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140 Cards in this Set
- Front
- Back
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Name the three cusps of the PV |
Anterior |
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Name the two cusps of the MV |
Anterior |
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Name the three cusps of the AV |
LCC |
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Name the three cusps of the TV
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Anterior |
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Which valve separates the areas of greatest pressure differences?
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MV |
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Which vessel is most anterior on the heart? centered? most posterior?
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PA
AV SVC |
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Which aortic leaflet is the superior one in the PLAX?
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RCC
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From the PLAX postion, which of the following ar you most likely to get accurate velocity measurements?
A) LVOT B) Aortic Stenosis C) Pulmonary Artery D) Mitral Regurgitation |
C) Pulmonary Artery. Accurate velocity measurements require the beam to be parallel to flow which rules out the other choices in PLAX
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Which TV leaflets are seen in the PLAX RV Inflow Tract view?
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Anterior (screen right) |
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What is the only standard view in which the TV posterior leaflet is seen?
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PLAX RV Inflow Tract
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In the PLAX RV Inflow Tract view, red inflow in the RA just below the posterior leaflet stems from what?
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IVC
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In the PSAX GV level, which TV leaflets are seen?
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Anterior (screen left)
Medial (screen right) |
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In what view is the LAA best visualized using TTE?
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Apical 2 |
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The coronary arteries come off the:
A) Descending Aorta B) Coronary Sinuses C) Pulmonary Artery D) Sinuses of Valsalva |
D) Sinuses of Valsalva |
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During which phase do the coronary arteries fill?
A) Early Systole B) Late Systole C) Early Diastole D) Late Diastole |
C) Early Diastole
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Starting at the top and working clockwise, name the four apical wall segments in the PSAX view
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Anterior
Lateral Inferior Septal |
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Starting at the top and working clockwise, name the six mid-cavity wall segments in the PSAX view
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Anterior
Anterolateral Inferolateral Inferior Inferoseptal Anteroseptal |
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Which mid-cavity wall segments control which papillary muscle in the PSAX view?
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Inferolateral > Lateral Papillary
Inferior > Medial Papillary |
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Starting at the top and working clockwise, name the six basal wall segments in the PSAX view
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Anterolateral
Inferolateral Inferior Inferoseptal Anteroseptal |
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Name the apical wall segment in the A4 & A2 views
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Apex
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In the SSN view, what is the structure onscreen beneath the arch?
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Right Pulmonary Artery (RPA)
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Name the vessels coming off the Aortic Arch
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Brachiocephalic (Innominate)
Left Carotid Left Subclavian |
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What cardiac pathology is associated with bicuspid aortic valves?
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Aortic Coarctation
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Where do most aortic coarctations occur?
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Aortic Isthmus
(after the takeoff of the Left Subclavian Artery) |
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In a standard A4 view, which pulmonary veins are visible?
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Right Superior Pulm. Vein
Left Superior Pulm. Vein (visible onscreen left-to-right, at top of LA) |
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Which TV leaflets are seen in the A4 view?
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Anterior
Medial (or Septal) |
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What standard view provides the same information as the PLAX?
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A3 (or ALAX)
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Which standard 2D TTE view typically allows viewing of the LAA?
A) PLAX B) A4 C) SC4 D) A2 |
D) A2
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Where is the coronary sinus located on the heart?
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Posterior AV Groove
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To visualize the coronary sinus in the A4 view you should tilt the transducer
A) medial B) anterior C) lateral D) posterior |
D) posterior
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Where is the chiari network (or system) located?
A) LA B) LV C) RA D) RV |
C) RA
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What portion of the pulmonary venous PW doppler represents atrial systole?
A) A wave B) S wave C) D wave D) E wave |
A) A wave (atrial contraction)
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What does the S wave represent in a pulmonary venous PW waveform?
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Systolic Inflow
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What does the D wave represent in a pulmonary venous PW waveform?
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Diastolic Inflow
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What is the standard frequency range for TEE probes, compared to TTE transducers?
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TTE (2 - 7 MHz)
TEE (5 - 7 MHz) |
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At what temperature is it unsafe to use a TEE probe?
A) 20-25C B) 25-30C C) 30-40C D) 40-45C |
D) 40-45C (104-113F)
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In an A2 TEE, what two structures appear onscreen in the upper right quadrant?
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Left Upper (or Superior) Pulmonary Vein
Left Atrial Appendage |
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Regardless of the modality (TTE/TEE), this structure always enters the aortic root at the level of the NCC
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IAS
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Why is the SA node the primary pacemaker?
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The SA node has the highest intrinsic rate (60-70 bpm)
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T/F - The depolarization wave moves from the endocardium to the epicardium
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True (inside to outside)
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What is the primary purpose of the AV node?
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Pause electrical conduction. This prevents simultaneous contraction of the atria and ventricles
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How to the SA node's electrical impulses make it to the left atrium?
