Echo - Final Exam (Jo's set)

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A4C

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A2C

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A3C or LONG AXIS

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Base or top

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Mid

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Apex or bottom

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PLAX

1. RV

2. LA

3. MV

4. LVOT

5. AV

6. Aortic root

7. Descending AO

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PLAX RVIT

A. RA

B. TV

C. RV

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PLAX RVOT

1. RV

2. PV

3. Main pulmonary artery

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PSAX AV Basal

1. Descending aorta

2. LA

3. IAS

4. RA

5. TV

6. RVOT

7. PV

8. Main pulmonary artery

9. Right coronary cusp

10. Noncoronary cusp

11. Left coronary cusp

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PSAX MV level

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PSAX LV

1. Papillary muscle

2. LV

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A4C

1. LA

2. MV

3. LV

4. RA

5. TV

6. RV

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A2C

1. LA

2. MV

3. LV

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A5C

1. LA

2. LV

3. RA

4. RV

5. Ao

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A3C

1. LA

2. MV

3. LV

4. AV

5. Ao

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Suprasternal view of descending aorta

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IVC Subcostal

1. SVC

2. RA

3. IVC

4. RV

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Subcostal four chamber

1. LA

2. MV

3. LV

4. RA

5. TV

6. RV

Where is the heart located?

Posterior to sternum within middle mediastinum

What is the most anterior chamber of the heart?

RV

What is the order of the layers of the heart?

1. Endocardium: Innermost layer

2. Myocardium: Middle layer

3. Epicardium: Outermost layer

What is the pericardium?

Membrane that lines pericardial cavity and encases heart

What is the crux of the heart?

Posterior portion of heart where all 4 chambers meet

What is the order of blood circulation through the heart?

1. SVC/IVC

2. Right atrium

3. Tricuspid valve

4. Right ventricle

5. Pulmonary valve

6. Pulmonary artery

7. Lungs

8. Pulmonary veins

9. Left atrium

10. Mitral valve

11. Left ventricle

12. Aortic valve

13. Aorta

14. Body

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1. RCA

2. LCA

3. Left circumflex artery

4. Left anterior descending artery

What is the normal firing rate of the conduction system of the heart?

1. SA node = 60-100 bpm

2. AV node = 40-60 bpm

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1. SA node

2. AV node

3. Bundle of HIS

4. Right bundle branches

5. Left bundle branches

6. Purkinje fibers

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1. Isovolumetric contraction

2. Ventricular systole

3. Isovolumetric relaxation

4. Diastole

5. Atrial systole

6. P wave

7. ST segment

8. T wave

9. QRS complex

What are the phases of the action potential curve (APC)?

1. Phase 0: Depolarization or sodium influx

2. Phase 1: Potassium influx

3. Phase 2: Calcium influx

4. Phase 3: Repolarization (recovery) or potassium outflow

5. Phase 4: Refractory or potassium influx and sodium outflow

How are the EKG and action potential waveforms related?

1. P wave: Atrial depolarization

2. QRS complex: Ventricular depolarization

3. T wave: Ventricular repolarization

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Phases of cardiac cycle

1. Ventricular filling and atrial contraction

2. Isovolumetric contraction

3. Ejection

4. Isovolumetric relaxation

5. Rapid ventricular filling

6. Diastasis

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Valvular events

1. MV closure

2. AV opening

3. AV closure

4. MV opening

What is the role of each segment of the heart during diastole?

1. Atria: Relaxation

2. AV valves: Open to allow blood to fill ventricles

3. Ventricles: Relaxation

4. Semilunar valves: Closed to prevent backflow of blood

What is the role of each segment of the heart during systole?

1. Atria: Contraction

2. AV valves: Closed to prevent backflow

3. Ventricles: Contraction

4. Semilunar valves: Open to allow flow to great vessels

What transducer should be used for an adult echocardiogram?

2.5 - 5 MHz

What are the patient positions used for echocardiograms?

1. Left lateral semidecubitus

2. Supine

3. Right lateral decubitus (Pedoff)

Where is the suprasternal window located?

Suprasternal notch

Where is the subcostal window located?

Midline and beneath costal margin

Where is the apical window located?

Over cardiac apex

Where is the parasternal window located?

Area bounded superiorly by left clavicle, medially by sternum, and inferiorly by apical region

Where is 12 o’clock located in echo?

Patient’s head

What are the long-axis views (PLAX)?

1. LV in sagittal plane

2. RV inflow (TV) achieved by inferior angulation

3. RV outflow (PV) achieved by superior angulation

Where is notch pointed in PLAX?

Patient’s right shoulder or 10 o’clock

Where is the notch pointed in PSAX?

Patient’s left shoulder or 2 o’clock

What are the short-axis views (PSAX)?

1. PSAX LV apex achieved by inferior angulation

2. PSAX MV achieved by superior angulation

3. PSAX AV basal achieved by superior angulation

Where is the notch pointed for apical views?

Toward bed or 3 o’clock

What are the apical views?

1. A4C

2. A5C achieved by superior angulation

3. A2C achieved by rotating probe counter-clockwise

4. Apical long or A3C achieved by rotating probe counter-clockwise

Where is the notch pointed for subcostal views?

Towards bed or 3 o’clock

What are the subcostal views?

