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100 Cards in this Set
- Front
- Back
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aneurysm eitology
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primary: connective tissue disorders like Marfan's
secondary; atherosclerosis, volume overload like AI, Htn |
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sacular aneurysm
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bulge
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aneurysm symptoms
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CP, asymptomatic, cough, Dyspnea, hemoptsis
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fusiform aneurysm
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wraps around the aorta
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list sections of aorta
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sinus of valsalva, sinotubular junction, acending,arch,decending thoracic
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list branches off aortic arch
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brachiocephalic (inodimate), Left common carotid, left subclavian
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which aortic cusp is most likely to have an aneurysm
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RCC
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What is the normal diameter of the Aorta
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3.7 cm ????????
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best view to see a sinus of valsalva aneurysm
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PSAX
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aortic dissection intimal tear appearence on echo
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false lumen
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symptoms of aortic dissection
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CP high BP
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eitology of aortic dissection
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Htn, athersclorosis, aging bicuspid AoV, pregnacy, blunt chest trauma, conn. tissue disorder (Marfan's) cocaine use
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most commonly affected by aortic dissection
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male, pregnent
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DeBakey class I of aortic dissection
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AAo, arch, DAo
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DeBakey class II of aortic dissection
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only AAo
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DeBakey class III of aortic dissection
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DAo only distal to LCA
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Stanford class A of aortic dissection
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AAo considered an surgical emergency
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Stanford class B of aortic dissection
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can be managed medically
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complications of aortic dissection
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progressive dilatation leading to AI, pericardial effusion, tamponade, MI (blockage at sinus), false lumen causing hemotoma
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what is a true lumen?
false lumen? |
true=
false=white line |
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what might be visualized in the RA
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eustation valve, charari network, appendage
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what might be visualized in the RV
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tribuculation, moderator band
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what are the tricuspid valves
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anterior, posterior, septal (medial)
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what is the shape of the RV
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triangular, crescent shaped, pyramid
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symptoms of RV enlargement
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RVVO, septal wall may be paradoxial, may have D shape septum
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causes of RV enlargement
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TR from pulmonary Htn, pacemaker wire,
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How to evaluate RA pressure using IVC collapse
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total IVC collapse add 5
50% IVC collapse add 10 < 50% collapse add 15 no IVC collapse add 20 |
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absence of IVC collapse indicates what?
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elevated RV pressure
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what is cor pumanale?
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RH failure
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symptoms of RH failure
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COPD
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equation to get RVSP
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=
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6 methods of evaluating diastolic dysfunction
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Trans-mitral inflow velocity (with and W/o valsalva)
PV flow velocity, Color M-mode, TDI, IVRT, LA volume |
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transmitral infow PW methods
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PW at MV tips
check peak E and A check decel time check A wave duration |
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Peak E and E;A ratio
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1.0-1.5
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Grade I dialostolic dysfunction
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impaired E:A <1.0
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Grade II dialostolic dysfunction
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pseudonormalization
enlarged LA, Dyspnea E:A reversak ub valsalva |
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Grade III dialostolic dysfunction
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restrictive reversible
E:A >2.0, will decrease with valsalva |
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Grade IV dialostolic dysfunction
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irreversible restrictive
valsalva has no effect |
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define Dressler's syndrome
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Post MI pericardial effusion, usually 6 to 10 days post
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Mural thrombi is
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common complication of MI attaches to akinetic walls
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complications from MI
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pericartis, pericardial effusion, Dressler's, Mural thrombi, aneurysm, pseudoaneurysm, valve dysfunction, ruptured pap. muscle
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PS eitology
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congenital (most common). carcinoid, endocarditis, rheumatic (uncommon)
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symptoms of PV stenosis
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dyspnea, DOE, CP, Syncope, cyanosis, Noonan's syndrome, mumur (sharp crescendo-de)
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complications of PS
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RH failure, RV infarct, endocarditits
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PS in 2D
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thick PV, systolic doming, flat IVS, RVHypertrophy, RA dilation, dilation of main & L Pulm A.
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Ebstien's anomaly
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displacement of TV, congenital,
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causes of RV pressure overload
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TS, Ebstien's,
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PV anatomy
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most superior valve, semilunar,
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PS define
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calcification and/or thickening of PV, obstruction of blood flow across narrow PV
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PS findings in M-mode?
