Cardiac Exam 2

How can one differentiate a PAC from a PJC?

by the P wave

What does the protective nature of a junctional escape beat prevent from occurring?

cardiac standstill

What is the primary purpose of a normally functioning AV junction?

slow the conduction of an impulse to the ventricles

What information can a right heart cath provide that a left heart cath cannot?

pulmonary capillary wedge pressure

True or False:

In a premature junctional complex the QRS is 0.11 sec or less unless it is conducted abnormally.

True

In a patient with A-fib, once a TEE is indicated, when should it be performed?

prior to cardioversion

What drug can be used as a stimulant in a stress echo if the patient is allergic to Dobutamine?

Adenosine

True or False:

In a left to right shunt, the negative contrast is revealed in the left ventricle.

False

What is the device that prohibits the patient from biting on the transesophageal transducer/cord?

bite block

What percentage of the maximum heart rate if considered to be the desired target heart rate sustainable for 1 minute?

85-90%

What type of transesophageal probe is the most commonly used in performing TEE?

omniplane

A stress echo has been ordered for a patient who complains of ankle and knee pain. What type of stress echo would be of most value for a diagnosis?

DSE

What is the most vital key to a successful stress echocardiogram?

patient education

Which of these is an advantage of stress echocardiography?

comparatively low cost

Which of these medications is used in conscious sedation?

Demerol

What treatment for coronary artery disease is not performed in the cath lab?

CABG

What can the simplified or modified Bernoulli equation be used to calculate for when using Doppler?

pressure gradients

Which of these is not considered an indication for cardiac catheterization?

screening for coronary artery disease

What type of transducer is being researched for continuous visualization of left ventricular function?

Transnasal probe

Which of these terms is NOT used in describing wall motion abnormalities?

hyperkinetic

What type of tricuspid valve prolapse is incorrect?

all three leaflets, mid-late diastole

What is the criteria for determining severe AS by the max PG method?

>64 mmHg

True or False:

A peak velocity of 5.0 m/sec would be considered mild AS.

False

What is a congenital cause of tricuspid regurgitation?

Ebstein's anomaly

What may happen to the murmur heard with pulmonic insufficency during inspiration?

increases

How would a Grade Ill mitral regurgitant jet be identified subjectively utilizing color flow Doppler?

MR jet extends 1/2 way into the left atrium

What is another name for an agonal rhythm?

dying heart

T/F: TEE is a vital diagnostic tool when evaluating the artic arch for dissecting aortic aneurysms.

True

The following is not a definition os Type Il aortic dissections.

B: All of the above except for A

T/F: Al creates a laminar systolic jet from the AOV into the LVOT and LV. (Page 74)

False

Common findngs of aortic stenosis are:

all of the above.

What type of murmur is associated with aortic stenosis?

systolic crescendo decrescendo

PISA is used to determine what parameter?

effective regurgitant orifice.

True or False

Pulmonary venous systolic flow reveral is found in cases of severe MR.

True

What parameter should be considered when calculating the RVSP/PAP using the tricuspid regurgitant jet?

perform sniff test of IVC; if collapses, use 10mmHg in formula, if not use 15-20mmHg in formula

Why will a small error in measuring the LVOT produce a large error in calculating the area of the aortic valve (AVA)?

diameter of LVOT is squared in continuity equation

Which of these markers is not typical of Al with 2D imaging?

Acute Al causes decreased EF

What is the most common cause of pulmonic stenosis?

congenital

What type of flow is found proximal to a stenotic valve?

laminar

Given the peak velocity of 4 m/sec, which answer is the correct pressure gradient?

64

Congenital aortic stenosis includes which subtype?

supravalvular

What type of PVC may cause ventricular tachycardia or ventricular fibrillation?

R on T

What is the range of valve area for moderate aortic stenosis when utilizing the Continuity Equation?

1.0 - 1.3 cm2

What is the low pitched, diastolic murmur associated with mitral stenosis known as?

rumble

True or False

The mean transvalvular pressure gradient as found in Doppler Echocardiography, correlates best with cath lab findings.

True

What are two common brand names of prosthetic valves with valvular rings?

Carpentier, Duran

T/F: The two types of prosthetic valves include bioprosthetic and mechanical valves.

