valve must be replaced
-LAE-this in turn can develop into LA thrombus- especially in the Left atrial appendage
Term
When must a Mitral Valve be replaced?
Definition
when the orifice is 1.0 cm ^2
Term
What are the MMode findings of a Mitral Stenosis?
Definition
-both anterior and posterior leaflets move anteriorly in diastole
-reduced EF slope- flat
-eventual loss of "A" wave-no atrial systole-no afib- no p waves
Term
What are the treatments for Mitral Stenosis?
Definition
-Balloon Valvuloplasty
-Replacement
Term
What is the definition of Mitral Valve Regurgitation?
Definition
A leaking of blood from the LV into the LA during systole
Term

MR is usually due to the abnormality of the MV leaflets from--and--

Definition
-damage to support apparatus (chordae/papillary muscles)
-dilation of annulus secondary to LV enlargement
Term
Can we see MR on 2D or MMode?  Why?
Definition
No. We need Color Doppler to see and assess blood flow disturbences with either color, PW or CW Doppler
Term
What happens with chronic MR?
Definition
It worsens over time, the amount of leakage results in chamber enlargement (LVE, LAE) which can be visualized on 2D/MMode and measured. If moderate to severe MR is present, LV function will be hyperdynamic
Term
What happens with acute MR?
Definition
no chamber enlargement-only hyperdynamic function
Term
What is the most common cause of MR?
Definition
Mitral Valve Prolapse
Term
How common is MVP in adults?
Definition
4% of adults have it
Term
What kind of disease is MVP?
Definition
congenital disease with a high risk for endocarditis
Term
What are patients with MVP prescribed with and when?
Definition
prescribed with prophylactic antibiotics prior to dental work and some surgical procedures such as TEE
Term
With MVP, what causes the valve to bow or sag backwards beyond the annular plane into the left atrial chamber during systole?
Definition
extra tissue that is present on the anterior mitral valve making it too long
Term
Who has MVP more---females or males?
Definition
females
Term
What is Barlow's Syndrome?
Definition
MVP with a noticed systolic click, murmur,having a high incidence of sudden death in young female patients
Term
What are the symptoms in Barlow's Syndrome?
Definition
-chest pain
-dyspnea
-panic attacks-anxiety
Term
What is also seen with 10% of patients that have MVP?
Definition
Tricuspid Valve Prolapse
Term
What are the Two types of MVP?
Definition
-Mid-Lat systolic (either anterior or posterior leaflet bows back into LA later 1/2 systole)

-Holosystolic-(both leaflets bow back throughout all of systole)
Term
 MVP should never be diagnosed from what view?  Why? 
Definition
Apical 4 Chamber view because the annulus is saddle shaped which gives the MV the appearance of prolapsing when it is not
Term
What is MVP often associated with?
Definition
a partial or complete flail of the prolapsed leaflet
Term
What will a person usually see with a flail leaflet?
Definition
A substantial amount of MR due to the leaflets failing to coapt or touch during closure
Term
What are the acute causes of MR?
Definition
-trauma
-MV endocarditis-
-torn chordae post pappilary muscle rupture or trauma
Term

What kind of wall motion occurs with acute MR?  Why?

Definition
Hyperdynamic wall motion because the ventricle is being forced to continually expel more blood volume with each beat
Term
What will chronic MR cause?
Definition
LVE and LAE as a compensatory mechanism
Term
What heart sounds are heard with MR?
Definition
-mid-systolic click with or without a late systolic ejection murmur

-holosystolic MVP- MR murmur lasts throughout systole
Term
What EKG findings are associated with MR?
Definition
rapid atrial arrhythmias; PAT, PSVT, frequent PACs, and sinus tachycardia
Term
What is the treatment for MVP?
Definition
Quadrangular Resection
Term
How is a Quadrangular Resection done?
Definition
A quadrangular shaped portion of tissue is surgically excised from the medial scallop. Then the posteromedial and anterolateral scallops are sewn together. A new ring is frequently sewn in to reduce the annulus because of having removed the excess tissue, the new annulus is smaller.
Term
Can Rheumatic fever cause MR?
Definition
yes
Term
What are the initials for Bacterial Endocarditis?
Definition
SBE
Term
What is Bacterial Endocarditis?
Definition
An infection of the lining of the endocardial layer and also the valves.

