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122 Cards in this Set
- Front
- Back
What does color do
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evaluations overall intracardiac flow patterns
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What does aliasing in color doppler mean
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it may indicate a turbulent or stenotic jet
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color also helps see and evaluate
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regurgitant flow
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when in PLAX, aortic flow is what color?
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red because its going towards the transducer
if the parasternal window is low, the flow could be blue |
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Aortic valve regurge is what color?
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blue
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In apical window aortic flow is what color?
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blue, away from the transducer
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Stenosis is also known as
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insufficiency
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a blocked or occluded valve will have
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regurge
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What is the vortex, and is it normal?
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in apical window the blood flows red along the lateral LV wall and then swirls at apex into blue flowing along the septum.
yes, its normal |
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Physiologic regurgitation is also known as
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trace regurgitation
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Mild PI is detectable in ______% of normal people
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70-80
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Trace amount of TR and MR is detectable in _____% of normal people
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70-80
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Small amounts of physiologic valvular regurg is/is not clinically significant?
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is not
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Which valve does not have physiologic regurg?
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aortic
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the clinical significance of regurg is based upon
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the amount of lumen it takes up and its length
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color is important in finding regurg because
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the jets are not always parallel to valve
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what does spectral doppler measure
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velocities and pressure gradients
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what does spectral doppler demonstrate
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spatial distribution of flow disturbances
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how must the ultrasound beam be aligned with the direction of flow
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at a parallel, zero degree angle
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what tools can help you align the spectral doppler trace with flow?
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2D imaging and color doppler
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What are the four stages of diastole
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IVRT, Early rapid ventricular filling, Diastasis, and atrial contraction
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What happens during the IVRT
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the time between semilunar closure and atrioventricular opening
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how much blood fills the ventricle during early rapid diastolic filling
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70-80%
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What is diastasis?
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when the pressures between the ventricles and the atria start to equalize, and leaflets drift together
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How many peaks does diastolic flow across mitral valve show?
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two
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what are the mitral valve waves called and what do they represent
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E: passive early diastolic filling
A: later diastolic filling due to atrial contraction |
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the MV inflow direction is usually how many degrees from the apex?
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20
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as the ventricle enlarges, what happens to the MV inflow?
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the vortex moves and the degree of the flow is from the apex increases
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When placing pulse wave sample gate, where should it be
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the leaflet tips
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what happens when you place the sample volume too close to the annulus or leaflet tips?
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it changes the contour of the E and A waves
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What is the doppler SV
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the amount of blood ejected with each heart beat
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what is the doppler SV equation
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SV=CSA x TVI
stroke volume equals valve cross sectional area times the valves time velocity integral |
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how do you obtain the LV inflow volume?
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PW with sample at MV annulus in apical 4, 3, or 2
parallel to flow |
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Why would you use CW doppler?
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to find the highers velocity of a valve
(PW at the valve orifice) |
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If valvular velocities exceed the Nyquist limit what do you do?
when would this happen |
eliminate aliasing by using CW
stenotic or regurgitant lesions |
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In PW of a valve volume what is measured
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E, A point with E/A ratio
MV decel time E at A velocity A duration |
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What is the normal E measurement for MV?
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less than or equal to 1.2-1.5 m/s
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When wishing to measure LVOT what do you do?
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obtain apical 3 or 5
get zero degree angle place PW sample in LVOT proximal to AV on LV side of valve walk out of valve until click is no longer visible or heard |
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What does the LV ejection Velocity look like?
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below baseline
steep acceleration slope sharply peaked early systolic max vel less steep decel slop |
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when whishing to obtain aortic outflow what do you do
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obtain apical 3, 5 (SSN, right para)
zero angle w/ color place CW gate through LVOT and AO |
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AV velocities normally measure
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less than 2 m/s
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when taking doppler of the arch what do you do
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use SSN view
PW walk through ascending and descending CW descending |
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Why would you use CW of SSN with a Pedoff?