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Bachmann's Bundle
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How to the SA node's electrical impulses make it to the ventricular epicardium?
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Purkinje Fibers
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What is the Frank-Starling law?
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The greater the load (incoming volume), the greater the force of contraction (ejection)
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What is preload?
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Volume; the load exerted on the ventricle at end diastole
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What is afterload?
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Pressure; the resistance against which the ventricle must pump
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Any vavlvular regurgitation, shunt (ASD/VSD), or fluid overload will result in what?
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Increased Preload
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Does a PDA increase LV preload?
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Yes (if the shunt is L-to-R)
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What echo finding indicates increased preload?
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Chamber Dilatation
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What echo finding indicates increased afterload?
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Hypertrophy
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Hypertension, aortic stenosis, and pulmonic stenosis will result in what?
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Increased Afterload
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Which study does not allow for the calculation of EF?
A) 2D echo B) cardiac angio C) chest x-ray D) cardiac nuclear study |
C) chest x-ray
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How do we calculate stroke volume?
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SV = EDV - ESV
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How do we calculate ejection fraction?
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EF = (SV / EDV) * 100
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How do we calculate cardiac output?
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CO = SV * HR
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How do we calculate pressure gradiants?
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Bernoulli Equation:
mmHg = 4 * (velocity^2) |
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With a velocity of 0.5 m/sec, what is the gradient?
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1 mmHg
[4 * (.5 * .5)] |
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With a velocity of 5 m/sec, what is the gradient?
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100 mmHg
[4 * (5 * 5)] |
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How can we calculate SV using VTI?
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SV = VTI * CSA
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How can we calculate CSA using Pi?
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cm^2 = 3.14 * (D / 2) ^2
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How can we calculate CSA without using Pi?
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cm^2 = 0.785 * (D^2)
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What does VTI represent?
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VTI represents how far the blood travels (in cm) with each ejection
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How is VTI obtained?
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VTI is calculated by tracing the doppler spectral display
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What does VTI x CSA equal?
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Doppler Stroke Volume
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Does venous return increase or decrease with inspiration?
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Increases
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Does venous return increase or decrease with expiration?
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Decreases
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Does standing increase or decrease venous return & stroke volume?
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Decreases
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Does squatting increase or decrease venous return, SV, and CO?
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Decreases
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Does squatting increase or decrease AR?
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Inscreases
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Does a tight handgrip increase or decrease HR, CO, arterial pressure, and MR?
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Increases
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Does a tight handgrip increase or decrease AS?
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Decreases
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Does the strain phase of the valsalva maneuver increase or decrease venous return, SV, CO, and murmurs?
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Decreases
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Does the strain phase of the valsalva maneuver increase or decrease IHSS?
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Increases
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Does the relaxation phase of the valsalva maneuver incrase or decrease venous return, CO, and BP?
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Increases
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Do sit-ups increase or decrease HR, CO, and SV?
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Increase
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Does amyl nitrite inhalation increase or decrease peripheral resistance?
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Decreases
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Does amyl nitrite inhalation increase or decrease HR, CO, SV, and most murmurs?
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Increases
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Does amyl nitrate inhalation increase or decrease AR and MR?
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Decreases
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Inhalation of amyl nitrite causes:
A) increased preload B) decreased preload C) increased afterload D) decreased afterload |
D) decreased afterload
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Does squatting increase or decrease IHSS?
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Decreases
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The time period from AV opening until closing is known by what two names?
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Systolic Ejection Time (SET)
LV Ejection Time (LVET) |
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The time period from onset of Q wave until AV opening is known as what?
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Pre-Ejection Period (PEP)
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When does isovolumic contraction (IVC) occur on an EKG?
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R wave
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When does isovolumic relaxation (IVR) occur on an EKG?
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End of T wave
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The duration of isovolumic relaxation time will be increased with:
A) tachycardia B) bradycardia C) increased sweep spead D) increased wall filter |
B) bradycardia
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During the cardiac cycle, this even NEVER happens:
A) AV open & MV open B) AV open & MV closed C) AV closed & MV open D) AV closed & MV closed |
A) AV open & MV open
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Which valve event starts isovolumic contraction?
A) MV open B) MV close C) AV open D) AV close |
B) MV close
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Which valve event ends isovolumic contraction?
A) MV open B) MV close C) AV open D) AV close |
C) AV open
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Which valve event starts isovolumic relaxation?
A) MV open B) MV close C) AV open D) AV close |
D) AV close
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Which valve event ends isovolumic relaxation?
A) MV open B) MV close C) AV open D) AV close |
A) MV open
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What is the AV doing during the Q-T interval?
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AV is open
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Normal arterial pressure is ___/___ mmHg. Thus, aortic pressure lives ___.