It is an acute cause of MR

The most dangerous kind
Term
How is Bacterial Endocarditis seen on 2D?
Definition
Long stringy echoes that are attached on the atrial side but rarely may attach on the ventricular side if the aortic valve has been infected
Term
What is the problem with Bacterial Endocarditis?
Definition
The main problem with valve infections is damage to the valve causing it to leak but embolization is also a worry. The longer the vegetation, the more likely they could break off and embolize
Term
In MR, Is Chordal Rupture acute or chronic?  Why?
Definition
Acute because if the amount of MR is significant, acute pulmonary edema and death may occur. Rapid diagnosis and surgery is essential to a patient's survival. This condition results in a "Flail" (acute cause)
Term
How is LVE chronic in a secondary situation in MR?
Definition
As LVE occurs, chords stretch and annulus enlarges resulting in "doming" of MV leaflets as they are prevented from coapting.
Term
What is another name for MR Ischemia ?  Why is it considered acute?
Definition
Pappilary Muscle Dysfunction
-Transient- symptoms and leak, and murmur appear when ischemia is present.
Term
How can Ischemia in MR be relieved?
Definition
Temporarily with NTG, or permanently with surgical intervention
Term
MAC is present ----% of the time and results in ----
Definition
50% MR
Term
MAC is ---- in nature
Definition
degenerative
Term
What age group commonly has MAC?
Definition
55-60 year olds and up
Term
What is MAC also known as and why?
Definition
Posterior Sub- Mitral Calcification because The annulus or ring of the Mitral Valve calcifies beginning by thickening behind the PMVL
Term
What is the term used to describe an appropriate reason to perform an ultrasound exam based on either a fact discovered while taking a history, a sign, and/or symptom?
Definition
Indication
Term
Why is it important to obtain a person's weight, race, or age?
Definition
Many diseases can be specific to the age, race, or sex of a person
Term
What do we use height and weight to determine?
Definition
BSA (Body surface area)
Term

What does "cc" stand for?

 

Definition
Chief complaint
Term
"I'm feeling weak or fatigued" is an example of a....
Definition
Symptom
Term
What is the difference between an alleviating symptom and an aggravating symptom?
Definition
An alleviating symptom relieves the symptom and an aggravating symptom makes it worse
Term
What is a "sign"?
Definition
A physical, objective change in bodily function that can be measured
Term
A change in mental state or consciousness level is an example of.....
Definition
a sign
Term
What kind of pain results from a lack of blood flow to and from the heart, like in CAD?
Definition
Ischemic pain
Term
What is another name for ischemic chest pain?
Definition
Stable angina pectoris
Term
Why is ischemic chest pain also called stable angina pectoris?
Definition
Because it is predictable
Term
How much blockage can you have up to unitl signs are shown?
Definition
50%
Term
What is coronary artery disease?
Definition
When plaque builds up within a coronary artery reducing blood flow and oxygen to the myocardium during increased workload/stress or an oxygen deficit.
Term
What is another name for a coronary artery spasm?
Definition
Prinz Metal
Term
What genetic disorders cause a blockage of blood flow out of the left heart caused by a thickened IVS?
Definition
IHSS (Idiopathic Hypertrophic Subaortic Stenosis)
HOCM (Hypertrophic Obstructive Cardiomyopathy)
Term
What disease is characterized by a decrease in hemoglobin or reduced number of RBCs which results in a decreased capacity of the blood to carry oxygen to the heart muscle?
Definition
Anemia
Term
With tachyarrhythmias, does the cardiac output eventually increase or decrease?
Definition
decrease
Term
What is another name for non-ischemic chest pain?
Definition
Unstable angina
Term
What is dyspnea?
Definition
The feeling of difficult breathing, being unable to catch their breath or shortness of breath
Term
What are the three types of dyspnea?
Definition
D.O.E. "Dyspnea on Exertion", Orthopnea, paroxysmal nocturnal dyspnea
Term
Which kind of dyspnea occurs minutes to hours after lying flat and is caused by progressive pulmonary congestion?
Definition
Paroxysmal Nocturnal Dyspnea
Term
What is defined as the feeling of having a "lack of energy"?
Definition
Fatigue
Term
What is edema?
Definition
Swelling of the extremities caused by excessive fluid accumulation
Term
What is it called when an indentation is created while pressing on a patient's ankle?
Definition
Pitting edema
Term
What is hemoptysis?
Definition
Coughing up blood
Term
What can cause hemoptysis?
Definition
M.S. , P.E., Rupture of a blod vessel in the lung, Long term severe M.R.
Term
What are the cardiac causes of palpitations?
Definition
PVCs or PACs, Congenital shunts, Complete heart block
Term
Pulses, blood pressure, temperature, and respiratory rate are all examples of....
Definition
Vital signs
Term
An absent pulse represents either.....
Definition
A severely blocked "or" a totally occluded artery
Term
Where is a temporal pulse located?  Carotid?  Femoral?  Brachial?
Definition
On the side of the head at the temporal bone, both sides of the neck, groin leve (near inguinal canal), at the elbow
Term
How are pulses rated?
Definition
According to their palpable strength
Term
What does a weak pulse indicate?
Definition
A significant decrease in blood flow through an artery (blockage)
Term
What is an accentuated pulse?
Definition
This means that there is a large pulse pressure difference between systolic and diastolic pressures
Term
True or False?  Pulses should not be of the same strength on both sides of the body and should not arrive at approximately the same time?
Definition
False
Term
True or False?  Radial pulses should arrive prior to the carotid pulse?
Definition
True
Term
What kind of pulse alternates in intensity, feeling strong one beat and weaker the next?
Definition
Pulsus Alternans
Term

