Echo Class Review

Front 1

what is the max diameter of the asc AO?

Back 1

4cm

Front 2

What is the most common AO valve etiology under 70years, and over 70 years/

Back 2

under 70=Bicuspid AoV
>70=degenerative

Front 3

What cusps are Raphe's between?

Back 3

Rt & Lt coronary cusps

Front 4

look at presure curves in notes/

Back 4

and understand them

Front 5

What is the pressure like with mild chronic AI compared to acute AI?

Back 5

Chronic=long PHT
Acute=short PHT

Front 6

What is the best view to analyze the vena contracta? What is the size of the vena contracta with mild, mod and severe AS or regurg?

Back 6

PSLA=best place
Mild=<3mm
Mod<3-6mm
Severe=>6mm
these numbers can be used for both stenosis and regurge .

Front 7

What would cause post stenotic dialation?

Back 7

-cystc medial nechrosis
-jet hitting the wall

Front 8

What is the best score for WMSI? what would the index have to be for a perfusion defect to be considered?

Back 8

best=1
>20% perfusion defect=>1.7

Front 9

What changes occur on ECG with infarct, injury, and ishemia?

Back 9

infarct-prominent Q wave
Injury=elevated ST
Ishemia=inverted t-wave

Front 10

what happens to the ECG on the opposite side of the heart to an infarct?

Back 10

opposite of what happens with ishemia

Front 11

name and explain the classifications of MI?

Back 11

subendocardial-only inner layer of myocardium
subepicardial-both inner, and middle layer
transdural-through all the layers of the myocardium

Front 12

what are the complications of MI?

Back 12

-pap muscle dysfucntion resulting in MR
-chordae or pap muscle rupture resulting in flail MV & severe MR
-Thrombus
-WM abnormalities
-PE(dressler's syndrome)
-VSD-more common in hypertensive females
-rupture of free wall w/ acute pericardial effusion

Front 13

Look in notes at pressure curves for diastolic dysfunction and compare them?

Back 13

do it

Front 14

What happens to LA pressure with pseudonormalization?

Back 14

mean LA pressure is increased

Front 15

What type of distolic dysfunction would most likely be happening when LVH is seen? What about if a dialated LA is seen?

Back 15

LVH-probably impared relaxation
Dialated LA-resitrictive

Front 16

What phase of diastolic dysfunction would you see a b-bump on m-mode?

Back 16

restrictive due to increased LVEDP

Front 17

HOw do you tell when there is diastolic dysfunction with color m-mode?

Back 17

look at the slope of the color.
normal=steep/no slope
abnormal=more horizontal angle

Front 18

what will the spectral waveform of severe acute MR look like?

Back 18

v-wave

Front 19

what are the components of the bernouli equation?

Back 19

convection acceleration
flow acceleration
viscous friction

Front 20

what are the diseases associated w/ MAC?

Back 20

high BP(common)
renal disease
AO stenosis
hypertrophic cardiomyopathy

Front 21

What does the 3rd heart sound represent? What is it associated with?

Back 21

ventricular gallop associated with :
-high cardiac output-anemia or hyperthyroidism
-increased LV filling during early diastole(MR)
-CHF

Front 22

what does the 4th heart sound represent?

Back 22

atrial gallop

Front 23

What ejection fraction is considered good conditions for clot formation?

Back 23

<35%

Front 24

What is pulmonic stenosis in adults usually the result of?

Back 24

congenital disease

Front 25

when a wall motion abnormality lasts 24-72 hours, but has not had irreversible damage, it is referred to as what/

Back 25

stunned tissue

Front 26

What is the most common cause of Mitral stenosis?

Back 26

rhumatic fever

Front 27

What are the categories of pericardidtis?

Back 27

-infectious
-inflammatory
-intracardiac-pericardial communications

Front 28

T/F PVC's may cause the aortic valve opening to be increased in amplitude?

Back 28

false

Front 29

T/F patients w/ bicuspid valves always have abnormal Eccentricity indices?

Back 29

false

Front 30

T/F siphilis is a common cause of AO root dialation in the united states?

Back 30

false

Front 31

Up to 10% of all cardiac disease is a result of endomyocardial fibrosis in which country?

Back 31

africa

Front 32

immobility of the AO root is due to what?

Back 32

reduced LA emptying and filling

Front 33

When tissue is abnormal at rest but functional with reprofusion through exercise or medication, what kind of tissue is it refered to?