True

Which is an etiology for valve replacement?

aortic dissection with severe Al

Which leaflet or cusp may aortic insufficiency caused by infective endocarditis demonstrate a "fluttering" pattern on M-mode?

anterior leaflet of mitral valve

True or False:

Performing the same Doppler measurements, in serial examinations of the prosthetic valve, is vitally important in order to dectect any changes due to stenosis, regurgitation and the overall function of the heart.

True

Which layer of the heart is affected in infective endocarditis?

endothelial layer

At what point in infective endocarditis is there a higher incidence of embolization?

>5mm in size and pedunculated

Which disease process has a low-risk of infective endocarditis?

coronary artery disease

What is the normal leaflet thickening of the aortic valve at the central coaptation region called?

nodule of Arantius

Scenario: An inpatient with positive blood cultures for Viridans Steptococci, fever, and an oscillating intracardiac mass on the aortic valve seen on 2D and M-mode echocardiography demonstrates red, tender spots under the skin on their fingers. These spots are known as:

Osler's nodes

True or False:

Pericardial effusion and heart failure are never seen with infective endocarditis.

False

True or False:

Artifacts from the prosthetic mechanical valve limit the 2D evaluation of the valve.

True

What type of prosthetic valve is recommended for children and young adults, (except women in their child-bearing years)?

mechanical

What is a fibrous ingrowth of tissue that can lead the prosthesis unable to open and/or close properly?

pannus

True or False:

All prosthetic valves have similar flow patterns which make the cardiac sonographer's evaluation process extremely simple.

False

Left ventricular volume overload pattern can be seen with what consequence of acute infective endocarditis?

severe, acute regurgitation

What would one expect to see in a patient with acute, severe aortic and/ or mitral insufficiency brought on by infective endocarditis using M-mode?

early closure of mitral valve, early opening of aortic valve

Which is NOT a cause of dehiscence?

single, small, central jet of regurgitation

Scenario: On Doppler evaluation of the mitral valve in a 46 y/o female patient, referred to the echo lab for history of fever, mitral valve prolapse, and recent routine dental cleaning, waveform suggests stenosis of the mitral valve. You've considered that this might be infective endocarditis, particularly of the mitral valve. Where would you expect to find vegetations on this particular atrioventricular valve?

mitral leaflets, on flow side

Which law explains that the greater the volume of blood that enters the ventricles in diastole, the greater the amount of blood that is pumped out during systole?

Frank-Starling

Why are elderly patients usually implanted with a bioprosthetic valve?

long-term durability is less important

What type of prosthetic valve is the St. Jude valve?

bileaflet tilting disc

T/F: TEE can detect vegetations greater than 1mm.

True

Stented prosthetic valves which are bovine in origin utilizes what structure to create leaflets for aortic valve replacement?

pericardium

True or False:

An allograft utilizes the aortic valve or dura mater.

True

What cardiac disease state is the leading cause of death in the US?

MI

What syndrome refers to syncopal episodes that occur suddenly as a result of transient interruption of cardiac output?

Adams-Stokes

What is the most important part of the rhythm strip for identifying a heart block?

PR interval

True or False:

Stress Echocardiography is the "Gold Standard" in coronary artery diagnosis.

False

What disease state presents with granulomas, and can be complicated by dysrhythmias and pulmonary HTN?

sarcoidosis

What determines ASH?

IVS/LVPW ratio > or = 1.3-1.0

T/F: Genetics does not play an important role in Hypertrophic Cardiomyopathy.

False

In what disease state of the heart would one expect to see an EPSS >7mm?

dilated CMO

What can be done to confirm the diagnosis of restrictive CMO?

biopsy

True or False:

Cocaine use can cause coronary artery spasm.

True

What cardiac disease process causes a stiffening of the heart muscle because of extracellular deposition of amyloid protein?

restrictive/infiltrative CMO

When would one consider Dresser's syndrome as a diagnosis?

weeks-months post MI

Where is the terminal force located?

the final portion of the QRS complex

Why is the AV nodal area vulnerable to blocks in conduction?

depolarization and repolarization are slow in this area

Which part of the bundle branch system has a dual arterial blood supply?

posterior fascicle of LBB

What cardiac disease is the leading cause of heart-related sudden death in the 30 and under population?

Hypertrophic CMO

What do emotional stress and atherosclerosis have in common?

both are causes of ischemic heart disease

What happens to areas of akinesis or dyskinesis within the heart?

formation of thrombus occurs