Term
| 5 viewing WINDOWS. Windows can have multiple views within them. |
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Definition
Parasternal
Apical
Subcostal
Suprasternal
Right parasternal |
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Term
| How many views needed for ACCURATE M-mode(motion over time) tracings? |
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Definition
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Term
| Window located at left sternal border, 4-5th intercostal space? 3 views from this window? |
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Definition
Left Parasternal Window...
Long & Short Axis.
Right Ventricle INFLOW |
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Term
4 structures to look for in PLAX?
AA
AV
MV
LV |
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Definition
Ascending Aorta: Size, Dissection
Aortic Valve
Mitral Valve
Left Ventricle |
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Term
| Some things to look for when inspecting valve structures? |
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Definition
Motion
Calcification
Stenosis
Vegetation
Annuals diameter
Thickness |
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Term
3 segments LV divided into in PLAX view?
A
M
B |
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Definition
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Term
Assess the following in PLAX:
Cavity___
Wall___ (including septum)
____track
Thickness
Calcification
Vegetation/_____ |
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Definition
Size
Thickness
Outflow
Emboli |
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Term
| Three levels of Parasternal Short Axis(PSAX)? |
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Definition
Basal (Aortic valve)
Mitral (LV/MV/RV)
Papillary (LV/RV, papillary muscle function) |
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Term
| PSAX view shows valves and ventricles from 90 degree head on view. What should you count from this angle? |
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Definition
| Ventricle wall segments and number of leaflets in valves. Also look for Calcification, motion, size. |
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Term
| Apical Window view: better if patient more supine. Place transducer on this heart pulse landmark... |
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Definition
| Apical pulse, Point of Maximal Intensity |
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Term
Apical Window: 4 views
(chambers..) |
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Definition
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Term
| 4 CHAMBER VIEW: Obvious things to look for in valves and chambers? |
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Definition
Mitral/Tricuspid motion, shape, veggie
Ventricle/Atrial size
LV wall motion
Inferoseptal Wall Motion |
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Term
5 CHAMBER VIEW: adds what to 4?
Look for? |
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Definition
Aorta
LVOT
MV,TV, AV motion & morphology
Aortic root
Right ventricle
Ventricluar apex
Left Atrium |
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Term
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Definition
Left Atrium
Left ventricular
Mitral motion & morphology
Ventricular apex
Coronary sinus(with slight tilt anteriorly of transducer) |
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Term
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Definition
Left Atrium
Left ventricular outflow tract, motion and size
Ventricular apex
Pericardium
Mitral motion & morphology
Mitral & tricuspid valve motion , morphology and vegatation
Right ventricle
Ventricular Spetum
Aortic valve and root |
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Term
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Definition
| Supine, flex knees, relax abs. Inhale deeply to lift lungs and reveal cardiac image. |
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Term
| Views from Subcostal window? |
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Definition
4 chamber
5 chamber
Short Axis View(Basal, Papillary, Mitral)
IVC inflow/hepatic vein |
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Term
4 chamber view. Assess?
*This is the best window for atrial septal defect assessment** |
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Definition
MV & TV valves, shape, veggies
Ventricle/Atrial size
LV lateral wall motion |
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Term
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Definition
| LVOT, MV,TV,AV motion/shape |
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Term
| Subcostal short axis views? |
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Definition
| Same as Parasternal Short Axis. |
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Term
| Which view do you assess IVC size and collapse in during inspiration and sniffing? |
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Definition
| Subcostal Short Axis Views |
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Term
| Suprasternal View/Window. Assess for? |
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Definition
Aorta for aneurysms, coarctation
Pulmonary arteries, prescense of PDA |
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Term
| Right Parasternal Window. Where to place transducer to view? Not traditionally used, but may image aortic aneurysms/dissections |
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Definition
| 4-5th intercostal space to the right of the sternal border. Commonly used for Doppler assessment of aortic stenosis. |
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Term
| What is the primary tool is Dx of congenital/acquired heart disease in infants, children, and teens |
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Definition
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Term
| Noninvasive, portable tool for cardiac assessment. Gives anatomic, hemodynamic, and physiologic info about pediatric heart |
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Definition
| Transthoracic Echocardiography |
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Term
| Why is PLAX first view and check for Heart Disease? |
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Definition
| Good view to assess Ejection Fraction. |
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Term
| Long list to exam in Congenital Heart Disease..... |
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Definition
Atrial situs, systemic veins, IVC, SVC, Pulmonary veins, continuity of septums, ID great vessels.
A normal variant, old valve over the IVC: Chiari network. |
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Term
| Common Congenital Heart Diseass defects |
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Definition
Persistant L & R SVC
Anomalous pulmonary venous return
RV enlargement |
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Term
| Thin, linear, perforated membrane in area of coronary sinus freely moving within the RA |
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Definition
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Term
| Term used to describe viewing bloodflow from RA to RV throught TV |
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Definition
| Right Ventricular Inflow Tract |
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Term
| How to Dx Persistent Left SVC? |
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Definition
| Left subclavian or a branch drains into coronary sinus. Injecting contrast into left arm to cause opaque appearance when viewing coronary sinus. |
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Term
| Persistent Right SVC. How to Dx? |
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Definition
| SVC drains into LA. Contrast injected into either arm colors the LA/LV. Viewed best in 4 chamber apical or subcostal. |
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Term
| How to Dx Anomalous Pulmonary Venous Return. |
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Definition
1 or more pulmonary veins empties into RA. Contrast injection shows abnormal flow through common pulmonary venous chamber(where all Pveins drain just before entering LA). Also see an ASD.
