ARDMS ECHO EVALUATION EXAMS ANSWERS AND
QUESTIONS SET A+
✔✔Early diastolic murmurs are due to what - ✔✔AI and/ or PI--- severity of regurg is
often inversely related to the duration of the murmur. With severe regurg Ao diastolic
pressure falls rapidly.
✔✔Increased pain with changing positions are taking deep breaths, severe chest
(precordial) pain are signs of what? - ✔✔Pericarditis
✔✔T/F Females slightly more effected by myxomas compared to males - ✔✔True
✔✔Symptoms of MVP - ✔✔Palpitations, sharp pain unrelated to exercise, Fatigue,
Dyspnea, Dizzy Spells
✔✔Can cause turbulent flow of blood in the aorta, - ✔✔increase CO
✔✔In normal (laminar) BF, the velocity of the flow is highest where? - ✔✔Center Stream
✔✔The system control that automatically calibrates for measurements? - ✔✔Depth
control
✔✔Increasing gain will ___- specular echoes and ___ artifacts - ✔✔Increase, Increase
✔✔What is the purpose of TGC's? - ✔✔1. Suppress near field echoes
2. Enhance far field echoes
3. Compensate for loss of ultrasound energy (attenuation)
✔✔T/F inspiration can affect SAM - ✔✔False--- neither inspiration or expiration affects
SAM
✔✔T/F valsalva and amyl nitrite can bring out SAM - ✔✔True
,✔✔The optimal Doppler angle is ----- degrees or ----- degrees. - ✔✔0 to 180
✔✔T/F the posterior leaflet of the MV is smaller than the anterior MV leaflet - ✔✔True
✔✔MV E-F slope can give indications for which diseases - ✔✔MS, and LV function
✔✔What is the mitral apparatus composed of? - ✔✔1. MV leaflets
2. Chordae Tendinae
3. Paps
4. Annulus
✔✔On M-Mode an increase in the A-C interval suggests what? - ✔✔Increased LVEDP
and possible poor LV function
✔✔How does lateral resolution affect measurements? - ✔✔Lateral resolution can make
lateral and medial walls appear wider. Axial resolution has no effect on measurements
✔✔Too high of gain can make orifice appear too _____ - ✔✔small
✔✔Following a commissuretomy of MV a valve orifice can be accurately evaluated
using what technique - ✔✔Doppler by using P1/2t
✔✔M-mode findings with Mitral Reurgitation? - ✔✔1. LAE
2. LVE
3. LVVO (hyperkinesis of the Left Ventricle walls w/Left Ventricle ventricular dilatation)
Note: regurgitation = preload = dilation = volume
✔✔myxomatous degeneration - ✔✔thickening of the MV leaflets (often seen in MVP)
✔✔MAC may obscure - ✔✔1. anterior Mitral Valve leaflet
2. Posterior Mitral Valve leaflet
3. Endocardial echoes caused by acoustic shadowing
✔✔How are MR and TR easily differentiated on Doppler - ✔✔1. Difference in timing of
the valve opening and closing
2. Different location of the jets
3. Different direction of the jets
4. different in forward flow velocity curves
✔✔The normal brief posterior displacement of the IVS with the onset of diastole
(diastolic dip) may be exaggerated in what condition? - ✔✔MS-- early diastolic LV filling
is restricted where as the RV fills rapidly. Therefore the septum bulges toward the LV in
early diastole.
