CCI Wrong Questions

The modified duke criteria are used to assess a PT for the likelihood of

A. Dias. Dys

B. PHTN

c. Endocarditis

d. CHD

c. Endocarditis

• used to assess possible endocarditis

• Blood cutures positive for bacteria; Major criteria to diagnose is

  • Echo w/ vegetation, paravalvular abcess, PHV dehiscence, or new valvular origin

• Minor criteria: w/o blood cultures

  • Pre existing heart probs, iv drug use, vascular findings (embli/hemorrhage), immulologic response, and other bio evidence

• 2 major or 1 maor + 3 minor or all 5 minor = diagnosis

What is given during a dobutemine SE to continue increase in HR?

Atropine

Which MV leaflet is seen in A2C?

Long one is AMVL, tiny one is PMVL apparently idk dude

Which of the following exams demonstrate hibernating myocardium caused by chronic ischemia?

a. Cardiac MRI

b. high dose dobutamine

c. low dose dobutamine

d. exercise SE

c. low dose dobutamine

• Low dose initially improve fxn/ high dose will returne hibernating segments to nonfunc. state

• dobutamine has NO effect on myocardium = irreversible damage

Echo guidance is used to demonstrate the tip of the bioptome entering the RA + RV in what procedure?

a. cardiac resynchronization

b. septal myectomy

c. balloon septostomy

d. myocardial biopsy

d. myocardial biopsy

• best way to confirm rejection of transplant

• Seldinger technique used to insert catheter into femoral or jugular v. > heart

• Echo guidance used to demonstrate tip of bioptome entering RA + RV

• Samples obtained from RV septum

• Complications: damage TV/apparatus, RV perforation, PE

• Can also used to diagnose infiltrative cmo and eval tumors

LAbel the structures

a. LAA

b. AMVL

c. LA

d. LV

What should be noted in a PT with an LVAD in the LV m-mode

pump speed ayo

Which most accurately assess thickness of pericardium?

a. TEE

b. xray

c. CT/MRI

d. TTE

c. CT/MRI

Which of the following descrives the correct change in probe position from S4C view inorder to see the PV4 empting into the LA?

a. Rotate 30-60 degrees clockwise

b. Rotate 60-90 degrees counter clockwise

c. rotate 30-60 degrees counter clockwise

d. angle slightly anterior

d. angle slightly anterior

• Modified suprasternal short axis (crab view)

Circumfrential and radial strain are evaluated in what view?

PSAX

• Circumferential strain

  • Negative %, describes shortening of myo. fibers

• Radial Strain

  • Positive %, descries thickening of myo. fibers

Label this IVC flow pattern

A: s wave: ventricular systole

B: D wave Early ventricular diastole

C: A wave, late ventricualr diastole

Which of the following is the purpose for an echo using perfluorocarbon microbubble UEA?

a. identify suspected vegetation

b. enhance doppler signal in LVOT with HOCM

c. increase CO + stress the heart

d. Eval a persistent LT SVC

b. enhance doppler signal in LVOT with HOCM

• used to enhance doppler signal lvot w/ HOCM

On the global longitudinal strain (GLS) graph, the x axis indicates _____ and the y axis indicates_____.

x axis = time

y axis = GLS

eval myocardial movement

A patient was referred for an echo to r/o clot in LV post MI. The prior echo gives a diagnosis of Eisenmenger’s syndrome. Which of the following procedures should be used to evaluate the presence ofLV thrombus in PT?

a. TTE w/ UEA

b. TEE

c. Nuclear Perfusion Exam

d. SE

b. TEE

• Eisenmenger’s is a contraindication for UEA; the shunt will effect contrast dispersion

What is the major advantage of using color doppler in TEE eval of a PHV over color doppler of the same PHV with a TTE?

a. TEE can identify turbulance due to stenosis, TTE cant do this successfully

b. TEE can accurately identify paravalvular leakage, which is usually very limited on TTE

c. TEE can use color doppler to assess the PISA radius of. MR which is usually limited by valve masking on TTE

d. TEE can identify valvular dehiscence while TTE usually cannot diagnse this abnormality w/ color doppler

b. TEE can accurately identify paravalvular leakage, which is usually very limited on TTE

• Valve masking of PHV apparatus limits visualization of paravalvular leaking

Dilated Ao Root in PLAX, look at

SSN Long axis

What is the Index of Myocardial Performance

Index Myo. Performance = Time from MV closure to MV opening - ejection time of LVOT / ejection time of LVOT

Normal Values: 0.34 to 0.44

Severely abnormal: 0.82 - 1.3 = myocardial dysfunction

Aneurysms due to symphilis is most commonly formed in the________ aorta.

