cci review echo 2 Questions &Answers
Right leaflet (the posterior leaflet is the non coronary) - ANSWERSWhich aortic leaflet is
the superior one in the parasternal long axis view?
Pulmonary artery - ANSWERSFrom the left parasternal window which of the following
are you most likely to get accurate velocity measurements?
Anterior and medial/ septal
Posterior can only be seen in RVIT plax - ANSWERSIn the parasternal short axis view
(PSAX), which tricuspid leaflets are seen
Sometimes in the parasternal SAX Aortic Valve level
(Typically seen in the apical 2ch)
Normal LAA Velocity 46 cm/ sec? - ANSWERSWhere is the LAA on TTE?
Sinuses of Valsalva - ANSWERSThe coronary arteries come off the?
Early diastole - ANSWERSDuring which phase do the coronaries fill?
Right pulmonary artery - ANSWERSWhat is the structure under the arch?
Coarctation of the aorta (80%)
NOTE: coarctation , MVP, and AO dissections, bicuspid AOV are all related to Marfans
Systolic click ejection= bicuspid AoV
Mid Systolic click = MVP
**TURNERS SYNDROME = MVP AND coarctation - ANSWERSWhat cardiac pathology
is associated with bicuspid aortic valve?
Right and left superior (upper) pulmonary veins inferior to the LV
NOTE: Can be seen on apical 4 chamber w/ inferior angulation. - ANSWERSWhere are
the pulmonary veins located?
Right Atrium
The chiari network is the Fenestrated portion of the Eustachian valve
it is located in the Right Atrium - ANSWERSWhere is the Chiari network (system)
located?
,TTE: 2-7 MHz
TEE: 5-7MHz - ANSWERSWhat frequency is usually used for TTE and TEE?
40-50C or the highest temperature - ANSWERSAt what temperature is it unsafe to use
a TEE probe?
That period when a muscle cell is not excitable- from phase I until into phase 3 the
"relative refractory period" is during phase 3 and the muscle cell might contract if the
stimulus is strong. - ANSWERSWhat is absolute refractory state?
Includes P-R segment (from atrial to ventricular depolarization) - ANSWERSWhat does
the P-R interval represent?
0.10 sec. - ANSWERSWhat is a normal duration for the QRS complex?
Hyper-contractile (Regurgitation increases preload, muscle tension/contractility
increases and eventually results in dilitation, Volume overloads - ANSWERSAcute
Aortic Insufficiency or Aortic regurgitation is _____ because we shift up the Starling
curve.
Failure - ANSWERSChronic Aortic Insufficiency or Aortic regurgitation is _____ when
we drop off the end.
Yes-when the shunt is Left to Right. - ANSWERSDoes a PDA increase Left Ventricle
preload?
CO=HR x CSA OR CO=SV x HR
Normal is 4-8 L/min depending on BSA
SV/EDV x 100 - ANSWERSCalculate CO:
4V2 NOTE: THIS EQUATION IS USED TO CHANGE VELOCITY TO PRESSURES -
ANSWERSWhat is the Bernoulli equation?
(0.5x0.5=.025 and 0.25x4=1
1mmHg NOTE: 4(0.5)2 BORNOULIS EQUATION TO CONVERT VELOCITIES TO
PRESSURES, ALSO USES THE 4 M/S = 64 mmHg - ANSWERSWith a velocity of
0.5m/sec what is the gradient?
Doppler stroke volume or SV=VTI X CSA - ANSWERSWhat does VTI (velocity time
integral) and CSA (cross-sectional area) equal?
Decreases
Note: Tricuspid Valve velocity increases with inspiration
,REMEMBER I=IV ( Increase on Inspiration in VENOUS) The revers is true for the left
systemic side. Inspiration causes decreases on the left side - ANSWERSMitral valve
velocity during inspiration?
Decreased after load
-Vasodilator
-BP drops
-less blood comes back
-HR increases
Decreases vascular resistance. Increases forward flow murmurs decreases AR/MR
( retro flow murmurs) - ANSWERSInhalation of amyl nitrite causes?
After R wave=Isovolemic contraction
After T wave=Isovolemic relaxation - ANSWERSWhat is the Isovolemic timing on the
ECG?
Aortic valve open - ANSWERSDuring the cardiac cycle this event NEVER happens?
The valve is open - ANSWERSWhat is the Aortic valve doing during the Q-T interval?
70 ms - ANSWERSWhat is the duration of IVRT and IVCT?
-Starts Mitral Valve close
-Ends Aortic Valve Opens
-70 ms duration - ANSWERSValve event
-Starts Aortic close
-Ends- Mitral Valve opens
-70 ms duration (time decreases in bradycardia) - ANSWERSvalve event
Early diastole - ANSWERSWhen is Left Ventricle pressure the lowest?
Left Ventricle angiogram
Angiographic techniques multiple SV x HR - ANSWERSBest cath technique for Left
Ventricle function?
