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
Epicardium which is also the visceral layer fo the serous pericardium. Myocardium which is the muscle layer. 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
|
|
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
|
|
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
|
|
Term
| Name the fold of tissue that guards the inferior vena cava. |
|
Definition
|
|
Term
| The two divisions of the right ventricle are? |
|
Definition
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
|
|
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
|
|
Term
The muscle bundles that line the walls of the right and left ventricles are the? |
|
Definition
|
|
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
|
|
Term
| The naturally occurring shunt between the aorta and the pulmonary artery in fetal circulation is referred to as? |
|
Definition
|
|
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
|
|
Term
| An inflammation that affect the cardiac valves, and inner lining is? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| What is considered moderate MS for MVA? |
|
Definition
|
|
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
|
|
Term
| What is considered moderate for mean pressure gradient of MS? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
Definition
| The amount of blood pumped out of the heart with each contraction or beat. |
|
|
Term
| What is the formula for Stroke Volume? |
|
Definition
|
|
Term
|
Definition
| The force the ventricle must eject blood against |
|
|
Term
|
Definition
| Initial stretching of the myocytes prior to contracting |
|
|
Term
| What is the amount of blood ejected by a ventricle in one minute? |
|
Definition
|
|
Term
| What is the calculation for cardiac output? |
|
Definition
| Stroke Volume x Heart Rate |
|
|
Term
|
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
|
Definition
| Markedly reduced wall thickening |
|
|
Term
| An absence of wall thickening is also known as what? |
|
Definition
|
|
Term
| What abnormal wall motion is associated with dyskinesis? |
|
Definition
|
|
Term
| What is the fractional amount of blood being pumped out of the ventricle with each contraction? |
|
Definition
|
|
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
|
Definition
| The number of contractions of heart in one minute |
|
|
Term
| What is affected most by heart rate? |
|
Definition
|
|
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
|
|
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
|
|
Term
| What regulates the Mean or Average Blood Pressure and controls blood flow into organs? |
|
Definition
|
|
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
|
|
Term
| This contains neurons that control blood vessel diameter via the sympathetic nervous system. |
|
Definition
|
|
Term
|
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
|
|
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
|
|
Term
| What acts as a pump for blood when one is lying down—supine? |
|
Definition
|
|
Term
| What acts as a pump when one is upright—walking? |
|
Definition
|
|
Term
| Which circulation of the heart provides constant supply of oxygen rich blood to the myocardium under varying conditions or demands? |
|
Definition
|
|
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
|
|
Term
| What artery feeds the Apical wall? |
|
Definition
| Left Anterior Descending (LAD) |
|
|
Term
| What artery feeds the Inferior wall? |
|
Definition
|
|
Term
| What artery feeds the Lateral wall? |
|
Definition
|
|
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
|
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
|
|
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
|
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
|
|
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
|
|
Term
| True or False? The esophagus is located between the pharynx and the stomach. |
|
Definition
|
|
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
|
|
Term
| What percentage of TEEs results in death? |
|
Definition
|
|
Term
| Which structure is more anterior, the trachea or the esophagus? |
|
Definition
|
|
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
|
|
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
|
|
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
|
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
|
|
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
|
|
Term
| True or False? TEE is low frequency ultrasound. |
|
Definition
|
|
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
|
|
Term
| What is normal tricuspid valve area? |
|
Definition
|
|
Term
| When is a commisurotomy most likely to be performed on the TV? |
|
Definition
|
|
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
|
|
Term
| What must the Doppler of Tricuspid Valve E wave measure in order to confirm the presence of TS? |
|
Definition
|
|
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
|
|
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
|
|
Term
| If the IVC is dilated with a partial collapse how many mmHg would you add to get your RVSP? |
|
Definition
|
|
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
|
|
Term
| What is the most common cause of pulmonic stenosis? |
|
Definition
|
|
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
|
|
Term
| What type of murmur is heard at the LSB when severe PI is present? |
|
Definition
|
|
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
|
|
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
|
|
Term
| A PI waveform has a maximum velocity of 1.8 m/s. Calculate the mean PA pressure. |
|
Definition
|
|
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
|
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