Ascending aorta

• 10 to 25 years after infection

• “Syphilitic Aortitis”: Extensive calcification of dilated Asc Ao

• Call calcifications can be seen on chest x-ray

LV peak systolic Pressure

LV Peak Sys. Press = 4(AoV Vel)² + Systolic BP

When is UEA injected during a Treadmilll SE?

~30 seconds prior cessation of exercise

How to differentiate epicardial fat pad from pericardial effusion?

Epicardial fat is usually seen as an isolated anterior echo free space

Small PE is an anechoic space posterior to heart

Effusionis displaced during cardiac cycle, epicardial fat stays the same sizeW

When preparing for 3D imaging on an echo, the Sonographer must determine the patient HR and rhythm to determine…

The best method of dataset collection

• Normal HR + Sinus rhythm = high resolution multicycle datasets

• Afib, consistend PVCs = single cycle sata set captured retroactively

• HR > 80BPM = single cycle dataset

You’re using contrast and it causes attenuation that obscures the endocardium. How do you fix this

Turn on color doppler for 1-3 seconds

• Increase beam intensity = destroy some microbubbles

Your’e doing an echo for a PRE OP TAVR. What linear measurements should be obtained?

1. Ao Annulus

2. Ao Root

3. Sinotubular Junction

PT has history of LE arteritis + supravalvular stenosis. What 2D view should you focus on?

SSN (Ao Coarc)

The largest antegrade flow component seen on a doppler tracing of a normal HV is identified during what part of the cardiac cycle?

Early Systole

What should be available in an echo room for a PT who is suffering from anaphylactic response due to injection of UEA?

Hydrocortisone

Which bioprosthetic valve can be used to replace the MV, TV or AoV

a. Bjork Shiley

b. hanchock

c. Ionescu Shiley

d. carpenter edwards

c. ionescu shiley; more versatile bovine pericardial valve

Which of the following are expected symptoms from a PT w/ an AVA of 0.7cm²? Choose all that apply

a. syncope

b. cyanosis

c. angina

d. recent TIA

syncope, angina, and recent TIA

A 3 lead EKG is used for resting echo. Where are they placed?

Under RT and LT clavicle @ mid clavicular line + on the lower LT abdomen w/in ribcage frame

How do you avoid underestimating Peak Vel measurement on a faint doppler waveform?

Increase gain until speckle artifact is displayed, then reduce slighlty

Chose all of the following that will fix this image.

a. move baseline

b. use CW doppler

c. Increase scale

d. change to a higher frequency TX

A,B,C

Which of the following describes the RV?

a. smooth lateral wall

b. several chordae tendinae attached directly to ventricular wall

c. 2 septal pap muscles

d. located posterior laterally in chest

b. several chordae tendinae attached directly to ventricular wall.

• 3 pap muscles + chordae connected directly to wall (septophilic)

• LV = 2 pap muscles + no chordae atached to vent. wall (septtophobic)

What is the perferred doppler measurement to eval MVA?

PHT

HCMO will usually result in what change in brachial BP during treadmill testing?

decreased systolic + diastolic pressure

Which of the following abnormalities should include the supplemental eval of the abd. ao.?

a. takayasu arteritis + Bi AOV

b. EF <20% or >80%

c. Kawasaki disease and fabry disease

d. PDA + septal defects

a. takayasu arteritis + Bi AOV

• Takayasu arteritis = abnorm tissue formation w/in ao + other med-large arteries

• BiAov assoc w/ coarc = abnormal monophasic flow distal to area

• Also Ao Dissection

A PT has a TAVR. What info must the sonographer get prior to performing echo? Choose all that apply

a. Size of valve

b. sys. bp

c. Date of implantation

d. prev EF

All of them !!!

• Date of surgery

• Valve type

• Valve size

• Prior EF

• Sys. BP

How do you differ between RVPO and RVVO?

RVPO = septal flattening throughout cardiac cycle

RVVO = septal flattening only during diastole

A 66yo male presents for a TEE with HX of MS. Chart shows severe MS was documented one month ago on semiannual TTE exam. He will have commissurotomy in 2 days. What is the primary purpose of todays exam?

R/O LA thrombus

• Eval LA clot is performed prior to

  • Cardioversion

  • AF ablation

  • Mitral commissurotomy

• High risk of embolization during procedure

WTF is this?

Intra-aortic balloon pump (IABP)

• Helps pump blood to body

• 2 parts

  • balloon inserted into Ao

  • Machine outside of body

• Balloon contracts + expands inside ao = blood flows

When plaing the electrodes on a pt for a 12 lead EKG to a stress echo, the LA electrode is placed…

2 CM below LT clavicle

What are all these waveforms?

