Download FINAL EXAM Prep Part 2

Lecture 22
Adult Echocardiography
Final Exam Review
Part 3
Holdorf
LV masses (weight) remains normal in chronic:
• Mitral stenosis
High angulation of an M-mode transducer
beam equals:
• Pseudo bicuspid aortic valve
What is the primary effect of long-standing
aortic regurgitation?
• Decreased ejection fraction
Which of the following syndromes fits with Aortic
regurgitation, Ao, dilatation, Ao dissections, & Ao
aneurysms?
• Marfan syndrome
Why follow chronic AI/AR patients?
• Check left ventricular size
RVSP =
• PAP
• Right ventricular systolic pressure = Pulmonary artery pressure
What causes a pericardial knock?
• Abrupt cessation of early diastolic inflow (Classic in constrictive pericarditis)
similar in timing to a very loud S3.
Systolic reversal of flow
• AKA RETROGRADE
Lambl’s Excerscenes are sometimes listed as a
potential answer.
• They are the thin filiform strands (fronds) that form on the edges of valve
leaflets.
A spectral trace of a high velocity jet of around
4 m/sec will be either a MS or AI…
• Aortic Insufficiency
What accompanies bicuspid aortic valves?
• Coarctation of the aorta (50% of coarctations have a bicuspid valve)
When is mitral pressure half-time NOT
accurate?
• Post valvulopasty
Given Tricuspid regurgitation and Right atrial
pressure, what can you calculate?
• Right ventricular systolic pressure
If your patient has a dilated Left Ventricle and thin
septum, what might be going on with this patient?
• Severe mitral regurgitation
What is the best way to determine the severity
of mitral regurgitation?
• Pulmonary venous flow
Which cardiac pathology affects the valves?
• carcinoid
Name the two layers of the pericardium
• Visceral and parietal
Which pericardial layer is serous?
• Visceral or epicardial
Cardiac tamponade is rapid filling of fluid:
• Causing restrictive diastolic filling
Question about the indication of tamponade
and the best answer was:
• Right atrial/right ventricular collapse in diastole
Beware of normal dropout vs. secundum ASD
on…
• Apical 4-chamber view
For contrast studies, know:
• Acyanotic shunt is Left to right
• Cyanotic shunt is right to left
Kids with tuberous sclerosis develop what type
of cardiac tumor?
• rhabdomyomas
Peripheral contrast NOT useful in:
• Aortic insufficiency
Which view shows the coronary sinus in long
axis
• Apical 4-chamber with posterior angulation
What is the valve of the IVC?
• Eustachian valve
What is meant by automaticity?
• The ability to initiate an electric impulse or beat
• INTRINSIC means pertaining exclusively to a part
What does amyl nitrate do to the heart rate?
• Increases Heart Rate
Know the difference on 2-D between a pacer
(pace-maker) wire and a catheter.
• Pacer wire goes to the right ventricle apex
• Central venous lines stay in the right atria
• Swan-Ganz catheters usually do not go to the right ventricular apex
Why are the right and left coronaries called
right and left?
• The left artery supplies most of the left ventricle and the right artery most of
the right ventricle
Why are the RCC, LCC and NCC called what
they are?
• Because of the coronaries
Where does the left anterior descending
coronary artery originate?
• Anterior interventricular sulcus
A systolic rumble might be?
• A tricuspid regurgitation
What is hematocrit?
• % of blood comprised of red blood cells
BREATHING…
• If you are doing an echo on a supine patient who becomes short of breath,
what should you do first?
•
Sit the patient upright
What do you do first for an apneic patient after
giving sedation?
• Check their airway
Why do an IVC SNIFF test?
• To check for elevated Right Atrial pressures
What is a pressure drop?
• Same as a GRADIENT across a valve
Superimposed respiratory tracing
Which of the following valves is LEAST likely to
be affected in rheumatic heart disease?
• pulmonic
Mitral valve inflow velocity should NOT be
affected by:
• Gender
Which valve is most likely to regurgitate in
normal?
• Tricuspid
Causes of acute mitral regurgitation
• Endocarditis
• Ruptured chordae
• Papullary muscle dysfunction
• Prosthetic valve dysfunction
With what disease should you NOT rely on M-mode
for quantifying left ventricular Ejection Fraction
• Apical infarction
Where do the coronaries drain?
• Into the coronary sinus
Which coronary supplies the left ventricular
apex?
• LAD- Left anterior descending
A myocardial infarction of the inferior wall
involves which coronary artery?
• Right coronary artery
What % of normal will have a patient foramen
ovale?