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in cases where there is AS
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If you wish to sample RV Inflow velocities what do you do
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use parasternal or apical window
place PW sample at TV tips on RV side |
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what are the normal values for tricuspid velocities
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less than those for mitral
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How does RV inflow vary during inspiration?
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E and A increase with inspiration
E and A decrease with expiration |
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What should you do with all velocities taken for the RV?
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average the measurements over a full respiration cycle
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Why does RV inflow velocities vary during inspiration?
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phasicity
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With phasicity what happens upon inspiration
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Thoracic pressure decreases (upper extremity venous flow increases) and abdominal pressure increases (lower extremity venous flow slows or stops)
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with phasicity what happens upon expiration
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thoracic pressure increases (upper extremity venous flow slows or stops) and abdominal pressure decreases (lower extremity venous flow increases)
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When wishing to get RVOT velocities what do you do
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parasternal or subcostal w/CW
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describe RVOT velocities
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it has an ejection curve similar to LV ejection curve, with a peak slighter lower and curve slightly rounded with a more gradual excel and decel
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What are the two methods of obtaining the IVRT?
which is preferred? |
1. aim CW beam between AV and MV
2. place PW sample in LVOT, increase volume CW |
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What is teh normal IVRT measurement
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70-90 msec
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When comparing E and A waves to a EKG....
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the E peak follows the T wave
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How can you tell the difference between a regurgitant jet and a stenotic jet?
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any regurgitant lesion includes the IVRT and/ or IVCT
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What happens first AI or MS
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AI
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What happens first, MR or AS
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MR
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SV stands for
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doppler stroke volume
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CO stands for
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Cardiac Output
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CI stands for
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Cardiac Index
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What is Doppler stroke volume
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the amound of blood ejected with each ehart beat
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What is the SV equation?
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SV = CSA x VTI
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What is the CSA equation?
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CSA (cm^2) = 0.785 x diameter ^2
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How do you get the CSA of the AO
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measure LVOT in PLAX
square it, times it by 0.785 |
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what is the normal value for LVOT diameter?
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1.8-2.4 cm
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What does VTI stand for
what does it represent |
velocity time integral, it represents the distance teh blood travels with each stroke
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when does the ultrasound machine calculate the VTI
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during planimetry of doppler spectral curve
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what is the equation for VTI
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ejection time times the square root of the max
over two |
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how do you obtain LVOT VTI
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PW from apical 3 or 5
place sample parallell to flow, no clicks planimeter the signal |
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how do you calcuelate doppler stroke volume using AV
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SV = 0.785 LVOT diameter^2 x LVOT VTI
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what is the normal AV SV
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70-100 cc
or mL |
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What is the equation you would used to get the SV using the MV
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SV = CSA MV x VTI LVIT
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Where is the most common site for SV and CO calculations?
why |
LVOT
easy to measure for multiple views, it's circular, systolic flow is constant |
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What is the cardiac output
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the effective volume of blood expelled per unit of time (minute)
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what is CO units?
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L/M
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What is a normal CO
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4-8 L/M
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CO of the left ventricle equals
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CO of the right ventricle
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What is the CO equation
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CO = SV x HR
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What does the cardiac index reflect
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the cardiac output for the body surface area
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what is the CI equation
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CI (liters/min/m^2) = CO (liters/min)
/ BSA (m^2) |
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What is a normal CI
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2.4-4.2 L/min/m^2
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Where are SV, CO, and CI accurate?
