Combined midterm practice (1.2.3 actuals)

Match the following

1) atrial depolarization

3-5) Ventricular repolarization

7) Ventricular repolarization

Isovolumic contraction (mechanical) correlates with this portion of the EKG complex (electrical)

R wave

During diastasis, the:

Ventricle filling/atria dumping

While performing an echocardiogram, you are in the parasternal short axis window using an M-mode) you are at the level of the mitral valve) your image contains all structures EXCEPT the:

*Papillary muscles

*interventricular septum

*right ventricle/right ventricular outflow tract

*anterior and posterior mitral leaflets

*pericardium

Papillary muscles

In sequence name the stages of myocardial damage caused by a lack of oxygen to the heart muscle:

Ischemia, injury, infarction

Using the wall motion scoring method, scoring a particular wall segment a “3” represents

Akinetic

using the wall motion scoring method, scoring a wall segment a “3” with no motion and thickening, represents:

Akinetic

Match the following

A-LV

B-LA

C-LVOT

D-AO ROOT / ASCENDING AO

E-AV

F-ANTERIOR MITRAL VALVE LEAFLET

G-RIGHT VENTRICLE

H-INFEROLATERAL LV WALL

In this image, which portion of the cardiac phase is it in?

Diastole

The signs and symptoms of a myocardial infarction can include all the following except:

1-Hemoptysis

2-Dizziness, syncope

3-Chest pain/ Arm or jaw pain

4-Nausea, vomiting, diaphoresis

5-shortness of breath

Hemoptysis

For a heart attack patient in route to or in the hospital, the first line of defense fro treatment includes all the following except:

1-Nitroglycerin

2-Oxygen

3-Tyenol

4-Morphine

5-Aspirin

Tylenol (remember the MONA acronym)

The sequence in the progression and development of atherosclerosis are:

Fatty steak formation, fibrous plaque formation, complicated lesion

During diastole the:

atrioventricular valves are open and the semilunar valves are closed

When the pressure in the aorta exceeds the pressure in the left ventricle, all the following occurs EXCEPT:

1- chordae tendineae become taught/tight

2-Semilunar valves close

3Ventricular pressure starts to rise

4-Atrial pressure starts to decline

5-Atrioventricuylar valves open

chordae tendineae become taught/tight

Match the following

A- IVS

B-LV APEX

D-RV

E-LV

F-SEPTAL LEAFLET OF THE TV

G-POST LEAFELET OF THE TV

H-ANTERIOR LEAFLET OF THE MV

I-POST LEAFLET OF MV

K-LA

L-IAS

M-RIGHT UPPER PULMONARY VEIN

N-DESCENINDG THORACIC AO

An ECG can display a STEMI as:

ST segment elevation, inverted T wave, Q wave formation

All the following are complication associated with a myocardial infarction (MI), except:

1- LV aneurysm/ LV thrombus

2-Pap muscle dysfunction / MR

3- Dressler Syndrome

4- LV wall rupture / VSD

5- Aortic insufficiency

Aortic insufficiency

All the following are true facts associated with the anatomy of an artery in comparison to a vein, except:

1- Small lumen

2-Thicker outer wall

3-Carries oxygenated blood

4-Has valves inside the lumen

5-Consists of elastic fibers in the thicker inner wall

Has valves inside the lumen

T or F: Cardiac markers/enzymes and proteins are used to detect myocardia injury and infarct, such as CPK, CK, Troponin T and troponin I

True

The key factors associated with ischemic heart disease or myocardial infarction, include all the following except:

1-Smoking

2-atheroclerosis

3-race/gender

4-renal disease

5-systemic hypertension

6-hyperlipidemia

7-genetic/family history

renal disease

Match the following

1-Basal inferoseptal wall - RCA

2-Mid inferoseptal wall - RCA / LAD

3- Apical septal wall - LAD

4- Apex - LAD

5- Apical lateral wall - LAD/LCX

6- Mid anterolateral wall LAD/LCX

7- Basal anterolateral wall - LAD/LCX

The upper limits of normal for the left ventricular internal dimension in diastole for woman is:

5.3 cm

All the following can result in an increase demand or myocardial workload and can cause IHD or a myocardial infarction, except:

