Echo URR
While performing the PLAX views of the heart, you notice dilation of the aortic root.
Which 2D echo view will help best evaluate the extent of this aortic abnormality?
A) 5C
B) suprasternal long axis
C) subcostal short axis
D) A3 - ✔️✔️B) if the aortic root is dilated, the ascending, arch and descending aorta
should be evaluated. This is the best accomplished by using the suprasternal view. The
2C can also provide the additional views of the descending thoracic aorta.
When is imaging performed during a stress echo using a supine exercise bike?
A) within 30 sec after the cessation of exercise
B) within 60 sec after the cessation of exercise
C) during peak exercise
D) when the HR increases by 50% from the rest - ✔️✔️C) bc the supine exercise bike
is normally used for valvular assessment, imaging is performed at peak exercise to
obtain the peak velocity
Which of the following cardiac abnormalities requires the use of the continuity equation
for proper calculation of AVA? A) decreased LV function B) HOCM C) supravalvular AS
D) Transcatheter AVR - ✔️✔️A) decreased LV function; The continuity equation
compensates for the changes in LV function when calculating AVA. CW Doppler is used
to assess flow across the AV. Because CW Doppler has no range resolution, it cannot
determine the location of the elevated velocity. HOCM and supravalvular stenosis will
cause an improper AVA calculation b/c the stenosis is not at the valve. A transcatheter
AV replacement relies on the pressure gradients and the velocity ratio to assess
stenosis.
The mitral deceleration time is 300msec. What is the valve area? A) 1.3cm^2 B)
2.8cm^2 C) 2.5cm^2 D) 1.5cm^2 - ✔️✔️C) 2.5cm^2 MVA = 759 / deceleration time
Which of the following is preferred to document motion of the disk in a St. Jude valve? -
✔️✔️M-mode. M-mode is used to doc the MOTION of ball/disk in a mechanical valve.
Doppler is used to assess the FLOW of the valve.
A patient presents for an echo to rule out WMA. The TTE 2D exam is suboptimal. What
should you do next? A) cancel the order and dismiss the patient B) consult the
physician for permission to perform contrast imaging C) cancel the order and schedule
the patient for a TEE D) contact the ordering physician to recommend that an MRI exam
is ordered instead - ✔️✔️B) consult the physician for permission to perform contrast
imaging; Suboptimal imaging of the LV wall motion on a 2D exam is an indication for
,contrast administration. A physician order for the contrast must be given, prior to
performing the contrast exam.
Which Doppler measurement of flow through a stenotic AV best correlated w/ the same
value obtained during heart catheterization? - ✔️✔️mean pressure gradient
The peak velocity of PI can be used to assess:
A) Peak systolic pulmonary artery pressure
B) mean pulmonary artery pressure
C) pulmonary artery end diastolic pressure
D) severity of pulmonary stenosis - ✔️✔️B) mean pulmonary artery pressure; MPAP =4
x (peak velocity of PI)^2 The peak velocity of PI is peak diastolic velocity so it cannot be
used to assess systolic pressure. The end diastolic velocity of PI can be used to assess
the end diastolic pressure in the PA.
If the LVOT Doppler tracing is obtained from a location that is too far from the AV:
A) the SV will be overestimated
B) the AVA will be overestimated by the continuity equation
C) the LVOT velocity will be overestimated
D) the AVA will be underestimated by continuity equation - ✔️✔️D) the AVA will be
underestimated by continuity equation; If the Doppler cursor is placed too far from the
AV, the LVOT peak velocity will be reduced from what it would be at the correct
location. This will cause the calculation of a smaller or underestimated AVA or
overestimated level of stenosis. The peak aortic velocity and pressure gradient will not
match the level of stenosis indicated by AVA.
What Doppler measurement is necessary to calculate the end diastolic pressure in the
pulmonary artery?
A) peak pressure gradient of PI
B) peak pressure of TR
C) end diastolic velocity of PI
D) peak systolic velocity of PI - ✔️✔️C) end diastolic velocity of PI; PA end diastolic
pressure = 4 (end diastolic pressure velocity of PI)^2 + RA pressure; normal PAEDP +
4-12mmhg
You identify a PFO on an echo and the cardiologist asks you to calculate the LAP. How
will you perform this calculation? - ✔️✔️Measure the peak velocity across the PFO,
calculate the peak pressure gradient across the defect and add the RAP.
