CCI ECHO EVALUATION EXAM UPDATED QUESTIONS AND
ANSWERS SURE A+
✔✔If your patient has a dilated Left Ventricle and thin septum what might be going on
with this patient? - ✔✔Severe mitral regurgitation.
On M mode anterior motion of the posterior leaflet
✔✔Which view shows the coronary sinus in long axis? - ✔✔Apical 4 chamber with
posterior angulation
NOTE: PLSVC, CHF, PHTN = dialated CS
✔✔Where does the left anterior descending coronary artery originate?
A. atrioventricular sulcus
B. coronary sinus
C. posterior intraventricular sulcus
D. anterior intraventricular sulcus
E. coronary sulcus - ✔✔D. anterior intraventricular sulcus
✔✔Are right-sided pressures elevated with a Valsalva maneuver? - ✔✔During the strain
phase=No
During the release phase=Yes
✔✔Which clinical finding is associated with a friction rub?
A. Cor pulmonale
B. mitral stenosis
C. aortic dissection
D. pericardial effusion - ✔✔D. pericardial effusion-
constrictive pericarditis (which leads to PE)- friction rub.
Constrictive pericarditis impaired ventricular filling
Pericardial knock Similar in timing to a very loud S3. It's caused by an abrupt cessation
of early diastolic inflow.
- respiratory variations of MV and TV
✔✔What does the sinus venous turn into? - ✔✔Atrial connections (IVC, SVC,
pulmonary veins, CS and part of the atria
✔✔In normal development which is the last to close?
a. ASD
b. PDA
c. VSD
d. PFO
,e. UFO - ✔✔D. patent foramen ovale
First to close is. ASD
✔✔What is Qp/Qs? - ✔✔Qp pulmonary circulatory flow
Qs = systemic circulatory flow
ASD surgery is mainly considered when the Qp/Qs exceed?
1:5
Normal ratio 1:1
✔✔What are the Qp/Qs for an ASD? - ✔✔>1 for left to right shunt
<1 for right to left shunt
✔✔In patients with A-fib which heart sound would be missing?
A. first
B. second
c. Third
d. Fourth - ✔✔d. Fourth (occurs during atrial contraction)
✔✔How do you position a patient for using a Pedoff probe along the right sternal
border?
a. Fowlers
b. Trendlenburg
C. left lateral decubitus
D. right lateral decubitus - ✔✔D. right lateral decubitus
✔✔A 52 year old woman develops a murmur after a myocardial infarction. What is the
most likely etiology?
A. pericarditis
B. pseudoaneurysm
C. ventricular septal defect
D. ruptured papillary muscle - ✔✔C. ventricular septal defect
✔✔How do you position a patient for a TEE exam? - ✔✔Left lateral decubitus
✔✔A 3 year old patient comes to the lab with a systolic murmur. What is the most likely
etiology? - ✔✔VSD
✔✔Which is the best stress echo technique for revealing hibernated or stunned
myocardium? - ✔✔Dobutamine-- increases HR but same perfusion
✔✔What vessel contains deoxygenated blood from peripheral tissue? - ✔✔Veins
✔✔In comparing the systemic circulation to the pulmonary circulation.
,Which has the higher pressure, higher resistance, higher oxygen content, thicker
ventricular and vessel walls and lower CO2 levels? - ✔✔Systemic circulation
✔✔What vessel has the lowest O2 SATURATION - ✔✔Coronary sinus 60%
Highest is Pulmonary Artery
✔✔What 3 vessels arise from the arch of the aorta? - ✔✔Inorder from first to last
Brachiocephalic/ Inamoniate
Left CCA
Left Subclavian
✔✔What is the normal O2 saturation for the left heart? - ✔✔98%
✔✔What rhythm has a wide QRS, regular rhythm and Heart Rate of 150 beats per
minute? - ✔✔V-tach
It is considered a lethal rhythm
✔✔From the fetal heart, sinus venosus becomes what in the adult heart? - ✔✔Coronary
sinus
✔✔Briefly describe the blood flow direction in the pulmonary circulation? - ✔✔Right
Ventricle --Pulmonary Valve -- Pulmonary artery/trunk -- lungs --Pulmonary veins
✔✔What occurs in the lungs during respiration? - ✔✔Pulmonary arteries carry blood to
lungs where RBCs release CO2 and pick up oxygen
✔✔If a patient is in shock what would be a good position to put them in? -
✔✔Trendlenburg (legs elevated)
✔✔What is the primary goal of the code of ethics? - ✔✔Moral obligation to do well.
✔✔cardiac output - ✔✔The total amount of blood ejected per minute
Cardiac Output = stroke volume x HR
Cardiac Output = 4-8 liter/min
✔✔What is the effect of increased afterload on the velocity of cardiac fiber shortening? -
✔✔-Slower contraction due to more resistance.
-Afterload is the tension or arterial pressure against which the ventricle must contract, IT
IS WHAT IS LEFT AFTER SYSTOLE
-Ventricles must use more force to contract resulting on thickening of the myocardium
(concentric hypertrophy) eventually leading to the muscle wearing out.
