Cardiology and Echocardiography: Key Concepts and Conditions

Where does AO dissection most commonly occur?

AAO

What is the most common disease of the AO?

Atherosclerosis

What is the most common and second most common valves that rheumatic disease affects?

First: mitral

Second: aortic

What is TS most commonly caused by?

Rheumatic disease

TV usually opens ________ MV opens and closes __________ MV closes.

Before

After

The PV usually opens _________ AOV opens and closes _______________ AOV closes.

Before

After

Normal valves open with what pressure gradient? Why do they open?

4mmHg pressure gradient

Open passively due to pressure

What is the most common and second most common symptoms for MS?

First: DOE

Second: hemoptysis (coughing up blood)

What is the most common and second most common congenital defects seen in adults?

First: Bicuspid AOV

Second: MVP and ASD's

What are the most common symptoms of AS?

SOB

Dyspnea

How long does systole begin after the QRS complex?

35ms

Systole ends after what wave?

T wave

IVRT begins before ________ after what wave?

Diastole

After T wave

IVRT begins and ends with what valves opening and closing

Begins when AOV closes

Ends when MV opens

Diastole begins at the end of what wave?

T wave

Diastole ends at the end of what wave?

QRS complex

IVCT occurs after what wave begins?

R wave

IVCT begins and ends with what valves opening and closing?

Begins with MV closes

Ends when AOV opens

How long is a normal R-R interval?

0.6-1sec

If the EKG alternans the echo might show?

Pericardial effusion

What conduction abnormality is commonly seen with MS?

Afib

What type of EKG waveform is seen with ventricular tachycardia?

High and curved E and A waves

What type of EKG waveform is seen with ventricular fibrillation?

Small waves

What type of EKG waveform is seen with atrial flutter?

Big saw tooth pattern before and after QRS

What type of EKG waveform is seen with atrial fibrillation?

Small saw tooth pattern before and after QRS, irregular pattern and rhythm

What is a normal EF%?

53%-73%

What is the normal EF% for men and women?

Men: 52-72%

Women: 54-74%

What are examples of vasovagal responses?

Bradycardia

Pallor/pale skin

Dizziness

Synscope

What are examples of anaphylaxis responses?

Tachycardia

Erythema/reddening of skin

What should you treat anaphylaxis with?

Hydrocortisone, such as epinephrine

Carcinoid syndrome affects what side of the heart?

Right

Chemotherapy has been shown to decrease what and lead to what?

Decrease EF

Heart failure

What may be seen in patients with advanced AIDS?

Pericardial effusion

Dilated CMO

COPD patients should not lay?

Flat

What is the best position for COPD patients to lay?

Semi erect/head and neck erect

LLD is best

When would you use amyl nitrate to evaluate MVP?

Patient with severe AS

What is modified duke criteria used for?

To assess likelihood of endocarditis

What is the Borg scale used for?

Exertion scale

Used to explain stress echos

What does hyperCalcemia and increased epinephrine do?

Increases HR and strength of contraction

What does hyperKalemia and hypernatremia do?

Decreases HR and strength of contraction

What is used to treat stable angina?

Nitroglycerin

What are osler nodes?

Red spots on soles and palms

What is osler nodes and janeway lessions assosciated with?

Infective endocarditis

When would you not do a MV balloon valvloplasty?

When patient has a LA thrombus

Interaortic balloon pump or heart transplants are recommended in patients with?

Dilated CMO

What is elevated serum levels of tropin, creatine kinase, and LDH indicate?

Acute MI

What is dilated CMO assosciated with?

Pheochromocytoma

Hypothyroidism

What deficiency is dilated CMO associated with?

Carnitine deficiency

What are pulses paradoxes and electrical alternans a sign of?

Tamponade

What is the most reliable predictor of tamponade?

Respiratory variation in flow velocity across the MV

What should patients do before a stress echo or TEEs?

Be NPO for 4-6 hours

What is pedal edema a sign of?

Congestive heart failure

What is trepopnea?

SOB in one position and not the other

What is loeys-dietz syndrome and what may it cause?