Left atrial pressure - ANSWERSWhat is PCW (pulmonary capillary wedge) measuring?
One in the Left Ventricle and one in the aorta or one in the Left Ventricle and "pulled
back" across the Aortic Valve or one catheter with two separate sensors - ANSWERSTo
determine Aortic Stenosis where catheters are places?
Thicker valve leaflets - ANSWERSWhat does Tissue Harmonic Imaging result in?
, Left ventricular hypertrophy
Note: Stenosis is a Afterload which leads to hypertrophy - ANSWERSA secondary
finding in aortic stenosis is?
Narrow
(Pulse pressure is the difference between systolic and diastolic pressures-it is wide in
Aortic Insufficiency ( Aortic regurgitation) and narrow in Aortic Stenosis - ANSWERSIn
aortic stenosis is pulse pressure wide or narrow?
Also called aortic arch syndrome this disease occurs more in young women from Asia.
There is fibrosis of the arch and descending Aortic of unknown etiology. In advances
stated multiple Coarctations may occur (look for Supravalvular Aortic Stenosis). -
ANSWERSWhat is Takayasu's arteritis?
3-4cm2
less than 1 is severe stenosis - ANSWERSThe normal aortic valve area is:
VTI works better in patients with poor Left Ventricle function and when moderate to
severe Aortic Insufficiency or Aortic regurgitation is present than peak velocities. -
ANSWERSWhen does VTI work better?
LVOT measured too large - ANSWERSUsing the continuity equation when would the
severity of Aortic Stenosis be underestimated?
Peak instantaneous (echo) and versus peak-to-peak (cath ) - ANSWERSKnow that
echo gradients are usually higher than cath gradients.
Classified as a cardiofacial syndrome with Pulmonic Stenosis, HCM and ASD (30%) -
ANSWERSWhat is Noonan Syndrome?
... - ANSWERSKnow that Pulmonic Stenosis does NOT cause pulmonary hypertension.
Subcostal short-axis - ANSWERSAsked if unable to obtain Pulmonic Stenosis gradient
from the parasternal window where else you can go?
Parachute mitral valve
NOTE: MOST COMMON FORM OF CONGENITAL MITRAL STENOSIS--it is a rare
cause of mitral stenosis
Remember that in pediatric question this is not a valid answer - ANSWERSWhich type
of mitral deformity occurs where there is only ONE PAPILLARY MUSCLE into which
both chordae insert
OR insertion of mitral chord into a single papillary muscle?
C. Left ventricular dilatation-
Right leaflet (the posterior leaflet is the non coronary) - ANSWERSWhich aortic leaflet is
the superior one in the parasternal long axis view?
Pulmonary artery - ANSWERSFrom the left parasternal window which of the following
are you most likely to get accurate velocity measurements?
Anterior and medial/ septal
Posterior can only be seen in RVIT plax - ANSWERSIn the parasternal short axis view
(PSAX), which tricuspid leaflets are seen
Sometimes in the parasternal SAX Aortic Valve level
(Typically seen in the apical 2ch)
Normal LAA Velocity 46 cm/ sec? - ANSWERSWhere is the LAA on TTE?
Sinuses of Valsalva - ANSWERSThe coronary arteries come off the?
Early diastole - ANSWERSDuring which phase do the coronaries fill?
Right pulmonary artery - ANSWERSWhat is the structure under the arch?
Coarctation of the aorta (80%)
NOTE: coarctation , MVP, and AO dissections, bicuspid AOV are all related to Marfans
Systolic click ejection= bicuspid AoV
Mid Systolic click = MVP
**TURNERS SYNDROME = MVP AND coarctation - ANSWERSWhat cardiac pathology
is associated with bicuspid aortic valve?
Right and left superior (upper) pulmonary veins inferior to the LV
NOTE: Can be seen on apical 4 chamber w/ inferior angulation. - ANSWERSWhere are
the pulmonary veins located?
Right Atrium
The chiari network is the Fenestrated portion of the Eustachian valve
it is located in the Right Atrium - ANSWERSWhere is the Chiari network (system)
located?
,TTE: 2-7 MHz
TEE: 5-7MHz - ANSWERSWhat frequency is usually used for TTE and TEE?
40-50C or the highest temperature - ANSWERSAt what temperature is it unsafe to use
a TEE probe?
That period when a muscle cell is not excitable- from phase I until into phase 3 the
"relative refractory period" is during phase 3 and the muscle cell might contract if the
stimulus is strong. - ANSWERSWhat is absolute refractory state?
Includes P-R segment (from atrial to ventricular depolarization) - ANSWERSWhat does
the P-R interval represent?
0.10 sec. - ANSWERSWhat is a normal duration for the QRS complex?
Hyper-contractile (Regurgitation increases preload, muscle tension/contractility
increases and eventually results in dilitation, Volume overloads - ANSWERSAcute
Aortic Insufficiency or Aortic regurgitation is _____ because we shift up the Starling
curve.