What kind of pulse has a delayed or difficult to palpate pulse from delayed passage of blood through a narrowed aortic valve or blocked vessel?

 

Definition
Pulsus Parvus
Term
What kind of drop happens with Pulsus Paradoxus?
Definition
An inspiratory drop greater than 20mmHg
Term

What angle do you inspect jugular veins at?

 

Definition
30-45 degrees
Term
What is the force exerted by blood on the arterial walls called?
Definition
Blood Pressure
Term
What is pulse pressure?
Definition
The difference between systolic and diastolic pressures
Term
What is it called when a patients B/P goes up because they are anxious?
Definition
White Coat Syndrome
Term
What is it called when the systolic B/P falls below 80mmHg?
Definition
Hypotension
Term
A patient is considered febrile when they have a....
Definition
fever
Term
How much does oxygen consumption and CO2 production rise for every 1 degree rise in body temperature?
Definition
10%
Term
What is hypothermia?
Definition
A body temperature below normal from exposure to excessive cold
Term
Which method to take a temperature is the most accurate?  Least accurate?
Definition
Rectal-most, axillary-least
Term
What does it indicate when skin temperature is cool to cold?  Is this life threatening?
Definition
An acute occlusion of an artery by an embolism, yes
Term
What is the number of times a patient breaths in a minute called?
Definition
Respiratory Rate
Term
What is the normal respiratory rate of an adult?
Definition
12-20 breaths/minute
Term
The average adult has how many liters of blood?
Definition
5 Liters
Term
What are erythrocytes?
Definition
RBCs (Red Blood Cells)
Term
How many RBCs are there normally per cc of blood?
Definition
4.5-6 million
Term
How long do RBCs survive?  How are they destroyed?
Definition
120 days, by macrophages in the liver, spleen, and bone marrow
Term
What are leukocytes?
Definition
WBCs (White Blood Cells)
Term
How many WBCs are there per cc of blood?
Definition
5,000-10,000
Term
What is the job of a WBC?
Definition
Fighting infections and helping the immune respponses/body defense
Term
What are the two subtypes of WBCs?
Definition
Granulocytes (Granular leukocytes)
Agranulocytes (agranular leukocytes)
Term
What is the most common granulocyte?  What does it do?
Definition
Neutrophils
They contain chemicals that kill bacteria
Term
Which granulocyte contains heparin and histamines?
Definition
Basophils
Term
Which granulocyte increases with an allergic reaction and fight parasitic worm infections?
Definition
Eosinophils
Term
Which agranulocyte has a single horseshoe shaped nucleus and can leave the circulation?
Definition
Monocytes
Term
Which agranulocyte produces antibodies and antimicrobial chemicals?
Definition
Lymphocytes
Term
What is another name for platelets?
Definition
Thrombocytes
Term
What are thrombocytes (platelets)?
Definition
WBC fragments essential for the blood clotting process (homeostasis)
Term
What is the main energy source for the body?
Definition
Glucose
Term
What does BUN stand for?
Definition
Blood Urea Nitrogen
Term
What nutrient is used to make hormones?
Definition
Cholesterol
Term

