Cci Echo Review Part 1

Front 1

In PLAX, which TV leaflets are seen?

Back 1

Anterior and medial/ septal
Posterior can only be seen in RVIT plax

Front 2

The coronary Arteries come off the?

Back 2

Sinuses of Valsalva

Front 3

What is the structure under the arch?

Back 3

Right Pulmonary Artery

Front 4

The formula for calculating EF is:

Back 4

EDV-ESV / EDV x 100

Front 5

Stroke Volume

Back 5

EDV-ESV

Front 6

The LA dimension is measured on M=mode during?

Back 6

End -systole

Front 7

Where are the pulmonary veins located?

Back 7

Can be seen in Apical 4 chamber w/inferior angulation.

Front 8

How do you bring in the RVIT in PLAX?

Back 8

Angle Medial and Inferior from Aortic Root. TV

Front 9

How do you bring in the RVOT in PLAX?

Back 9

Angle Lateral and Superior from Aortic root. PV

Front 10

Where is the Chiari Network located?

Back 10

RA

Front 11

Where is the aortic isthmus located?

Back 11

Area between the left subclavian and the ductus arteriosus(where most coarctations occur)Sinus of Valsalva is the most common area of dissections).

Front 12

The ____ is the most anterior chamber of the heart?

Back 12

RV

Front 13

Pulmonary artery is _____, _____

Back 13

anterior, superior

Front 14

The Eustachian valve is located in the?

Back 14

IVC

Front 15

Can you see the moderator band in the PLAX?

Back 15

No- Moderator band is located in the RV

Front 16

Where does the moderator band extend?

Back 16

From the lower intraventricular septum to the anterior wall where it joins the papillary muscle.

Front 17

Spontaneous chordal rupture more often occurs on which leaflet of the Mitral Valve?

Back 17

Posterior
Also psterior medial papillary muscle
Single blood supply to posterior wall

Front 18

The heart tube normally loops?

Back 18

Anterior and to the right

Front 19

Where is the coronary sinus located in relation to the descending aorta

Back 19

The coronary sinus is located anterior to the descending aorta. If the coronary sinus is dilated, it can be mistaken for the descending aorta.

Front 20

How would you angle to view the coronary sinus in the apical four chamber view?

Back 20

From the apical four chamber you you would angle inferior in order to visualize the coronary sinus, which is located posterior to the mitral annulus.

Front 21

Why is it important to know the location of the coronary sinus and the descending aorta?

Back 21

Pericardial Effusions lie posterior to the coronary sinus and anterior to the descending aorta.
Pleural effusions lie posterior to the descending aorta.

Front 22

What is another name for the RVOT?

Back 22

Infundibulum

Front 23

Where is the coronary sinus located in the parasternal long axis view?

Back 23

The coronary sinus lies in the posterior AV groove. This groove is located between the LA and LV walls and lies posterior to be MV. In the parasternal long axis view, the coronary sinus can sometimes be seen as a small echo free circle.

Front 24

What would cause the coronary sinus to become dilated?

Back 24

The coronary sinus dialates due to increased pressure in the RA, increased flow to coronary sinus.

Front 25

Describe the anatomy of the tricuspid valve, including the name and location if each leaflet.

Back 25

Location is between the Right atria and right ventricle. It has three leaflets: anterior, posterior, and medial or (septal) leaflets.
The names reflect the anatomical relationship to the right ventricle. The medial leaflet is connected to the septal wall. It's insertion is located closer to the cardiac apex than that of the anterior mitral valve leaflet.

Front 26

Name and describe two main layers of the pericardium?

Back 26

Often referred to as 2 main layers as visceral and parietal. This visceral layer lies directly upon external surface of the heart and is commonly referred as the epicardium. The parietal or fibrous pericardium is the thick outer sac. Pericardial cavity lies between the two layers.Anatomically 3 layers are: serous visceral, serous parietal, fibrous pericardium.

Front 27

Name the three major coronary arteries.

Back 27

The three major coronary arteries are the right, left ant descending (LAD), and the circumflex arteries

Front 28

The heart tube loops _______ at day ____

Back 28

The heart tube loops ANTERIORLY and RIGHTWARD at day 22

Front 29

The AV canal is a large communication between the __________ and ________

Back 29

Primitive atria and primitive ventricle

Front 30

The ________ divides the AV canal into right and left AV orifices

Back 30

Endocardial cushions

Front 31

The ductus arteriosus closes after birth due to increased systemic pressure and becomes the _______

Back 31

Ligamentum arteriosum

Front 32

What are the two Right to Left shunts in the normal fetal circulation?

