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124 Cards in this Set
- Front
- Back
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Numerate the views for TV examination
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RVIT
Subcostal AP4 AP5 PSAX AoV |
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Numerate the causes of aortic aneurysm
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Athlerosclerosis **most common
Infection --> mycotic trauma Marfans syndrome Aortic Stenosis Syphillis |
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Numerate the branches of the aortic arch
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Brachiocephalic
LT CCA LT Subclavian |
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The most common location to have a ruptured sinus of valsalve is the ____
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Right Coronary Cusp
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What is the most common benign cardiac turmor and what is its most common location and complication?
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Myxoma ... most commonly found in LA and the most common complication is embolism/MS
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What is stroke volume?
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The amount of blood ejected per contraction
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Tracing the doppler waveform calculates ____ and _____
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VTI and MPG
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With significant pulmonary hypertension M mode and doppler waveform shows:
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Flying W (mid systolic notch)
E/A reversal of MV flow RV dilation |
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What are the causes of RA dilatation?
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Tricuspid Regurge
Tricuspid Stenosis Pulmonary HTN Pulmonary Stenosis |
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What is the best view for identifying ebstein anomaly?
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AP4
Subcostal |
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Name the 3 structures that drain into the RA
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SVC
IVC CS |
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Name the normal varients of the heart,
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RA - Moderator band & trabeculation
LV - false tendon/ectopic chordae/ chirari network RA - prominent eustachian valve/crista terminalis LA - n/a |
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What is the effect carcinoid heart disease has on the heart?
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Damages the TV and PV, leaves them stuck partially open leading to TS and TR
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Numerate the causes of aortic dissection
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Systemic HTN ** most common
Athlerosclerosis Marfan syndrom Bicuspid AoV Trauma Cocaine Aortic Coarctation |
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What is the normal Tricuspid valve area
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5 to 8 cm*
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What is the area of TV when severely stenotic
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< 1 cm*
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What is papillary fibroelastomas and what is most common valve affected with this disease?
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2nd most common benign tumor of the heart, affecting the valve, predominately the MV
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Marfans syndrom usually occur in ______
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Marfans usually affects the aorta ... the aortic root and the ascending aorta
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What is the doppler waveform shape seen with acute severe TR
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Dense triangular shape with early systolic peaking.
V Shape Dagger shape |
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to evaluate PASP you need to obtain
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The max TR velocity and apply Bernoulli
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What are the common echo findings in patients with systemic HTN
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Concentric LVH
LV Dilatation LA dilatation Aortic root diltation Aortic dissection Sclerosis of the valves Grade I diastolic dysfunction |
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if you suspect the cause of TS to be rheumatic, the next thing you do is >>>
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Examine MV
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What are the 2D findings of pulmonary HTN
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RVH/dilatation
D Shaped LV Pancake Septum |
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Which are confusing conditions for left ventricular thrombus
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False tendon
traburculation |
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What are the different views used to evaluate the PV
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PSAX AoV
RVOT |
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What are the causes of an increase EPSS
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Dilated LV
Mitral Stenosis Low EF |
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The most common cardiac metastic tumors come from
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Melatonin --- Skin
Bronchiogenic ---Lungs |
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Which tumor invades the heart via extension through the IVC
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Angiosarcoma
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lipomatous hypertrophy commonly involve the
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IAS ... dumbbell appearance
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When severe TR is suspected systolic flow reversal may be noted in the ______
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S wave of the hepatic vein
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How do you increase color frame rate
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Decrease box size
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How do you decrease sensitivity to color flow?
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Lower scale and filter
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What are the complications of Tricuspid valve vegetation
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Rt heart failure
Renal failure Pulmonary embolism regurge |
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What is the effect of carcinoid syndrome on the heart?
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TR
PR |
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An aortic root diameter greater then ____ is considered high risk for spontaneous rupture?
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> 5 cm .... require surgery
> 6 cm ... require IMMEDIATE attention |
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What are the probable sources of right atrial thrombus
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Tricuspid Stenosis
DVT |
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The equation used to calculate PASP is
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Bernoulli
4(max TR*) + RAP |
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What are the marfan syndrom 2D findings
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Dilated aortic root
LA compressed Mitral valve prolapse |
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What are the possible findings of pulmonic regurge?
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RV Volume overload
RV dilatation Pul Artery dilatation |
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What are the echo findings in patients with Cor-pulmonale
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RVH
D shape LV Pancake septum |
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What is the cause of IVS rupture?