Back 33

hibernation tissue

Front 34

the term "second obstruction" of mitral stenosis refers to what/

Back 34

-pulmonary hypertension

Front 35

What is one of the most well known cardiac complications in patients with lupus erythatosis?

Back 35

Libman-Sack's endocarditis(smal; vegges)

Front 36

What are some mediastinal substances which may cause cardiac tamponade?

Back 36

Compression mass
air due to barotraumas

Front 37

When there is a flail MV, what may happen to the LV function?

Back 37

It may become hyperkinetic

Front 38

What does the gret cardiac vein anastamose with?

Back 38

oblique vein of marshal

Front 39

An aneurysm of the IAS is considered when the septal bulging is greater than how many cm's?

Back 39

>1,5cm

Front 40

Symptoms of which cardiomyopathy may only be experienced during exercise?

Back 40

hypertrophic cardiomyopathy

Front 41

A MV prolapse may be augmented by having the pt. do what/

Back 41

valsalva maneuver

Front 42

What gender do unicuspid AO vavles more commonly occur?

Back 42

males

Front 43

What is the most common cause of AO dissection?

Back 43

chronic hypertension

Front 44

T/F ebsteins is not a possible cause of Tricuspid stenosis?

Back 44

true

Front 45

T/F when mitral and aortic stenossi are present together, the trans aortic pressure gradient may be increased due to increased volume?

Back 45

false

Front 46

The part of the heart most often affected in patients with scleroderma is what?

Back 46

myocardium

Front 47

What are osler nodes?

Back 47

lesions seen in patients with acute bacterial endocaridits which are small, raised, red and tender areas on the finger and toe pads.

Front 48

T/F amyl nitrate may be used to enhance the obstruction in a hypertrophic obstroctive cardiomyopathy?

Back 48

true, you can also do the valsalva

Front 49

What is the most common cause of a bioprosthetic valve dysfunction?

Back 49

tissue degeneration

Front 50

What is the most common cause of adult aortic stenosis?

Back 50

calcified aortic stenosis

Front 51

HOw does aortic stenosis affect the atrial pressure curve?

Back 51

a-wave is elevated w/ aortic stenosis

Front 52

HOw does MR affect the atrial pressure cuve?

Back 52

v-wave becomes more prominent because the v-wave represents the systolic filling, and there is more systolic filling with MR

Front 53

There is a small dicrotic notch in the AO pressure curve. What does this represent?

Back 53

closure of the aortic valve

Front 54

cor pulmonale

Back 54

lung disease

Front 55

What will m-mode of the PV look like with PHTN?

Back 55

absent a-dip
mid-systolic notching

Front 56

What is the difference in the flattening of the septum with RVVO compared to RVPO?

Back 56

with RVVO, septal flattening occurs only in diastole wheras flatteing with RVPO occurs throughout the cycle

Front 57

What is the systolic, diastolic, and mean pressure associated with PHTN?

Back 57

systolic>35mmHg
diastolic>25mmHg
mean>25mmHg

Front 58

How does the MV inflow help you with PHTN?

Back 58

Helps you differentiate btw PHTN caused by cor pulmonale(lung disease), or increased Lt sided pressures.
-if the mitral inflow shows a restrictive pattern, this probably indicates elevated LV pressures causeing PHTN
-if the mitral inflow is normal to impared relaxation, this indicates PHTN caused by lung problems

Front 59

Where is the transverse sinus located?

Back 59

-pericardial fold behind great vessels

Front 60

HOw is the tissue doppler different btw restrictive cardiomyopathy, and constrictuve pericardidis?

Back 60

restrictive cardiomyopathy=lower amplitude tissue doppler

Front 61

Why would there be mid-systolic notching of the aortic valve with IHSS?

Back 61

because half way through systole the AMVL is sucked up(ventrui effect), and obstructs the aortic ouflow breifly. This is what causes the notch

Front 62

What type of diastolic function would likely be present w/ hypertrophic cardiomyopathy?

Back 62

impared relaxation due to
LVH

Front 63

There is a small dicrotic notch in the AO pressure curve. What does this represent?

Back 63

closure of the aortic valve

Front 64

cor pulmonale

Back 64

lung disease

Front 65

What will m-mode of the PV look like with PHTN?

Back 65

absent a-dip
mid-systolic notching

Front 66

What is the difference in the flattening of the septum with RVVO compared to RVPO?

Back 66

with RVVO, septal flattening occurs only in diastole wheras flatteing with RVPO occurs throughout the cycle

Front 67

What is the systolic, diastolic, and mean pressure associated with PHTN?

