Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
75 Cards in this Set
- Front
- Back
|
Define pericarditis
|
Inflammation of the pericardium between the parietal and visceral layers
|
|
|
Define pericardial effusion
|
Visceral pericardium secreting fluid. Fluid build up between the parietal and visceral layers
|
|
|
Define cardiac tamponade
|
Moderate to large pericardial fluid build up caused by rapid increase in venous pressure
|
|
|
Define constrictive pericarditis
|
Thickening of the pericardium/becoming fibrous
|
|
|
What are the causes of pericarditis/PE
|
-idiopathic
- infectious -Immune inflammatory - Trauma - congenital |
|
|
What are the signs and symptoms of Pericarditis/PE
|
- Elevated cardiac enzymes
- hypodynamic heart with cardiomegally |
|
|
What are the complications of pericarditis/PE
|
-Cardiac tamponade
- Chronic pericarditis leading to constrictive pericarditis |
|
|
What are the most important ECG findings in patients with pericarditis/pericardial effusion?
|
- Elevated ST segments with upright T wave
- Sinus tachycardia - Reduction in QRS - Supraventricular arrythmias - electrical alternans |
|
|
What are the most important M mode findings in patients wtih Pericardial effusion?
|
Echo free space between epicardium and pericardium
|
|
|
What are the most important 2D findings in patients with pericardial effusion
|
Echo free space between epicardium and pericardium
- fibrin strands (long standing PE) |
|
|
What are the most important differential diagnosis anterior pericardial effusion?
|
Pericardial fat
|
|
|
What are the pericardial effusion severity scale?
|
Physiologic - only seen in systole
Small - seen during systole & Diastole in posterior ONLY < 1 cm Moderate - seen in systole and diastole posteriorly and anteriorly 1 - 2 cm Large - seen in systole and diastole surrounding the entire heart > 2 cm |
|
|
What are the signs and symptoms of cardiac tamponade
|
-hypotension
- hepatomegally - cold extremities - total paradoxus |
|
|
What are the complications of cardiac tamponade?
|
- Hypotension
- loss of consciousness - shock - death |
|
|
What are the most important medical and surgical procedures in patients with cardiac tamponade?
|
IV volume expansion
Isoproterenol vasodilator Surgical = Pericardiocentesis pericardiectomy |
|
|
What are the most important ECG findings in patients with cardiac tamponade?
|
- Electrical alternans (alternating from high voltage to low voltage)
- Low voltage QRS in limb leads - sinus tachycardia - ST segment elevation |
|
|
What are the most important M Mode findings in patients with cardiac tamponade?
|
RV collapse @ Diastole
RA collapse @ early systole |
|
|
What are the most important 2D findings in patients with Cardiac tamponade
|
- Moderate to large PE
- Collapse of RV @ diastole - Collapse of RA @ early systole - Dilated IVC with no collapse - IVS and IAS have inspiratory bounce |
|
|
What are the most important doppler findings in patients with cardiac tamponade?
|
- change of > 25% with respiration
Increase MV velocity with expiration Increase TV velocity with inspiration - hepatic vein decrease or reversal with respiration |
|
|
What are the most important M mode findings with constrictive pericarditis?
|
Atrial or spanish notch
|
|
|
What are the most important 2D findings in patients with constrictive pericarditis
|
- thickened pericardium > 3 mm
- septal bouncing - bound down appearance of LV - Dilated IVC with no collapse |
|
|
What are the complications of constrictive pericarditis
|
Heart failure due to diastolic dysfunction
|
|
|
What are the most important cardiac ausculation findings in patients with constrictive pericarditis
|
Diastolic pericardial knock
|
|
|
What are the most important cardiac catherization findings in patient with constrictive pericarditis
|
elevated and equal pressure in all chambers
|
|
|
What are the most important doppler findings in patients with constrictive pericarditis
|
- change of 25% with respiration
MV increase EXPIRATION TV increase INSPIRATION AOV increase INSPIRATION - Hepatic vein decrease and or reversal with EXPIRATION |
|
|
What are the most important medical and surgical procedures in patients with constrictive pericarditis?
|
Medical
diuresis/salt reduction digitalis Surgical Pericardiectomy |
|
|
Mosterate pericardial fluid may be detected by the following views
|
Plax Psax Ap4 and subcostal 4
|
|
|
True or False
Pericarditis/PE is caused by inflammation of pericardium |
TRUE
|
|
|
True or False
Pericarditis/PE cannot be differentiated from pleural effusion |
FALSE. located above DTA = pericardial
located below DTA = PE |
|
|
True or False
Pericarditis/PE is anterior to DTA |
True
|
|
|
True or False
Pericarditis/PE can be seen as echo free space by M Mode and 2D |
True
|
|
|
The echocardiographic sign of swining heart is associated with
|
Cardiac tamponade
|
|
|
Complications of PE include
|
Cardiac tamponade
Constrictive Pericarditis |
|
|
2D and M mode of pericardial tamponade include
|
Moderate to large PE
Collapse of RV during diastole Collapse of RA during early systole Dilated IVC with no collapse Swinging heart IVS and IAS = inspiratory bounce |
|
|
The purpose of the pericardium is
|
Pericardium is a membranous sac that protects the heart from infection and prevents the chambers from overfillings (creates a limitation)
|
|
|
Fluid volume in a small pericardial effusion is
|
< 100 cc
|
|
|
Fluid volume in a moderate pericardial effusion is
|
100-500 cc
|
|
|
Fluid volume in a large pericardial effusion is
|
> 500 cc
|
|
|
True or False
Constrictive pericarditis is usually associated with large PE |
True
|
|
|
True or False
Constrictive pericarditis increases diastolic filling |
False.
constrictive pericarditis limits or decreases diastolic filling because of the pressure on the ventricles |
|
|
True or False
Constrictive pericarditis is sometimes referred to as dresslers syndrom |
False.