- cardiac performance will decrease
, NOTE: STENOSIS, HYPERTENSION (SYSTEMIC AND PHTN), COARCTATION OF
AORTA INCREASES AFTERLOAD- RESISTANCE TO THE EJECTION OF BLOOD
(OUTSIDE FORCES PUSHING IN ON THER CHAMBER)
HYPERTROPHY (CONSTRICTIVE HYPERTROPHY) ARE THE MAIN ECHO
FINDINGS IN INCREASED
✔✔What happens during preload? - ✔✔Preload is defined as the volume of blood in the
Left Ventricle at end-diastole (EDP or EDV)
- The amount of blood available to eject
- The maximum stretch of the muscle fibers at end-diastole
The heart responds to increased preload by an increase in
CONTRACTILITY AND OVER TIME DILITATION
NOTE: REGURGITATION, SHUNTS,VOLUME OVERLOAD INCREASES PRELOAD
**DILITATION IS THE MAIN ECHO FINDING IN INCREASED PRELOAD
✔✔Describe the blood flow in the systemic circulation - ✔✔Left Atria Left Ventricle
Aortic Valve all arteries/veins throughout body back through IVC/SVC/CS Right Atria
✔✔Filling of the coronary arteries with blood occurs during.... - ✔✔Diastole
✔✔Effects of left heart failure - ✔✔Blood backs up to lungs and patient has shortness of
breath
✔✔Right heart failure - ✔✔The heart does not adequately circulate blood to the
pulmonic system. Can be due to volume overload or regurgitation in Tricuspid Valve or
Pulmonic Valve.
Can lead to systemic edema, back up of blood in liver and lower extremities
✔✔If you have pulmonary edema, it is the _____ heart that is affected? - ✔✔Left
✔✔Left heart failure - ✔✔The heart does not adequately circulate blood to systemic
system. Due to pressure overload or volume overload
✔✔The endocardial cushions contribute to the closure of the ostium primum and the
membranous septum and form the ______ and ______ leaflets - ✔✔Anterior mitral
valve leaflet and septal tricuspid leaflet
✔✔If you have peripheral edema, it is the _____ heart that is affected? - ✔✔Right
✔✔You will see jugular venous distention with? - ✔✔right heart failure
✔✔The primary cause of R heart failure is - ✔✔left heart failure
✔✔Right heart failure due to intrinsic pulmonary disease? - ✔✔Cor pulmonale
ANSWERS SURE A+
✔✔If your patient has a dilated Left Ventricle and thin septum what might be going on
with this patient? - ✔✔Severe mitral regurgitation.
On M mode anterior motion of the posterior leaflet
✔✔Which view shows the coronary sinus in long axis? - ✔✔Apical 4 chamber with
posterior angulation
NOTE: PLSVC, CHF, PHTN = dialated CS
✔✔Where does the left anterior descending coronary artery originate?
A. atrioventricular sulcus
B. coronary sinus
C. posterior intraventricular sulcus
D. anterior intraventricular sulcus
E. coronary sulcus - ✔✔D. anterior intraventricular sulcus
✔✔Are right-sided pressures elevated with a Valsalva maneuver? - ✔✔During the strain
phase=No
During the release phase=Yes
✔✔Which clinical finding is associated with a friction rub?
A. Cor pulmonale
B. mitral stenosis
C. aortic dissection
D. pericardial effusion - ✔✔D. pericardial effusion-
constrictive pericarditis (which leads to PE)- friction rub.
Constrictive pericarditis impaired ventricular filling
Pericardial knock Similar in timing to a very loud S3. It's caused by an abrupt cessation
of early diastolic inflow.
- respiratory variations of MV and TV
✔✔What does the sinus venous turn into? - ✔✔Atrial connections (IVC, SVC,
pulmonary veins, CS and part of the atria
✔✔In normal development which is the last to close?
a. ASD
b. PDA
c. VSD
d. PFO
,e. UFO - ✔✔D. patent foramen ovale
First to close is. ASD
✔✔What is Qp/Qs? - ✔✔Qp pulmonary circulatory flow
Qs = systemic circulatory flow
ASD surgery is mainly considered when the Qp/Qs exceed?
1:5
Normal ratio 1:1
✔✔What are the Qp/Qs for an ASD? - ✔✔>1 for left to right shunt
<1 for right to left shunt
✔✔In patients with A-fib which heart sound would be missing?
A. first
B. second
c. Third
d. Fourth - ✔✔d. Fourth (occurs during atrial contraction)
✔✔How do you position a patient for using a Pedoff probe along the right sternal
border?
a. Fowlers
b. Trendlenburg
C. left lateral decubitus
D. right lateral decubitus - ✔✔D. right lateral decubitus
✔✔A 52 year old woman develops a murmur after a myocardial infarction. What is the
most likely etiology?