,✔✔What is MV leaflet motion influenced by - ✔✔1. relative pressures in the LA and LV
2. velocity and lood volume of blood flow through the mitral orifice
3. LV diastolic compliance
4. systolic performance of the LV
✔✔What is the common secondary finding of AS - ✔✔LVH
✔✔why does AS lead to LVH - ✔✔systolic pressure overload, increase in afterload (
LVEDp) which leads to increase in LA pressure
✔✔Which valve separates the areas of greatest pressure difference? - ✔✔MV
✔✔The only standard view in which you see the posterior TV leaflet? - ✔✔PLAX RVIT
✔✔TV leaflets seen in the PSAX-AoV - ✔✔Medial (septal)
Anterior
✔✔Severe ---- is suggested when holodiastolic flow reversal is seen in the DAO. - ✔✔AI
✔✔How can you differentiate between MR and LVOT Doppler traces? - ✔✔MR duration
is longer than LVOT
✔✔Common systolic hypertension findings include - ✔✔Aortic dilation
Aortic Stenosis
Concentric Left Ventricular Hypertrophy
✔✔A patient with constrictive pericarditis the MV inflow Doppler will have an E velocity
that is --- by ---% with -----. - ✔✔Decreased by >25% w/ INSPIRATION
✔✔Smaller size prosthetic valves give ____ Doppler velocities - ✔✔Higher, smaller the
size the smaller the office- increased velocity
✔✔What happens to CO with MS? - ✔✔It decreases
CO=HR x CSA
Causes a reduced filling and decreases output
✔✔T/F prosthetic valves have a higher velocity than native valves - ✔✔True
✔✔T/F MS = PHTN - ✔✔True
✔✔auscultory sound of AS - ✔✔Decreased/absent A2
✔✔Bicuspid valve signs - ✔✔1. Eccentric m-mode closure (25% will be normal)
, 2. Thick leaflets
3. SYSTOLIC DOMING LAX
4. FOOTBALL SHAPES SAX
5. COARCTATION OF AO ( 50-80%)
6. post stenotic dilation
7. Left Ventrincular Hypertrophy
8. SYSTOLIC EJECTION CLICK
✔✔What is the Best view to check for subvalvular membranes? - ✔✔AP5CH
✔✔Pt BP is 110/84, AoV velocity is 5 m/sec
What is the peak LV pressure of this pt - ✔✔210 mmHg
SBP + Ao Gradient
4(5)2 = 100mmHg
100 + 110 = 210 mmHg
✔✔VTI works better in what type of patients? - ✔✔Patients with poor Left Ventricle
function and when moderate to severe Aortic Insufficiency or Aortic reurgitation is
present.
✔✔Which pressure is obtained during Doppler? - ✔✔Peak to Peak instantaneous
✔✔Signs of AS - ✔✔1. LVH
2. Increased gradient
3. decreased valve area
✔✔M-mode indicators of PS - ✔✔INCREASED "a" wave on PV. more than 7 mm.
"a" is exaggerated in PS ----it disappears in PHTN
✔✔Does PS cause PHTN - ✔✔NO!!!
✔✔Most common cause of MS - ✔✔Rheumatic (congenital rare)
✔✔Parachute leaflet= - ✔✔congenital MS RARE
✔✔Hockey stick leaflet= - ✔✔Rheumatic MS
✔✔CVP (central venous pressure) refers to the pressure in the ______ - ✔✔IVC
✔✔HV flow is _______ baseline - ✔✔primarliy BELOW baseline
✔✔In the absence of PS RVSP should equal what? - ✔✔PA pressure
QUESTIONS SET A+
✔✔Early diastolic murmurs are due to what - ✔✔AI and/ or PI--- severity of regurg is
often inversely related to the duration of the murmur. With severe regurg Ao diastolic
pressure falls rapidly.
✔✔Increased pain with changing positions are taking deep breaths, severe chest
(precordial) pain are signs of what? - ✔✔Pericarditis
✔✔T/F Females slightly more effected by myxomas compared to males - ✔✔True
✔✔Symptoms of MVP - ✔✔Palpitations, sharp pain unrelated to exercise, Fatigue,
Dyspnea, Dizzy Spells
✔✔Can cause turbulent flow of blood in the aorta, - ✔✔increase CO
✔✔In normal (laminar) BF, the velocity of the flow is highest where? - ✔✔Center Stream
✔✔The system control that automatically calibrates for measurements? - ✔✔Depth
control
✔✔Increasing gain will ___- specular echoes and ___ artifacts - ✔✔Increase, Increase
✔✔What is the purpose of TGC's? - ✔✔1. Suppress near field echoes
2. Enhance far field echoes
3. Compensate for loss of ultrasound energy (attenuation)
✔✔T/F inspiration can affect SAM - ✔✔False--- neither inspiration or expiration affects
SAM
✔✔T/F valsalva and amyl nitrite can bring out SAM - ✔✔True
,✔✔The optimal Doppler angle is ----- degrees or ----- degrees. - ✔✔0 to 180
✔✔T/F the posterior leaflet of the MV is smaller than the anterior MV leaflet - ✔✔True
✔✔MV E-F slope can give indications for which diseases - ✔✔MS, and LV function
✔✔What is the mitral apparatus composed of? - ✔✔1. MV leaflets
2. Chordae Tendinae
3. Paps
4. Annulus
✔✔On M-Mode an increase in the A-C interval suggests what? - ✔✔Increased LVEDP
and possible poor LV function
✔✔How does lateral resolution affect measurements? - ✔✔Lateral resolution can make
lateral and medial walls appear wider. Axial resolution has no effect on measurements
✔✔Too high of gain can make orifice appear too _____ - ✔✔small
✔✔Following a commissuretomy of MV a valve orifice can be accurately evaluated
using what technique - ✔✔Doppler by using P1/2t
✔✔M-mode findings with Mitral Reurgitation? - ✔✔1. LAE
2. LVE
3. LVVO (hyperkinesis of the Left Ventricle walls w/Left Ventricle ventricular dilatation)
Note: regurgitation = preload = dilation = volume
✔✔myxomatous degeneration - ✔✔thickening of the MV leaflets (often seen in MVP)
✔✔MAC may obscure - ✔✔1. anterior Mitral Valve leaflet
2. Posterior Mitral Valve leaflet
3. Endocardial echoes caused by acoustic shadowing
✔✔How are MR and TR easily differentiated on Doppler - ✔✔1. Difference in timing of
the valve opening and closing
2. Different location of the jets
3. Different direction of the jets
4. different in forward flow velocity curves
✔✔The normal brief posterior displacement of the IVS with the onset of diastole
(diastolic dip) may be exaggerated in what condition? - ✔✔MS-- early diastolic LV filling
is restricted where as the RV fills rapidly. Therefore the septum bulges toward the LV in
early diastole.