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in any valve that is not regurgitant
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Which valve site is commonly used to represent systemic circulation
why |
LVOT/AO
its easy to duplicate and can be used even in instances of AS because flow remains laminar prox to stenosis |
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What is the continuity equation
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A1 V1 = A2 V2
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If the area halves, the velocity
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doubles
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Why is the continuity equation used
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the calculate valve areas, especially stenotic valve areas using valve annulus and velocities
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In order to get the AV area measurement using the continuity equation what measurements must you get
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LVOT diameter w/ 2D (PLAX)
LVOT velocity VTI w/ PW (AP 5) AV peak velocity VTI w/ CW (AP 5) |
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CW wave is good for
PW is good for |
highest velocities
seeing the E and A |
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Normal aortic valve area is
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>2.0 cm^2
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Normal AV velocities are
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< 2.0 m/s
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When finding the MVA using the continuity equation you are assuming
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the SV through the MS is equal to the SV within the LVOT
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what is the equation used to find the MV area using the continuity equation
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MVA (cm^2) = CSA LVOT x VTI LVOT / VTI MV
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what is the normal valve area for the MV
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4-6 cm^2
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what is the normal velocities for the MV
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<1.3 m/s
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The Teicholz Method assumes that
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the LV dilates along its minor axis
however, the LV becomes more spherical as it dilates so the major and minor axis relationship changes |
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Using the Teicholz Method the EF can be estimated using
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a single minor axis dimension of the LV
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the D^3 method or Cubed Method permits volume to be calculate from
its downfall is |
a single linear dimension
it makes many major assumptions about LV shape |
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what are the 2D and MMode volume pitfalls
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it does not depict the major axis of the ventricle
an over or under estimation may occur if M-line isnt centered if the walls have motion abnormalities or are non-symmetric in shape, it will not be reflected the single line difficulty obtaining posterior wall visualization non-orthogonal measurements |
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Single Plane method of obtaining volume is useful when
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only one apical view can be assessed
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Biplane method is
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the same as single plane but using two different views to obtain measures ex apical 2 and 4
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Modified Simpson's Biplane Rule uses the theory that
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the Volume of a large figure can be calculated from the sum of volumes of smaller, similar figures
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How does Simpson's work
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by dividing the chamber into slices of known thickness, finding their individual volumes, and summing them together
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Which method of obtaining volume is ASE recommended
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Simpson's Biplane
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How do you obtain the Simpson's measurements
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by tracing the 2D endocardial borders in both apical 2 and 4: diastole and systole
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What are the Simpson pitfalls
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limited acoustic windows
the difference in length from AP 2-4 is greater than 20% algorithm is very complicated cannot foreshorten difficulty visualizing endocardium patient/bed limitations ultrasound equipment technologist variations EKG patterns and beat irregularities |
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What things are done to evaluate systolic function
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SV
Ejection Fraction Fractional Shortening/Quinone's Visualization |
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How do you evaluate systolic function based on stroke volume?
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SV = EDV - ESV
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What does ejection fraction measure
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the % of diastolic volume that is ejected during systole
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what is the equation for finding the EF%
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EF % = (SV / EDV) x 100
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What is the normal EF value?
mildly reduced moderately reduced severely reduced |
>55%
40-55% 20-40% <20% |
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What does fractional shortening measure
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the percent of change in LV cavity dimension with systole
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What is the fractional shortening equation
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FS % = ((LVID D - LVID S) / LVID D) x 100
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What is the the pitfall of FS
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its a rough measurement of the LV systolic function but does not account for asymmetric ventricles
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What is the normal FS range
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25-45 %
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What is Quinones' Method
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uses fractional shortening methods of minor and long axis to determine systolic function
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What is Quinones equation
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Delta D^2 = (LVID D^2 - LVID S^2) / LVID D^2
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What are the pitfalls of visual assessment
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observer dependent, subjective, and eacho report should mention whether EF is based on visual assessment or planimetry
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What is the apical contractility component delta L for:
Normal Hypokinetic Akinetic Slightly dyskinetic Largely dyskinetic |
15%
5% 0% -5% -10% |
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How do you calculate the EF% using Quinones equation
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EF% = {delta D^2 + [(1-delta D^2)(delta L)]} x 100
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How is RV wall motion/ejection more complex than LV
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in LV all walls and base move somewhat equally towards that center
in RV the base to apex shortening is more pronounced |
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What is observed to evaluate the RV using ultrasound
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thickness
size shape contractility |