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109 Cards in this Set
- Front
- Back
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What does IVCT stand for? |
Isovolumic Contraction Time
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What is IVCT?
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The time between mitral / tricuspid valve closure and aortic / pulmonic valve opening.
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When does systole begin?
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when LV pressure exceeds LA/RA pressure
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What does systole result in?
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closure of MV/TV
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What is systole defined as?
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the segment of the cardiac cycle that spans from atrioventricular closure to semilunar closure
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What stage does systole also include?
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IVCT
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What does IVRT stand for?
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Isovolumic Relaxation Time
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What is IVRT?
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the time between aortic/pulmonic valve closure and mitral/tricuspid valve opening
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When does diastole begin?
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when LA/RA pressure exceeds LV/RV pressure
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What does diastole result in?
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the opening of MV/TV
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What is diastole defined as?
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the segment from semilunar closure to atrioventricular closure
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what is also included in diastole?
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IVRT
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Name the four stages of diastole
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Isovolumic relaxation, early rapid diastolic filling, diastasis, and late diastolic filling from atrial contraction
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How much of the blood that enters the ventricles during systole occurs during the early rapid stage
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about 70%
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How much of the blood that enters the ventricles during systole occurs during the late stage
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20-30%
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What happens during Diastasis?
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the MV and TV leaflets drift together because of the almost equal atrium and ventricle pressures
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Name the two parts of the P wave
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atrial depolarization and the electrical stimulation of the LA
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Where on the EKG do we see the atrial repolarization?
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we don't, its buries in the QRS complex
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What does the PR interval reflect?
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AV conduction time
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What does the QRS complex represent?
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the simultaneous depolarization of RV and LV
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What are the three things that happen at end-diastole
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Onset of QRS (and atrial repolarization), The frame after the MV closure, and the frame where the cardiac dimension is largest.
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when is the cardiac dimension largest?
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end-diastole
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What are the two things that happen at End-Systole
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the frame before MV opening, and the fame where cardiac dimension is smallest
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when is the cardiac dimension smallest?
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systole
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what does the T wave represent?
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ventricular recharging
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What does PEP stand for
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Pre-ejection Period
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When does PEP occur
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From Q onset to AV open, includes IVCT
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when does LVET stand for
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left ventricular ejection time
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when does (L/R)VET occur
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(AV/PV) open to close
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What is the patients position for Subcx
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supine with knees bent and/or chest elevated
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what is probe position for subcx
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below xiphoid tip, indicator towards patient's left appx 3:00
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What is the eustachian valve?
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an incompetent valve flap of the IVC, remant from fetal hear
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Is the eustachian valve visible on all patients?
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no
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where does the eustachian valve appear
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at the junction of IVC, extending across right atrial posterior wall and attaches to interatrial septum below fossa ovalis
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Is the Subcx view the only place where the eustachian valve may be seen?
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no it appears in many views
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What is the Chiari Network
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a remnant of the fetal heart; web-like membrane extending from the crista terminalis to the valve of the IVC
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What is the crista terminalis
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a prominent muscular ridge between IVC and SVC orifices
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How common is the chiari network?
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its in 2-3% of normal hearts
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What is the clinical significance of the chiari network?
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none
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what is the sonographic appearance of the chiari network?
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highly reflective and mobile with no attachment to the TV and movement isn't synchronous with TV
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Why is SSN LAX important?
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its good for finding aneurysms
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What is standard procedure for patients with aortic stenosis?
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using a non-imaging probe to measure peak velocities in SSN
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What is the absolute value for the aortic arch?
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2.7 +/- 0.3 cm
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what is the range of the aortic arch?
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2-3.6 cm
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What should be added to the protocol of aortic stenosis patients?
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placing a non-imaging probe in the 2-5th intercostal space, right parasternal
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True or False:
The subcostal window is particularly useful for patients with COPD? |
True
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What types of patient positioning and breathing exercises can your patient perform in order to optimize the subcostal image?
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Supine position or slightly elevated, knees bent, and deep held inspiration.
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Why odes deep held inspiration help when imaging Subcox
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it pushes the liver and the heart closer to the transducer
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Why does "drop-out" of the interatrial septum not occur from the subcostal position?
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because the interatrial septum is now perpendicular to the ultrasound beam
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Subcostal short axis views are similar to what other views?
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they are similar to the vies found in the parasternal window, but rotated 90 degrees clockwise
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What echocardiographic window creates the "crab" vies?
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the suprasternal short axis of the pulmonary venous drainage into the left atria
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What view can the superior vena cava be visualized in long axis?
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the supraternal short axis of he aortic arch
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True or False:
When detected, aortic dissection positive predictive value on transthoracic imaging is high. |
true
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Explain how a left pleural effusion can be used as a window?
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When imaging from the posterior chest wall a large left pleural effusion provides an echo free acoustic window with high quality images
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During MMode examination, motion or time is displayed on the _____ axis, while distance or depth is displayed on the ____ axis.
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horizontal, vertical
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The optimum window selection for MMode interrogation is the view in which the ultrasound beam is ____ to the structure(s) of interest.