Back 32

Foreman ovale
Ductus arteriosus

Front 33

Following electrical depolarization of the myocardial cell membrane, which ion rushes in first and which ion rushes in later?

Back 33

Sodium is a rest

* Calcium is 2nd and responsible for contraction

Front 34

Where is a subaortic membrane (DSS) located?

Back 34

just below the Aortic Valve

Front 35

Tricuspid Valve leaflets seen in the PSAX-Aortic valve

Back 35

Medial (septal)
Anterior

Front 36

Name the cardiac walls supplied by each of the coronary arteries.

Back 36

right coronary artery
a) inferior wall
b) inferoseptal
c) right ventricular apex
d) right ventricular free wall.
**RIGHT= inferior, septals, right

Front 37

Left anterior descending artery - LAD

Back 37

a) anterior wall
b) anteroseptal
c) left ventricular apex
**LEFT = anterior, apical, left

Front 38

Circumflex artery

Back 38

a) anterior lateral wall
b) inferolateral wall
CIRC = laterals

Front 39



What walls do the LAD supply?

Back 39

Anterior IVS, Anterior Left Ventricle and Apex

Front 40

What walls do the CX supply?

Back 40

Anterolateral and inferolateral

Front 41



What walls do the Posterior descending artery supply?

Back 41

Inferior Left Ventricle, Inferior Right Ventricle and Inferior IVS

Front 42

The LAD lies in the _______ interventricular sulcus?

Back 42

anterior

Front 43

walls and coronary artery circulation on PLAX?.

Back 43

1. anterior RVOT - RCA
2. anterior IVS - LAD
3. inferolateral - CX/RCA

Front 44

walls and coronary artery circulation on PSAX?

Back 44

1. anterior IVS - LAD
2. anterior - LAD
3. anterolateral - CX/LAD
4. inferolateral - CX/RCA
5. inferior - Posterior descending
6. inferior IVS - Posterior descending /LAD

Front 45

walls and coronary artery circulation A4?

Back 45

1. anterolateral - CX/LAD
2. apex - LAD
3. inferior IVS - LAD/RCA
4. lateral Right Ventricle - RCA

Front 46

walls and coronary artery circulation Apical 2 Ch?

Back 46

1. anterior - LAD
2. apex - LAD
3. inferior - Posterior descending artery (of the RCA)

Front 47

The circumflex artery supplies?

Back 47

anterolateral and inferolateral walls

Front 48

The Posterior descending artery ( of the right coronary artery) supplies?

Back 48

inferior Left Ventricle, inferior Right Ventricle and inferior IVS

Front 49

The anterior septum and anterior wall of the Left Ventricle is supplied by the?

Back 49

LAD

Front 50



The anterolateral, lateral and inferolateral walls of the Left Ventricle are supplied by the?

Back 50

Circumflex

Front 51

The inferior wall of the Left Ventricle and inferior septum are supplied by the?

Back 51

Posterior descending artery

Front 52

The cardiac apex is supplied by the?

Back 52

LAD

Front 53

Which coronary artery provides blood to the Right Ventricle?

Back 53

RCA

Front 54

Which coronary artery provides blood to the inferior septal walls in right dominant?

Back 54

Posterior descending artery

Front 55

Which walls of the left ventricle are seen in the parasternal and apical long axis views

Back 55

The anterior septal and the inferolateral walls of the LV are seen in the parasternal apical long axis Views.

Front 56

Which two aortic valve leaflets are seen in these views?

Back 56

The right & non coronary leaflets are seen in these views. The right leaflet is on top (superior) and the non-coronary is on the bottom (inferior)

Front 57

Where are the coronary arteries located on the surface of the heart?

Back 57

The coronary arteries are located on the outer, epicardial surface of the heart as follows:
the right coronary artery (RCA) arises from the right aortic root sinus, follows the right atrioventricular junction, and to descends along the posterior interventricular groove.
The left anterior descending coronary artery (LAD) follows the Anterior interventricular groove.
The circumflex coronary artery's or courses along the left AV junction.

