Echo Boards

Normal male LVIDD?

Normal female LVIDD?

50 +/- 4 mm for male

45+/- 4 mm for female

How can you tell if an LV or LA measurement is foreshortened when doing biplane method of discs

4C and 2C lengths should be within 10% of each other

If apical views have poor imaging definition, how should you measure LV size instead of biplane method of discs?

area-length method from PSAX (area) and apical 4c (length)

Where should the LV borders be traced

between compacted and non-compacted myocardium

Normal LVEDVI male?

Normal LVEDVI female?

54 ± 10 ml/m2 for male

45 ± 8 ml/m2 for female

Formula to calculate LV mass (g)

0.8 × 1.04 x [(IVS + LVID + PWT)³ - LVID³]+0.6

Formula for relative wall thickness and normal value

Relative wall thickness (RWT) = 2 x PWT / LVIDD, normal value is <0.42. If > 0.42, this is concentric hypertrophy or remodeling

Normal cutpoints for LV mass index (gm/m2)

<= 95 for female

<= 115 for male

Formula for ejection fraction

100 x (EDV-ESV)/EDV

Upper limit of normal for indexed LA size (ml/m2)? mild, moderate, severe enlargement sizes?

up to 34 ml/m2 is normal

up to 41 - mildly enlarged

up to 48 - moderately enlarged

more than 48 - severely enlarged

RA volume indexed normal limits for male and female

(lower yield)

25 ± 7 ml/m² (male)

21 ± 6 ml/m² (female)

Normal RV basal and mid diameter (mm)

bonus: RV length

basal < 41 mm (not at annulus, widest portion in basal 3rd)

mid < 35 mm

length: 83 mm (annulus to apex)

What is RIMP (RV index of myocardial performance)? When should you use this and what are the limitations

RIMP = (IVCT+IVRT)/RV Ejection Time

This is really not used because it underestimates severity of disease (especially if RAP is high). If right atrial pressure is high, the isovolumetric contraction time (IVCT) of the RV is decreased.

Normal TAPSE?

17 mm

Normal RV S’?

10 cm/s

Normal RV vs LV strain?

normal RV strain -25%

nromal LV strain -20%

Normal RVEF?

42%

what is the gold standard for MS assessment?

CW across MV (better than invasive)

formula for MV area based on PHT?

MVA = 220/PHT

limitations for MVA by PHT?

affected by pressure in the LV and LA - if the LV pressure is high, the PHT will be short and you will underestimate the degree of stenosis. Same if LA compliance is messed up.

Also not as good for calcific/degenerative MV disease. ONLY for rheumatic!!

how do you calculate MVA by continuity?

(LVOT area x LVOT VTI)/MV VTI which is stroke volume/MV TVI

what is severe MV stenosis criteria for rheumatic MV disease

not defined by gradient. MVA < 1.5cm.

time from S2 to diastolic opening snap indicates what

shorter esp less than 80ms = severe MS (opens early due to high LA pressure)

how do you calculate PHT from decel time

Decel time x 0.29 = PHT

how do you calculate MVA by PISA

2*pi*r² * aliasing velocity / peak mitral valve velocity. Then multiple by the theta/180 correction.

what are the absolute contraindications to TEE (4)

known esophageal stricture or obstruction

active upper GI bleeding

esophageal perforation

esophageal diverticulum

what causes methemoglobinia in TEE? how do you treat?

the benzocaine spray causes it, treat with methylene blue, peripheral sat is not helpful for this

what are your reversal agents and doses for moderate sedation?

naloxone (0.4mg IV) and flumazenil (0.2-0.4mg.

might have to redose the flumazenil since half life is shorter than that of the benzos

If ultrasound were to travel through a medium that is 2x a fast as blood, what would happen to the velocity detected?

the velocity is doubled

velocity = c (speed of US in blood)/2 x deltaf/fo

what is the relationship between pulse repititon frequency and nyquist limit?

proportional -

Nyquist limit = PRF /2

if you want to increase your NyQuist limit, what are 2 things you could do?

decrease the depth of ultrasound —> increased PRF —> increased Nyquist Limit

or just increase the PRF

what PHT corresponds to SEVERE for acute aortic regurgitation

< 200 ms

what mechanical index do you usually image at?

less than 0.3. often less than 0.2.

what mechanical index would you use for suspected LVNC

0.3-0.4 to help deliniate the endocardial border

how do you perfusion imaging with contrast/UEA

can transiently go high (0.8-1) to destroy microbubbles and deplete the myocardium and watch to see how long it takes to replenish - normal is within 5 seconds at rest, within 2 seconds at stress

how to correct swirling of contrast

use a very low MI imaging, or increase the UEA infusion rate, move focus to nearfield

how ot deal with contrast attenuation artifact

can FLASH high MI briefly, or can decrease the contrast infusion rate

how do you calculate the wavelength from a frequency of 3MHz of an ultrasound probe transducer

in soft tissue, the velocity is 1540 m/sec

velocity = frequency * wavelength

so wavelength = 1540 m/s divided by 3MHz = 0.5 mm

what is a duty factor

percentage of time that hte ultrasound system is transmitting a pulse.

pulse duration / pulse repetition period

decreasing imaging depth will do what to the PRF

will increase the PRF — inverse relationship

what is this finding indicative of?

pulsus alternans at LVOT — VERY sick left ventricle, can be seen in end stage DCM

which leaflet of the tricuspid valve is the longest

anterior