Hemodynamics (Add-On)

Front 1

what does IHSS stand for?

Back 1

idiopathic hypertrophic subaortic stenosis=SAM + ASH

Front 2

what is sam caused by?

Back 2

venturi effect(suction of the anterior mitral valve leaflet)
-the closer the leaflet comes to being in contact w/ the IVS, the more severe the obstruction

Front 3

differentiate btw mild sam, mod sam, and severe sam?

Back 3

mild-leaflet>10mm from IVS
mod-leaflet within 10mm of IVS
severe-leaflet touches IVS for >30% of systole

Front 4

explain dynamic stenosis? HOw does this change the appearance of the doppler waveform?

Back 4

-occurs only in mid-late systole and severity of the obstruction can be altered by loading conditions(preload)
-by changing preload, the doppler waveform changes to a dagger shape

Front 5

what part of the cardiac cycle does dynamic stensois occur? What can you do to increase the velocity?

Back 5

mid-late systole=preload dependant
-do valsalva to increase velocity

Front 6

what is the m-mode of subaortic stenosis like?

Back 6

-ASH, concentric LVC, apical hypertrophy, mid ventricular hypertrophy
-SAM-may creat LVOTO
-b-notch of MV-increased LVEP
-mid systolic closure of the arotic valve due to a sudden decrease in cardiac output

Front 7

what is the b-notch on m-mode due to?

Back 7

increased LVEP w/ subaortic stenosis

Front 8

what part of the cardiac cycle does the AO close w/ IHSS?

Back 8

mid systole due to sudden decrease in cardiac output

Front 9

what is the doppler like w/ IHSS? what should you do?

Back 9

-w/ LVOTO, obtain max PSV by doing valsalva
-diff LVOT from MR
-evaluate diastolic dysfunction

Front 10

how do you differentiate LVOT from MR?

Back 10

MR is higher velocity and holosystolic

Front 11

differentiate amyloidosis from IHSS?

Back 11

amyloidosis:
-LVH
-Has small PE

IHSS:
-thickened basal septum
-mid-systolic closure

Front 12

what is seen on echo w/ marfans?

Back 12

-AO dialated(if >5, surgery is done)
-MVP
-MR and AI

Front 13

why is the valsalva done for TEE bubble studies?

Back 13

-decrease in preload
-pressures in Rt are higher than left, so it goes from RT to left.

Front 14

what is the normal flow velocity for the LAA?

Back 14

46cm/sec

Front 15

where are pseudoanerurysms most commonly seen?

Back 15

inferior wall; true aneurysms in apex

Front 16

dresslers syndrome

Back 16

pericarditits caused by myocardial infarct(seen 6 weeks later)

Front 17

what is the difference btw true and false aneurysms

Back 17

true:
-involves all 3 layers
-large neck

Pseudo:
-doesn't involve all 3 layers
-small neck
-to/fro flow

Front 18

What can MAC cause?

Back 18

a-fib

Front 19

hemochromatossi

Back 19

iron overload

Front 20

hypovolemia

Back 20

decrease in blood plasma
low fluid which can cause LV to look small

Front 21

SV formula

Back 21

Area x TVI
EDV-ESV

Front 22

between preload and afterload, which one refers to stenosis, and which one refers to regurge?

Back 22

preload=regurge
afterload=stenosis

Front 23

what equasions do you use to figure out stenosis severity?

Back 23

AO stenosis=continuity; can use TVI or peak velocity
MV=plaminetry or 220/PHT

Front 24

when does the PHT for stenosis not work to accurately assess mitral stenosis?

Back 24

-AO regurge-due to increase in LV pressures; underestimates the severity of stenosis
-restrictive diastolic dysfunction also underestimates the severity of stenosis because the slope is very sharp to begin with.

Front 25

what does stenosis look like on 2D?

Back 25

domes

Front 26

w/ mitral stenosis, what will the "a" look like on m-mode and doppler?

Back 26

M-mode=no a
doppler=exaggerated A

Front 27

when do the anterior and posterior septum move together?

Back 27

90% of the time w/ mitral stenosis

Front 28

would tissue doppler be effected w/ tamponade?

Back 28

no, because you're assessing the myocardium w/ tissue doppler, not the pericardium

Front 29

what is another name for the sawtooth appearance

Back 29

cutoff

Front 30

what e-velocity of the MV will tell us that there is significant MR?

Back 30

>1,7

Front 31

what will the vena contracta measure with severe regurge of the AO, and MV?

Back 31

Ao=>0.7
MV>1.0cm

Front 32

what is the most common cause of thrombus in the LA?

Back 32

a-fib

Front 33

where are myxomas attached?

Back 33

-the secundum or foramen ovale

Front 34

what should worry about w/ marfans'

Back 34

dissection

Front 35

what usually causes pulmonary stenosis

Back 35

usually congenital causes

Front 36

what sign will you see w/ pulmonary hypertension?

Back 36

flying w

Front 37

what is normal accel time for the pulmonary valve?

Back 37

120-130ms

Front 38

what are the 2 most common thingsthat associated w/ ebsteins?

Back 38

-ASD
-WPW-wolf parkinson white

Front 39

eisenmenger's is secondary to what?

Back 39

pulmonary hypertension

Front 40

what does cor triatriatum mimic?

Back 40

mitral stenosis

Front 41

what do you need to figure out RVSP?

Back 41

-systolic BP
-peak velocity of VSD or PDA

Front 42

what echo signs will you see w/ turners syndrome?

Back 42

-bicuspid AO valve
-coarctation

Front 43

how often do people w/ coarctations have a abicuspid AO valve?

Back 43

50% of the time

Front 44

with williams syndrome, what will you see on echo?

Back 44

supravalvular stenosis

Front 45

what indicates the severity of ebsteins?

Back 45

-see how atrialized the ventricle is
->20mm btw TV and MV=ebsteins

Front 46

How do you tell the diff. btw coronary sinus, and desc. ao in PSLA?

Back 46

-Desc. ao is bigger, and outside the heart
-coronary sinus is smaller, and inside the heart

Front 47

if you see an enlarged coronary sinus, what might you suspect?

Back 47

-anomolous pulmonary venous return into coronary sinus

Front 48

what makes something cyanotic?

Back 48

higher right sided pressures

Front 49

how are dissections classified?

Back 49

-stanford and debakey

Front 50

what is the 1st structure you see on tee?

Back 50

LA

Front 51

raffe

Back 51

bit of tissue that occurs w/ a bicuspid AO valve

Front 52

what is the main complication of bioprosthetic and mechanical valves?

Back 52

bioprosthetic=degeneration
mechanical=thrombus

Front 53

what do you always see w/ disecting aneurysm?

Back 53

-intimal flap
-true lumen is smaller than false aneurysm

Front 54

what is the anatomical location of the PV and TV

Back 54

PV=most superior and anterior
TV=most inferior and posterior

Front 55

what do you see w/ kawasaki's? what is the best view?

Back 55

-coronary artery aneurysms and infarcts, abnormal wall segments
-best veiw=short axis

Front 56

what procedures fix transposiiton?

Back 56

Jantene and mustard procedure
Jantene=great artery switch
Mustard=atrial switch

Front 57

if you see a saw tooth, and flow continuous in diastole when dopplering the desc. ao in suprasternal, what should you ssupect?

Back 57

-coarct

Front 58

where are most sinus of venous ASD's seen?

Back 58

-close to the SVC

Front 59

what should you do if you suspect SEC?

Back 59

turn up gain to see blood swirling.