Front 58

Complications with MI?

Back 58

1. pericarditis/PE
2. Dressler's syndrome (PE post MI)
3. Left Ventricle true aneurysm
4. Left Ventricle false or pseudo aneurysm
5. Left Ventricle thrombus
6. Ventricular septal defect
7. papillary muscle dysfunction
8. Right Ventricle infarct

Front 59

While scanning a 43 old man with history of an old myocardial infarction, you notice at the anterior cardiac wall is akinetic. Which coronary artery is most likely to have been involved in the infarction?

Back 59

The left anterior descending (LAD) coronary artery, which supplies blood to the inferior cardiac wall, is most likely to have been involved. This artery also supplies the inferior portion of ventricular septum and the left ventricular apex.
**LEFT = anterior, apical, left

Front 60

In the apical 4 ch view of another patient, the distal ventricular septum and left ventricular apex are hypo-contractile. Which coronary artery is most likely to be diseased?

Back 60

Again, the left Anterior descending (LAD) coronary artery is the most likely choice. Some patients with distal septal hypocontractility, the proximal portion of the septum moves normally because it is supplied by the RCA.
NOTE: LEFT= left, ant, apicals

Front 61

To visualize the inferior lateral wall the left ventricle, which 2D view would you use?

Back 61

The anteriolateral wall of the left ventricle is best visualized in the apical four chamber view.( The lateral wall can also be seen in the short axis views, but the four chamber view is the best.)
NOTE: 2 CH is anterior & inferior

Front 62

The normal intracardiac pressure for the Right Atrium is?

Back 62

5mmHG
NOTE: RIGHT SIDED PULMONARY PRESSURES ARE LOWER THAN THE LEFT

Right Atrium=5, Right Ventricle=25, PA=25 5-25-25
Left Atrium=10, Left Ventricle=120, Aorta =120. 10-130-120

Front 63

The normal intracardiac pressure for the Right Ventricle is?

Back 63

25/5mmHg

Front 64

The normal intracardiac pressure for the PA is?

Back 64

25/10mmHg

Front 65

The normal intracardiac pressure for the Left Atrium is?

Back 65

10mmHg

Front 66

The normal intracardiac pressure for the Left Ventricle is?

Back 66

120/10mmHg

Front 67

The normal intracardiac pressure for the Aorta is?

Back 67

120/80mmHg

Front 68

Describe the normal mitral valve anatomy

Back 68

The mitral valve is a bi-leaflet valve situated between the left atrium on the left ventricle. The valves anterior leaflet is relatively long, lies close to the aorta, and comprises one third of the valves circumference. The posterior leaflet is shorter and is usually divided into three sections (scallops). Both the anterior and the posterior leaflets are attached to the ventricular Papillary muscle by multiple cordae tendonae

Front 69

Which aortic leaflet is the superior one in the parasternal long axis view?

Back 69

Right leaflet (the posterior leaflet is the non coronary)

Front 70

During which phase do the coronaries fill?

Back 70

Early diastole

Front 71

Inhalation of amyl nitrite causes?

Back 71

Decreased after load
-Vasodilator
-BP drops
-less blood comes back
-HR increases

Decreases vascular resistance. Increases forward flow murmurs decreases AR/MR ( retro flow murmurs)

Front 72

When is Left Ventricle pressure the lowest?

Back 72

Early diastole

Front 73

Which type of mitral deformity occurs where there is only ONE PAPILLARY MUSCLE into which both chordae insert
OR insertion of mitral chord into a single papillary muscle?

Back 73

Parachute mitral valve
NOTE: MOST COMMON FORM OF CONGENITAL MITRAL STENOSIS--it is a rare cause of mitral stenosis

Front 74

Which is the most common chamber for a sinus of Valsalva aneurysm to rupture into?

Back 74

Right Atrium
NOTE: SINUS OF VALSALVA IS MOST COMMON AREA OF ANEURYSM IN MITRAL STENOSIS

Front 75

Systolic flow reversal of bubbles in the IVC is indicated of Tricuspid Regurgitation or tamponade?

Back 75

Tricuspid Regurgitation

Severe grade TR

Regurgitation is a preload= volume = Dilitation
It affects the chamber behind it. ( which is Left atria and the Ivc)

Front 76

Which of the following is used in echo to measure dp/dt?

