Echo Qtr 2 Test 1

Front 1

What does color do

Back 1

evaluations overall intracardiac flow patterns

Front 2

What does aliasing in color doppler mean

Back 2

it may indicate a turbulent or stenotic jet

Front 3

color also helps see and evaluate

Back 3

regurgitant flow

Front 4

when in PLAX, aortic flow is what color?

Back 4

red because its going towards the transducer

if the parasternal window is low, the flow could be blue

Front 5

Aortic valve regurge is what color?

Back 5

blue

Front 6

In apical window aortic flow is what color?

Back 6

blue, away from the transducer

Front 7

Stenosis is also known as

Back 7

insufficiency

Front 8

a blocked or occluded valve will have

Back 8

regurge

Front 9

What is the vortex, and is it normal?

Back 9

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

Front 10

Physiologic regurgitation is also known as

Back 10

trace regurgitation

Front 11

Mild PI is detectable in ______% of normal people

Back 11

70-80

Front 12

Trace amount of TR and MR is detectable in _____% of normal people

Back 12

70-80

Front 13

Small amounts of physiologic valvular regurg is/is not clinically significant?

Back 13

is not

Front 14

Which valve does not have physiologic regurg?

Back 14

aortic

Front 15

the clinical significance of regurg is based upon

Back 15

the amount of lumen it takes up and its length

Front 16

color is important in finding regurg because

Back 16

the jets are not always parallel to valve

Front 17

what does spectral doppler measure

Back 17

velocities and pressure gradients

Front 18

what does spectral doppler demonstrate

Back 18

spatial distribution of flow disturbances

Front 19

how must the ultrasound beam be aligned with the direction of flow

Back 19

at a parallel, zero degree angle

Front 20

what tools can help you align the spectral doppler trace with flow?

Back 20

2D imaging and color doppler

Front 21

What are the four stages of diastole

Back 21

IVRT, Early rapid ventricular filling, Diastasis, and atrial contraction

Front 22

What happens during the IVRT

Back 22

the time between semilunar closure and atrioventricular opening

Front 23

how much blood fills the ventricle during early rapid diastolic filling

Back 23

70-80%

Front 24

What is diastasis?

Back 24

when the pressures between the ventricles and the atria start to equalize, and leaflets drift together

Front 25

How many peaks does diastolic flow across mitral valve show?

Back 25

two

Front 26

what are the mitral valve waves called and what do they represent

Back 26

E: passive early diastolic filling

A: later diastolic filling due to atrial contraction

Front 27

the MV inflow direction is usually how many degrees from the apex?

Back 27

20

Front 28

as the ventricle enlarges, what happens to the MV inflow?

Back 28

the vortex moves and the degree of the flow is from the apex increases

Front 29

When placing pulse wave sample gate, where should it be

Back 29

the leaflet tips

Front 30

what happens when you place the sample volume too close to the annulus or leaflet tips?

Back 30

it changes the contour of the E and A waves

Front 31

What is the doppler SV

Back 31

the amount of blood ejected with each heart beat

Front 32

what is the doppler SV equation

Back 32

SV=CSA x TVI

stroke volume equals valve cross sectional area times the valves time velocity integral

Front 33

how do you obtain the LV inflow volume?

Back 33

PW with sample at MV annulus in apical 4, 3, or 2

parallel to flow

Front 34

Why would you use CW doppler?

Back 34

to find the highers velocity of a valve

(PW at the valve orifice)

Front 35

If valvular velocities exceed the Nyquist limit what do you do?

when would this happen

Back 35

eliminate aliasing by using CW

stenotic or regurgitant lesions

Front 36

In PW of a valve volume what is measured

Back 36

E, A point with E/A ratio
MV decel time
E at A velocity
A duration

Front 37

What is the normal E measurement for MV?

Back 37

less than or equal to 1.2-1.5 m/s

Front 38

When wishing to measure LVOT what do you do?

Back 38

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

Front 39

What does the LV ejection Velocity look like?

Back 39

below baseline
steep acceleration slope
sharply peaked early systolic max vel
less steep decel slop

Front 40

when whishing to obtain aortic outflow what do you do

Back 40

obtain apical 3, 5 (SSN, right para)
zero angle w/ color
place CW gate through LVOT and AO

Front 41

AV velocities normally measure

Back 41

less than 2 m/s

Front 42

when taking doppler of the arch what do you do

Back 42

use SSN view
PW walk through ascending and descending
CW descending

Front 43

Why would you use CW of SSN with a Pedoff?