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Pressure overload
myocardial infraction |
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What are the complications of MI
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Death
LVH RVH Slow moving blood |
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What are the causes for thrombus to develop in LV
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Aneurysm
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Papillary muscle dysfunction or rupture usually results from ______
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Surgery
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What are the causes of acute severe MR
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Ruptured chordae
Mitral valve prolapse Acute ischemia |
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Describe the different movements of the LV walls
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Hyperkinetic
Hypokinetic Akinetic Dyskinetic |
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What are the causes of concentric LVH
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Systemic HTN
volume overload Aortic Stenosis Coarctation of the Aorta |
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What are the causes of concentric RVH
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Pul HTN
Pul Stenosis |
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What are the 2D findings of pulmonary HTN
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RVH
Pancake septum D shape LV |
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Define TS
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Narrowing of the TV orifice
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What is the most common etiology of TS
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Rheumatic fever 90% of the time
10% - carcinoid disease or congenital |
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What are the signs and symptoms in patients with TS
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Fatigue
edema ascites hepatomegally pressure overload of RA Dilation of RA Mitral stenosis symptoms (dyspnea) |
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What are the complications of TS?
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Pressure overload in RA
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What are the most important cardiac auscultation findings in patients with TS
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opening snap
Diastolic rumble murmur @ LT sternal border |
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What are the most important EKG findings with TS
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Atrial enlargement
A fib |
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What are the most important medical and surgical procedures in patients with TS
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Prophylaxis
Balloon commissurotomy Valve repair/replacement |
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What are the most important M Mode findings in patients with TS
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Thickened leaflets
Decreased EF slope Anterior motion of the posterior leaflet |
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What are the most important 2D findings in patients with tricuspid stenosis
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RA enlargement
Enlarged IVC, SVC, CS Thickened leaflets diastolic doming commissure fusion leftward protrusion of IAS Pul HTN |
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What are the most important doppler findings in patient with TS
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Red candle falme into RV
Increased E velocity Decreased EF slope MPG > 5 mmHg = severe |
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TVA equation
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TVA = 190/PHT
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Severe TS has a TVA of?
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< 1 cm*
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Define TR
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Backflow of blood from RV to RA during systole
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What are the most common etiology of TR
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Pul HTN
Eisenmenger Ebstein anomaly Constrictive pericarditis Trauma Carcinoid disease Rheumatic Infective endocarditis |
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What are the signs and symptoms of TR
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Edema
Ascites Anasarca Jugular dissection hepatomegaly RT heart failure |
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What are the complication of TR
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RT side heart failure
Renal failure jaundice Dilation of anything connected to RA |
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What are the most important cardiac auscultation findings in patient with TR
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Holosystolic blowing murmuar @ LT lower sternal border
Increases with Inspiration |
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What are the most important EKG findings in TR
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RA enlargment
A Fib P-Pulmonale (large P wave) |
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What are the most important medical and surgical treatments in patients with TR
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None -- treat underlying cause
Annuloplasty TV replacement |
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What are the most important M mode and 2D findings in patients with TR
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Paradoxical septal motion
RV dilation RA dilation RV volume overload Ruptured chordae Pul HTN Ebstein anomaly |
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What are the most important PW doppler findings in patients with TR
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Round - chronic
Dagger - acute Reversed flow in hepatic veins (s wave above baseline) increased E velocity > 1 m/sec |
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What are the most important CW doppler findings in patients with TR
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intensity/density of waveform indicates severity
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What are the common causes of severe TR?
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Flail leaflet
infective endocarditis |
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What are the most common color doppler findings in patients with TR?
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Jet/RA ratio >34% = severe
Jet into IVC/hepatic vein = severe Reversed flow in hepatic (red) = severe Vena contracta > 0.7 = severe PISA > 0.9 = severe blue jet in RA during systole Area of Jet > 10 cm* |
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What is physiologic TR
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Normal apparatus, normal chambers, TR appears short with small jet
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What are the 3 causes of concentric LVH
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Aortic Coarctation
Systemic HTN AoV stenosis |
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Define TV prolapse
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Prolapse of any part of the TV > 2 mm past the annular plane during systole
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Numerate the types of TV prolapts
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mid to late systolic
holosystolic |
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What are the 2D findings in patients with TV prolapse
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Seen best in AP4 & RVIT
Tricuspid annular dilatation Prolapse of 1 or all of the leaflets |
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What are the doppler findings in patients with TV prolapse
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TR
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Define Pul regurge
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Backward flow from Pul artery into RVOT during diastole
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What is the most common etiology of Pul regurge?
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Pul HTN **most common
I. E Rheumatic heart disease Carcinoid disease congenital abnormality |
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What are the signs and symptoms in patients with PR
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Rt heart failure
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PR is ____ overload
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RV volume overload
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What are the most important cardiac auscultation findings in patients with PR
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Diastolic murmur @ 2nd innercostal space @ LT sternal border
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What is graham steele murmur?