1- Extreme physical exertion

2- severe systemic HTN

3-hypertrohic cardiomyopathy/ HOCM

4-Increase aortic diastolic pressure

5-Severe aortic stenosis

Increase aortic diastolic pressure

The volume of blood in the ventricles at end diastole in diastole is called the:

pre load

Match the following

1- basal inferior wall - RCA

2- Mid inferior wall - RCA

3- Apical Inferior wall - LAD

4- Apex - LAD

5-Apical anterior wall - LAD

6-Mid anterior wall - LAD

7- Basal anterior wall - LAD

8- Left atrial appendage

Match the following

1-Spetal perforators

2-RCA

3-LAD

4-Left circumflex

5-Posterior descending artery

The degree of fiber stretch due to the quantity of blood in the chamber prior to contraction at end diastole is known as:

Left ventricular end diastolic pressure

The layer of the arterial wall that consists of loose fibrous connective tissue and provides strength to the vessel is:

Tunica externa

The length tension relationship that refers to the more blood that enters the ventricle during diastole, the greatest the force of contraction required to eject the blood is called the:

Frank starling law

The upper limits of normal for left ventricular end diastolic volume for a man is:

150 mL

Some treatment options used for patients during or following a myocardial infarction (MI), include all the following except:

1-PTCA, percutaneous transluminal coronary angioplasty

2-CABG, Coronary artery bypass graft

3-Stress echocardiogram

4-Bed test, telemetry, medical therapy, drugs, oxygen, thermolytic therapy, pain relievers, nitrates

5-AICD, defibrillator, LVAD, RVAD assisted devices

Stress echocardiogram

The upper limits of normal for left atrial volume indexed is:

34 ml/m2

The apical 4 chamber view is used to evaluate all he following except:

1-Aortic valve pathology

2-LV diastolic function

3-chamber sizes

4-pericardial effusion

5-MV and TV pathology

6-LV and RV systolic function

Aortic valve pathology

The upper limits of normal for left ventricular end diastolic volume indexed for a man is:

74 ml/m2

possible causes of myocardial infarction include all the following except:

1-Coronary artery spasm

2-decreased myocardial workload/demand

3-atherosclerosis

4-coronary artery thrombosis

5-decreased blood flow

decreased myocardial workload/demand

The most accurate to calculate the left ventricular ejection fraction is by:

bi plane Simpsons method of discs

The sax aortic level view is used to evaluate all the following except:

1-Aoritc valve pathology

2-TV and PV pathology

3-ASD and VSD

4-MV pathology

5-RVOT, LA, and RA chamber size

MV pathology

Occasionally the origin of the right coronary artery can be visualized by echo in this view(s)

PLAX and PSAX

The wall motion abnormality that demonstrates little or decreased motion and thickening is calls

Hypokinetic

On and ECG, Ischemia is demonstrated as _______, injury as ________ and infarction as ________.

Inverted T wave/ST depression

ST elevation

Deep q wave / ST elevation

Match the following

A-Aorta

B-Pulmonary artery

D-Left main coronary

E-Right coronary

H-Left circumflex

N-Left anterior descending

What type of injury has occurred

subendocardial/ Non transmural

What wall segment is involved in this injury

Inferior wall MI - RCA

The mid inferoseptal territory is supplied oxygenated blood via this artery (ies)

RCA/LAD

From the parasternal short axis view, blood moving through the tricuspid valve during diastole is moving:

Towards the transducer, red

From the parasternal short axis view, blood moving through the pulmonic valve during systole is moving

away from the transducer, blue

From the apical four chamber view, blood moving through the tricuspid valve during diastole is moving

towards the transducer, red

Match the following

1- Mid anterior - LAD

2-Mid anterior lateral - LAD/CX

3-Mid inferior lateral - RCA / CX

4- Mid inferior - RCA

5-Mid inferior septal - LAD/RCA

6-Mid anterior septal - LAD

Estimated EF

30-40% (in the clip the more anterior wall is not moving )

M-mode ejection fraction (M-mode EF)

(4.7)3-(3.3)3 x 100 =

(4.7)3

65% (Normal)

Cardiac output indexed (M-mode)

First get SV SV = EDV - ESV

(4.7)3-(3.3)3= 67.89

Second get CO CO = SV x HR

67.89 × 84 / 1000 = 5.7

Third now get COi CO / BSA

5.7 / 1.7 = 3.35 L/min/m2

3.35 L/min/m2 (Normal)

2D Ejection fraction (2D area length EF)

Calculate Diastole and systolic values for EDV and ESV by the area and length methods

EF = EDV - ESV / EDV x 100% =

112.9 - 82.64 / 112.9 × 100% =

26.8% (BAD)

