Echo Board Exam

RCA

Supplies blood to both atria, RV free wall, RV apex, inferoseptal and inferior LV walls

LCX

Supplies anterior wall, septal and anterior septal walls, LV apex, RV apex, and moderator band

LAA

A fib patients have an increased risk of thrombus formation here

Fibrous pericardium

Outermost layer

Parietal

outer, thicker, fibrous

Electromechanical delay

Electrical activation occurs but mechanical contraction hasn’t happened yet

Ventricular systole

MV closure to AV closure, peak of R wave to T wave

Normal valves open when there is a what pressure gradient

4 mmHg

Bernouli calculates the

peak instantaneous gradient

Pulmonary wedge pressureL

LA pressure or LVEDP

Increased afterload is associated with

stenosis, HTN, PHTN, aortic coarctation

Cardiac index

Considered body surface area

SA node

Pacemaker of the heart

P wave

Atrial systole

Orthopnea

Difficulty breathing while laying down

Jugular vein distention

Associated with TS, PTHN, TR, constrictive pericarditis, tamponade

PDA murmur

Continous

Chagas

LV apical aneurysm

LVOT Diameter

Inner to inner, mid-systole

TAPSE

< 16 mm indicates RV dysfunction

TEE Indications

Endocarditis, CHD, wall motion, thrombus, stenosis, regurgitation, prosthetic, AO dissection, intraoperative monitoring

Stress testing echo

Have 60 seconds to get images

True positive of CAD with stress

Wall motion abnormality, global decrease EF, and increased LV volume

Global longitudinal strain (GLS)

Normal -17 to -26

Settings for contrast

MI < 0.3

VSD murmur

Holosystolic

VSD

Normal QP/QS: 1:1

Perimembranous VSD

MC type, 10-12 o’clock position PSAX

ASD murmur

Fixed split systolic murmur

Sinus Venosus

MC vein to have anomalous origin: right upper

Partial AVSD

Septum primum and cleft MV

Bicuspid AV

Associated with coarctation

Subvalvular AS

Tissue obstructs LV ejection and stimulates AS

Ebstein Anomaly

Associated with secundum ASD

Persistant Left SVC

Inject bubbles into left arm

PDA

Continuous murmur

Coarctation of aorta

BP and pulses may be decreased in abdomen and lower extremities

Tetralogy of Fallot

VSD, Overriding aorta, RVOT obstruction/pulmonary stenosis, RVH

Vena contracta

Measured at narrowest segment of width

Severe AI

Holodiastolic flow in abdominal aorta

PI most common cause is

Pulmonary hypertension

Rheumatic TS involves

Leaflet tips

Carcinoid TS involves

Entire leaflet

MC cause of TS

Rheumatic

Equation for RVSP

TRPG + RAP

MC cause of MS

Rheumatic

AI can cause….

Underestimation of MS

Normal values of MV PHT

30-60

MVP

Mid systolic clicking

MVP has an increased risk of

Endocarditis

Acute MI Complications

MC is LV Aneurysm

LV Pseudoaneurysm

Blood in pericardium, eval neck and stalk

Non-compaction LV myocardium

Hypertrophied LV, multiple trabeculations, deep recesses

Dilated CM

Alcohol use #1 cause

Chagas CM

LV apical aneurysm and thrombus form

Dilated CM EF

10-20%

Amyloidosis

Apex is spared

Amyloidosis strain appearance

Cherry on top

Hemochromatosis

Iron deposits in myocardium, liver, pancreas, and pituitary gland

Bacterial endocarditis

Causes vegetations due to damage to endocardial surface

Valve MC affected by bacterial endocarditis

Mitral valve

MV Vegetation

Prolapses into LA during systole

Liebman Sacks Endocarditis

Associated with lupus

MC location for a myxoma

Left atrium

Papillary Fibroelacstomas

MC valve tumor

Papillary fibroelastomas MV

LV side

Papillary fibroelastomas AV

AO side

Tamponade

Rapid collection of fluid increases pressure buildup outside of heart, restricts diastolic filling

Becks Triad for Tamponade

IVJ distention, hypotension, muffed sound

Most reliable factor for Tamponade on sono

MV flow variation, restricts filling

How to measure AO root and ascending AO

Outer to inner or leading edge to leading edge

What is a common cause of sudden death with Marfan’s syndrome?

AO dissection

Normal E/E’ ratio

<14

Normal peak TR

<2.8 cm/s

Normal LA volume index

<34

Normal E’ septal

>7cm/s

Normal E’ lateral

>10 cm/s

MVA equation

220/PHT

AVA equation

0.785 x (LVOT d)² x LVOT PSV/ AV PSV

M-mode is b-notched means

Elevated LVEDP

Dimensionless index equation

LVOT vti / AVR vti

What is the most common valve tumor?

Papillary fibroelastomas

How does valsalva manuever affect diastolic function?

Decrease preload