Back 43

in cases where there is AS

Front 44

If you wish to sample RV Inflow velocities what do you do

Back 44

use parasternal or apical window
place PW sample at TV tips on RV side

Front 45

what are the normal values for tricuspid velocities

Back 45

less than those for mitral

Front 46

How does RV inflow vary during inspiration?

Back 46

E and A increase with inspiration
E and A decrease with expiration

Front 47

What should you do with all velocities taken for the RV?

Back 47

average the measurements over a full respiration cycle

Front 48

Why does RV inflow velocities vary during inspiration?

Back 48

phasicity

Front 49

With phasicity what happens upon inspiration

Back 49

Thoracic pressure decreases (upper extremity venous flow increases) and abdominal pressure increases (lower extremity venous flow slows or stops)

Front 50

with phasicity what happens upon expiration

Back 50

thoracic pressure increases (upper extremity venous flow slows or stops) and abdominal pressure decreases (lower extremity venous flow increases)

Front 51

When wishing to get RVOT velocities what do you do

Back 51

parasternal or subcostal w/CW

Front 52

describe RVOT velocities

Back 52

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

Front 53

What are the two methods of obtaining the IVRT?

which is preferred?

Back 53

1. aim CW beam between AV and MV
2. place PW sample in LVOT, increase volume

CW

Front 54

What is teh normal IVRT measurement

Back 54

70-90 msec

Front 55

When comparing E and A waves to a EKG....

Back 55

the E peak follows the T wave

Front 56

How can you tell the difference between a regurgitant jet and a stenotic jet?

Back 56

any regurgitant lesion includes the IVRT and/ or IVCT

Front 57

What happens first AI or MS

Back 57

AI

Front 58

What happens first, MR or AS

Back 58

MR

Front 59

SV stands for

Back 59

doppler stroke volume

Front 60

CO stands for

Back 60

Cardiac Output

Front 61

CI stands for

Back 61

Cardiac Index

Front 62

What is Doppler stroke volume

Back 62

the amound of blood ejected with each ehart beat

Front 63

What is the SV equation?

Back 63

SV = CSA x VTI

Front 64

What is the CSA equation?

Back 64

CSA (cm^2) = 0.785 x diameter ^2

Front 65

How do you get the CSA of the AO

Back 65

measure LVOT in PLAX

square it, times it by 0.785

Front 66

what is the normal value for LVOT diameter?

Back 66

1.8-2.4 cm

Front 67

What does VTI stand for
what does it represent

Back 67

velocity time integral, it represents the distance teh blood travels with each stroke

Front 68

when does the ultrasound machine calculate the VTI

Back 68

during planimetry of doppler spectral curve

Front 69

what is the equation for VTI

Back 69

ejection time times the square root of the max

over two

Front 70

how do you obtain LVOT VTI

Back 70

PW from apical 3 or 5
place sample parallell to flow, no clicks
planimeter the signal

Front 71

how do you calcuelate doppler stroke volume using AV

Back 71

SV = 0.785 LVOT diameter^2 x LVOT VTI

Front 72

what is the normal AV SV

Back 72

70-100 cc

or mL

Front 73

What is the equation you would used to get the SV using the MV

Back 73

SV = CSA MV x VTI LVIT

Front 74

Where is the most common site for SV and CO calculations?

why

Back 74

LVOT

easy to measure for multiple views, it's circular, systolic flow is constant

Front 75

What is the cardiac output

Back 75

the effective volume of blood expelled per unit of time (minute)

Front 76

what is CO units?

Back 76

L/M

Front 77

What is a normal CO

Back 77

4-8 L/M

Front 78

CO of the left ventricle equals

Back 78

CO of the right ventricle

Front 79

What is the CO equation

Back 79

CO = SV x HR

Front 80

What does the cardiac index reflect

Back 80

the cardiac output for the body surface area

Front 81

what is the CI equation

Back 81

CI (liters/min/m^2) = CO (liters/min)
/ BSA (m^2)

Front 82

What is a normal CI

Back 82

2.4-4.2 L/min/m^2

Front 83

Where are SV, CO, and CI accurate?

