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103 Cards in this Set
- Front
- Back
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what is spectral analysis?
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to asses true blood flow conditions, the signal received must be broken down into individual components by means of spectral analysis. This is charted as amplitude vs. frequency
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what is the doppler eqation?
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2FVcos/C
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what is normal acceleration time
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less than 120 ms
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what is the acceleration time of severe pulmonary hypertention?
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<60msec
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what are the 3 components of the bernouli equation?
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1. convection acceleration-when there is a change in the cross sectional flow area
2. flow acceleration-change of flow rate with time 3. viscous friction-caused by friction among blood cells |
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What are the 3 measurements for continuity?
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2D diameter of LVOT
PW doppler LVOT CW Ao valve |
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what is the normal RVOT TVI?
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10-13 cm
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WHat is modal frequency?
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greatest doppler ampitude(brightest)
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doppler of hepatic veins
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best view is subcostal
-4 components=systole, systolic flow reversal, diastole, diastolic flow reversal |
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what is the pressure gradient of mild and severe AO stenosis?
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mild=<30mmhg
severe>50mmhg |
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Flow profile
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Flat flow profile=plug flow=low flow in the same direction
Variable flow profile=different velocity and same direction(laminar( |
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what happens to the E-F slopw, and pressure half time with mitral stenosis
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decreased E-F slope which results in an increase ni pressure half time
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what are the 3 ways to get pulmonary artery pressure?
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1. TR=RVSP=PAP
2. PR=end diastole 3. acceleration time |
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If a heart had normal pulmonary artery pressure, what would the AT be? What about with mild, mod, and severe PHT?
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normal=.120s
mild PHTN=80-100ms mod-60-80ms severe=<60ms |
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What is the PHT of a normal MV? What about with mild, mod, and severe stenosis?
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NORMAL=30-60Ms
mild stenosis=90-150ms mod stenosis=150-219msec severe=>220ms |
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what are some changes on M-mode with mitral stenosis?
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-thick leaflets
-decreased E-f slope -anterior motion of post leaflet -decreased A-wave -decreased diastolic separation -LA dialation -Pulmonary hypertension -RVH -Paradoxical septral motion |
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what are some diseases associated with MAC?
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-high blood pressure(most common)
-renal disease -AO stenosis -hypertrophic cardiomyopathy |
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what are some complications associated with mitral stenosis?
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-co-existant MR
-Pulmonary hypertension -LA thrombus -Embolization -Infective endocarditis -Decrease CO -Right heart failure -pulomonary edema, hemorrhage, embolism, and/or infarction |
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what are the normal, mild and severe PHT's?
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normal PHT=30-60ms
mild=90-150 severe=>220 |
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what indications are present on PW doppler for mitral regurge?
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-increased e-velocity
-decreased decel time - |
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what 4 specific things should you check on 2D while determining MS?
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-Determine if there is an ASD(lutembacker's syndrome)
-Determine if ther is AO, Tricuspid, or pulmonic stenosis -measure MV area in short axis -determine score index |
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what is the most common cause of MVP?
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myxomatous degeneration
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what are the 4 grades of MS?
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mobility
thikening chordal involvement calcification |
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what are the letters and their meanings the corrispond to the m-mode of the mitral valve?
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cd-mitral valve closes
de-max excursion ef-slope/pressure changes a-atrial systole b-bump-increased end diastolic pressure |
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what is the PISA formula?
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2pieRsquared X PISA V =(ERO)(MR V)
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what is continuous wave best for?
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determining peak velocites
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what is M-mode of the tricuspid and pulmonic valves used for?
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-to demonstrate thickness and motion(not routine)
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Where is the aortic valve best sampled?
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from the apical 5; blood is moving away from the transducer in systole so the waveform appears above the baseline. Peak velocity should not exceed 1.7m/s
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Where is the pulmonic valve best sampled?
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In PSSA-aortic level; Peak velocity should not exceed .9m/s.
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where is tricuspid best sampled?
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RVIT, or apical 4(peak velocity should not exceed .7m/sec)
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What are the M-mode measurements for the mitral valve?
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D-E excursion->1.6cm
E-F slope>70mm/sec E point septal separation-no greater than 1 cm. |
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Which aortic cusp is closest to the interatrial septum?
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non-coronary cusp
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which two leaflets of the tricuspid valve are demonstrated in the short axis?