A: MR

B: Valvular AS:not closing click on valve + timing

C: TR: note timing; most of flow is during mid to late systole + velocity is lower + less dense waveform

D. Sub Ao Stenosis; late peaking dagger waveform

Which of the following is true regarding porcine bioprosthetic valves? Choose all of the following!

a. Valve leaflets are nonviable tissue, preserved until needed in glutaraldehyde

b. higher transvalvular gradients than Mechanical valves

c. lower risk of clot formationf

d. valvular rejection is common

A,C

• Risk of rejection is lower with Bioprosthetic valves

• lower gradient than mechanical valves

When evaluating Ao Arch in SSN, how do you get SVC?

Scan rightward w/ slight anterior angulation

In tamponade, the RV will collapse in diastole, except when the PT w/ signifigant

PHTN

How is dyskinetic LV wall segments differentiated from true LV aneurysm?

Aneurysm segment = LV wall deformity throughout cardiac cycle, dyskinetic segment = deformity only during systole

PT w/ marfan syndrome have abnormal levels of what proteins that affect the connective tissues of the body?

Increased transforming growth factor beta and decreased fibrillin-1

Performing a MR assessment on a TEE by measuring PISA radius of jet. What do you do with the color?

Shoft color baseline up to betweej 20-40 to allow aliasing

A ____ must be present to present in order to diagnose overiding Ao?

Perimembranous VSD

Austin flin murmur assoc. with

AR

Bi atrial enlargment is a normal finding in a PT that has had a

Cardiac transplant

• in orthotropic cardiac transplant, the atria of native heart is attached to remnant atria from the heart that is removed = Biatrial Enlargement

• Atrial suture lines may be visible

Hemolytic anemia can be caused by?

Mechanical Heart Valves

Which of the following technical factors can negatively affect 2D planimetry of MVA?

a. Valve masking from mechanical MVR + Lat res

b. TX with short SPL + Short wavelength

c. Lat res + gain settings

d. TX with short SPL + High freq

c

• High fain + dec lat res = understimate valve area

What sonographic exam is best for eval Ao Dissection?

TEE

How to measure LA in PLAX?

LE to LE, from Ao sinus to posterior atrial wall

Which doppler flow parameter is most accurate when assessing AS in a PT with signifigant AR?

MPG

• AI = hypercontractive LV

• False Peak vel

What structure is most commonly evamuated on a focused TTE 3D exam

LV

LV ejection time is measured on M-mode of

AoV

Which view is offered to eval diam of thoracic ao

Apicals 2+3

On the ROI on a 3D exam, the x-axis represents the ___ and the y axis represents the _____.

x = width of box

y = height of box

z = depth of sweep or volume angle

What is wrong with the LVPWd?

Its measuring effusion NOT the LVPW

A patient who has ________ would NOT be a good canidate for 3D eval?

Rhythm abnorm (afib etc), stable hr and tx position for artifact free imaging is required

A saline study consists of _______ solution w/bubbles large/small enough to avoid passage through pulmonary beds.

NaCl, Large

LV non compaction assoc findings

• Congenital heart anomalies

• Manifests clically as DCMO

A 5mm PW doppler SV size would be perferred for…

PV4 eval for sev MR (3-5mm)

How to get LAP

LAP = PFO peak Pressure grad + RAP

How to get all 3 hepatic veins

Subc trans view, angles to RT shoulder

Sonographers role in a 3D TEE

1. Optimize 2D images w/ highest freq + gain

2. Surround valve w/ 3D sector

3. Confirl valve is fully captures using biplane viewa

4. Confirm vcel rate is >15MHz

5. Activate 3D zoom

6. Single cycle sataset acceptable in TEE

7. Sector should be enlarged to encompass valve + annulus

8. UAE is NOT used for 3D echo due to speckle artifact

How can UEA help confirm constrictive pericardits?

By eval the IVC

Appearance of presystolic UEA reversal @ RA junction is a positive indication for Constrictive Pericarditis

LAP w/o PFO

LAP = Sys BP - Peak Grad MR

Valsalva strain causes a reduction in preload that can be demonstrated on doppler eval as…

E to A reversal w/ grade 2 dias dys

Which doppler measurement of AS best correlates with the same value obtained during a heart cath?

MPG

• Directly comparable

• Max peak to peak grad during cath is lower than thatof doppler

• Peak flow velocity isnt obtained during cath

Eval of the abd ao should be done when what abnotmalities are present

1. Aneurysm; one in a prox segment can be assoc w/ an aneurysm else where

2. Coarc: reduces flow to body

3. Severe AR: diastolic flow reversal in Abd AO

Best view to see a muscular VSD

S4C

What is best eval using supine exercise bike

Dias. Dys

• Treadmil = CAD

• supine bile = Dias Dys, PHTN

  • Doppler eval is performed during peak exercise

  • Best vel + pressure grad for characterization of flow abnorm

Preferred technique to get PASP

RT heart Cath