• 20-30%
What 2D finding would you see in a patient
with a Persistent left superior vena cava
• A dilated coronary sinus
Know about Pre-systolic opening or the aortic
leaflets
• Also caused by an elevated Left ventricular End diastolic pressure LVEDP
Patients with ankylosing spondylitis may
develop?
• Aortic regurgitation
What is kyphosis?
• Exaggerated anterior spinal curvature.
• Skeletal deformity may compress the pulmonary artery and cause
pulmonary hypertension
What is Uhl’s anomaly?
• Congenital absent right ventricular myocardium.
• Also called “parchment heart” – may be confused clinically with Ebstein’s
What can cause contrast to dissipate too
quickly?
• High myocardial infarction
Does a patient ductus arteriosus increase left
ventricular preload?
• Yes-when the shunt is left to right
Diastole is measured at the onset of QRS
Systole at smallest diameter
Name the three heart muscle layers:
• 1. epicardium-thin outer layer
• 2. Myocardium – mid wall (thickest)
• 3. Endocardium - inside
Normally, how much pericardial fluid is there?
• 40 cc
What may cause jugular venous distension?
• Cardiac tamponade
• Pulmonary hypertension
• Tricuspid stenosis
• Constrictive pericarditis
If a patient has Cor Pulmonale, which of the
following conditions are MOST likely to exist?
• Right ventricular increase
• It is the failure of the right side of the heart brought on by long-term high
blood pressure
How do cardiac problems cause renal failure, jugular
venous pulsations, and peripheral edema?
• Mostly through systolic failure and low perfusion causing multi-system
complications
An enlarged heart on chest x-ray could be all of
the following:
• Pericardial effusion
• Aortic stenosis
• Hypertrophic cardiomyopathy
How many weeks until the heart is developed?
• 6 weeks
Know persistent fetal circulation
• Pulmonary hypertension with right to left shunting across the foramen and
ductus
Which embryonic aortic (1-6) develops into the
transverse arch?
• fourth
Preload
Afterload
• Preload = volume = thin walls
• Afterload = pressure = thick walls
Are right-sided pressures elevated with a
Valsalva maneuver?
• During the strain phase = no
• During the release phase = yes
What kind of murmur will a patient with a VSD
have?
• Harsh holo-systolic
Which clinical finding is associated with a
fraction rub?
• Pericardial effusion
Where is the chiari network (system) located?
• Right atrium
Aortic regurgitation starts at the:
• Beginning of IVRT (isovolumic relaxation time)
Know frequency for TEE probes vs. TTE
• TEE probes are usually higher in frequency (5-7 MHz)
• TTE probes are usually 2-7 MHz
What causes a left parasternal fraction rub?
• pericarditis
BiPlane Simpsons rule is used from calculating
• Ejection fraction
A patient with a secundum ASD has a bubble
study. It shows the following:
• Bubbles from RA to LA
• Negative contrast jet to RA
• Bubbles in the pulmonary artery
In the apical four-chamber view, where you
would see a reverberation artifact?
• Apex
The QRS complex…
• Equals depolarization
All of the following can lead to a false
diagnosis of pericardial effusion on M-m0de:
• Descending Ao
• Calcified mitral annulus
• ascites
Where are most fibro-elastomas found?
• Usually on the valves (mitral and aortic)
• May be described as Frond-like (feathery)
The reason for using ultrasound gel is to:
• Keep the air out
How many years are echo records kept?
• seven
What might you see in a patient with
scleroderma?
• Usually pulmonary hypertension or, secondly, pericardial effusion
Will an ascending Ao dissection cause severe
Mitral regurgitation?
• No
• Not severe, but perhaps mild
What is the most common type of pediatric
cardiac tumor?
• Rhabdomyoma
Why is the SA node the primary pacemaker?
• The SA node has the fastest (highest) intrinsic rate of any cardiac tissue.
• SA node = 60-70/minute
• AV node = 50/minute
• Myocardium 30/min
The wave on contraction (depolarization) moves
from the endocardium to the epicardium:
• Inside to outside
What is the Ao valve doing during the Q-T
interval
• The valve is open
Know the 4 defects that make up Shone’s
Syndrome:
• Supravalvular mitral membrane
• Parachute Mitral valve
• Subaortic stenosis
• Coarctation of the Ao
When is the left ventricle ventricular pressure
the lowest?
• Early diastole
The primary cause for papillary muscle
dysfunction is:
• Apical infarction
Valve timing:
• Which valve event starts isovolumic contraction?
•
Mitral valve close
• Which valve event ends isovolumic contraction?
•
Ao open
• Which valve event starts isovolumic relaxation?
•
Ao close
• Which valve event ends isovolumic relaxation?
•
Mitral valve open