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septal and anterior
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in the short axis view, at the base level, what structure is seen posterior to the aortic root?
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LA
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how is the posterior mitral valve leaflet divided?
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It has 3 scallops: medial, central, and lateral
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What are the two types of chordae?
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marginal-attach at the free edge of the leaflets
basal-attach at the lt ventricular surface of the leaflet. |
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what are the most common causes of valvular heart disease?
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-age
-rhumatic heart disease -endocarditis -cogenital disorers -cardiomyopathies |
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inotropic force
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contractility of heart muscle or force of contraction
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when there is volume overload, and paradoxical septal motion, which side of the heart is affected?
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the RV-only when there is RVVO is there paradoxical septal motion
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name and explain the components of the atrial pressure curve, and draw and example of this?
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-a-wave-presystolic wave from atrial contraction; elevated in aortic stenosis
-c-wave-start of systole; .8sec after Q-wave -V-wave-atrial filling; elevated with AV insufficiency |
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chornotropic force
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heart rate or the rate of contraction
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what does the circuflex artery supply?
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anterolateral and inferolater
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what does the RCA supply?
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inferior wall
inferior septum |
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What does the LAD supply?
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ant, ant sept, and apex
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how is a person co-domnant?
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if the circumflex supplies the ILA and the RCA supplies the PDA
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What is the normal RA mean pressure?
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2-8 mmHg
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When does the RA fill?
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During inspiraion
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what are the 3 types of circulation?
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pulmonary, systemic, and coronary
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what are thesbian veins?
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small veins that go directly into the RA
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What are the 4 things you need for the fetal heart to survive?
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-placenta
-umbilical vein -3 shunts: ductus arteriosus-protects lungs agains circuatory overload ductus venosus-to bypass liver foramen ovale-to bypass pulmonary arteries |
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what does the sympathetic nervous system innervate?
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both atria and ventricles
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Which vagas nerves innervate what?
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Rt vagas nerve innervates the SA node. Lt vagus nerve innervates the AV node.
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what is the conduction pathway of the heart from the beggining to the end?
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SA
AV bundle of his Rt and Lt bundle branches pirkije fibers |
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what is the differnce btw parasympathetic and sympathetic nervous sytsems?
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parasympathetic-innervates the atria via the vagas nerve, and has little or no effect on junction or ventricles
-sympathetic: -innervates both atria and ventricles -incfreases heart rate, av conductin, and irritability |
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what happens if some of the P wave are different?
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P waves should resemble eachother. If some of them are different, it means that the cardiac cyle is not beginning with the SA node, and the AV node is taking over.
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What does the AV node do?
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causes a slight delay which permits the atrium to pump blood into the ventricles giving the ventricles timet o fill before the contract.
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what happens if the PR interval is longer than .2 seconds?
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there is a first degree heart block.
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what is paroxysmal?
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arrhythmia that suddenly begins and ends
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what are AV nodal blocks?
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a conduction block within the AV node that impairs impulse conduction from the atria to the ventricles.
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what is seconde degree AV nodal block? what does it look like on ECG?
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-Conduction velocity is slowed to the point whee some impulses from atria cannot pass through AV node
-P waves that do not have a QRS complex |
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What is Left bundle branch block?
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where the septum in unable to be depolarized from left to right, so it is depolarized from right to left by the right bundle branch.
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what does Left bundle branch block cause?
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paradoxial septum motion
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What is ischemia?What does it look like on ECG?
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lack of suffiecient oxygenated blood to the left ventricle. There are inverted T waves, or ST depression. It is reversable
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What is injury? How is it shown on ECG?
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stage beyond ischemia where the ST segment is eleveated. Injury is reversable, and there isn't normally permanet damage.
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what is AC interface?
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an artifact that originates from electrical interference at the pateints bedside.
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Explain the 3rd heart sound?
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occurs during ventricular diastole. Ventricular gallop caused by sudden tensing of bentricular wall
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Explain the 4th heart sound?
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Occurs during atrial systole and is associated with pressure overload. Atrail gallop.
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What are the 7 phases of the heart?
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1)Atrial systole
2)IVCT 3)Early Systole(rapid ejection_ 4)Late systole(reduced ejection) 5)IVRT 6)Early diastole(rapid filling) 7)Late diastole(reduced filling) |
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Explain phase one of the cardiac cycle?
