CCI ECHO REVIEW 2023, With Complete
Solution
In PLAX, which TV leaflets are seen?
Anterior and medial/ septal
Posterior can only be seen in RVIT plax
The coronary Arteries come off the?
Sinuses of Valsalva
What is the structure under the arch?
Right Pulmonary Artery
The formula for calculating EF is:
EDV-ESV / EDV x 100
Stroke Volume
EDV-ESV
The LA dimension is measured on M=mode during?
End -systole
Where are the pulmonary veins located?
Can be seen in Apical 4 chamber w/inferior angulation.
How do you bring in the RVIT in PLAX?
Angle Medial and Inferior from Aortic Root. TV
How do you bring in the RVOT in PLAX?
Angle Lateral and Superior from Aortic root. PV
Where is the Chiari Network located?
RA
Where is the aortic isthmus located?
Area between the left subclavian and the ductus arteriosus(where most coarctations occur)Sinus
of Valsalva is the most common area of dissections).
The ____ is the most anterior chamber of the heart?
RV
Pulmonary artery is _____, _____
anterior, superior
The Eustachian valve is located in the?
IVC
Can you see the moderator band in the PLAX?
No- Moderator band is located in the RV
Where does the moderator band extend?
From the lower intraventricular septum to the anterior wall where it joins the papillary muscle.
Spontaneous chordal rupture more often occurs on which leaflet of the Mitral Valve?
Posterior
Also psterior medial papillary muscle
Single blood supply to posterior wall
The heart tube normally loops?
,Anterior and to the right
Where is the coronary sinus located in relation to the descending aorta
The coronary sinus is located anterior to the descending aorta. If the coronary sinus is dilated, it
can be mistaken for the descending aorta.
How would you angle to view the coronary sinus in the apical four chamber view?
From the apical four chamber you you would angle inferior in order to visualize the coronary
sinus, which is located posterior to the mitral annulus.
Why is it important to know the location of the coronary sinus and the descending aorta?
Pericardial Effusions lie posterior to the coronary sinus and anterior to the descending aorta.
Pleural effusions lie posterior to the descending aorta.
What is another name for the RVOT?
Infundibulum
Where is the coronary sinus located in the parasternal long axis view?
The coronary sinus lies in the posterior AV groove. This groove is located between the LA and
LV walls and lies posterior to be MV. In the parasternal long axis view, the coronary sinus can
sometimes be seen as a small echo free circle.
What would cause the coronary sinus to become dilated?
The coronary sinus dialates due to increased pressure in the RA, increased flow to coronary
sinus.
Describe the anatomy of the tricuspid valve, including the name and location if each leaflet.
Location is between the Right atria and right ventricle.
It has three leaflets: anterior, posterior, and medial or (septal) leaflets.
The names reflect the anatomical relationship to the right ventricle. The medial leaflet is
connected to the septal wall. It's insertion is located closer to the cardiac apex than that of the
anterior mitral valve leaflet.
Name and describe two main layers of the pericardium?
Often referred to as 2 main layers as visceral and parietal. This visceral layer lies directly upon
external surface of the heart and is commonly referred as the epicardium. The parietal or fibrous
pericardium is the thick outer sac. Pericardial cavity lies between the two layers.
Anatomically 3 layers are: serous visceral, serous parietal, fibrous pericardium.
Name the three major coronary arteries.
The three major coronary arteries are the right, left ant descending (LAD), and the circumflex
arteries
The heart tube loops _______ at day ____
The heart tube loops ANTERIORLY and RIGHTWARD at day 22
The AV canal is a large communication between the __________ and ________
Primitive atria and primitive ventricle
The ________ divides the AV canal into right and left AV orifices
Endocardial cushions
The ductus arteriosus closes after birth due to increased systemic pressure and becomes the
_______
Ligamentum arteriosum
What are the two Right to Left shunts in the normal fetal circulation?
Foreman ovale
Ductus arteriosus
,Following electrical depolarization of the myocardial cell membrane, which ion rushes in
first and which ion rushes in later?
Sodium is a rest
* Calcium is 2nd and responsible for contraction
Where is a subaortic membrane (DSS) located?
just below the Aortic Valve
Tricuspid Valve leaflets seen in the PSAX-Aortic valve
Medial (septal)
Anterior
Name the cardiac walls supplied by each of the coronary arteries.
Normally, the major coronary arteries supply the cardiac walls as follows (based on the ASE 17
segment model):
right coronary artery
a) inferior wall
b) inferoseptal
c) right ventricular apex
d) right ventricular free wall.
**RIGHT= inferior, septals, right
Left anterior descending artery - LAD
a) anterior wall
b) anteroseptal
c) left ventricular apex
**LEFT = anterior, apical, left
Circumflex artery
a) anterior lateral wall
b) inferolateral wall
CIRC = laterals
What walls do the LAD supply?
Anterior IVS, Anterior Left Ventricle and Apex
What walls do the CX supply?
Anterolateral and inferolateral
What walls do the Posterior descending artery supply?
