Mod 3 Tee/sources Of Emboli

Front 1

what isn't TEE good for?

Back 1

-evaluation of AO stenosis
-imaging apex
-seeing aortic arch

Front 2

what are the types of TEE transducers?

Back 2

-monoplane
-biplane
-multiplane
-panoramic

Front 3

monoplane transducer

Back 3

-single set of phased array
-64 elements/set transverse imaging
-5mHz
-produces only 2 or the three primary planes(short axis, and 4 chamber)
-not used anymore

Front 4

Biplane transducer

Back 4

-second generation-single set of phased array elements
-64 elements/seg-distal=longitudinal Proximal=transverse
-5-7HHz, or 3-5MHz
-not used anymore

Front 5

panoramic transducer

Back 5

-annular array, rotation crystal
-13mm diameter
-sector angle, 15 degrees to 270 degrees
=4-10mHz for 2D
-3.3 MHz for doppler

Front 6

multiplane transducer

Back 6

-64 element phase array
-steerable array-rotates 0-180 degrees
transverse=0 degrees
-longitudinal=90 degrees

Front 7

Name and explain the 5 tranducer positions

Back 7

1. repositioning-up and down esophagus
2. rotation-retating from 0-180 degrees
3. turing-moving transducer in a rotational fashion to show medial and lateral
4. angulation-superior to inferior
5. tilt-lateral motion of the tip to image different structures in the same imaging plane

Front 8

what kind of prep is there for a TEE?

Back 8

-assemble supplies
-intravenous supplies
-lidocaine spray and tonge blade
-scope lubricant, gloves, safetly glasses, probe, and bite block
-maintin and check suction, O2 and basic life support
-check U/S machine

Front 9

what supplies are used for TEE's?

Back 9

medication
saline flushes
contrast media
intravenous supplies(angiocatheter, three way stop cock)

Front 10

What drugs are used for TEE's?

Back 10

-endocardits prophylaxix(of they have a vegge)
-pharyngeal anesthesia-lidocain(10%)spray(freezes tounge and throat)
-drying agent(robinul)
-sedative(demerol)

Front 11

what should be done for patient prep for TEE's?

Back 11

-Confirm NPO 4-6 hours prior to TEE
-breif history of allergies, and medication
-explain procedure-obtain baseline vital signs, and monitor rhythm
-remove dentures
-establish IV(for emergency meds, for bubble study)
-Turn patient LLD

Front 12

What is the TEE procedure during the test?

Back 12

-position and maintain bite block
-monitor vital signs, rhythm, respiration, BP, and O2
-use suction if neccessary
-have life support equipment available
-help w/ knobology

Front 13

what is the TEE procedure after the TEE is completeted?

Back 13

-assist patient during recovery period
-remove IV catheter
-instruct patient not to drive for 12 hours
-recod vital signs, and pt. condition
-arrange for escort
-clean room and transducer

Front 14

what are the 4 standard TEE imaging views?

Back 14

-Basal
-Four chamber
-Transgastric
-Aorta

Front 15

explain the 4 chamber TEE view?

Back 15

-0 degree probe
-probe post to LA
-Lateral and inferior septal walls seen

Front 16

IF a probe is angled anteriorly in the 4 chamber view, what does this show?

Back 16

-AV, and LVOT

Front 17

what is seen in the 4 chamber view if the probe is moved to the right?

Back 17

Right:
-TV, and IAS

Front 18

what is seen on 4 chamber view if the probe is withdrawn a little with anterior angulation?

Back 18

-LAA

Front 19

explain the orthoonal view

Back 19

from 4 chamber view, turn 90 degrees for appendage

Front 20

If the probe is angled suprior and inferiorly to the left of the 4 chamber view, what is seen?

Back 20

-pulmonary veins

Front 21

2 chamber view ?

Back 21

-60 degrees from 4 chamber
-ant. and inf walls of LV seen
-can calculate EF using simpsons
-only the anterior leaflet of the mitral valve is seen

Front 22

Explain the long axis plane?

Back 22

-high esophagus posiitoin to LA
-retation of 120 degrees
-asc. ao well seen
-ant. and post MV leaflets seen
-ant. septum and post LV walls seen.

Front 23

what is seen if you angle cephalad from the long axis plane? 90 degrees to the left? 90 degrees to the right?

Back 23

Cephalad=see ascendind AO
90 left=RVOT, pulmonary artery
90 right=SVC, IVC, LA, A< IAS(aka bicaval views)

Front 24

explain the short axis plane with TEE?

Back 24

-image rotated btw 30-45 degrees
-aortic valve-seen very well
-LCA-easily seen
-RCA-NWS

Front 25

explain the standard transgastric position in the short axis plane?