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orthogonal
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What echocardiographic window is primarily used for MMode applications?
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Parasternal
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Name two disadvantages of MMode
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1. MMode measurements are dependent on the recognition of clearly defined borders, which are often ambiguous.
2. Many measurements used to indirectly assess left ventricular performance are affected by many variables, thus are unreliable. |
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List two factors that influence the accuracy of MMode measurements
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1. Theoretical resolution-dependent on transducer frequency and inherent spatial resolution of imaging system.
2. The overall technical quality-clarity of interface delineation, etc. |
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The ASE recommended method for measurement structures by MMode is to follow the:
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Most continuous echo line
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The MMode derived ejection fraction that is calculated and quoted by man echocardiographic machines is the ___ method.
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Teicholz
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MMode has far superior ___ resolution in comparison to other methods.
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temporal
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True or False:
Lack of spatial information is predominant limitation of MMode. |
True
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True or False:
Atrial contraction on the MMode trace will precede the P waved on the ECG. |
False
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Give a brief history of MMode
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First used in the 1960's, its role in clinical diagnosis of pathology has diminished with 2D and Doppler information
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About how many mHz does MMode use
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1,000-2,000
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What does MMode echo depict?
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One dimensional motion of structures along a single scan line or plane as a function of time
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What are the three types of info displayed on MMode
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1. Motion or time on horizontal axis
2. Distance or depth on vertical axis 3. Echogenicty of structures |
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What role does brightness play in MMode
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it can make valves look bigger than they really are when the view is overgained
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What are te primary uses of MMode
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Measuring cardiac chamber dimension, valvular motion, LV systolic fxn, and identifying pathologies like effusions and vegetations
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What are the four standard scan lines found in PLAX
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1. Aortic valve
2. Mitral Valve annulus 3. Mitral valve 4. Left ventricle at papillary muscle |
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Which of the four standard lines is rarely used?
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mitral valve annulus
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In MMode what does Aortic root motion reflect?
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Changes in LA dimensions
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If the aortic root is displaced anteriorly what is happening?
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LA filling (systole)
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What is happening if the aortic root is displaced posteriorly?
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LA emptying (diastole)
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What does Aortic leaflet coaptation appear as in MMode
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a thin line in the center of the aortic root 'walls'.
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If the nodes of arrantius appear off center between the aortic root walls, what does that suggest?
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bicuspid aortic leaflets aka eccentric closure
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what is eccentric closure in MMode
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when there is a bicuspid aortic valve
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Do mechanical and electrical events occur at the same time?
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no, there is a short delay from electrical event to mechanical event
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When the P wave is seen on ECG, will atrial contraction occur at the same time, before, or after?
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after
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When are end diastolic measurements made?
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from the onset of QRS
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When are end systolic measurements made (except for LV)?
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at the end of the T wave
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How should LV measurements be performed?
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based on IVS motion
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What method of measurement is used to determine AoRoot dimension?
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leading edge to leading edge.
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What method of measurement is used to determine LA dimension?
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trailing edge to leading edge
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What method of measurement is used to determine RV dimension?
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leading edge to ant ao wall
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What structures does mitral valve level MMode scan line transect?
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Anterior right ventricular wall, right ventricle chamber, interventricular septum, anterior mital leaflet, posterio mitral leaflet, and posterior LV wall
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What pattern does AML have?
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M shaped
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What pattern does PML have?
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w shaped
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What is the E point
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maximum early diastolic motion of AV during early, rapid filling phase of diastole. PML, due to size move opposite but not as much due to less excursion.
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What is F point
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Most posterior position of AML immediately following E point. Pressure gradient between LA and LV. Marks beginning of mid-diastole diastasis.
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What is A point
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late diastole separation due to atrial systole
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What is C point
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Closure point of leaflets prior to ventricle systole
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What is D point
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Valve leaflets separate at end of ventricle systole. Marks beginning of ventricle diastole.
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What is EPss
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E point septal separation. The distance between the E point and the maximum posterior motion of the ventricle septum.
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Why is EPSS important?
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Track it overtime it patients with leaky AoV, which gets wider overtime, and LV gets bigger.
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What is E-F slope
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rate of LA emptying and LV filling. Measure from max opening of AML to end of rapid filling.
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What is Excursion
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distance from D point to max anterior motion of AML (E point).
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What is the A wave (pulmonic valve)
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atrial contraction
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What is the B point (pulmonic valve)
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onset of RV ejection
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What is the C point (pulmonic valve)
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maximum opening
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What is the D point (pulmonic valve)
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end ejection
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What is the E point (pulmonic valve)
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valve closure
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What is the F point (pulmonic valve)
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precedes atrial contraction
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Why is the Pulmonic valve observed in MMode
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when the patient has portal hypertension
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What does IVS(d/s) stand for
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Interventricular septum diameter (diastole/systole)
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What does LVID(d/s) stand for
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Left Ventricular Internal dimension (diastole/systole)
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What is the normal range for EFs
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>55% and <75%
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What are ESD and EDD
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End diastolic dimension and End systolic dimension
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