1. Subcostal 4C

2. Subcostal IVC achieved by rotating probe counter-clockwise

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A4C

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A2C

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A3C or LONG AXIS

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Base or top

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Mid

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Apex or bottom

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PLAX

1. RV

2. LA

3. MV

4. LVOT

5. AV

6. Aortic root

7. Descending AO

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PLAX RVIT

A. RA

B. TV

C. RV

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PLAX RVOT

1. RV

2. PV

3. Main pulmonary artery

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PSAX AV Basal

1. Descending aorta

2. LA

3. IAS

4. RA

5. TV

6. RVOT

7. PV

8. Main pulmonary artery

9. Right coronary cusp

10. Noncoronary cusp

11. Left coronary cusp

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PSAX MV level

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PSAX LV

1. Papillary muscle

2. LV

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A4C

1. LA

2. MV

3. LV

4. RA

5. TV

6. RV

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A2C

1. LA

2. MV

3. LV

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A5C

1. LA

2. LV

3. RA

4. RV

5. Ao

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A3C

1. LA

2. MV

3. LV

4. AV

5. Ao

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Suprasternal view of descending aorta

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IVC Subcostal

1. SVC

2. RA

3. IVC

4. RV

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Subcostal 4C

1. LA

2. MV

3. LV

4. RA

5. TV

6. RV

Which blood flow abnormalities can cause a murmur?

1. Left heart disease such as AS, AR, MS, and MR

2. Intracardiac shunt such as an ASD, VSD, or PDA

3. Right heart disease such as PS, PR, TS, TR

4. Normal echo seen as a flow murmur with regurgitation

When performing an echo, what are questions that should be asked about the LV?

1. Is the EF normal?

2. Is the LV normal in size or dilated?

3. Are there any wall motion abnormalities?

When performing an echo, what are questions that should be asked about the valves?

1. Are the valves thick or stenotic?

2. Do the valves have normal mobility?

When performing an echo, what are questions that should be asked about the right side of the heart?

1. Is the size and function normal?

2. Are the pressures normal?

When performing an echo, what are questions that should be asked about other anatomy?

1. Is there pericardial effusion present?

2. Is the IVC dilated?

3. Are there any masses?

What is m-mode?

Function that allows for identification of thin moving structures such as endocardium

What are the uses for m-mode?

1. Timing of rapid cardiac motion

2. Precise measurements of cardiac dimensions

3. Further evaluation of structures seen on 2D imaging

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PLAX image showing LA and AV

1. RV

2. Aortic root

3. AV leaflets opening

4. LA

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PLAX or PSAX image showing MV

1. IVS

2. RV

3. LVOT

4. Anterior MV leaflet

5. Posterior MV leaflet

6. Posterior wall

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PLAX or PSAX image showing LV

1. LV end systolic dimension

2. IVS

3. LV end diastolic dimension

4. LV posterior wall

5. Chordae

6. RV

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1. IVSDd

2. PWDd

3. IVSDs

4. PWDs

5. LVIDd

6. LVIDs

How do you measure the LVOT?

Measure in PLAX when AV is open so LVOT is at largest diameter and place calipers proximal to AV annulus from inner to inner

How do you measure LV volume and LVEF?

Measure in A4C and A2C using modified Simpson’s at end-systole and end-diastole while tracing blood pool interface

What structures should be excluded from LV volume and LVEF measurement?

Papillary muscles

What is the formula for LVEF?

LVEF = LVEDV - LVESV / LVEDV

What is the difference between LV enlargement and LV hypertrophy?

1. LV enlargement: Widening of LV chamber OR combination of increased wall thickness and chamber size

2. LV hypertrophy: Increase in thickness of LV muscular walls

What is diastolic function?

How well ventricles relax

What is the criteria needed to assess LV diastolic function in patients with normal LVEF?

1. Average inflow velocities (E’)

2. Septal and lateral mitral annulus early diastolic velocity (e’)

3. Peak TR velocity

4. LA volume index

What PW images should be taken of AV?

1. A5C or A3C with PW sample volume placed 5 mm proximal to AV in center of LVOT

2. Trace to measure peak velocity and VTI

What CW images should be taken of AV?

1. A5C or A3C with CW sample volume placed through AV

2. Trace to measure peak velocity, peak gradient, mean gradient, and VTI

What is the continuity equation for aortic valve area (AVA)?

NEED TO FIND LVOT CSA PRIOR BY USING CSA LVOT EQUATION***

AVA = (CSA LVOT x VTI LVOT) / VTI AV

What measurements impact aortic valve area (AVA) calculation?

1. Inaccurate LVOT diameter (squared value)

2. Inaccurate transvalvular sampling or not obtaining highest velocity

What is aortic stenosis (AS)?

Narrowing of AV due to congenital, degenerative or calcific, and rheumatic conditions

What criteria could be used to determine severity of AS other than aortic valve area (AVA)?

1. Peak velocity

2. Mean gradient

3. Velocity ratio

4. Indexed AVA

Identify this image.

Bicuspid AV seen as football shape or two leaflets

What are the associated anomalies of a bicuspid AV?

1. Aortic dilation

2. Aortic aneurysm

3. Aortic dissection

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Unicuspid AV seen as one solitary opening or one cusp

What are the associated anomalies of an unicuspid AV?

Stenosis

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Quadricuspid AV seen as X shape in PSAX or four leaflets

What are the associated anomalies of a quadricuspid AV?

Regurgitation

What should be measured with PW when evaluating the MV for diastolic function?

1. Peak E velocity

2. Peak A velocity

3. Early diastolic DT