If _________________ is present, the RVSP calculation from the TR gradient is
inaccurate as the measurement of the PAP.
A) CHF
B) PI
C) PS
,D) PHTN - ✔️✔️C) PS; The PA pressure is used to assess the pressure in the lungs. If
the PV is stenotic, the flow velocity and resistance increase the pressures within the RV,
TR is then related to the increased pressure at the valve instead of the lungs.
Which of the following correctly describes how AS is evaluated by catheterization?
A) the catheter is placed at the AV to assess the peak pressure gradient
B) Doppler ultrasound is used to assess the flow velocity in the LVOT and at the AV
C) the catheter is placed in the LV and then advanced through the AV to assess the
pressure difference
D) the intracoronary transducer is inserted into the aorta to assess the peak pressure -
✔️✔️C)
Which of the following correctly describes how to measure the acceleration time of the
PV waveform?
A) measure the time from onset of sys to the systolic peak
B) trace the waveform from start to finish
C) measure the slope of the line from the onset of systole to the systolic peak
D) measure the distance from the onset of sys to the systolic peak - ✔️✔️A)
A patient presents for a 6 month follow up echo for a reported AVA of 1.0cm^2. On
today's exam, the continuity equation demonstrates an AVA of 1.6cm^2. Which of the
following could explain the variation in measurements?
A) improved EF% from the last exam
B) overestimated aortic velocity on current exam
C) overestimated LVOT diameter on prior exam
D) overestimated LVOT diameter on current exam - ✔️✔️D)
Which of the following can be used to differentiate subvalvular from valvular AS?
A) CW Doppler
B) TDI of aortic annulus
C) M-mode of the LV
D) M-mode of the aortic cusps - ✔️✔️D)
Which of the following correctly describes how to manipulated the transducer from the
PLAX to the RVOT - ✔️✔️tilt superiorly w/ a slight clockwise rotation
Which sonographic view best demonstrates the LV inflow across a bioprosthetic MV?
A) subcostal
B) PLAX
C) PSAX
D) apical - ✔️✔️D) the LV inflow across a mechanical MVR would best be evaluated in
4C but regurg is best performed in subcostal view dt valve masking from the apparatus
in the apical view. A bioprosthetic valve is composed of less dense material and
, produce less artifact to obstruct flow visualization in the standard preferred apical view
from MV assessment.
The difference in LV length measuremens obtained in the 4C and 2C should be:
A) less than 20%
B) less than 10%
C) less than 5mm
D) less than 1 cm - ✔️✔️B) less than 10%
The dobutamine infusion for a stress echo is typically stopped when the HR reaches
85% of the calculated maximum HR. Which of the following is a secondary reason the
infusion will be stopped?
A) systolic BP below 100mmHg
B) diastolic BP below 100 mmHg
C) systolic BP above 140mmHg
D) motion abnormality in at least 1 wall segment - ✔️✔️A) Infusion endpoints:
Primary - when HR reaches 85% of maximum calculated HR.
Maximum allowable dose of dobutamine received. WMA in 2 or more adjacent
segments. Systolic BP greater than 200mmHg or less than 100mmHg, Diastolic BP
>120mmHg
Which of the following measurements are required to calculate end diastolic pressure of
the LV?
A) systolic BP and end diastolic velocity of AI
B) systolic BP and peak diastolic velocity of AI
C) diastolic BP and peak diastolic velocity of AI
D) diastolic BP and end diastolic velocity of AI - ✔️✔️D) LVEDP = diastolic BP - end
diastolic pressure gradient of AI
Ex: BP 120/66mmHg, end diastolic velocity of AI 3m/s
4(3)^2 = 36mmHg end diastolic pressure of the AI 66 - 36 = 30mmHg LVEDP
What is the first parameter to consider when assessing a pt for diastolic dysfunction?
A) LV EF
B) TR
C) mitral valve e velocity
D) mitral valve e' velocity - ✔️✔️A) when evaluating a pt for LVDD, you must know if
the EF% is normal and there is no evidence of myocardial disease.