Inferior Left Ventricle, Inferior Right Ventricle and Inferior IVS
The LAD lies in the _______ interventricular sulcus?
anterior
walls and coronary artery circulation on PLAX?.
1. anterior RVOT - RCA
2. anterior IVS - LAD
3. inferolateral - CX/RCA
walls and coronary artery circulation on PSAX?
1. anterior IVS - LAD
2. anterior - LAD
3. anterolateral - CX/LAD
4. inferolateral - CX/RCA
, 5. inferior - Posterior descending
6. inferior IVS - Posterior descending /LAD
walls and coronary artery circulation A4?
1. anterolateral - CX/LAD
2. apex - LAD
3. inferior IVS - LAD/RCA
4. lateral Right Ventricle - RCA
walls and coronary artery circulation Apical 2 Ch?
1. anterior - LAD
2. apex - LAD
3. inferior - Posterior descending artery (of the RCA)
The circumflex artery supplies?
anterolateral and inferolateral walls
The Posterior descending artery ( of the right coronary artery) supplies?
inferior Left Ventricle, inferior Right Ventricle and inferior IVS
The anterior septum and anterior wall of the Left Ventricle is supplied by the?
LAD
The anterolateral, lateral and inferolateral walls of the Left Ventricle are supplied by the?
Circumflex
The inferior wall of the Left Ventricle and inferior septum are supplied by the?
Posterior descending artery
The cardiac apex is supplied by the?
LAD
Which coronary artery provides blood to the Right Ventricle?
RCA
Which coronary artery provides blood to the inferior septal walls in right dominant?
Posterior descending artery
Which walls of the left ventricle are seen in the parasternal and apical long axis views
Which two aortic valve leaflets are seen in these views?
The anterior septal and the inferolateral walls of the LV are seen in the parasternal apical long
axis Views.
The right & non coronary leaflets are seen in these views. The right leaflet is on top (superior)
and the non-coronary is on the bottom (inferior)
Where are the coronary arteries located on the surface of the heart?
The coronary arteries are located on the outer, epicardial surface of the heart as follows:
the right coronary artery (RCA) arises from the right aortic root sinus, follows the right
atrioventricular junction, and to descends along the posterior interventricular groove.
The left anterior descending coronary artery (LAD) follows the Anterior interventricular groove.
The circumflex coronary artery's or courses along the left AV junction.
Complications with MI?
1. pericarditis/PE
2. Dressler's syndrome (PE post MI)
3. Left Ventricle true aneurysm
4. Left Ventricle false or pseudo aneurysm
5. Left Ventricle thrombus
6. Ventricular septal defect
Solution
In PLAX, which TV leaflets are seen?
Anterior and medial/ septal
Posterior can only be seen in RVIT plax
The coronary Arteries come off the?
Sinuses of Valsalva
What is the structure under the arch?
Right Pulmonary Artery
The formula for calculating EF is:
EDV-ESV / EDV x 100
Stroke Volume
EDV-ESV
The LA dimension is measured on M=mode during?
End -systole
Where are the pulmonary veins located?
Can be seen in Apical 4 chamber w/inferior angulation.
How do you bring in the RVIT in PLAX?
Angle Medial and Inferior from Aortic Root. TV
How do you bring in the RVOT in PLAX?
Angle Lateral and Superior from Aortic root. PV
Where is the Chiari Network located?
RA
Where is the aortic isthmus located?
Area between the left subclavian and the ductus arteriosus(where most coarctations occur)Sinus
of Valsalva is the most common area of dissections).
The ____ is the most anterior chamber of the heart?
RV
Pulmonary artery is _____, _____
anterior, superior
The Eustachian valve is located in the?
IVC
Can you see the moderator band in the PLAX?
No- Moderator band is located in the RV
Where does the moderator band extend?
From the lower intraventricular septum to the anterior wall where it joins the papillary muscle.
Spontaneous chordal rupture more often occurs on which leaflet of the Mitral Valve?
Posterior
Also psterior medial papillary muscle
Single blood supply to posterior wall
The heart tube normally loops?
,Anterior and to the right
Where is the coronary sinus located in relation to the descending aorta
The coronary sinus is located anterior to the descending aorta. If the coronary sinus is dilated, it
can be mistaken for the descending aorta.
How would you angle to view the coronary sinus in the apical four chamber view?
From the apical four chamber you you would angle inferior in order to visualize the coronary
sinus, which is located posterior to the mitral annulus.
Why is it important to know the location of the coronary sinus and the descending aorta?
Pericardial Effusions lie posterior to the coronary sinus and anterior to the descending aorta.
Pleural effusions lie posterior to the descending aorta.
What is another name for the RVOT?
Infundibulum
Where is the coronary sinus located in the parasternal long axis view?
The coronary sinus lies in the posterior AV groove. This groove is located between the LA and
LV walls and lies posterior to be MV. In the parasternal long axis view, the coronary sinus can
sometimes be seen as a small echo free circle.
What would cause the coronary sinus to become dilated?
The coronary sinus dialates due to increased pressure in the RA, increased flow to coronary
sinus.
