Midterm Echo 2

Front 1

Name the two types of Prosthetic Valves.

Back 1

Mechanical Valves are made of stainless steel or Dacron Graft.

Bioprosthetic Valves are harvested from pigs or cows which last from 10 to 12 years.

Front 2

Define a mechanical valve.

Back 2

They are a synthetic metallic valve.
The Doppler velocity should be less

Front 3

There are three types of mechanical valves.

Back 3

#1.)Ball and Cage Valves (Starr Edwards Valve).

#2.)Tilting Disc (Bjork – Shiley).

#3.)Bi–leaflet (St. Jude) Least stenotic

Front 4

Define a Bio–prosthetic Valve replacement.

Back 4

Either from a (Pig) Porcine Carpenter Edwards
or (Cow) Bovine Ionescu – Shiley.

A.)Semilunar are replaced by Porcine
B.)Atrioventricular are replaced by Bovine
Valves usually last 10 – 12 years.
Homo graft valves – taken from another human being
Autograft valves – made from your own tissue

Front 5

Etiology of prosthetic valves.

Back 5

Native valves are replaced for reasons like stenosis, regurgitation, and infection.

Valve repairs are becoming more common with porcine valves and bovine valves especially Mitral valves.

Front 6

Pathophysiology of the prosthetic valves.

Back 6

Complications include systemic embolization, peri valvular leaks, valve degeneration, thrombus formation, and endocarditis.

All prosthetic have a transvalvular gradient.

Front 7

Physical Signs of prosthetic valves.

Back 7

Mechanical valves have a systolic click.

Bioprosthetic valves do not click.

Front 8

Echo Findings of prosthetic valves.

Back 8

They are specific to each valve.


Valve motion is best studied by M mode to record the maximum disc motion.

TEE is very helpful for the evaluation of vegetations and or thrombus.

Front 9

Doppler for prosthetic valves.

Back 9

Normal mechanical prosthetic valve will have some regurgitation.

Valve should be checked for prosthetic leaks due to poor measurement.

TEE is necessary for evaluating MR.

Front 10

How do we evaluate prosthetic valves?

Back 10

"Zoom in" use Doppler then trace the entire wave form.
On AV valves trace the top.
On Semilunar valves trace the bottom.
Use CW (continuous flow)
Mitral Prosthetic – 1.5 to 2.0 meters per second peak velocity
Mean gradient 3–7mmHg
Aortic Prosthetic – 2.0 – 3.0 meters per second peak velocity

Front 11

Hypokinesis

Back 11

less than normal – negative 5% per wall. Global hypokinesis means anything less than 15%

Front 12

Hyperkinesis

Back 12

more than normal – positive 5% per wall. Global Hyperkinesis means anything more than 60% EF.
Supraventricular Tachacardia can produce hyperkinesis

Front 13

Akinesis

Back 13

no motion no contraction – 0%

Absence of either inward or outward (dyskinesia) movement of a ventricular region during systole.

Front 14

Dyskinesis

Back 14

motion in the opposite direction

An impairment in the ability to control movements, characterized by spasmodic or repetitive motions or lack of coordination

Front 15

eyeball technique

Back 15

When EF is diagnosed via eyes only

Front 16

Simpson method is only done on

Back 16

Apical 2 and 4.

Front 17

What is the ideology behind Hypertrophic Cardiomyopathy?

Back 17

1) Hypertension.
2) Idiopathic (unknown)
3) Hereditary (transmitted by dominant Gene)
4) Common in African Americans.

Front 18

What are the types of Hypertrophic Cardiomyopathy?

Back 18

1) A.S.H (Asymmetrical Septal Hypertrophy)
2) I.H.S.S (Idiopathic Hypertrophy Sub–aortic Stenosis)
3) H.C.M (Hypertrophy Cardiomyopathy)
4) H.O.C.M (Hypertrophy Obstructive Cardiomyopathy)

Front 19

What is A.S.H?

Back 19

It Is seen at the anterior septum (thick), bottom normal; doesn't affect mitral valve.

Front 20

What is the definition of I.H.S.S?

Back 20

1) L.V.O.T gets thick.
2) Right cusp is obstructed.
3) Causing S.A.M and sudden death.

Front 21

What is the definition of H.C.M?

Back 21

1) Symmetrical thickness of the ventricles.
2) CO will be diminished.
3) Chambers will shrink.

Front 22

What is the definition of H.C.O.M?