|
|
Term
| Where is the transducer placed on the body to obtain a PLAX? |
|
Definition
|
|
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
|
|
Term
| From the PLAX the RV tilt is obtained by aiming the beam in what direction? |
|
Definition
|
|
Term
| Which TV leaflets are seen in the RV tilt? |
|
Definition
|
|
Term
| Which chamber is the moderator band found in? |
|
Definition
|
|
Term
| What two walls are seen in the Apical 2 chamber? |
|
Definition
|
|
Term
| What non-cardiac structure is seen in the subcostal long axis? |
|
Definition
|
|
Term
| This is a fetal remnant that is occasionally seen in the RA as thin strands. |
|
Definition
|
|
Term
| Name the only view that the TV posterior leaflet can be visualized. |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| In Doppler Effect, there must be movement between either the - of the sound or the - of the sound |
|
Definition
|
|
Term
| What changes as the distance between the sound source and the reflector changes? |
|
Definition
|
|
Term
| True or False. As the distance between the source and the reflector decreases, the frequency increases or becomes higher. |
|
Definition
|
|
Term
| What is the difference between the emitted frequency and the received frequency called? |
|
Definition
|
|
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
|
|
Term
| On Spectral Doppler, where is the positive shift positioned? |
|
Definition
|
|
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
|
|
Term
| On Spectral Doppler, where is a negative shift positioned? |
|
Definition
|
|
Term
| What units does the Doppler Shift use? |
|
Definition
|
|
Term
| What units does velocity use? |
|
Definition
|
|
Term
| What must be known in order to convert from Doppler Shift to velocity? |
|
Definition
|
|
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
|
|
Term
| What angle are you at when you are perpendicular to something? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| What happens when the Doppler Shift exceeds 1/2 of the PRF? |
|
Definition
|
|
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
|
|
Term
What can CW Doppler measure? |
|
Definition
-extremely fast blood flow
-eliminates the problem of aliasing |
|
|
Term
|
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
|
|
Term
| What CW Doppler has a better signal-to-noise ration? |
|
Definition
|
|
Term
| What must you have to note the part of the cardiac cycle you are in? |
|
Definition
|
|
Term
| What is the relaxation phase for the ventricles called? |
|
Definition
|
|
Term
| What is the contraction phase of the ventricles called? |
|
Definition
|
|
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
|
|
Term
| ---- blood flow will be filled in with white in the center. |
|
Definition
|
|
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
|
|
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
|
|
Term
| What cardiac cycle does Aortic and Pulmonic regurgitation occur in? |
|
Definition
|
|
Term
| What is the shape of a severe Mitral Stenosis? |
|
Definition
|
|
Term
| What should always be used to get the highest peak velocities? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| When does Mitral Stenosis severity show up in the heart regarding Rheumatic Fever? |
|
Definition
|
|
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
|
|
Term
| Where does MAC usually start? |
|
Definition
| Posterior in the posterior wall, infiltrates the anterior leaflet |
|
|
Term
|
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
|
|
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
|
|
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
|
|
Term
| The MV becomes stenotic when the area is less than---- |
|
Definition
|
|
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
|
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
|
|
Term
| How common is MVP in adults? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| What are the initials for Bacterial Endocarditis? |
|
Definition
|
|
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
|
|
Term
|
Definition
|
|
Term
| What age group commonly has MAC? |
|
Definition
|
|
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
|
|
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
|
|
Term
What does "cc" stand for? |
|
Definition
|
|
Term
| "I'm feeling weak or fatigued" is an example of a.... |
|
Definition
|
|
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
|
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
|
|
Term
| What kind of pain results from a lack of blood flow to and from the heart, like in CAD? |
|
Definition
|
|
Term
| What is another name for ischemic chest pain? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| With tachyarrhythmias, does the cardiac output eventually increase or decrease? |
|
Definition
|
|
Term
| What is another name for non-ischemic chest pain? |
|
Definition
|
|
Term
|
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
|
|
Term
|
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
|
|
Term
|
Definition
|
|
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
|
|
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
|
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
|
|
Term
| True or False? Radial pulses should arrive prior to the carotid pulse? |
|
Definition
|
|
Term
| What kind of pulse alternates in intensity, feeling strong one beat and weaker the next? |
|
Definition
|
|
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
|
|
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
|
|
Term
| What is the force exerted by blood on the arterial walls called? |
|
Definition
|
|
Term
|
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
|
|
Term
| What is it called when the systolic B/P falls below 80mmHg? |