What term is used to describe mass/volume?

 

Definition
Density
Term
What term is used to describe the thickness of blood?
Definition
Viscosity
Term
How does anemia alter the ability of blood to flow?
Definition
Less RBCs, less viscosity, blood flows easier
Term
What is polycythemia vera?
Definition
A disease that results in the overproduction of RBCs that cause the blood to thicken and resist flowing
Term
What is systolic pressure caused from?
Definition
Increased pressure and volume caused by cardiac contraction
Term

What causes diastolic pressure?

Definition
Decreased pressure from cardiac relaxation
Term
How do you calculate pulse pressure?
Definition
SBP-DBP ( systolic pressure minus diastolic pressure)
Term
What is stroke volume?
Definition
The amount of blood ejected with each beat
Term
What is the speed of ejection determined by?
Definition
The health of the heart muscle and its ability to pump
Term
What are energy or pressure differences called?
Definition
Gradients
Term
What do the skeletal or calf muscle pumps do?
Definition
Forces blood up from the feet toward the heart when walking
Term
What propels venous blood flow towards the heart when lying down or supine?
Definition
Diaphragm and respiration
Term
What is the total resistance the ventricles have to overcome so blood will flow into the Great Vessels towards the lungs and body?
Definition
Afterload
Term
Where is blood shunted during digestion?
Definition
Towards the gut
Term
Where is blood shunted during exercise?
Definition
From the gut to the myocardium and skeletal muscles to meet the increased demand for oxygen
Term
Who relates velocity and pressure inside a narrowing?
Definition
Bernoulli
Term
Who described the relationship between flow volume and resistance?
Definition
Poiseuille
Term
What affects the amount of blood flow volume more than any other factor?
Definition
Tube diameter
Term
Who described the difference between laminar and turbulent flow?
Definition
Reynolds
Term
Where is there normal turbulent flow?
Definition
Location of a bifurcation
Term

What is the main advantage of color doppler?

Definition
It's a fast, easy way to assess the direction, the timing, and the relative velocity of blood flow
Term
What is it called when you angle the probe to "interrogate" or search for flows so they won't be missed or underestimated?
Definition
Panning
Term
True or False?  Color doppler generates a lot of energy, intensity, and heat?
Definition
True
Term
When can the heat of color doppler be a factor?
Definition
During a TEE
Term
What takes the frequency and makes it (color) something you can see?
Definition
Autocorrelation
Term
The color box is made up of individual lines, and each line is made up of individual_________, where flow is sampled.
Definition
Sample volumes or gates
Term
True or False?  Making the color box bigger increases the frame rate and resolution of your image.
Definition
False
Term
How mant sample volumes are contained in one packet?
Definition
3-20
Term
What is the lowest acceptable frame rate?
Definition
18
Term

What are the two different types of color maps?

Definition
Velocity maps
Variance maps
Term
What color is usually seen above the baseline?
Definition
red
Term
What does BART stand for?
Definition
Blue Away Red Towards
Term
The black line is the baseline and represents....
Definition
No or zero doppler shift
Term
What is aliasing represented by?
Definition
A mosaic pattern
Term
Convergence maps are special variance maps with two halves.  One half is ________and the other half is the amount of _________.
Definition
Velocity
Energy
Term
Clutter or ghosting can be eliminated with a ___________?
Definition
Wall filter
Term
What is the nyquist limit?
Definition
The point at which aliasing occurs
Term
What is the optimum range for the nyquist limit?
Definition
around 60-65
Term
True or False?  Increasing color sclaes too high will overestimate regurgitation?
Definition
False
Term

When was the first prosthetic valve replacement performed?