,✔✔What is MV leaflet motion influenced by - ✔✔1. relative pressures in the LA and LV
2. velocity and lood volume of blood flow through the mitral orifice
3. LV diastolic compliance
4. systolic performance of the LV
✔✔What is the common secondary finding of AS - ✔✔LVH
✔✔why does AS lead to LVH - ✔✔systolic pressure overload, increase in afterload (
LVEDp) which leads to increase in LA pressure
✔✔Which valve separates the areas of greatest pressure difference? - ✔✔MV
✔✔The only standard view in which you see the posterior TV leaflet? - ✔✔PLAX RVIT
✔✔TV leaflets seen in the PSAX-AoV - ✔✔Medial (septal)
Anterior
✔✔Severe ---- is suggested when holodiastolic flow reversal is seen in the DAO. - ✔✔AI
✔✔How can you differentiate between MR and LVOT Doppler traces? - ✔✔MR duration
is longer than LVOT
✔✔Common systolic hypertension findings include - ✔✔Aortic dilation
Aortic Stenosis
Concentric Left Ventricular Hypertrophy
✔✔A patient with constrictive pericarditis the MV inflow Doppler will have an E velocity
that is --- by ---% with -----. - ✔✔Decreased by >25% w/ INSPIRATION
✔✔Smaller size prosthetic valves give ____ Doppler velocities - ✔✔Higher, smaller the
size the smaller the office- increased velocity
✔✔What happens to CO with MS? - ✔✔It decreases
CO=HR x CSA
Causes a reduced filling and decreases output
✔✔T/F prosthetic valves have a higher velocity than native valves - ✔✔True
✔✔T/F MS = PHTN - ✔✔True
✔✔auscultory sound of AS - ✔✔Decreased/absent A2
✔✔Bicuspid valve signs - ✔✔1. Eccentric m-mode closure (25% will be normal)
, 2. Thick leaflets
3. SYSTOLIC DOMING LAX
4. FOOTBALL SHAPES SAX
5. COARCTATION OF AO ( 50-80%)
6. post stenotic dilation
7. Left Ventrincular Hypertrophy
8. SYSTOLIC EJECTION CLICK
✔✔What is the Best view to check for subvalvular membranes? - ✔✔AP5CH
✔✔Pt BP is 110/84, AoV velocity is 5 m/sec
What is the peak LV pressure of this pt - ✔✔210 mmHg
SBP + Ao Gradient
4(5)2 = 100mmHg
100 + 110 = 210 mmHg
✔✔VTI works better in what type of patients? - ✔✔Patients with poor Left Ventricle
function and when moderate to severe Aortic Insufficiency or Aortic reurgitation is
present.
✔✔Which pressure is obtained during Doppler? - ✔✔Peak to Peak instantaneous
✔✔Signs of AS - ✔✔1. LVH
2. Increased gradient
3. decreased valve area
✔✔M-mode indicators of PS - ✔✔INCREASED "a" wave on PV. more than 7 mm.
"a" is exaggerated in PS ----it disappears in PHTN
✔✔Does PS cause PHTN - ✔✔NO!!!
✔✔Most common cause of MS - ✔✔Rheumatic (congenital rare)
✔✔Parachute leaflet= - ✔✔congenital MS RARE
✔✔Hockey stick leaflet= - ✔✔Rheumatic MS
✔✔CVP (central venous pressure) refers to the pressure in the ______ - ✔✔IVC
✔✔HV flow is _______ baseline - ✔✔primarliy BELOW baseline
✔✔In the absence of PS RVSP should equal what? - ✔✔PA pressure