Back 67

systolic>35mmHg
diastolic>25mmHg
mean>25mmHg

Front 68

How does the MV inflow help you with PHTN?

Back 68

Helps you differentiate btw PHTN caused by cor pulmonale(lung disease), or increased Lt sided pressures.
-if the mitral inflow shows a restrictive pattern, this probably indicates elevated LV pressures causeing PHTN
-if the mitral inflow is normal to impared relaxation, this indicates PHTN caused by lung problems

Front 69

Where is the transverse sinus located?

Back 69

-pericardial fold behind great vessels

Front 70

HOw is the tissue doppler different btw restrictive cardiomyopathy, and constrictuve pericardidis?

Back 70

restrictive cardiomyopathy=lower amplitude tissue doppler

Front 71

Why would there be mid-systolic notching of the aortic valve with IHSS?

Back 71

because half way through systole the AMVL is sucked up(ventrui effect), and obstructs the aortic ouflow breifly. This is what causes the notch

Front 72

What type of diastolic function would likely be present w/ hypertrophic cardiomyopathy?

Back 72

impared relaxation due to concentric LVH

Front 73

HOw is the regurgitant jet directed with an anterior flail MV leaflet vs. a posterior flail MV leaflet.

Back 73

with an anterior flail leaflet, reguge jet is directed posteriorly and visa versa

Front 74

When can you not use the pisa parameter?

Back 74

when there is an accentric jet(ie. flail MV)

Front 75

what is the area where the coronary sulcus meets the interventricular septum?

Back 75

coronary sinus

Front 76

with which type of transducer is there increased side love intensity?

Back 76

phased array

Front 77

What is another name for MVP? (syndrome)

Back 77

barlow's syndrome

Front 78

At what rate does m-mode sample?

Back 78

1800frames per second

Front 79

Supraventricular aortic stenosis is asssociated with what syndrome?

Back 79

william's syndrome

Front 80

what valve is most often affected by papillary fibroelastomas?

Back 80

mitral valve

Front 81

Which type of mitral deformity occurs where there is only one papillary muscle into which both cordae inser?

Back 81

parachute mitral valve

Front 82

What are the two ways in which muscular dystrophy cause heart failure?

Back 82

muscle weakness
thoracic deformity

Front 83

IVC plethora

Back 83

<50% reduction in diameter of the IVC wth inspiration

Front 84

what type of endocarditis is non-bacterial and results in an accumulation of debris in the endocarduium?

Back 84

atypical verrucous

Front 85

What auscultory finding may be heard with constrictive pericarditis?

Back 85

pericardial knock

Front 86

What should the mean pressure gradient be to consider MV stenosis?

Back 86

>10mmHg

Front 87

Which type of hypertrophic cardiomyopathy involves only the anterior interventricular septum?

Back 87

type 1

Front 88

When a tricuspid repair is done in conjuction with a mitral valve replacement, what kind of annuloplasty may it be?

Back 88

Devega

Front 89

Where is the eustachian valve?

Back 89

in the IVC

Front 90

What is the water balloon appearance associated with?

Back 90

marfan's syndrome

Front 91

What is the most common form of cyanotic heart disease?

Back 91

TOF

Front 92

Which of the following is not a common occurance with a parachute MV:
-subaortic stenosis
-pulmonic stenosis
-suprvalvular ring of the left atrium
-coarctation of the aorta

Back 92

pulmonic stenosis

Front 93

What type of infarct may cause a dialation of the mitral valve annulus with subsequent MR?

Back 93

anterior wall MI

Front 94

How do PVC's affect the M-mode tracing of the MV?

Back 94

loss of the a-wave

Front 95

tortus aorticus is found where

Back 95

right atrium

Front 96

what should the aortic peak pressure gradient be for a severe stenosis be considered?

Back 96

>70mmHg

Front 97

what tumor occurs on the AV node?

Back 97

mesotheliomas

Front 98

T/F decreased LV systolic function is a common finding in chronic hypertensio?

Back 98

false

Front 99

A small fibroelastic protrusion seen on the aortic valve in older patients may represent what

Back 99

lamble's excressence

Front 100

T/F patients with mitral snetosis may have a momentary anterior displacement of the IVS during diastole?

Back 100

true

Front 101

HOw might the mitral inflow waveform be affected if the patient has tachycardia?

Back 101

have a single e/a velocity

Front 102

What is the rudimentry valve which guards the coronary sinus?

Back 102

thesbian valve

Front 103

HOw does LV systolic function affect the pre-ejection period?