Back 25

-passed into stomach
-probe tip in stomach, superior angulation
-see global LV systolic and diastolic function
-wall thickness and LV diameters
-regional LV function

Front 26

explain the apical postion -4chamber or the transgastric postion?

Back 26

-probe advanced to fundus of stomach
-usually 0 degrees(f LV lies on diaphtragm)
-probe may not be on the true LV apex, so this view is forshortened.

Front 27

explain the apical long axis postion in transgastric?

Back 27

-120 degrees from apical four
-difficult to obtain because of lung

Front 28

explain how the descending thoracic AO is visualized with TEE?

Back 28

-from transesophageal or transgastric position, probe is turned until image is duirected left of patients spine to obtain a short axis of the descending AO(0 degrees)
-90=long axis of desc ao.

Front 29

What are some indications for TEE's?

Back 29

-obese patient
-evaluate the AO
-LV function
-encocarditis
-sosrce of embolism
-right heart function and prosthetic valves

Front 30

what are some absolute contraindications for TEE's?-

Back 30

-esophageal tumors, stenosis, strictures, diverticulum, varicies, perforated viscus, gastric volvus or perforation, GI bleeding
-unwilling patient

Front 31

what are some relative contraindications for TEE's?

Back 31

-prior esophageal surgery, radiation therapy
-oropharyngeal distortion, servical spondylosis, cervica arthritis(kinky spine)
-severe cardiopulmonary distress
-suspected esophageal varices

Front 32

what are the mechanical complications of TEE>

Back 32

-probe buckling
-probe compression of surrounding structures
-probe interference w/ other esophageal or nasogastric devices

Front 33

What are the procedure related complications of TEE's?

Back 33

-pt. intolerance
-sore throat
-transient hypoxia
-supraventricular tachycardia
-transient hypertension or hypotension
-blood tinge sputum etc.

Front 34

How is TEE helpful in evaluation of LV function and Ischemia?

Back 34

-priary indication for assessment of global and regional LV function
-suprior in obese patienst, chest deformities, and chronic lung disease
-has a role in the OR(open heart surgery)

Front 35

TEE stress echo?

Back 35

-exercise=impractical
-atrial paced TEE or pharmacologic TEE
-TEE and stress echo combinations allows for better delineation of endocardial borders.

Front 36

explain percentages of embolism from the heart?

Back 36

-6-23% of all ischemic strokes are due to heart emboli
-75% of cardiac emboli lodge in the brain

Front 37

what are the causes of cardiac sources of emboli?

Back 37

1st-LA thrombus due to atrial fibrillation
Then:
-acute myocardial infarction,
- ventricular aneurysm,
-rhumatic heart disease and -prosthetic valves

Front 38

Name and explain the classifcations of emboli?

Back 38

Direct source:
-high probablility of stroke=throbus, tumor, vege, aortic atheroma

Indirect source:
-lower probability of causing strok
-dilated cardiomyopathy, ASD, PFO, spontaneous echo contrast

Front 39

explain spontaneous echo contrast in relation to cardiac emboli?

Back 39

-dynamic echos within LA and appendage which resembles swirling smoke
-best seen w/ high frequencies
-when suspecte, decrease gain
-may be a marker for increased risk of embolism

Front 40

what can cardiac emboli be in relation to?

Back 40

-atrial septum
-valvular abnormalitites
-pulmonary emboli
-A-fib

Front 41

explain embolic events related to the atrial septum?

Back 41

-atrial septal aneusysms
-PFO

Front 42

explain embolic events related to valvular abnormaliies/

Back 42

-vege and aortic sclerosis
-valvular strands seen on native as well as prosthetic valves

Front 43

explain embolic events related to pulmonary emboli?

Back 43

-result in 50,000 deaths each year in USA

Front 44

what are the echo signs of pulmonary emboli?

Back 44

-dialated Right heart
-dialated pulmonary artery
-smal LV cavity
-Paradoxical septal motion
-thrombi visualization in pullmonary arteries

Front 45

explain embolic events related to atrial fibrilation?

Back 45

-thromboembolism is a consequence of a-fib
-most common cardiac rhythm disturbance
-untrated patients w/ a-fib=higher risk of strok=%

Front 46

what is the treatment for a-fib?

Back 46

-cardiovrsion
-antiarrytmic drugs
-anticoagulation therapy

Front 47

differentiate btw LA tumors and thrombus?

Back 47

-thrombus sits on Lt side of LA
-tumors are closer to septum

Front 48

what do pectonate muscles look like sonographically?

Back 48

-linear and bright, seen in LAA

Front 49

what is the main reason for Right sided thrombus w/out pulmonary hypertension?

Back 49

DVT

Front 50

What is seen on ECG w/ a-fib?

Back 50

-no p wave

Front 51

what is the difference btw PFO, and ASD?

Back 51

PFO-flap not closing
ASD-defect