ASD will show abnormal Doppler Flow Patterns. |
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Term
| Views to see Anomalies of Ventricular inflow cortriatrium & supravalvular membrane? |
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Definition
| apical, subcostal, PLAX. Both are membranes in LA which partially obstruct the LA emptying. |
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Term
| Differentiating a supravalvular membrane from a cortriatrium is based on how close the membrane is to the mitral valve. Supravalvular membranes are closer to the valve. |
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Definition
M-mode findings:
•A thin line noted in the left atrium
•Reduced E-E measurement
•Reduced E-F slope
•Reduced C-E, D-E, and EPSS |
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Term
| Three types of congenital Mitral Stenosis: |
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Definition
Parachute- only 1 papillary muscle gets chordae
Anomalous Mitral Arcade deformity-multiple small pap muscles
Double Orifice Mitral Valve- 2 MV openings w or wo commissural fusion |
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Term
| 3 views to best view MV stenosis? |
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Definition
PLAX, Apical, Subcostal windows
Seen from PSAX or Apical 4 chamber |
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Term
| Mital Valve Hypoplasia & atresia. Define each... |
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Definition
Hypoplasia-small annulus with small leaflets obstructing flow
Atresia-absence of a valve so complete obstruction between LA/LV
Must have ASD or VSD to survive
Common in pts with hypoplastic left Heart Syndrome |
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Term
| Tricuspid atresia. Define. Best viewed. Contrast will show? |
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Definition
–Absence of a functional tricuspid valve.
–Best examined from the subcostal or apical views.
–Contrast injection will show an ASD and VSD with flow from RA to LA to LV to the AO and PA. |
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Term
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Definition
Apical is best for viewing.
–Characterized by a downward displacement of the tricuspid valve.
–The right heart is broken down into the small physiological ventricle, atrialized ventricle, and large RA.
–May be associated with TR and an ASD.
–Tricuspid is late to close at end diastole with it trailing MV closure by up to 80 ms
Criteria for diagnosis is different.
–The Mayo clinic uses 8mm/M of BSA as diagnostic criteria.
–Feigenbaum uses 20 mm displacement.
•If anterior leaflet is tethered to the RV wall, valve replacement is in order. |
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Term
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Definition
| View in Short axis, ANTERIOR leaflet will have gap or cleft. Usually not significant. |
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Term
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Definition
The AV valve (usually tricuspid) has chords that attach on both sides of the septum.
•Must be associated with a VSD.
•Contrast injection will opacify the RA then RV and LV. |
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Term
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Definition
RA empties into the LV and LA empties into the RV.
•The inflow tracks criss-cross.
•One mechanism for the correction of transposition of the great vessels. |
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Term
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Definition
–A type of congenital AS; the most common of which is bicuspid aortic valve.
–Bicuspid AO is most common congenital defect.
–On M-mode eccentric closure of the valve is noted.
–Aorta must be interrogated from several windows to ensure maximum velocity is found. |
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Term
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Definition
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Term
| Supravalvular Aortic Stenosis |
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Definition
Parasternal long axis shows narrowing of the ascending aorta.
–Echocardiographic findings are the same as those seen with acquired stenosis. |
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Term
| Hypoplastic left heart syndrome |
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Definition
The left side of the heart forms incorrectly so that the LV is hypoplastic, there is aortic atresia, and the AO is hypoplastic.
–This condition is not compatible with life. Surgery performed must be done immediately. |
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Term
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Definition
The valve may be present but the aortic diameter is decreased.
–Best visualized in the parasternal short axis, long axis, and the suprasternal. |
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Term
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Definition
–The aorta ends completely in the arch after the carotid branch.
–Best visualized using the suprasternal view. |
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Term
Hypertrophic Cardiomyopathy:
Asymmetrical Septal Hypertrophy (ASH)- genetically determined thickening of IVS. Notes... |
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Definition
•IVS/LVPW ratio greater than 1.3 is diagnostic criteria for ASH.
•Septum thickness may increase to 20mm.
•Parasternal long axis and subcostal show the IVS the best due to the perpendicular relation of the structure to the beam.
•Improper angulation during the M-mode examination may lead to a false positive.
•The septum is often to seen have a "speckled" pattern, caused by areas of higher density muscle.
•ASH may be present without LVOT obstruction.
•Since it is a genetic disease the whole family should be studies if one member is diagnosed. |
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Term
| Idiopathic Hypertrophic Subaortic Stenosis (IHSS) or Hypertrophic Obstructive Cardiomyopathy (HOCM) |
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Definition
Parasternal long axis and subcostal views show gross thickening of the septum and the LVPW.