Back 22

1) Part of the LVOT from half of the septum and the Aortic valve is obstructed.

Front 23

What is the Pathophysiology of Hypertrophic Cardiomyopathy?

Back 23

1) M.A.C ( Mitral Annular Calcification) can be seen.
2) Obstructive Cardiomyopathy can be seen.
3) Diastolic Dysfunction from a non–compliant ventricle( A wave is taller than E)
4) Muscle Hypertrophy can effect the annulus, becomes shorter and will cause MR.
5) LA enlargement because of the MR.

Front 24

What are the Physical signs of Hypertrophic Cardiomyopathy?

Back 24

1) Angina, Arrhythmia, Syncope, and Sudden death
2) Systolic Murmur ( Crescendo–Decrescendo) because the high velocity at the LVOT and also the Mitral Regurgitation (I.H.S.S)

Front 25

What are the Echo–findings of Hypertrophic Cardiomyopathy?

Back 25

1) Myocardium may have a bright appearance.
2) Abnormal thickness of ventricular walls which could be symmetrical or asymmetrical.
3) S.A.M of the Mitral will be present.

Front 26

What you see in Doppler?

Back 26

1) MR may be present.
2) Turbulence and Increase velocity at the site of the structure
(Pre=Normal, Obstruction=High, Post=Turbulence)
3) MID ventricular or Sub–Aortic gradient may be present,
4) Dagger shape waveforms are seen on LVOT when there is obstruction or I.HS.S of the LVOT.

Front 27

What is the Ideology of Dilated (Constrictive) Cardiomyopathy?

Back 27

1) Idiopathic.
2) HIV. *
3) Ischemic.
4) Toxic due to alcohol.*
5) Thiamin Deficiency.
6) Chagas Disease= bite from an insect causing dilated cardiomyopathy.

Front 28

What is the Pathophysiology of Dilated (Constrictive) Cardiomyopathy?

Back 28

Increased LV mass where the walls are thin and the chambers are dilated affecting systolic function.

Front 29

What are the Physical signs of Dilated (Constrictive) Cardiomyopathy?

Back 29

1) Symptoms present are like those of heart failure, Fatigue, Edema, and Dsypnea.
2) Sinus Tachycardia.
3) Mitral Regurgitation and Tricuspid Regurgitation are usually present.
4) Left atrial & Right Atrial enlargement.

Front 30

What are the Echo–findings of Dilated (Constrictive) Cardiomyopathy?

Back 30

1) Thrombus may be present.
2) Global Hypokinesis.
3) Small Pericardial Effusion.
4) Aortic & Pulmonic Insufficiency may be present.

Front 31

What is the Ideology of Restrictive (Infiltrative) Cardiomyopathy?

Back 31

1) Amyloidosis (most common) is a protein that infiltrates into the cardiac muscle, causing it to enlarge.
2) Sarcoidosis.
3) Excess Iron.
4) Glycogen storage aka (Pompeis Disease)

Front 32

What is the Pathophysiology of Restrictive (Infiltrative) Cardiomyopathy?

Back 32

1) Bi–atrial enlargement.
2) Infiltration of Myocardium resulting in rigid ventricular walls impeding diastolic filling.
3) Sarcoidosis may infiltrates the conduction system leading to AV block.

Front 33

What are the physical signs of Restrictive (Infiltrative) Cardiomyopathy?

Back 33

1) Fatigue, Dyspnea and Angina

Front 34

What are the Echo–findings of Restrictive (Infiltrative) Cardiomyopathy?

Back 34

1) Ventricular Hypertrophy–a small or normal ventricular chamber.
2) Ground glass appearance of Myocardium.
3) Ventricular systolic function may be normal or decrease.
4) Pericardial effusion may be present.
5) Endocardium may appear echogenic (bright)
6) Atrioventricular valves may appear echogenic.

Front 35

What you see in Doppler at Restrictive (Infiltrative) Cardiomyopathy?

Back 35

1) Abnormal diastolic filling pattern of Atrioventricular valves, reduced AV flow velocity with atrial contraction causing less respiratory flow variation than tamponade or constrictive patients.
2) Mitral Regurgitation and Tricuspid Regurgitation may be present.

Front 36

What is the Etiology of Pericardial Effusion?

Back 36

1) Tuberculosis.
2) Idiopathic.
3) Bacterial or fungus infection.
4) Trauma, Post Cardiac Surgery.
5) Auto–immune or inflammatory disorder.

Front 37

What is the pathophysiology of pericardial effusion?

