Cardiac Final Semester 1

Front 1

When the heart has to compensate for increased after load, the result is ___ of the ventricular walls because the heart has to work harder to pump the blood.

Back 1

Hypertrophy

Front 2

Acquired valvular heart disease may be due to

Back 2

Age, rheumatic heart disease, or endocarditis

Front 3

Regurgitation travels in the ___ direction of the normal flow while stenosis travels in the ___ direction as the normal flow

Back 3

Opposite, same

Front 4

We refer to normal flow as ___ flow. It is smooth and it's highest velocity is within the center of the flow.

Back 4

Laminar

Front 5

True or false. If the area decreases, the cardiac output increases, so the velocity must decrease in an attempt to maintain the cardiac output.

Back 5

False. If area decreases, CO decreases, so velocity must increase to maintain CO

Front 6

We use the Bernoulli equation to describe the relationship between pressure and velocity. The simplified Bernoulli equation =

Back 6

4(V)2

Front 7

True or false. The incidence of valvular heart disease has decreased due to advanced technology and antibiotics.

Back 7

True

Front 8

In the chamber that is ___ to the stenotic valve, the blood backs up, drives the pressure up, and creates a pressure overload pattern.

Back 8

Proximal

Front 9

True or false. In order to acquire a quick maximum pressure gradient, one can utilize the modified Bernoulli's equation.

Back 9

True

Front 10

True or false. Planimetry of the doppler waveform will provide the maximum pressure gradient, mean pressure gradient, and peak velocity across a cardiac valve.

Back 10

True

Front 11

A regurgitant valve creates a volume overload pattern because it is dumping extra blood into the ____

Back 11

Proximal chamber

Front 12

Regurgitation increases

Back 12

Preload

Front 13

Stenosis increases

Back 13

Afterload

Front 14

Congenital heart disease means

Back 14

One is born with it

Front 15

When a normal valve is open there is a low ___

Back 15

Pressure gradient. The pressure on either side of the valve is effectively equal.

Front 16

Laminar flow is also known as

Back 16

Parabolic flow

Front 17

Normal valve has

Back 17

Laminar flow, normal pressure and chambers

Front 18

A stenotic valve leads to

Back 18

Pressure overload pattern with turbulent flow, increased pressure and hypertrophy

Front 19

A regurgitant valve leads to

Back 19

Volume overload pattern with turbulent flow, increased volume and dilation.

Front 20

With color flow doppler, flow traveling away from the transducer is

Back 20

Blue

Front 21

With color flow doppler, flow traveling toward the transducer is

Back 21

Red

Front 22

With spectral doppler flow traveling toward the transducer appears ___ the baseline

Back 22

Above

Front 23

With spectral doppler, flow traveling away from the transducer appears ___ the baseline

Back 23

Below

Front 24

Normal, laminar color flow

Back 24

Travels in proper direction during proper phase of cardiac cycle.

Front 25

Stenotic, turbulent flow

Back 25

Travels in the same direction and time as normal flow

Front 26

Regurgitant, turbulent colorflow

Back 26

Travels in the opposite direction and phase of the cardiac cycle.

Front 27

Normal MV and TV doppler waveforms

Back 27

Travel toward the transducer (above baseline)

Front 28

Normal AOV and PV waveforms

Back 28

Travel away from transducer (below baseline)

Front 29

Stenotic waveforms

Back 29

Travel in same direction as normal, but different shape and greater velocity.

Front 30

Regurgitant waveforms

Back 30

Travel in the opposite direction during opposite phase of the cardiac cycle and take on different shape than normal waveform.

Front 31

MR waveform usually has a higher velocity than___

Back 31

TR because the LV is the high pressure side.

Front 32

A narrowing, thickening, fusion or blockage of a valve that produces obstruction to blood flow

Back 32

Valvular stenosis

Front 33

Stenosis can be caused by

Back 33

calcified valves or an obstruction

Front 34

Proximal to the stenotic valve

Back 34

Blood backs up, pressure increases, creates a pressure overload pattern (increased afterload),The heart must work harder to compensate for increased afterload causing hypertrophy.