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120/80 mmHg
AO pressure lives HIGH |
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Normal left atrial pressure is ___ mmHg. Thus, the atrial pressure lives ___.
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10 mmHg
LA pressure lives LOW |
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LV pressure bounces between ___ and ___
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AO pressure (HIGH)
LA pressure (LOW) |
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Do the following characterize the pulmonary or system hemodynamics?
- low pressure - low resistance - thin RV wall - low arterial oxygen content |
Pulmonary
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Do the following characterize the pulmonary or system hemodynamics?
- high pressure - high resistance - thick LV wall - high arterial oxygen content |
Systemic
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What type of vessel has thick, elastic walls which expand during systole and recoil during diastole to keep the blood moving forward?
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Arteries
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What type of vessel has thin, collapsible walls which can expand rapidly to accomodate large volumes of blood (and contains the majority of circulating blood)?
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Veins
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What is hematocrit?
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% of blood composed of RBCs
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54% of blood is ___?
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Plasma
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45% of blood is ___?
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RBCs (erythrocytes)
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1% of blood is ___?
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WBCs (leukocytes) & Platelets (thrombocytes)
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What are normal RA pressures (sys/dia)?
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8/5 mmHg
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What are normal RV pressures (sys/early dia/late dia)?
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25/0/5 mmHg
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What are normal PA pressures (sys/dia)?
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25/10 mmHg
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What is the normal PCW pressure?
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10 mmHg
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What are normal LA pressures (sys/dia)?
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10/12 mmHg
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What are normal LV pressures (sys/early dia/late dia)?
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120/0/12 mmHg
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What are normal AO pressures (sys/dia)?
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120/80 mmHg
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Oxygenated blood (aka ___ blood) starts in the ___ and continues to the end of the ___
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Pink Blood
Pulmonary Veins Systemic Arteries |
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Deoxygenated blood (aka ___ blood) starts in the ___ and continues to the ___
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Blue Blood
Systemic Veins Pulmonary Arteries |
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Right side oxygen saturation levels are normally ___%
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75%
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Left side oxygen saturation levels are normall ___ %
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95%
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Where is the oxygen saturation the lowest?
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Coronary Sinus
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What is the normal oxygen saturation of pulmonary veins?
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95%
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What is the normal oxygen saturation of pulmonary arteries?
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75%
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In the cath lab, what is the best technique for determining LV function?
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LV Angiogram
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In this procedure, contrast medium is injected with the results filmed. Vessel narrowing, regurgitation, shunts, and ejection fraction can be identified.
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LV Angiogram (aka Ventriculogram, Selective Angiogram, Angiocardiogram)
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This cath lab technique calculates CO based entirely on oxygen consumption.
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Fick Method
CO = O2a / (O2b - O2c) (where a = oxygen breathed in, b = arterial oxygen level, c = venous oxygen level) |
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How can shunts be identified without imaging modalities in a cath lab?
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Oximetry - O2 saturations will be abnormal if shunts are present
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How can shunt size be calculated without imaging modalities in a cath lab?
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Using the difference between pulmonary and systemic blood flow
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In a cath lab, what is Pulmonary Capillary Wedge (PCW) measuring?
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LA pressure
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In a cath lab, to determine AS where are catheter(s) placed?
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1) one in LV; one in AO
2) one in LV; pull it back to AO 3) one with one sensor in LV and another in AO |
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In a cath lab, is it normal or abnormal for AO & LV pressures to track together?
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Normal
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In a cath lab, if the LV pressure was higher than AO pressure in systole (ie, they were not tracking together), what would this indicate?
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Aortic Stenosis
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In 2D imaging, how does gain settings affect resolution (and why)?
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Higher the gain, lower the resolution (due to increased noise)
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Does a low frequency transducer offer increased or decreased penetration?
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Increased
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Does a low frequency transducer offer increased or decreased resolution?
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Decreased
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Does a high frequency transducer offer increased or decreased penetration?
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Decreased
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Does a high frequency transducer offer increased or decreased resolution?
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Increased
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When you transmit and receive at the same frequency, what is this called?
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Fundamental Imaging
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When you transmit at one frequency but receive at twice the transmit frequency, what is this called?
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Harmonic Imaging
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What warning should we remember when using harmonics?
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Harmonics can cause the appearance of slight valvular thickening. Turn off harmonics to examine valves.
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Where in the thoracic cavity is the heart?
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Middle Mediastinum
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What are the layers of the heart muscle called?
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1) Endocardium
2) Myocardium 3) Epicardium |
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What are the layers of the heart's pericardium called?
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1) Fibrous Pericardium
2) Serous Pericardium - Parietal Layer - Pericardial Space/Fluid - Visceral Layer |
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Which valves are open during systole?
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PV/AV
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Which valves are open during diastole?
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TV/MV
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Which valves are closed during systole?
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TV/MV
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Which valves are closed during diastole?
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PV/AV
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