|
Definition
|
|
Term
| A patient is considered febrile when they have a.... |
|
Definition
|
|
Term
| How much does oxygen consumption and CO2 production rise for every 1 degree rise in body temperature? |
|
Definition
|
|
Term
|
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
|
|
Term
| What is the normal respiratory rate of an adult? |
|
Definition
|
|
Term
| The average adult has how many liters of blood? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How many RBCs are there normally per cc of blood? |
|
Definition
|
|
Term
| How long do RBCs survive? How are they destroyed? |
|
Definition
| 120 days, by macrophages in the liver, spleen, and bone marrow |
|
|
Term
|
Definition
|
|
Term
| How many WBCs are there per cc of blood? |
|
Definition
|
|
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
|
|
Term
| Which granulocyte increases with an allergic reaction and fight parasitic worm infections? |
|
Definition
|
|
Term
| Which agranulocyte has a single horseshoe shaped nucleus and can leave the circulation? |
|
Definition
|
|
Term
| Which agranulocyte produces antibodies and antimicrobial chemicals? |
|
Definition
|
|
Term
| What is another name for platelets? |
|
Definition
|
|
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
|
|
Term
|
Definition
|
|
Term
| What nutrient is used to make hormones? |
|
Definition
|
|
Term
What term is used to describe mass/volume? |
|
Definition
|
|
Term
| What term is used to describe the thickness of blood? |
|
Definition
|
|
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
|
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
|
|
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
|
|
Term
| Where is blood shunted during digestion? |
|
Definition
|
|
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
|
|
Term
| Who described the relationship between flow volume and resistance? |
|
Definition
|
|
Term
| What affects the amount of blood flow volume more than any other factor? |
|
Definition
|
|
Term
| Who described the difference between laminar and turbulent flow? |
|
Definition
|
|
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
|
|
Term
| True or False? Color doppler generates a lot of energy, intensity, and heat? |
|
Definition
|
|
Term
| When can the heat of color doppler be a factor? |
|
Definition
|
|
Term
| What takes the frequency and makes it (color) something you can see? |
|
Definition
|
|
Term
| The color box is made up of individual lines, and each line is made up of individual_________, where flow is sampled. |
|
Definition
|
|
Term
| True or False? Making the color box bigger increases the frame rate and resolution of your image. |
|
Definition
|
|
Term
| How mant sample volumes are contained in one packet? |
|
Definition
|
|
Term
| What is the lowest acceptable frame rate? |
|
Definition
|
|
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
|
|
Term
| What does BART stand for? |
|
Definition
|
|
Term
| The black line is the baseline and represents.... |
|
Definition
|
|
Term
| What is aliasing represented by? |
|
Definition
|
|
Term
| Convergence maps are special variance maps with two halves. One half is ________and the other half is the amount of _________. |
|
Definition
|
|
Term
| Clutter or ghosting can be eliminated with a ___________? |
|
Definition
|
|
Term
| What is the nyquist limit? |
|
Definition
| The point at which aliasing occurs |
|
|
Term
| What is the optimum range for the nyquist limit? |
|
Definition
|
|
Term
| True or False? Increasing color sclaes too high will overestimate regurgitation? |
|
Definition
|
|
Term
When was the first prosthetic valve replacement performed? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
True/False- It is normal for mechanical valves to have a small amount of regurgitation? |
|
Definition
|
|
Term
|
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
|
|
Term
How will a mechanical valve fail? |
|
Definition
|
|
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
|
|
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
|
|
Term
Which brand name of porcine valves is the most common? |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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? |
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Definition
| Consisted of 2 semi-circular leaflets that pivot on hinges. The carbon leaflets were strong and had excellent biocompatibility |
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Term
When was the first St. Jude’s or CarboMedics valves introduced? |
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Definition
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Term
When performing Doppler on a St. Jude’s or CarboMedics valve where should the cursor be placed to get an accurate velocity? Why? |
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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. |
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Term
True/False- St. Jude’s or CarboMedics valves provide the closest approximation to central flow achieved in a natural heart valve. |
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Definition
| TRUE- The leaflets swing open completely, parallel to the direction of blood flow. |
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Term
True/False- St. Jude’s or CarboMedics valves are considered an ideal valve. |
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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. |
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Term
What are the brand names of Bi-Leaflet Tilting Disc valves? |
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Definition
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Term