Describe the anatomy of the tricuspid valve, including the name and location if each leaflet.
Location is between the Right atria and right ventricle.
It has three leaflets: anterior, posterior, and medial or (septal) leaflets.
The names reflect the anatomical relationship to the right ventricle. The medial leaflet is
connected to the septal wall. It's insertion is located closer to the cardiac apex than that of the
anterior mitral valve leaflet.
Name and describe two main layers of the pericardium?
Often referred to as 2 main layers as visceral and parietal. This visceral layer lies directly upon
external surface of the heart and is commonly referred as the epicardium. The parietal or fibrous
pericardium is the thick outer sac. Pericardial cavity lies between the two layers.
Anatomically 3 layers are: serous visceral, serous parietal, fibrous pericardium.
Name the three major coronary arteries.
The three major coronary arteries are the right, left ant descending (LAD), and the circumflex
arteries
The heart tube loops _______ at day ____
The heart tube loops ANTERIORLY and RIGHTWARD at day 22
The AV canal is a large communication between the __________ and ________
Primitive atria and primitive ventricle
The ________ divides the AV canal into right and left AV orifices
Endocardial cushions
The ductus arteriosus closes after birth due to increased systemic pressure and becomes the
_______
Ligamentum arteriosum
What are the two Right to Left shunts in the normal fetal circulation?
Foreman ovale
Ductus arteriosus
,Following electrical depolarization of the myocardial cell membrane, which ion rushes in
first and which ion rushes in later?
Sodium is a rest
* Calcium is 2nd and responsible for contraction
Where is a subaortic membrane (DSS) located?
just below the Aortic Valve
Tricuspid Valve leaflets seen in the PSAX-Aortic valve
Medial (septal)
Anterior
Name the cardiac walls supplied by each of the coronary arteries.
Normally, the major coronary arteries supply the cardiac walls as follows (based on the ASE 17
segment model):
right coronary artery
a) inferior wall
b) inferoseptal
c) right ventricular apex
d) right ventricular free wall.
**RIGHT= inferior, septals, right
Left anterior descending artery - LAD
a) anterior wall
b) anteroseptal
c) left ventricular apex
**LEFT = anterior, apical, left
Circumflex artery
a) anterior lateral wall
b) inferolateral wall
CIRC = laterals
What walls do the LAD supply?
Anterior IVS, Anterior Left Ventricle and Apex
What walls do the CX supply?
Anterolateral and inferolateral
What walls do the Posterior descending artery supply?
Inferior Left Ventricle, Inferior Right Ventricle and Inferior IVS
The LAD lies in the _______ interventricular sulcus?
anterior
walls and coronary artery circulation on PLAX?.
1. anterior RVOT - RCA
2. anterior IVS - LAD
3. inferolateral - CX/RCA
walls and coronary artery circulation on PSAX?
1. anterior IVS - LAD
2. anterior - LAD
3. anterolateral - CX/LAD
4. inferolateral - CX/RCA
, 5. inferior - Posterior descending
6. inferior IVS - Posterior descending /LAD
walls and coronary artery circulation A4?
1. anterolateral - CX/LAD
2. apex - LAD
3. inferior IVS - LAD/RCA
4. lateral Right Ventricle - RCA
walls and coronary artery circulation Apical 2 Ch?
1. anterior - LAD
2. apex - LAD
3. inferior - Posterior descending artery (of the RCA)
The circumflex artery supplies?
anterolateral and inferolateral walls
The Posterior descending artery ( of the right coronary artery) supplies?
inferior Left Ventricle, inferior Right Ventricle and inferior IVS
The anterior septum and anterior wall of the Left Ventricle is supplied by the?
LAD
The anterolateral, lateral and inferolateral walls of the Left Ventricle are supplied by the?
Circumflex
The inferior wall of the Left Ventricle and inferior septum are supplied by the?
Posterior descending artery
The cardiac apex is supplied by the?
LAD
Which coronary artery provides blood to the Right Ventricle?
RCA
Which coronary artery provides blood to the inferior septal walls in right dominant?
Posterior descending artery
Which walls of the left ventricle are seen in the parasternal and apical long axis views
Which two aortic valve leaflets are seen in these views?
The anterior septal and the inferolateral walls of the LV are seen in the parasternal apical long
axis Views.
The right & non coronary leaflets are seen in these views. The right leaflet is on top (superior)
and the non-coronary is on the bottom (inferior)
Where are the coronary arteries located on the surface of the heart?
The coronary arteries are located on the outer, epicardial surface of the heart as follows:
the right coronary artery (RCA) arises from the right aortic root sinus, follows the right
atrioventricular junction, and to descends along the posterior interventricular groove.
The left anterior descending coronary artery (LAD) follows the Anterior interventricular groove.
The circumflex coronary artery's or courses along the left AV junction.
Complications with MI?
1. pericarditis/PE
2. Dressler's syndrome (PE post MI)
3. Left Ventricle true aneurysm
4. Left Ventricle false or pseudo aneurysm
5. Left Ventricle thrombus
6. Ventricular septal defect