Back 37

1) Pericarditis leads to fluid moving into the pericardial space.
2) If the fluid accumulates, slowly the pericardium will expand to accommodate a larger effusion.

Front 38

What are the physical signs of Pericardial Effusion?

Back 38

1) Chase pain.

2) Dyspnea.

3) Distended neck veins.

Hint 38

D
3) Distended neck veins.

Front 39

What are the Echo–findings of Pericardial Effusion?

Back 39

1) The pericardial fluid is seen between the epicardium & pericardium.
2)Decrease echo gain to identify pericardial effusion (brightness).

Front 40

What are the Echo–findings of Pericardial Effusion?

Back 40

3) Isolated anterior space may be a pericardial fat pad.
4) Fibrin strands are commonly see in long standing effusions or effusions from metastatic diseases.
5) Pericardial effusion is position between the L.A and descending aorta, plural effusion posteriorly to the descending aorta.
6) Inspiration & Expiration variation( sample the MV and TV with CW and decrease the sweep speed to 25mm/s.

Front 41

How many types of Aneurysm are there?

Back 41

Pseudo aneurysm and True aneurysm

Hint 41

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Front 42

What is the etiology of Constrictive Pericarditis?

Back 42

1) Idiopathic.
2) Chronic Pericarditis.
3) Radiation Therapy.

Front 43

What is the pathophysiology of Constrictive Pericarditis?

Back 43

1) Fibrosis or Calcification of pericardium results in restriction of ventricular filling.
2) Equalization of RV and LV diastolic pressures by catheterization, treatment involves pericardial ectomy.

Front 44

What are the physical signs of Constrictive Pericarditis?

Back 44

1) Dyspnea.
2) Edema.

3) Distended Neck Veins.
4) Pericardial Nock during Diastole.

Front 45

What are the echo–findings in Constrictive Pericarditis?

Back 45

1) Normal LV diastolic function.
2) Thick pericardium.
3) Flat LV posterior wall motion in diastole.
4) Early diastolic notch of the IVS.
5) Right & Left Atrial enlargement.
6) Dilated IVC no collapse.
7) Premature opening of the PV.

Front 46

What are the Doppler findings in Pericardial Effusion?

Back 46

1) TR & MR are usually present.
2) Respiration Variation will increase.

Front 47

Definition of Cardiac Tamponade?

Back 47

It is a rapid filling of fluid causing restrictive diastolic filling.

Front 48

What is the etiology of Cardiac Tamponade?

Back 48

1) Occurs mostly with moderate to severe effusion all though small, rapid accumulated effusions can cause Carsiac Tamponade.
2) It's clinical diagnosis made at the bed side.
3) echo helps determine the amount and location of the fluid.

Front 49

What is the pathophysiology of cardiac Tamponade?

Back 49

1) Depends on both volume and rate of accumulation.
2) Decrease cardiac filling and output caused by increase pericardial pressure.
3) Required emergent pericardial synthesis a.k.a pericardial window.

Front 50

What are the physical signs of cardiac Tamponade?

Back 50

1) Tachycardia.
2) Pulsus Paradoxus.
3) Becks Triad (elevated venus pressure, Hypotension, and a quiet heart)
4) Dyspnea.
5) Fatigue.
6) EKG may show electrical alterans.

Front 51

What is the echo–findings on Cardiac Tamponade?

Back 51

1) You will see RV diastolic collapse.
2) You will see RA late diastolic, early systolic collapse.
3) RV & LV volume changes with respiration variation.
4) Possible to have pericardial effusion (PE) either small, medium or large)
5) Effusion demonstrate swinging Heart.
6) Dilated IVC will not collapse.

Front 52

What will be seen in Doppler on cardiac Tamponade?

Back 52

1) Usually shows respiratory variations in the MV and TV with a greater of 25% difference .
2) Flow will decrease across the MV & Aortic valve and increase across the TV & Pulmonic with inspiration.

Front 53

What is the protocol for Cardiac Tamponade?

Back 53

1) Measure effusion.
2) Effusion will be small, medium or large.
3) Visualize RA & RV collapse during diastole (Apical 4 & 5 and Subcostal)
4) M–mode of the RA & RV to confirm collapse.
5) Subcostal view IVC dilatation and ask patient to sniff.
6) Place you sweep in 25mm/s sample MV & TV respiration variation, should be greater of 25% to be consider cardiac Tamponade.
7) Turn oximetry on.