Left atrial volume indexed (2D area length method)

First calculate LA volume

LA volume = 0.85 x (a1 x a2 / L)

0.85 x (21 × 19 / 1.7) = 72.6

Second calculate LA volume indexed

LAVI = LA volume / BSA

72.6 / 1.7 =

42.45 mL/m2 (Dilated)

Image:

1. left ventricle

2. right atrium

3. left atrium

4. right ventricle

5. IVS

6. IAS

7. MV

8.TV

9. Moderator Band

The length-tension relationship that refers to the greater the stretch of the cardiac muscle or volume of blood in the ventricles during diastole, the greater the force of contraction required to eject the blood is called the:

Frank-starling law

Your patient has left atrial volume of 45ml, and a body surface area of 1.8m^2. This measurement is considered:

Normal

In M-mode of the aorta, what chamber is above the aortic root.

right ventricular outflow tract

T/F: during the rapid filling phase, the pressure in the aorta is greater than the ventricular pressure.

True

Image:

1. RV

2. TV

3. RA

4. IVC

5. Anterior leaflet

6. posterior leaflet

Image:

1. p wave/ atrial contraction

2. QRS complex

3. T wave

4. R wave

All the following are true facts about the left atrial appendage, except::

Helps in the conduction pathway

Stroke volume is defined as:

The volume of the blood pumped out the ventricle per beat or contraction

T/F: The semilunar valves are tethered by chordae tendineae and are attached to papillary muscles

False

Image:

Phase 6

Image:

Left ventricular

Image:

80 mmHg

Image:

Aortic root

Image:

5 mmHg

Image:

Phase 4

Image:

100 mmHg

Image:

Phase 2

Image:

Left ventricular volume

Normal right atrial pressure is ________ mmHg.

2-8

Image:

Isovolumic

Image:

1. DTA

2. Anterior mitral leaflet

3. Right ventricular

4. Interventricular

5. Chordae Tendinea

During systole:

The semilunar valves are open and the atrioventricular valves are closed

The degree of fiber stretch related to the quantity of blood in the ventricle prior to contraction at end-diastole is:

Preload

The resistance against which the ventricles must pump to eject blood is:

Afterload

Image:

1. endocardium

2. epicardium

3. pericardium

4.

5. moderator band

7. chordae tendinea

The volume of blood at end-diastole at which the cardiac myofibril is stretched is called:

LV end diastolevolume

T/F: once the ventricular pressure exceeds the great vessels pressure, the atrioventricular valves open.

False

The majority of the heart muscle is a sponge-like meshwork of interwoven myocardial fibers or crisscross muscular bundles or bands on the inner surface of the LV and RV. The term used to describe the surface is:

Trabeculation

The upper limits of normal for left atrial volume indexed is:

34 mL/m^2

The normal range for CO is:

4-8 L/min

In a normal ECG complex, what represents atrial contraction (atrial depolarization)?

P-wave

The sympathetic nervous system ________ the heart rate as part of fight or flight, while the parasympathetic nervous system_____ the heart rate via the vagus nerve.

Increase/decrease

On M-mode of the mitral valve, the E-F segments represents:

Diastasis

In the PLAX view, what direction does blood flow during systole?

From the left ventricle through the aortic valve

Image:

1. IVS

2. LA

5. PMVL

6. AMVL

7. RCC

8. NCC

10. Aorta

11. LVPW

12. RV

13. LV

9. RV free wall

The upper limits of normal for the interventricular septum, for a man is:

1.0cm

In M-mode, the left atrial dimension is measure at:

End-systole

The upper limits of normal for left ventricular internal dimension for a woman is:

5.3cm

You are using M-mode in your echocardiogram examination. you are at the level of the aortic valve. Your image contains all structures except:

Anterior mitral leaflet

The upper limits of normal for left atrium dimension for a man is:

4.0cm

The valve located at the junction of the IVC and the right atrium during fetal circulation and usually disappearing after birth, sometimes visualized as a thin crescentic fold is known as the:

Eustachian Valve

The longer the interval between heart beats, the stronger the contraction required to pump the blood out is known as:

interval-strength relationship

Image:

3.7 cm

Stroke volume is dependent upon all the following except:

Heart rate

During Diastole:

Atrioventricular valves are open ventricular filling occurs

Isovolumic contraction time occurs:

period after mitral valves closes and the aoritc valve has not yet opened.