Dresslers syndrome is often associated with PE following an MI |
|
|
True or False
Constricitive pericarditis impairs diastolic filling |
True.
ventricles cannot expand so contraction is limited |
|
|
Cardiac tamponade occur when
|
Interpericardial pressure increases due to accumulation of PE
Pericardium pressure becomes GREATER than Right atrial pressure |
|
|
The echo techniques that are useful when evaluating for the prescence of pericardial effusion are
|
AV valve variation (on M Mode)
prescence of PE (Plax, psax, ap4 and subcostal) |
|
|
The structure that often aids in the differentiating PE from Pleural effusion on 2D exam is ....
|
DTA
|
|
|
Flat mid to late diastolic motion of the posterior wall on M Mode echo suggests
|
Constrictive pericarditis
|
|
|
A patient diagnosed with Dresslers syndrome, 2D study should be performed to rule out
|
PE from previous MI
|
|
|
Normally how much fluid is in the pericardial sac
|
5 to 10 cc (less than 40 cc = normal)
|
|
|
True or False
When a patient has clinical diagnosis of pericarditis, PE should be present on 2D echo? |
True
|
|
|
The EKG of a patient with large PE may show
|
Electrical alternans (alternating from high to low voltage)
|
|
|
A patient referred to the echo lab because of positional and respiratory variation in chest pain is likely to have
|
Pericardial effusion
|
|
|
At cardiac catherization a patient has equal end diastolic pressure between both atria and both ventricles suggesting
|
constrictive pericarditis
|
|
|
Diastolic collapse of RV anterior wall is consistent with
|
Cardiac Tamponade
|
|
|
True or False
Echocardiography free spaces noted anteriorrly but not posteriorly should always be considered PE |
False.
Could be epicardial fat |
|
|
In performing cardiac doppler exam, the best angle is
|
0 or 180 degrees
|
|
|
Aliasing by ____ doppler and corrected by 1, 2, 3
|
Aliasing by PULSE WAVE doppler, is corrected by
1. decrease baseline 2. decrease scale 3. swtich to CW |
|
|
Velocity calculations are dependent on the following factors...
|
Doppler shift x prop speed
------------------------------------ 2 x's operating frequency x cosine theta |
|
|
An advantage of continuous wave doppler over pulse wave is
|
- obtain max velocity
- no aliasing |
|
|
Too much doppler gain by PW or CW causes the following
|
- Mosaic color/artifact
- aliasing |
|
|
What is doppler shift?
|
The difference between transmitted and received frequency
|
|
|
What is the doppler equation?
|
2 x operating freq X velocity X cosine theta
-------------------------------- prop speed |
|
|
According to the doppler equation, velocity is equal to
|
doppler shift X prop speed
------------------------------------- 2 x op freq X cosine theta |
|
|
What is positive and negative doppler shift?
|
Positive doppler shift is towards the sound beam (above baseline)
Negative doppler shift is away from sound beam (below baseline) |
|
|
What is aliasing and how do you correct it?
|
Aliasing is passing the nyquist limit. it indicates turbulent flow and is seen as mosaic.
Correct by decreasing baseline, increasing scale or switching to CW |
|
|
What is CW and its advantage/disadvantages compared to PW?
|
Continuous wave has 1 crystal sending and 1 crystal receiving at all times.
Advantage - high velocities with no aliasing Disadvantage - Range ambiguity no window no image |
|
|
What is ghosting artifact and how do you correct it?
|
Ghosting artifact is artifact that comes from tissue movement when using color. It appears as a flash of color. To correct it increase wall filter
|
|
|
Numerate the controls you can use to detect slow blood flow by color doppler
|
Lower scale
Increase packet size Increase priority |
|
|
How can you improve doppler frame rate
|
Decrease sector width
decrease packet size |
|
|
What is spectral mirror artifact and how can you correct it?
|
An identical copy of waveform on the other side of baseline
Correct by decreasing angle Decrease sample volume move gate to center of vessel |
|
|
What is Bernoulli effect
|
Relationship between pressure and velocity.
If velocity decreases = pressure will increase |
|
|
Numerate the advantages of using color doppler
|
-prescence of blood flow
- average velocity of blood flow - direction of blood flow - nature of blood flow (laminar/turbulent) |
|
|
What is the nyquist limit
|
1/2 PRF
|
|
|
What is the simplified bernoulli equation
|
Delta P (pressure gradient) = 4(v*)
|
|
|
Simplified bernoulli equation used in doppler Echo to measure >>>>
|
Pressure gradient
|
|
|
What is the continuity principle and equation?
|
Blood flow volume must be the same pre, @ and post stenosis.
SV = CSA x VTI Stroke volume = cross sectional area TIMES velocity time intergral |