Definition
1960
Term
What are the causes in which native valves are replaced?
Definition
Stenosis, regurgitation, or infection
Term

True/False- All prosthetic valves maintain orifice size of the native valve.

Definition
False- are considered to be a man made stenosis
Term

What kinds of complications can be seen with prosthetic valves?

Definition
Systemic embolization, perivalvular leaks, degeneration/dehiscence, ring abscess, thrombus formation, endocarditis, & hemolysis
Term

Can prosthetic valves be heard?

Definition
Yes
Term

What kind of sound is heard and what type of prosthetic valve will make the sound?

Definition
Valve/poppet “click” heard & mechanical valve
Term

How does a prosthetic valve appear on echo when it becomes dehisced?

Definition
Dehisced valves will “rock” relative to the attachment.
Term

On m-mode, which prosthetic valve replacement will appear like m-mode of mitral stenosis?

Definition
M-mode of an aortic valve replacement
Term

True/ False- Prosthetic valves are considered to be a permanent cure?

Definition
False- Considered being palliative; meaning eliminates symptoms, but not a permanent cure. Replacing one disease for another
Term

Where are homograft prosthetic valves obtained?

Definition
Obtained from cadavers and cryopreserved quickly after death.
Term

What valve is replaced with a homograft prosthetic valve and why?

Definition
Aortic valve - Mitral valve replacements have proven largely unsuccessful and fail within 5 years due to leaflet thickening calcification, and regurgitation.
Term

How does a homograft prosthetic valve fail?

Definition
Failure usually results from a gradual increase in AI.
Term

How does a tissue prosthetic valve fail?

Definition
Degeneration is the main risk of failure.
Term
True/False- Tissue valves normally don’t have valvular insufficiency
Definition
True
Term

What kind of medication will a tissue prosthetic valve person have to take for the rest of their life and why?

Definition
Antibiotics before dental work to prevent staph infections
Term

How durable are tissue prosthetic valves before they fail?

Definition
Low durability with few surviving 10 years, & 5 years in the mitral position
Term

True/False- Incidence of endocarditis is low with a tissue valve.

Definition
False- tissue valves are more likely to become infected with endocarditis.
Term

Is there a difference between stented and unstented homograft prosthetic valves?  If yes what is it?

Definition
Yes. Unstented valves are slightly more echogenic than native valves and are made by removing the entire aortic root and adjacent aorta as a block, then is sewn into the root.
Term

What is the Ross Procedure? 

Definition
Pulmonic valve is used to replace a diseased aortic valve. Then the pulmonic valve is replaced with a homograft pulmonic valve.
Term

Where does the pulmonic valve come from for the Ross Procedure?

Definition
It comes from the same patient needing the Ross Procedure.
Term

In what valve positions are porcine valves used?

Definition
Mitral, aortic and tricuspid valve positions
Term

How long will porcine tissue valves last?

Definition
10 – 15 yrs
Term

How are porcine valves made?

Definition
They are constructive of aortic porcine valves sewn to a metal wire stent, often made from a cobalt-nickel alloy. The wire is bent to form three U-shaped prongs. A Dacron cloth sewing skirt is attached to the base of the wire stent, and the stents themselves are also covered with cloth.
Term

True/False- Porcine tissue valves are treated with gluteraldehyde to make them stiffer?

Definition
TRUE
Term

What is a disadvantage of porcine tissue valves?

Definition
Limited sizes are available & Small valve sizes will sometimes have “incomplete openings” due to small orifice, and with lower flow rates, creates a favorable environment for failure (size mismatch).
Term

What material is used to make bovine tissue valves?

Definition
Fashioned from cow pericardium
Term

How will a bovine tissue valve fail?

Definition
Valvular regurgitation or stenosis are the common methods of failure.
Term

What is the advantage of bovine tissue valves?

Definition
Unlimited range of sizes can be custom designed.
Term

What medication will a patient need to take for the rest of their life with a mechanical valve? Why?