–LVOT obstruction may be present, especially with the increased contractile state seen with exercise.
–Pulsed Doppler confirms the presence of AO/LVOT gradient.
–M-mode findings
•Systolic anterior motion (SAM) of the anterior mitral valve leaflet.
•Thick hypokinetic IVS.
•Reduced LV chamber size.
–Exaggerated LVPW motion to compensate for the hypokinetic septum. Partial closure of the aortic valve in mid-systole. |
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Term
| Three types of ASDs based on septal location of shunt? |
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Definition
–Sinus venosus ASD
•Posterior portion of the septum
•Contributes to 15% of ASDs
–Secundum ASD
•Patent foramen ovale
•Contributes to 70% of ASDs
–Primum ASD
•Anterior portion of the septum.
•2-D from the subcostal window is the best view for diagnosis with color flow or contrast study.
•RVE, RAE, abnormal atrial septal motion and paradoxical septal motion are characteristic findings. Color Doppler is diagnostic. |
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Term
| Ventricular Septal Defects (VSD) |
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Definition
Subcostal View (color flow) is best.
Can be in muscular or membranous septum
PLAX, PSAX, 3 chamber used to interrogate.
M-Mode scan from LV-AO traditional exam. Pulsed & color Doppler are Dx. |
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Term
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Definition
Can be post-MI complication. Echo equal to cath lab in Dx. Apical aneurysms most common.
2 chamber can assess Ant/Post LV walls. |
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Term
Tetralogy of Fallot: combination of 4 defects
VSD
Overriding AO
RVOT obstruction (Pulmonary Stenosis)
RVH |
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Definition
•Parasternal long axis will show the overriding AO.
•Short axis view is used to detect the PS.
•Four chamber view allows assessment of chamber sizes.
•The RVH may cause paradoxical septal motion, RVE and RAE.
•M-mode can be used to diagnose the overriding AO. |
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Term
| Patent Ductus Arteriosus (PDA) |
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Definition
–PDA is a communication between the AO and the PA which is necessary for fetal circulation but should close within days after birth.
–It is located between the descending aorta and the LPA after bifurcation of the MPA.
•Suprasternal view is good for spectral and color diagnosis. |
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Term
| Doppler Criteria for PDA exam |
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Definition
–Parasternal short axis can be used to detect turbulent flow in the PA. PI can cause turbulent flow in the PA so it must be ruled out.
–From the suprasternal notch, retrograde flow in the descending may be seen. This can be a finding with AI so it must be ruled out.
–Ascending AO flow will be normal.
–Spectral Doppler will show a turbulent flow pattern in systole and diastole. |
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Term
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Definition
–A single pumping chamber receives blood from both atria.
–A rudimentary hypoplastic ventricle may be seen with the functioning ventricle either left or right in morphology.
•Tricuspid atresia is similar but with it there will not be two functioning valves as is the case with a single ventricle.
•Often occurs with transposition of the great arteries.
•Short axis basal view will show the AO to be anterior and to the right of the PA |
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Term
| Transposition of the Great Vessels |
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Definition
Transposition is broken down into two categories
–Type D (Uncorrected)
•AO arises from the RV
•PA arises from the LV
•The patient must have a VSD, ASD, or PDA to sustain life.
•A balloon septostomy may widen an ASD in the case of the type D listed above.
–Type L (Corrected)
Two variations:
»Criss cross AV valves
»Inversion of the ventricles |
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Term
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Definition
–One blood vessel arising from the ventricles.
–Patient will have a VSD and the blood vessel overrides both ventricles.
–The MPA, LPA or RPA usually exits the truncus posteriorly.
•Images from several views may be needed to establish the diagnosis. |
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Term
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Definition
–A congenital disorder of the connective tissue characterized by abnormal length of the extremities, fingers, toes, etc.
–Commonly affects the tunica media of the AO which weakens the vessel and may lead to dilation, degeneration, and possibly rupture.
•Parasternal long axis is usually a good view for assessment of the AO size and LA size.
•AI is a distinct possibility and should be carefully assessed. |
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Term
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Definition
–Coarctation is caused by a shelf like obstruction located in descending aorta just distal to the left subclavian artery.
–It can be visualized in using 2-D at the suprasternal notch.
•Parasternal long axis will show dilation of the ascending AO with prominent pulsation.
•Doppler examination shows high velocities in the descending AO distal to the narrowing |
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Term
TransThoracic Echocardiogram (TEE)
Views from Left Parasternal Window
*patient lying on left side |
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Definition
»Parasternal Long Axis
»Parasternal Short Axis
»Basal Level
»Mitral Level
»Papillary Muscle Level |
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Term
TEE. Apical Window Views:
*pt. on left side, transducer on PMI |
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Definition
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Term
TEE. Subcostal Window Views:
*pt. lies supine, flex knees, relax abs, inhale deeply. |
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Definition
|
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Term
| TEE. Suprasternal Window View |
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Definition
| Ascending and Descending AO |
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