Back 103

the pre-ejection period would be longer with LV systolic function

Front 104

where do most metastatic tumors of the heart come from?

Back 104

lung and breast

Front 105

T/F you will probably have normal distaolic function with restrictive cardiomyopathy?

Back 105

false-usually impared relaxation

Front 106

What are the support structures at the end of the aortic valve cusp called?

Back 106

arantius nodules

Front 107

What does VTI calculate?

Back 107

mean pressure gradient

Front 108

which type of ASD may be associated with abnormal drainage of the right pulmonary vein?

Back 108

sinus venosus

Front 109

where does the moderator band extend?

Back 109

from the lower interventricular septum to the anterior wall where it joins the papillary muscle.

Front 110

spontaneous cordal rupture more often occurs on which leaflet of the MV?

Back 110

posterior

Front 111

what is the largest TV leaflet?

Back 111

anterior

Front 112

what is another name for the RVOT?

Back 112

infundibulum

Front 113

what will the a-wave be on a person with sever pulmonic stenosis

Back 113

>7mm

Front 114

T/F LA enlargement is not a possible finding with constrictive pericarditis?

Back 114

false

Front 115

which valve is least commonly affected by endocarditis

Back 115

pulmonary valve

Front 116

when mitral valve leaflets are flail, which chamber do they point towards?

Back 116

LA

Front 117

carvallo's sign

Back 117

An auscultory finding in tricuspid stenosis of an increased intensity of the diastolic murmur

Front 118

When would you hear an austin flint murmer?

Back 118

heard along the left sternal border

Front 119

Frand starlings law

Back 119

the increase degree of streatch=hyperdynamic ventrical (ie. the more recoil)
-associated with severe AI

Front 120

When you see a b-bump on the mitral valve, what does the probably mean the LT atrium is starting to look like?

Back 120

starting to dialate because of increased LVEDP translating to the atria

Front 121

With severe AI, how can this sometimes affect fow in the desc. aorta?

Back 121

You can sometimes have reversed diastolic flow in the desc. ao.

Front 122

w/ AI, are the more concerned with the width or length of the regurgitant jet?

Back 122

length

Front 123

What is the formula for regurge fraction? explain it

Back 123

SV(av)-SV(mv)/SV(av)
Done if there is a normal MV and regitant AoV to quantify the severity of the regurge. You can do the same with the MV if the MV has regurge, and the AO doesn't.

Front 124

What is normal PV a duration and A-velociey?

Back 124

A-duration=<30 normally
A velocity=<150ms normally

Front 125

HOw does an m-mode tracing of the aortic valve change with Dialated cardiomyopathy, or low CO?

Back 125

"sloping aorta" due to low cardiac output, and the valve starts to close early
-don't have the nice box appearance

Front 126

HOw does the MV inflow change with dialated cardiomyopathy?

Back 126

decreased MV inflow due to increased LV pressure with dialated cardiomyopathy.

Front 127

HOw can dialated cardiomyopathy give a false impression of stenosis? What should be done in this situiation?

Back 127

May underestimate the severity of stenosis.
-This is because the heart is dialated thus separating the valves decreasing the severity of the stenosis.
-there is also lower cardiac output, so blood my give a normal velocity through what would normally be a stenotic valve.
-This patient should get a stres echo done to ring out the true AO v area.

Front 128

Arrythmogenic RV cardiomypoathy

Back 128

fatty infiltrative disease
-typical features=young male w/ right sided heart disease.

Front 129

What should you automatically think of when a patient has a hx of rhumatic fever?

Back 129

Ms or Aos

Front 130

Why is there no E-A peak on an m-ode of Mitral stenosis

Back 130

because leaflets move together

Front 131

What MVA is considered severe stenosis?

Back 131

<2

Front 132

Which chambers are ort affected w/ MS?

Back 132

LV because blood is backing up into right side

Front 133

Formula for PHT

Back 133

DT x 0.29

Front 134

Whta would caus underestimation of MV stenosis?

Back 134

AI becuase pressures in the ventrical are equalizing faster, so the PHT wouldn't be as long as it normally would
-An ASD can also cause the same affect

Front 135

What conditions can mimic Mitral stenosis?

Back 135

vegetation
LA myxoma

Front 136

What is the most common form of congenital MV stenosis?

Back 136

parachute MV

Front 137

What should you think if a mid-systolic click is heard?

Back 137

MV prolapse

Front 138

What is normal LAA velocity

Back 138

46cm/s

Front 139

what is the best window to assess MVP?

Back 139

PSLA