Definition
Anticoagulants- mechanical valves have increased thrombogenicity.
Term

What types of patients are better suited for a mechanical valve? Why?

Definition
Younger male patients or females who don’t plan to become pregnant. Coumadin can cross the placental barrier and it is dangerous for the baby.
Term

Which prosthetic valves are the most durable out of all of the prosthetic valve types?

Definition
Mechanical valves
Term

True/False- It is normal for mechanical valves to have a small amount of regurgitation?

Definition
TRUE
Term

What is pannus?

Definition
An overgrowth of tissue around the valve perimeter
Term

What is a perivalvular leak?

Definition
A leak around the valve annulus
Term

What is the usual cause of a perivalvular leak?

Definition
Suture failure
Term

How will a mechanical valve fail?

Definition
Pannus & suture failure
Term

What are the types of mechanical valves?

Definition
Ball-In-Cage, Single Disc Tilting Disc, Bi-leaflet Tilting Disc
Term

How are Ball-In-Cage mechanical valves constructed?

Definition
Two U-shaped struts form a cage that houses a silastic ball occluder.
Term

What is the mechanism of failure for a Ball-In-Cage mechanical valve?

Definition
The ball would swell and freeze in the open or closed position
Term

What type of medication will a patient have to take with a Ball-In-Cage valve?

Definition
Anticoagulants- mechanical valves have increased thrombogenicity.
Term

What is the disadvantage of Ball-In-Cage mechanical valves?

Definition
The ball was notorious for causing damage to blood cells due to collisions.
Term

Are Ball-In-Cage mechanical valves still being used today?

Definition
No, they were eventually taken off the market.
Term

How was the Single Disc Tilting Disc valves supposed to be an improvement over Ball-In-Cage valves?

Definition
Single Disc Tilting disc valves were designed to mimic the natural patterns of blood flow. This reduced damage to blood cells, improved flow patterns, reduced blood clotting and infections.
Term

What is the mechanism of failure for a Single Disc Tilting Disc valve?

Definition
The struts tend to fracture due to fatigue from repeated ramming of the struts by the disc.
Term

How are Single Disc Tilting Discs constructed?

Definition
A polymer disc held in place by 2 welded struts. The disc floats between the two struts in such a way, as to close when the blood begins to travel backward and then reopens when blood begins to travel forward again.
Term

How are Bi-Leaflet Tilting Disc valves constructed?

Definition
Consisted of 2 semi-circular leaflets that pivot on hinges. The carbon leaflets were strong and had excellent biocompatibility.
Term

When was the first Bi-Leaflet Tilting Disc introduced?

Definition
1979
Term

When performing Doppler on a Bi-Leaflet Tilting Disc where should the cursor be placed to get an accurate velocity? Why?

Definition
Move the cursor to the side a little because the unusual profile causes the flow velocities to be higher when obtained from the central, slit like orifice.
Term

True/False- Bi-Leaflet Tilting Disc valves provide the closest approximation to central flow achieved in a natural heart valve.

Definition
TRUE- The leaflets swing open completely, parallel to the direction of blood flow.
Term

True/False- Bi-Leaflet Tilting Disc valves are considered an ideal valve.

Definition
FALSE- The leaflets don’t close completely, which allows some backflow. Since this is a property of a defective valve, the bi-leaflet valve is still not an ideal valve.
Term

What kind of valves are Hancock and Carpentier-Edwards?

Definition
Porcine valves
Term

Which brand name of porcine valves is the most common?

Definition
Carpentier-Edwards
Term

In what valve positions are Hancock and Carpentier-Edwards’ valves used?

Definition
Mitral, aortic and tricuspid valve positions
Term

How long will a Carpentier-Edwards or a Hancock valve last?

Definition
10 – 15 yrs
Term

How are Carpentier-Edwards or Hancock valves made?

Definition
They are constructive of aortic porcine valves sewn to a metal wire stent, often made from a cobalt-nickel alloy. The wire is bent to form three U-shaped prongs. A Dacron cloth sewing skirt is attached to the base of the wire stent, and the stents themselves are also covered with cloth.
Term

True/False- Carpentier-Edwards or Hancock valves are treated with gluteraldehyde to make them stiffer?