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atrial contraction(atrial systole); end ventricular diastole:
-20% of LV is filled -P wave on ECG -Mitral valve is open -AO is closed -Volume of LV is the largest |
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explain phase 6 of the cardiac cycle
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Early diastole/ventricular filling
-80% of LV filling occurs -MV open; AV closed -Atrial pressure continues to rise -Rapid inflow of blood into ventricle |
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WHen does the sinus of valsalva fill with blood?
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During IVRT
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What is profusion? When does it occur?
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coronary flow; occurs mostly in diastole
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what does the left main pulmonary artery branch into?what grooves do they follow What do they supply?
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-Left anterior descending-follows the anterior interventricular groove and supplies the sepal, anterior, and apical wall.
-left circumflex artery-follows the atrioventricular groove(coronary sulcus), and supplies the atria and posterior left ventricle |
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what is flick?
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oxygen saturation used to see shunts
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what are the branches of the right coronary artery? what grooves do they follow, where do they supply blood to?
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-acute marginal-small branch which supplies the RV
-posterior descending which follows the atrioventricular groove posteriorly, and then descends down the interventriclar sulcus to supply the inferior portion of the heart |
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what are the 2 large veins that drain into the coronary sinus?
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-great cardiac vein-drains blood from the anterior heart
-middle cardiac vein-drains blood from the posterior heart |
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what is a pulmonary wedge?
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indirect method to measure the end distolic pressure(LA presure)
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what is CO depedant on?
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preload, afterload, intropic force(contraction), pronotropic force-heart rate
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what does the moderator band do?
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shortens the path of conduction
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why are insufficiencies over the whole cycle? When is stenoss not seen?
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reguge is when valve is closed; stenosis is not seen during IVRT, or IVCT
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what is profusion? When does it occur?
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coronaray artery flow..occurs in diastole
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what are some echo findings of pulmonary hypertension?
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-d-shaped LV
-RV hypertrophy -paradoxical septal motion -Dialated IVC and hepatic veins(failure of IVC to colapes during sniff test) -Dialated PA -absent or decreased a-dip |
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what does stimulation of the sympathetic nervous system cause?
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-increased heart rate
-increased AV transmittion -decreased force of contraction -increased conduction |
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what is the dicrotic notch indicative of?
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valvular closure
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what is the effect of MI increasing preload on the heart?
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-LA and LV enlargement
-RA and RV enlargement -LV hypertrophy -LV hypercontractile |
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what are some possible findings of a patient with mitral stenosis?
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-decreased E-F slope
-decreased A wave -pulmonary hypertension with long standing Mitral stenosis -diastolic doming of anterior mitral valve leaflet. |
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what do the walls of the aortic root become?
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anterior wall becomes anterior septum
-posteior wall becomes anterior mitral valve leaflet |
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what is the best view to demonstrate the RV free wall?
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subcostal
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what is CO dependant on?
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preload, afterload, intropic force(contraction), pronotropic force(heart rate)
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what is PCW?
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pulmonary capillary wedge pressure-equal to RA pressure
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what is seen the in RVOT with stenosis?
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course fluttering
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what is the mean pressure and oxygen saturation of the pulmonary arterial wedge, pulmonary vein, and left atrium?
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pressure-10mmhg
oygen-95-100 |
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explain LVVO
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preload problem
big heart Mitral regurge aortic regurge |
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what are some echo findings of pulmonary stenosis?
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-thickened PV leaflets with systolic doming
-RVH -dialation of main PA -Flattened IVS and LV takes a D-shape -increased depth of A-wave with with severe steosis |
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where is the LA measured?
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end systole(at the t-wave)
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what are some conditions associated with the third heart sound?
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-high cardiac output-anemia or hyperthyroidism
-increased left ventricular filling during eartly diastole(mitral regurg) -congestive heart failure |
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what does the "c" wave represent?
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start of systol
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LVPO(left ventricular pressure overload)
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afterload
thick walls aortic stenossi hypertention |
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where is the moderator band found?
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in the RV
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what are the 3 factors that stroke volume is influenced by?
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preload
afterload contractility |
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where does most profusion occur?
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in diastole by the coronary artery
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what is the smallest tricuspid valve leaftlet?
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posterior
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what 2 structures do we see when we have a perfect apical 2?
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LAA and coronary sinus
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