Back 83

in any valve that is not regurgitant

Front 84

Which valve site is commonly used to represent systemic circulation

why

Back 84

LVOT/AO

its easy to duplicate and can be used even in instances of AS because flow remains laminar prox to stenosis

Front 85

What is the continuity equation

Back 85

A1 V1 = A2 V2

Front 86

If the area halves, the velocity

Back 86

doubles

Front 87

Why is the continuity equation used

Back 87

the calculate valve areas, especially stenotic valve areas using valve annulus and velocities

Front 88

In order to get the AV area measurement using the continuity equation what measurements must you get

Back 88

LVOT diameter w/ 2D (PLAX)
LVOT velocity VTI w/ PW (AP 5)
AV peak velocity VTI w/ CW (AP 5)

Front 89

CW wave is good for

PW is good for

Back 89

highest velocities

seeing the E and A

Front 90

Normal aortic valve area is

Back 90

>2.0 cm^2

Front 91

Normal AV velocities are

Back 91

< 2.0 m/s

Front 92

When finding the MVA using the continuity equation you are assuming

Back 92

the SV through the MS is equal to the SV within the LVOT

Front 93

what is the equation used to find the MV area using the continuity equation

Back 93

MVA (cm^2) = CSA LVOT x VTI LVOT / VTI MV

Front 94

what is the normal valve area for the MV

Back 94

4-6 cm^2

Front 95

what is the normal velocities for the MV

Back 95

<1.3 m/s

Front 96

The Teicholz Method assumes that

Back 96

the LV dilates along its minor axis

however, the LV becomes more spherical as it dilates so the major and minor axis relationship changes

Front 97

Using the Teicholz Method the EF can be estimated using

Back 97

a single minor axis dimension of the LV

Front 98

the D^3 method or Cubed Method permits volume to be calculate from

its downfall is

Back 98

a single linear dimension

it makes many major assumptions about LV shape

Front 99

what are the 2D and MMode volume pitfalls

Back 99

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

Front 100

Single Plane method of obtaining volume is useful when

Back 100

only one apical view can be assessed

Front 101

Biplane method is

Back 101

the same as single plane but using two different views to obtain measures ex apical 2 and 4

Front 102

Modified Simpson's Biplane Rule uses the theory that

Back 102

the Volume of a large figure can be calculated from the sum of volumes of smaller, similar figures

Front 103

How does Simpson's work

Back 103

by dividing the chamber into slices of known thickness, finding their individual volumes, and summing them together

Front 104

Which method of obtaining volume is ASE recommended

Back 104

Simpson's Biplane

Front 105

How do you obtain the Simpson's measurements

Back 105

by tracing the 2D endocardial borders in both apical 2 and 4: diastole and systole

Front 106

What are the Simpson pitfalls

Back 106

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

Front 107

What things are done to evaluate systolic function

Back 107

SV

Ejection Fraction

Fractional Shortening/Quinone's

Visualization

Front 108

How do you evaluate systolic function based on stroke volume?

Back 108

SV = EDV - ESV

Front 109

What does ejection fraction measure

Back 109

the % of diastolic volume that is ejected during systole

Front 110

what is the equation for finding the EF%

Back 110

EF % = (SV / EDV) x 100

Front 111

What is the normal EF value?

mildly reduced

moderately reduced

severely reduced

Back 111

>55%

40-55%

20-40%

<20%

Front 112

What does fractional shortening measure

Back 112

the percent of change in LV cavity dimension with systole

Front 113

What is the fractional shortening equation

Back 113

FS % = ((LVID D - LVID S) / LVID D) x 100

Front 114

What is the the pitfall of FS

Back 114

its a rough measurement of the LV systolic function but does not account for asymmetric ventricles

Front 115

What is the normal FS range

Back 115

25-45 %

Front 116

What is Quinones' Method

Back 116

uses fractional shortening methods of minor and long axis to determine systolic function

Front 117

What is Quinones equation

Back 117

Delta D^2 = (LVID D^2 - LVID S^2) / LVID D^2

Front 118

What are the pitfalls of visual assessment

Back 118

observer dependent, subjective, and eacho report should mention whether EF is based on visual assessment or planimetry

Front 119

What is the apical contractility component delta L for:
Normal

Hypokinetic

Akinetic

Slightly dyskinetic

Largely dyskinetic

Back 119

15%

5%

0%

-5%

-10%

Front 120

How do you calculate the EF% using Quinones equation

Back 120

EF% = {delta D^2 + [(1-delta D^2)(delta L)]} x 100

Front 121

How is RV wall motion/ejection more complex than LV

Back 121

in LV all walls and base move somewhat equally towards that center

in RV the base to apex shortening is more pronounced

Front 122

What is observed to evaluate the RV using ultrasound

Back 122

thickness
size
shape
contractility