Definition
TRUE
Term

What is a disadvantage of Carpentier-Edwards or Hancock valves?

Definition
Limited sizes are available & Small valve sizes will sometimes have “incomplete openings” due to small orifice, and with lower flow rates, creates a favorable environment for failure (size mismatch).
Term

What kind of valve is an Ionescu-Shiley valve?

Definition
Bovine tissue valve
Term

What material is used to make Ionescu-Shiley valves?

Definition
Fashioned from cow pericardium
Term

How will an Ionescu-Shiley valve fail?

Definition
Valvular regurgitation or stenosis are the common methods of failure.
Term

What is the advantage of Ionescu-Shiley valves?

Definition
Unlimited range of sizes can be custom designed.
Term

What are the brand names of Ball-In-Cage valves?

Definition
Starr Edwards silastic ball, Starr Edwards satellite ball, & Smeloff Cutter
Term

What was the brand name of the first mechanical valve in 1952 and what type of mechanical valve was it?

Definition
Starr Edwards silastic ball & Ball-In-Cage
Term

How are Smeloff Cutter or Starr Edwards valves constructed?

Definition
Two U-shaped struts form a cage that houses a silastic ball occluder.
Term

What is the mechanism of failure for a Smeloff Cutter or Starr Edwards valve?

Definition
The ball would swell and freeze in the open or closed position
Term

What type of medication will a patient have to take with a Smeloff Cutter or Starr Edwards valve?

Definition
Anticoagulants- mechanical valves have increased thrombogenicity.
Term

What is the disadvantage of Smeloff Cutter or Starr Edwards valves?

Definition
The ball was notorious for causing damage to blood cells due to collisions.
Term

Are Smeloff Cutter or Starr Edwards valves still being used today?

Definition
No, they were eventually taken off the market.
Term

What kind of valves are Medtronic-Hall or Bjork-Shiley valves?

Definition
Single Disc Tilting Disc valves
Term

Which brand name of Single Disc Tilting Disc valves is the most common and what type of valve is it?

Definition
Bjork-Shiley valves & Single Disc Tilting Disc valves
Term

How was the Bjork-Shiley or Medtronic-Hall valves supposed to be an improvement over Starr Edwards or Smeloff Cutter valves?

Definition
Bjork-Shiley or Medtronic-Hall valves were designed to mimic the natural patterns of blood flow. This reduced damage to blood cells, improved flow patterns, reduced blood clotting and infections.
Term

What is the mechanism of failure for a Bjork-Shiley or Medtronic-Hall valve?

Definition
The struts tend to fracture due to fatigue from repeated ramming of the struts by the disc.
Term

How are Bjork-Shiley or Medtronic-Hall valves constructed?

Definition
A polymer disc held in place by 2 welded struts. The disc floats between the two struts in such a way, as to close when the blood begins to travel backward and then reopens when blood begins to travel forward again.
Term

How are St. Jude’s or CarboMedics valves constructed?

Definition
Consisted of 2 semi-circular leaflets that pivot on hinges. The carbon leaflets were strong and had excellent biocompatibility
Term

When was the first St. Jude’s or CarboMedics valves introduced?

Definition
1979
Term

When performing Doppler on a St. Jude’s or CarboMedics valve where should the cursor be placed to get an accurate velocity? Why?

Definition
Move the cursor to the side a little because the unusual profile causes the flow velocities to be higher when obtained from the central, slit like orifice.
Term

True/False- St. Jude’s or CarboMedics valves provide the closest approximation to central flow achieved in a natural heart valve.

Definition
TRUE- The leaflets swing open completely, parallel to the direction of blood flow.
Term

True/False- St. Jude’s or CarboMedics valves are considered an ideal valve.

Definition
FALSE- The leaflets don’t close completely, which allows some backflow. Since this is a property of a defective valve, the bi-leaflet valve is still not an ideal valve.
Term

What are the brand names of Bi-Leaflet Tilting Disc valves?

Definition
St. Jude’s & CarboMedics
Term

Which brand name of Bi-leaflet Tilting Disc valves is the most common?

Definition
St. Jude’s valves
Term

True/False- Regurgitation of prosthetic valves appears the same severity on both TTE and TEE?