Failure - ANSWERSChronic Aortic Insufficiency or Aortic regurgitation is _____ when
we drop off the end.
Yes-when the shunt is Left to Right. - ANSWERSDoes a PDA increase Left Ventricle
preload?
CO=HR x CSA OR CO=SV x HR
Normal is 4-8 L/min depending on BSA
SV/EDV x 100 - ANSWERSCalculate CO:
4V2 NOTE: THIS EQUATION IS USED TO CHANGE VELOCITY TO PRESSURES -
ANSWERSWhat is the Bernoulli equation?
(0.5x0.5=.025 and 0.25x4=1
1mmHg NOTE: 4(0.5)2 BORNOULIS EQUATION TO CONVERT VELOCITIES TO
PRESSURES, ALSO USES THE 4 M/S = 64 mmHg - ANSWERSWith a velocity of
0.5m/sec what is the gradient?
Doppler stroke volume or SV=VTI X CSA - ANSWERSWhat does VTI (velocity time
integral) and CSA (cross-sectional area) equal?
Decreases
Note: Tricuspid Valve velocity increases with inspiration
,REMEMBER I=IV ( Increase on Inspiration in VENOUS) The revers is true for the left
systemic side. Inspiration causes decreases on the left side - ANSWERSMitral valve
velocity during inspiration?
Decreased after load
-Vasodilator
-BP drops
-less blood comes back
-HR increases
Decreases vascular resistance. Increases forward flow murmurs decreases AR/MR
( retro flow murmurs) - ANSWERSInhalation of amyl nitrite causes?
After R wave=Isovolemic contraction
After T wave=Isovolemic relaxation - ANSWERSWhat is the Isovolemic timing on the
ECG?
Aortic valve open - ANSWERSDuring the cardiac cycle this event NEVER happens?
The valve is open - ANSWERSWhat is the Aortic valve doing during the Q-T interval?
70 ms - ANSWERSWhat is the duration of IVRT and IVCT?
-Starts Mitral Valve close
-Ends Aortic Valve Opens
-70 ms duration - ANSWERSValve event
-Starts Aortic close
-Ends- Mitral Valve opens
-70 ms duration (time decreases in bradycardia) - ANSWERSvalve event
Early diastole - ANSWERSWhen is Left Ventricle pressure the lowest?
Left Ventricle angiogram
Angiographic techniques multiple SV x HR - ANSWERSBest cath technique for Left
Ventricle function?
Left atrial pressure - ANSWERSWhat is PCW (pulmonary capillary wedge) measuring?
One in the Left Ventricle and one in the aorta or one in the Left Ventricle and "pulled
back" across the Aortic Valve or one catheter with two separate sensors - ANSWERSTo
determine Aortic Stenosis where catheters are places?
Thicker valve leaflets - ANSWERSWhat does Tissue Harmonic Imaging result in?
, Left ventricular hypertrophy
Note: Stenosis is a Afterload which leads to hypertrophy - ANSWERSA secondary
finding in aortic stenosis is?
Narrow
(Pulse pressure is the difference between systolic and diastolic pressures-it is wide in
Aortic Insufficiency ( Aortic regurgitation) and narrow in Aortic Stenosis - ANSWERSIn
aortic stenosis is pulse pressure wide or narrow?
Also called aortic arch syndrome this disease occurs more in young women from Asia.
There is fibrosis of the arch and descending Aortic of unknown etiology. In advances
stated multiple Coarctations may occur (look for Supravalvular Aortic Stenosis). -
ANSWERSWhat is Takayasu's arteritis?
3-4cm2
less than 1 is severe stenosis - ANSWERSThe normal aortic valve area is:
VTI works better in patients with poor Left Ventricle function and when moderate to
severe Aortic Insufficiency or Aortic regurgitation is present than peak velocities. -
ANSWERSWhen does VTI work better?
LVOT measured too large - ANSWERSUsing the continuity equation when would the
severity of Aortic Stenosis be underestimated?
Peak instantaneous (echo) and versus peak-to-peak (cath ) - ANSWERSKnow that
echo gradients are usually higher than cath gradients.
Classified as a cardiofacial syndrome with Pulmonic Stenosis, HCM and ASD (30%) -
ANSWERSWhat is Noonan Syndrome?
... - ANSWERSKnow that Pulmonic Stenosis does NOT cause pulmonary hypertension.
Subcostal short-axis - ANSWERSAsked if unable to obtain Pulmonic Stenosis gradient
from the parasternal window where else you can go?
Parachute mitral valve
NOTE: MOST COMMON FORM OF CONGENITAL MITRAL STENOSIS--it is a rare
cause of mitral stenosis
Remember that in pediatric question this is not a valid answer - ANSWERSWhich type
of mitral deformity occurs where there is only ONE PAPILLARY MUSCLE into which
both chordae insert
OR insertion of mitral chord into a single papillary muscle?
C. Left ventricular dilatation-