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Heard with Pul HTN
PASP > 70 mmHG high pitched blowing descrescendo |
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What are the most important ECG findings of PR
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RVH
Right bundle branch block |
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What are the most important medical and surgical procedures in patients with PR
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None.
Valvoplasty Valve replacement |
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What are the most important 2D findings in patients with Pul Regurge
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RVVO == RV dilatation and paradoxical septal motion
Enlarged MPA PV annulus dilatation RA dilataion Pul HTN findings |
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What are the most important PW doppler findings in patients with PR
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Decreased decelleration slope
Pul HTN |
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What are the most important CW doppler findings in patient with Pul Regurge
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Jet density determines severity
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What are the most important doppler findings in patients with PR
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Red jet in RVOT during diastole
Jet width vs length ... wider than 10 mm= severe Jet/RVOT ration > 70% = severe holodiastolic flow reversal in MPA |
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What is physiological PI
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< 1 cm in length
not holodiastolic normal Pul Artery pressure |
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Define pulmonic stenosis
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Obstruction of flow from RV into MPA during systole
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What is the most common etiology of PS
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Congenital
Carcinoid disease Rheumatic IE |
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What are the signs and symptoms in patients with PS
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Asymptomatic
Dyspnea Cyanosis RT heart failure |
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Pulmonic Stenosis is ___ overload
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RV pressure overload
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What are the most common cardiac auscultation findings in patients with PS
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Harsh systolic murmur crescendo-decrescendo
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What are the most important ECH findings in patients with PS
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Normal
RVH |
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What are the most important medical and surgical procedures in patients with PS
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Treatment for heart failure
Valve replacement ROSS procedure |
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What are the most important M Mode findings in patients with PS
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Thickened leaflets
RVH > 7 mm Deep A wave Systolic doming |
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What are teh most important 2D findings in patients with PS
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Systolic doming
RVH RA dilatation Post stenotic dilatation |
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What are the most important PW doppler findings in patients with PS
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Increased velocity > 1.2 m/sec = severe
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What are the most important CW doppler findings in patients with PS
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Increased velocity
MPG . 64 mmHg PVA < 1 cm* Peak velocity > 4 cm = severe |
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What are the most important color doppler findings in patients with PS
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Flow convergence for PR
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What are the most important doppler findings in patients with Pulmonic Stenosis
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PR
increased velocity |
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Define Ao aneurysm
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Localized abnormal dilatation of Aorta
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What are the types of AO aneurysm
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Fusiform - walls are stretched evenly
Saccular - walls stretched only on one side |
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what is the most common aortic aneurysm
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Infarenal
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What is the most common etiology of AO aneurysm
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Athlerosclerosis
- MI - Trauam - Syphyllis - Congenital |
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What are the signs and symptoms in patients with Ao aneurysm
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Asymptomatic
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What are teh most important cardiac auscultation findings in patients with Ao aneurysm
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AR murmur/bruit
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What are the most important medical and surgical procedures in patients with Ao aneurysm
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Antihypertensive drugs
stent bypass graft |
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what are best views for ascending aorta
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Suprasternal
PLAX AP3 AP5 Subcostal 5 |
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What are the best views for aortic arch
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Suprasternal
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What are the best views for DTA
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PLAX
AP2 AP4 Subcostal/IVC Suprasternal |
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What are the important echo views used to look for Ao Aneurysm
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PLAX
PSAX AP2 Subcostal RT Plax |
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What are the most important 2d findings in patients with Ao aneurysm
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Dilatation of aorta > 4 cm
systolic explanstion of the walls compressed LA |
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What are teh most important doppler findings in patients with Ao aneurysm
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AR in ascending aorta
Swirling waveform above and below baseline |
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If you found Ao aneurysm by TTE what would you do next?
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TEE --> site, size and extent
also scan abdominal aorta |
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What are the complications of Ao aneurysm
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Rupture
thrombus |
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Define Ao dissection
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A tear in the aortic intima allowing blood in, destroying the media and strippling intima from adventitia
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What are the types of Ao Dissection
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DeBakey
Type 2 - ascending Type 3 - descending Type 1 - both Stanford Type A ascending aorta Type B does not include ascending |
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What is the most common etiology of AO dissection
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Systemic HTN
Athlerosclerosis Marfan syndrome Bicuspid AoV Trauma |
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What are the signs and symptoms in patients with Ao Dissection
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Systemic HTN
Severe chest pain radiating to the back heart failure |