Definition
FALSE- The regurgitation always appears worse on TEE than on TTE.
Term

List 4 things in which serial exams of prosthetic valves will include.

Definition
1-CW velocities (antegrade) through the valve,
2-Look for any change in the amount of “normal” prosthetic valvular regurgitation
3-Appearance of perivalvular leaks d/t dehiscence or abscess
4-Heart changes such as LVH, chamber dilatation, or ventricular dysfunction d/t wrong size valve used.
Term

Is a baseline echo needed for a prosthetic valve once the valve has been implanted?

Definition
YES- a baseline echo will establish what is normal for the prosthetic valve and can be used to compare later echo studies to see if anything has changed with the prosthetic valve.
Term

True/False- Wedge pressures are not affected by implantation of prosthetic valves.

Definition
FALSE- Once a prosthetic valve is in place, invasive information of valvular malfunction in the mitral or aortic position requires transthoracic or transeptal puncture cardiac catherization to assess the hemodynamics. Wedge pressures can no longer be performed.
Term

What kind of information does a “medical device card (MDC)” provide?

Definition
Manufacturer of prosthetic valve, model number of prosthetic valve and size of prosthetic valve
Term

How will velocities change with prosthetic valve in comparison to a native valve?

Definition
Peak velocities will be increased with a prosthetic valve from those obtained in native valves.
Term

List the Doppler tools which are used for assessment of all prosthetic valves.

Definition
1- CW
2- Color Doppler
Term

True/False- The continuity equation can be used for all prosthetic valves to calculate the AVA.

Definition
FALSE- The continuity equation can be used to tissue valves, but not mechanical valves.
Term

What is the name of the index which is used for assessment of the aortic valve prosthetics and what kind of prosthetic valve uses it?

Definition
Dimensionless Index & Mechanical Valves
Term

What is the ratio used for calculation of the dimensionless index for mechanical valves?

Definition
LVOT VTI ÷ AOV VTI
Term

Using a VTI of 15 for LVOT and a VTI of 51 for the AOV, calculate the ratio and is it stenotic?

Definition
15÷51 = .29
Yes- <0.3 is stenotic
Term

What are the units of the dimensionless index?

Definition
There are no units for the dimensionless index.
Term

What’s the normal range for the dimensionless index and when is it considered to be stenotic?

Definition
Normally between 0.35 - 0.5
<0.3 is stenotic
Term

What valve positions can be assessed with P1/2T & VTI tracings?

Definition
Mitral and Tricuspid valve areas
Term

Which method is more accurate for calculating prosthetic valve velocities in the mitral & tricuspid valve positions?

Definition
VTI calculation to get the mean gradient is more accurate. Normal values must be looked up in a table for each valve.
Term

When should a baseline ratio be performed?

Definition
6 months after surgery
Term

List everything that can assess regurgitation in a prosthetic valve.

Definition
1-Color to determine jet width, origin, and jet area
2-PW to look for S wave reversal in the pulmonary or hepatic veins with severe MR or TR
3-PW to assess severity of AI in descending aorta
4-CW to assess flow shape for acute or chronic MR and severity
Term

True/ False- It can be very difficult to discern perivalvular leakage d/t the fact that many mechanical valves normally have unusual color patterns that make it difficult to tell.

Definition
TRUE
Term

How will a ring abscess appear on 2D echo?

Definition
An anechoic area surrounding the annulus.
Term

What is the brand name of the prosthetic valves which are in clinical trials and are not yet approved by the FDA?

Definition
3F Therapeutics
Term

True/False- Anechoic areas in the annulus suggest perivalvular abscess, color Doppler is necessary to determine the presence of perivalvular leakage in patients with no dehiscence.

Definition
TRUE
Term
What does Pulsus Paradoxus provoke when Pericardial effusion is present?
Definition
Decrease > 10mmHg in systolic blood pressure during inspiration creates Pulsus Paradoxus
Term
Define Tamponade
Definition
Rapid accumulation of fluid within the pericardial space that causes the pressures in the pericardium to exceed the pressures in the chambers resulting in impaired cardiac filling
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