Back 76

Mitral Regurgitation

NOTE:
The rate (dP/dt max) of left ventricle (LV) pressure rise in early systole measures LV SYSTOLIC FUNCTION.

Front 77

What is beck's triad?

Back 77

-elevated venous pressure
-hypotension
-quiet heart
associated with acute tamponade
* IT IS THE CLINICAL DIAGNOSIS OF CARDIAC TAMPONADE

Becks triad ( cardiac tamponade ) 3 Ds
Distant heart sounds
Distended jugular veins
Decreased arterial pressure

Front 78

A huge, dilated PA, severe Tricuspid Regurgitation and Right Ventricle enlargement best describes?

Back 78

Pulmonary hypertension

Tricuspid reguritation. Is a preload, volume overload affects chambers ahead of it.

Front 79

The size of aneurysms during systole:

Back 79

Increase

Front 80

What is the most common (mechanical) complication of an MI.

Back 80

Aneurysm formation

Front 81



Which of the following occurs first in the setting of severe mitral regurgitation due to a flail leaflet?

Back 81

Dilated Right Ventricle

FLAIL LEAFLET WILL CAUSE MITRAL REGURGITATION

This is a sudden onset (acute) and the heart does not have time to adjust yo the pressure difference.

Front 82

What type of MI causes papillary muscle rupture?

Back 82

inferior MI
-Inferior pap muscle has a single blood supply (Medial papillary muscles receives dual blood supply and is less likely to rupture)

* posterior papillary muscle single blood supply is most likely to rupture

Front 83

From where do the coronaries originate?

Back 83

In the LEFT and RIGHT aortic sinus of Valsalva

Front 84

Which coronary supplies the Interatrial septum?

Back 84

Right (also usually supplies the SA and AV nodes)

Front 85

Which coronary artery feeds the inferoseptal wall?

Back 85

Right coronary artery

Front 86

What would be a contraindication to performing a stress test on an athlete with chest pain?

Back 86

Unstable angina

Front 87

Know that Atropine may be given at peak dose if the target heart rate is not reached.

Back 87

Peak HR is 80%

Front 88



Calculate the RVSP in a patient with 5m/sec VSD jet and BP of 130/80

Back 88

RVSP=SBP-4(V)2
=130-4(5)2
=130-4(25)2
=130-100
=30 mm Hg

Front 89

If your patient has a dilated Left Ventricle and thin septum what might be going on with this patient?

Back 89

Severe mitral regurgitation.

On M mode anterior motion of the posterior leaflet

Front 90

Which view shows the coronary sinus in long axis?

Back 90

Apical 4 chamber with posterior angulation
NOTE: PLSVC, CHF, PHTN = dialated CS

Front 91

Where does the left anterior descending coronary artery originate?

Back 91

anterior intraventricular sulcus

Front 92

Are right-sided pressures elevated with a Valsalva maneuver?

Back 92

During the strain phase=No
During the release phase=Yes

Front 93

Which clinical finding is associated with a friction rub?

Back 93

pericardial effusion-
constrictive pericarditis (which leads to PE)- friction rub.
Constrictive pericarditis impaired ventricular filling
Pericardial knock Similar in timing to a very loud S3. It's caused by an abrupt cessation of early diastolic inflow.
- respiratory variations of MV and TV

Front 94

What does the sinus venous turn into?

Back 94

Atrial connections (IVC, SVC, pulmonary veins, CS and part of the atria

Front 95

In normal development which is the last to close?

Back 95

patent foramen ovale
First to close is. ASD

Front 96

What is Qp/Qs?

Back 96

Qp pulmonary circulatory flow
Qs = systemic circulatory flow
ASD surgery is mainly considered when the Qp/Qs exceed?
1:5
Normal ratio 1:1

Front 97

What are the Qp/Qs for an ASD?

Back 97

>1 for left to right shunt
< 1 for right to left shunt

Front 98

In patients with A-fib which heart sound would be missing?

Back 98

Fourth (occurs during atrial contraction)

Front 99

How do you position a patient for using a Pedoff probe along the right sternal border?

Back 99

right lateral decubitus

Front 100

A 52 year old woman develops a murmur after a myocardial infarction. What is the most likely etiology?

Back 100

ventricular septal defect