Cardio & Surgery Terms - Echo Techniques & Treatments

pros of echo

safe/noninvasive

portable

relatively inexpensive

cons of echo

operator dependent

patient dependent (obesity, COPD, kyphoscoliosis)

what kind of waves is ultrasound

mechanical longitudinal wave

frequency for echo

> 20,000 Hz

types of echo

M mode

2D imaging

doppler

types of doppler used

pulsed

continuous wave/spectral

color flow

CWD/spectral

measures velocities along entire line

good for high gradients (Aortic stenosis, Mitral regurg)

PWD

measures velocity at a specific site

good for low gradients (LV outflow tract, Mitral valve inflow)

color flow doppler

shows direction of flow

good for regurgitation

TEE is used to look for

thrombus/embolic stroke

what type of echo is used for a patent foramen ovale

agitated saline with 2D

what type of echo would be used for someone with a fib and a stroke

TEE

what type of echo would be used for aortic stenosis

continuous wave

what type of echo would be used for tricuspid regurg

color doppler

what type of echo would be used for L atrial myxoma

2D

aortic stenosis

crescendo decrescendo murmur

aortic insufficiency

marfans

decrescendo murmur that is louder when leaning forward

widened mediastinum

dilated cardiomyopathy

ventricular chamber enlargement

impaired systolic contractile function

hypertrophic cardiomyopathy

abnormally thickened LV wall

abnormal diastolic relaxation

restrictive cardiomyopathy

abnormally stiffened myocardium leads to elevation of diastolic pressure

systolic function preserved until late stages

viral dilated cardiomyopathy

Coxsackie B

young pt w/ hx of viral infection (runny nose)

reversible causes of dilated cardiomyopathy

alcohol

atrial myxoma

pathophysiology of dilated cardiomyopathy

neurohormonal activation

angiotensin II and NE

activation of RAS and SNS --> LV remodeling

treatment for dilated cardiomyopathy

ACEI

B blockers

s/s of hypertrophic cardiomyopathy

dyspnea

harsh crescendo decrescendo systolic murmur that increases with valsalva and squat to stand

how do we determine if a crescendo decrescendo murmur is from aortic stenosis or hypertrophic cardiomyopathy

valsalva or squat to stand

treatment for hypertrophic cardiomyopathy

verapamil

B blockers

disopyramide

Causes of restrictive cardiomyopathy

amyloidosis

what is seen on echo with cardiac amyloidosis

speckling/salt and pepper myocardium

tako-tsubo syndrome

associated with various psychological and physical stressors (broken heart syndrome)

reversible LV apical ballooning/dysfunction without CAD

tako-tsubo syndrome is more common in

females

indications for CABG

refractory to medical therapy

triple vessel disease (RCA, LAD, L circumflex)

> 50% L main disease

two vessel disease 2/ >75% proximal LAD

best surgical option for CABG

L internal mammary artery

where to put/connect saphenous vein graft

RCA or circumflex

where to put/connect LIMA graft

LAD

treatment for postop a fib

metoprolol

diltiazem

amiodarone

aortic valve replacement is done for

aortic stenosis and regurgitation

indications for replacement of the aortic valve

CHF

syncope

angina

treatment for mitral stenosis

Percutaneous balloon valvuloplasty