CT disorder

AO anneurysms

Hypothyroidism can demonstrate what on the heart?

Bradycardia

Global hypokinesis

Pericardial effusion

With rhabdomyomas associated with tuberous sclerosis and found in the RV occur in __________% of patients and they have __________.

90%

Multiple tumors

What valve diseases is assosciated with AO coarctiation?

MVP

Bicuspid AOV

How should the patient be positioned during TEEs?

LLD with head elevated 30 degrees

Thickened ventricular walls and pericardial effusion are typical signs of?

Restrictive cardimyopathy

What are common signs of MVP?

Leaflet redundancy

Myxomatous degenerarion

MVP is measured by the leaflet passing the annulus by?

>2mm

What is Dressler syndrome? When does it occur?

Pericarditis and pericardial effusion post MI

6-8 weeks post MI

Afib and first degree atrioventricular block with cause a preamature closure of what valve?

MV (LA may dilate)

AI will first lead to?

LV hyperkinesis

What PHT is assosciated with severe AI?

<200m/s

What is Kawasakis disease and where is it best seen?

Dilation of the coronaries

PSAX

How does afib appear on doppler with MV and pulmonary veins?

Loss of A wave on mitral tracing

Atrial reversal on pulmonary veins tracing

What type of diease is Fabrey disease?

Congenital

What is seen with Fabrey disease?

LV hypertrophy

Conduction abnormalities

Hyperechoic endocardial layer

Constrictive pericarditis and tamponade can cause dilated?

Dilated jugular and hepatic veins

What is the most identified cause of dilated CMO?

Alcoholism

Knocking sounds heard during cardiac ausculation and distended jugular veins are signs of?

Constrictive pericarditis

What is the most common complication of an acute MI?

LV aneurysm formation

What is a cortriatrium?

Congenital malformation of LA involving a membrane across the atria above the fossa ovalis and limits flow through MV

Cortriatrium mimics ________ and causes ______?

Mimics MS

Causes PS

What is the pressure if the pulmonary capillary wedge is the same as the LA?

Normal pressure, 10mmHg

On what side of the valve is vegetation seen?

Flow side (upstream/low pressure side)

Papillary fibroelastoma forms on what side of the valve?

AO side of AV

What cardiac changes are seen with pregnancy?

Dilated CMO

Pericardial effusion

Grade 3 diastolic dysfunction of the LV is commonly assosciated with?

Advanced restrictive CMO

What is the difference in septal flattening from RV pressure overload and RV volume overload

Pressure overload: septal flattening throughout entire cardiac cycle

Volume overload: IVS flattened during diastole

Eisenmanger syndrome occurs if the RVSP exceeds?

120mmHg (avg LV systolic pressure)

What mean pressure gradient for prosthetic valves indicate normal function and stenosis?

Normal: <20mmHg

Stenosis: >20mmHg

Mid diastolic closure of the MV can be seen with what abnormalities and why?

DCMO and severe AI

Because of elevated LVEDP

TR velocity ___________ with inspiration and ____________ with expiration.

Increases

Decreases

What is the measurement for severe AO root dilation?

>5cm

Ankylosing Spondyitis, Loeys-Dietz syndrome, and Ehlers-Danlos are assosciated with?

Dilation of AO room

What is the most common cardiac presentation with cocaine use?

Acute MI

What is the equation for RVSP with PS?

RVSP - 4(TR)^2 - 4(PS)^2

A cardiac transplant can cause?

Biatrial enlargement

Severe EF is when its under?

30%

Renal cell carcinoma goes through __________ and its?

IVC and RA

Finger like

What is the normal AOV size?

3-4cm^2

What information is needed to calculate LA pressure?

Systolic BP - MR velocity(4xV^2)

Flail MV or TV leaflets is a sign of?

Acute MI

What is the most common cause of AS?

Degenerative disease

In post coarctation the waveform is?

Monophasic

What is the formula for finding SV?

SV = EDV-ESV

or

SV= CSA x VTI

Phen-Fen use has been assosciated with?

Pulmonary HTN

What is annulus reversus and what cant be used?

Septal e greater than lateral e

These TDI measurements cant be used