Which brand name of Bi-leaflet Tilting Disc valves is the most common? |
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Definition
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Term
True/False- Regurgitation of prosthetic valves appears the same severity on both TTE and TEE? |
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Definition
| FALSE- The regurgitation always appears worse on TEE than on TTE. |
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Term
List 4 things in which serial exams of prosthetic valves will include. |
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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. |
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Term
Is a baseline echo needed for a prosthetic valve once the valve has been implanted? |
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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. |
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Term
True/False- Wedge pressures are not affected by implantation of prosthetic valves. |
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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. |
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Term
What kind of information does a “medical device card (MDC)” provide? |
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Definition
| Manufacturer of prosthetic valve, model number of prosthetic valve and size of prosthetic valve |
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Term
How will velocities change with prosthetic valve in comparison to a native valve? |
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Definition
| Peak velocities will be increased with a prosthetic valve from those obtained in native valves. |
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Term
List the Doppler tools which are used for assessment of all prosthetic valves. |
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Definition
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Term
True/False- The continuity equation can be used for all prosthetic valves to calculate the AVA. |
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Definition
| FALSE- The continuity equation can be used to tissue valves, but not mechanical valves. |
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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? |
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Definition
| Dimensionless Index & Mechanical Valves |
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Term
What is the ratio used for calculation of the dimensionless index for mechanical valves? |
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Definition
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Term
Using a VTI of 15 for LVOT and a VTI of 51 for the AOV, calculate the ratio and is it stenotic? |
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Definition
15÷51 = .29
Yes- <0.3 is stenotic |
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Term
What are the units of the dimensionless index? |
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Definition
| There are no units for the dimensionless index. |
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Term
What’s the normal range for the dimensionless index and when is it considered to be stenotic? |
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Definition
Normally between 0.35 - 0.5
<0.3 is stenotic |
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Term
What valve positions can be assessed with P1/2T & VTI tracings? |
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Definition
| Mitral and Tricuspid valve areas |
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Term
Which method is more accurate for calculating prosthetic valve velocities in the mitral & tricuspid valve positions? |
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Definition
| VTI calculation to get the mean gradient is more accurate. Normal values must be looked up in a table for each valve. |
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Term
When should a baseline ratio be performed? |
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Definition
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Term
List everything that can assess regurgitation in a prosthetic valve. |
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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 |
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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. |
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Definition
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Term
How will a ring abscess appear on 2D echo? |
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Definition
| An anechoic area surrounding the annulus. |
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Term
What is the brand name of the prosthetic valves which are in clinical trials and are not yet approved by the FDA? |
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Definition
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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. |
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Definition
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Term
| What does Pulsus Paradoxus provoke when Pericardial effusion is present? |
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Definition
| Decrease > 10mmHg in systolic blood pressure during inspiration creates Pulsus Paradoxus |
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Term
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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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