A. pericarditis
B. pseudoaneurysm
C. ventricular septal defect
D. ruptured papillary muscle - ✔✔C. ventricular septal defect
✔✔How do you position a patient for a TEE exam? - ✔✔Left lateral decubitus
✔✔A 3 year old patient comes to the lab with a systolic murmur. What is the most likely
etiology? - ✔✔VSD
✔✔Which is the best stress echo technique for revealing hibernated or stunned
myocardium? - ✔✔Dobutamine-- increases HR but same perfusion
✔✔What vessel contains deoxygenated blood from peripheral tissue? - ✔✔Veins
✔✔In comparing the systemic circulation to the pulmonary circulation.
,Which has the higher pressure, higher resistance, higher oxygen content, thicker
ventricular and vessel walls and lower CO2 levels? - ✔✔Systemic circulation
✔✔What vessel has the lowest O2 SATURATION - ✔✔Coronary sinus 60%
Highest is Pulmonary Artery
✔✔What 3 vessels arise from the arch of the aorta? - ✔✔Inorder from first to last
Brachiocephalic/ Inamoniate
Left CCA
Left Subclavian
✔✔What is the normal O2 saturation for the left heart? - ✔✔98%
✔✔What rhythm has a wide QRS, regular rhythm and Heart Rate of 150 beats per
minute? - ✔✔V-tach
It is considered a lethal rhythm
✔✔From the fetal heart, sinus venosus becomes what in the adult heart? - ✔✔Coronary
sinus
✔✔Briefly describe the blood flow direction in the pulmonary circulation? - ✔✔Right
Ventricle --Pulmonary Valve -- Pulmonary artery/trunk -- lungs --Pulmonary veins
✔✔What occurs in the lungs during respiration? - ✔✔Pulmonary arteries carry blood to
lungs where RBCs release CO2 and pick up oxygen
✔✔If a patient is in shock what would be a good position to put them in? -
✔✔Trendlenburg (legs elevated)
✔✔What is the primary goal of the code of ethics? - ✔✔Moral obligation to do well.
✔✔cardiac output - ✔✔The total amount of blood ejected per minute
Cardiac Output = stroke volume x HR
Cardiac Output = 4-8 liter/min
✔✔What is the effect of increased afterload on the velocity of cardiac fiber shortening? -
✔✔-Slower contraction due to more resistance.
-Afterload is the tension or arterial pressure against which the ventricle must contract, IT
IS WHAT IS LEFT AFTER SYSTOLE
-Ventricles must use more force to contract resulting on thickening of the myocardium
(concentric hypertrophy) eventually leading to the muscle wearing out.
- cardiac performance will decrease
, NOTE: STENOSIS, HYPERTENSION (SYSTEMIC AND PHTN), COARCTATION OF
AORTA INCREASES AFTERLOAD- RESISTANCE TO THE EJECTION OF BLOOD
(OUTSIDE FORCES PUSHING IN ON THER CHAMBER)
HYPERTROPHY (CONSTRICTIVE HYPERTROPHY) ARE THE MAIN ECHO
FINDINGS IN INCREASED
✔✔What happens during preload? - ✔✔Preload is defined as the volume of blood in the
Left Ventricle at end-diastole (EDP or EDV)
- The amount of blood available to eject
- The maximum stretch of the muscle fibers at end-diastole
The heart responds to increased preload by an increase in
CONTRACTILITY AND OVER TIME DILITATION
NOTE: REGURGITATION, SHUNTS,VOLUME OVERLOAD INCREASES PRELOAD
**DILITATION IS THE MAIN ECHO FINDING IN INCREASED PRELOAD
✔✔Describe the blood flow in the systemic circulation - ✔✔Left Atria Left Ventricle
Aortic Valve all arteries/veins throughout body back through IVC/SVC/CS Right Atria
✔✔Filling of the coronary arteries with blood occurs during.... - ✔✔Diastole
✔✔Effects of left heart failure - ✔✔Blood backs up to lungs and patient has shortness of
breath
✔✔Right heart failure - ✔✔The heart does not adequately circulate blood to the
pulmonic system. Can be due to volume overload or regurgitation in Tricuspid Valve or
Pulmonic Valve.
Can lead to systemic edema, back up of blood in liver and lower extremities
✔✔If you have pulmonary edema, it is the _____ heart that is affected? - ✔✔Left
✔✔Left heart failure - ✔✔The heart does not adequately circulate blood to systemic
system. Due to pressure overload or volume overload
✔✔The endocardial cushions contribute to the closure of the ostium primum and the
membranous septum and form the ______ and ______ leaflets - ✔✔Anterior mitral
valve leaflet and septal tricuspid leaflet
✔✔If you have peripheral edema, it is the _____ heart that is affected? - ✔✔Right
✔✔You will see jugular venous distention with? - ✔✔right heart failure
✔✔The primary cause of R heart failure is - ✔✔left heart failure
✔✔Right heart failure due to intrinsic pulmonary disease? - ✔✔Cor pulmonale