2D? |
elevated A wave
thick white valves |
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Pulm Htn is a normal finding, what is a finding in severe Pulm Htn?
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PR, RVVO
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How to determine RVSP AND SPAP (PSAP) in the presense of PS?
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use TR jet in diastole and in systole. use bernoulli on both and subtract diast from syst. calc.
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How is Pulm. Htn graded using mmHg?
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calc PA pressure using TR jet since RV and PA pressure are the sam in the absense of RVOT obstruction.
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Pulm. Htn. grading scale
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normal=18-25mmHg
mild =30-40 moderate=40-70 severe=>70 |
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calc. for Pulm. Htn.
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4(peak TR) sq.+RAP
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How to use PR waveform to determine Mean PA pressure (MPAP) and EDPAP
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MPAP=4(TR) sq.
EDPAP= |
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what is the leading cause of death in the US?
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CAD
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what is artherosclerosis?
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plaque, fatty streak in the arteries
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symptoms of CAD
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angina, SOB. heart attack, asympotomatic (silent ischemia}
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risk factors of CAD
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age, gender Nth, hyerchlorestermia, diabetes, smoking, abdomianl obesity, famaily history,
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Stable angina
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related to effort, short duration, nitro
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unstable angina
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not effort related, last longer, nitro may help
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Prinzmetal's angina
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variant angina, occurs at rest, early hours of am.
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what artery feeds the lateral wall?
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Cx
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what artery feeds the inferiaor wall?
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RCA
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what artery feeds the anterior wall?
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LAD
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what artery feeds the interventricular septum?
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RCA feeds inferior portion
RCA and LAD feeds mid portion |
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When do the cornary arteries fill
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diastole
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where is the LAD located?
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interventricular sulcus
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Where is the LtCx located
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AV sulcus
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where is the RCA located
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right AV grove
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how does the flow of blood feed the walls of the heart
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from epicardium to endocardium
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label heart walls in apical 4
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x
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label heart walls in apical 2
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x
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label heart walls in apical 3
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x
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label heart walls in PLAX
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z
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How is LV funciton determined
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Simpson's bi-plane method of discs,, WMSI, visual inspection
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What is hibernating myocardium?
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Occurs in severe CAD, shuts itself down to use less O. Alive but loweres it's energy needs. Use Dobutamine to see if it improves
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What is stunned myocardium?
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Heart in shock. may be salvaged post MI. Dobutamine may cause response
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RV infarct with 2D
views findings |
apical 4, subcostal
RV dialation failure, free wall hypokinesis, TR |
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RV infarct seen with
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inferior wall infarct
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valve dysfunction with Anterior MI
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MR in 60% due to disruption of support apparatus
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valve dysfunction with inferior infarct
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MR due to papillary muscle dysfunction
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Mi and ruptured papillary muscle
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catastrophic usually inferior Mi an dflail MV Posteromedial usually
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aneurysm in MI
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bulge in LV wall persists during diastole and systole, usually anterior MI can be apical inferior posterior
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pseudoaneurysm in MI
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narrow perforaion in endocardium appears saccular of global in contur
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VSD in MI
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rupture in IVS creating a shunt between RV and LV
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E and A wave represent>
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E=early diastolic filling 80%
A=atrial kick 20% |
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Where do we measure Pht and decel time?
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E wave slope
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What diastolic grades need unmasking?
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grade II psuedo (look for changes)
grade III rdstrictive (see if velocity peak changes) |
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how is valsalva used to evaluate diastolic dysfunction
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decrease venous return
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ohter methods for evaluation of diastolic dysfunction
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LA filling from PA vein
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What is S wave in P vein
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peak systolic flow
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what is D wave in P vein
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peak diastolic flow
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what is AR wave in R P vein
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atrial reversial
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other methods for diastolic dysfunction
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TDI at the annulus of septal or anterior leaflet of MV
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IVRT measurement
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PW between AV and MV measure from middle of AV closure click to onset of MV flow
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color M-mode in diastolic dysfunction
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apical 4 impairment of LV relaxation causes slower velocity so color slope is prolonged
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simpson bi-plane in diastolic dysfunction
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LA volume measured
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Label walls
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x
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