Front 35

Aortic stenosis causes left ventricular

Back 35

Hypertrophy

Front 36

When the AV valves are stenotic the atria tend to

Back 36

Enlarge

Front 37

Mitral stenosis causes a pressure increase in the LA leading to left atrial

Back 37

Dilation

Front 38

At the level of the stenotic valve, the leaflets experience

Back 38

Doming during open phase and decreased valvular area within the valve orifice

Front 39

The increased pressure in the chamber proximal to the stenosis causes

Back 39

Doming of the tethered leaflets while open

Front 40

This valve is notorious for doming

Back 40

Mitral valve

Front 41

If the valves area decreases the cardiac output decreases so the velocity must ___ to maintain the CO

Back 41

Increase

Front 42

Distal to the stenotic valve the flow is turbulent and the pressure

Back 42

Decreases

Front 43

The more severe the stenosis

Back 43

The smaller the area, the greater the velocity, & more turbulent the blood flow

Front 44

Turbulent bloodflow displays a ___ pattern

Back 44

Mosaic

Front 45

Increased pressure proximal to stenosis and decreased pressure distal to stenosis causes an increased

Back 45

Pressure gradient

Front 46

The Max pressure gradient is acquired via ___ doppler

Back 46

CW

Front 47

Doppler echo doesn't measure pressure directly. Instead it measures ___

Back 47

Velocity

Front 48

___ equation is used to describe the relationship between pressure and velocity (pressure gradients)

Back 48

Bernoulli

Front 49

Bernoulli equation

Back 49

P1-P2=PG=4(V)2

or simplified: PG=4(V)2

P1: pressure proximal to valve

P2: pressure distal to valve

V: peak velocity of flow between 2 chambers (use CW to aquire)

Front 50

Absolute peak velocity

Back 50

Overall peak velocity of same valve from various views. Use for valvular calculations. Can be done with steerable CW doppler or PEDOF

Front 51

The best correlation between the echo lab and the cath lab is the ___

Back 51

Mean PG, not the Max PG

Front 52

If there is stenosis you should always ___ the waveform

Back 52

Trace. (Planimetry) to get the mean PG, max PG, and peak velocity

Front 53

Valvular Regurgitation (insufficiency) is the result of

Back 53

A valve that doesn't close properly. Portion of the blood travels backward from the distal chamber, through the valve while it's closed.

Front 54

Initially, a regurgitant valve creates

Back 54

Volume overload pattern (increased preload) because it's dumping extra blood into the proximal chamber. This leads to dilated chambers.

Front 55

Dilation can be good because it allows the chamber to accommodate for increased volume without causing

Back 55

An increase in pressure

Front 56

The pressure the heart must pump against

Back 56

Afterload

Front 57

Stenosis initially causes

Back 57

Pressure overload (increased afterload)

Front 58

MR

Back 58

Front 59

TR

Back 59

Front 60

MR and TR spectral doppler

Back 60

Normal MV and TV (diastolic)

MR and TR (systolic)

Front 61

AI

Back 61

Front 62

PI

Back 62

Front 63

AI and PI spectral doppler

Back 63

Normal systolic AOV and PV

and abnormal diastolic AI and PI

Front 64

Diastolic function parameters depend on our ability to evaluate

Back 64

Pressure/volume relationships of LV filling

Front 65

Mitral valve flow provides critical information about diastolic function including

Back 65

E to A ratio, E wave deceleration time, A wave duration

Front 66

Tissue doppler imaging of mitral annular motion measures the velocity of myocardial movement as it passes through sample gate

Back 66

True

Front 67

The pulmonic A wave normally equals

Back 67

2.7mm

Front 68

Several steps are required during the diastolic function calculations to include

Back 68

Mitral valve flow, pulmonary venous flow, isovolumic relaxation time.

Front 69

When a LVOT obstruction is present, a typical finding is

Back 69

A dagger shape doppler waveform

Front 70

While acquiring diastolic function parameters, it is advised that the sweep speed be decreased from 50 mm/sec to 25 mm/sec

Back 70

False. Increased to 100 mm/sec

Front 71

The mitral A wave duration should be greater than or equal to the

Back 71

Pulmonary vein a wave duration

Front 72

An indication of increased left ventricular end diastolic pressure and decreased diastolic compliance is a pulmonary venous a wave reversal that is greater than 35 cm/sec

Back 72

True

Front 73

An indication of increased left ventricular end diastolic pressure is a pulmonary venous "a" wave duration that is less the mitral A wave duration

Back 73

False

Front 74

The isovolumic relaxation time can be found

Back 74

Between the aortic valve closing click and mitral valve opening click

Front 75

How to obtain Aortic valve area using the continuity equation

Back 75

LVOTd: PLAX 2D early-systole right before opening of cusps.

VTI of LVOT: 5c or 3c, color, PW doppler, trace waveform.

VTI of AOV: 5c or 3c, CW through AOV, trace waveform.

Front 76

VTI is measured in units of

Back 76

Distance

Front 77

Continuity equation

Back 77

Front 78

Continuity equation simplified

Back 78

Front 79

CSA

Back 79

To find the CSA of the LVOT use

d^2×.785