What Doppler measurements are normally used to evaluate a cardiac transplant for
rejection? - ✔️✔️Mitral decel time, IVRT time and E velocity
The American Society of Echo recommends that, whenever possible, all 2D and 3D
measurements of the LV be take at the interface between:
A) compacted and non compacted myocardium
B) endocardial lining and blood
C) blood and myocardium
While performing the PLAX views of the heart, you notice dilation of the aortic root.
Which 2D echo view will help best evaluate the extent of this aortic abnormality?
A) 5C
B) suprasternal long axis
C) subcostal short axis
D) A3 - ✔️✔️B) if the aortic root is dilated, the ascending, arch and descending aorta
should be evaluated. This is the best accomplished by using the suprasternal view. The
2C can also provide the additional views of the descending thoracic aorta.
When is imaging performed during a stress echo using a supine exercise bike?
A) within 30 sec after the cessation of exercise
B) within 60 sec after the cessation of exercise
C) during peak exercise
D) when the HR increases by 50% from the rest - ✔️✔️C) bc the supine exercise bike
is normally used for valvular assessment, imaging is performed at peak exercise to
obtain the peak velocity
Which of the following cardiac abnormalities requires the use of the continuity equation
for proper calculation of AVA? A) decreased LV function B) HOCM C) supravalvular AS
D) Transcatheter AVR - ✔️✔️A) decreased LV function; The continuity equation
compensates for the changes in LV function when calculating AVA. CW Doppler is used
to assess flow across the AV. Because CW Doppler has no range resolution, it cannot
determine the location of the elevated velocity. HOCM and supravalvular stenosis will
cause an improper AVA calculation b/c the stenosis is not at the valve. A transcatheter
AV replacement relies on the pressure gradients and the velocity ratio to assess
stenosis.
The mitral deceleration time is 300msec. What is the valve area? A) 1.3cm^2 B)
2.8cm^2 C) 2.5cm^2 D) 1.5cm^2 - ✔️✔️C) 2.5cm^2 MVA = 759 / deceleration time
Which of the following is preferred to document motion of the disk in a St. Jude valve? -
✔️✔️M-mode. M-mode is used to doc the MOTION of ball/disk in a mechanical valve.
Doppler is used to assess the FLOW of the valve.
A patient presents for an echo to rule out WMA. The TTE 2D exam is suboptimal. What
should you do next? A) cancel the order and dismiss the patient B) consult the
physician for permission to perform contrast imaging C) cancel the order and schedule
the patient for a TEE D) contact the ordering physician to recommend that an MRI exam
is ordered instead - ✔️✔️B) consult the physician for permission to perform contrast
imaging; Suboptimal imaging of the LV wall motion on a 2D exam is an indication for
,contrast administration. A physician order for the contrast must be given, prior to
performing the contrast exam.
Which Doppler measurement of flow through a stenotic AV best correlated w/ the same
value obtained during heart catheterization? - ✔️✔️mean pressure gradient
The peak velocity of PI can be used to assess:
A) Peak systolic pulmonary artery pressure
B) mean pulmonary artery pressure
C) pulmonary artery end diastolic pressure
D) severity of pulmonary stenosis - ✔️✔️B) mean pulmonary artery pressure; MPAP =4
x (peak velocity of PI)^2 The peak velocity of PI is peak diastolic velocity so it cannot be
used to assess systolic pressure. The end diastolic velocity of PI can be used to assess
the end diastolic pressure in the PA.
If the LVOT Doppler tracing is obtained from a location that is too far from the AV:
A) the SV will be overestimated
B) the AVA will be overestimated by the continuity equation
C) the LVOT velocity will be overestimated
D) the AVA will be underestimated by continuity equation - ✔️✔️D) the AVA will be
underestimated by continuity equation; If the Doppler cursor is placed too far from the
AV, the LVOT peak velocity will be reduced from what it would be at the correct
location. This will cause the calculation of a smaller or underestimated AVA or
overestimated level of stenosis. The peak aortic velocity and pressure gradient will not
match the level of stenosis indicated by AVA.
What Doppler measurement is necessary to calculate the end diastolic pressure in the
pulmonary artery?
A) peak pressure gradient of PI
B) peak pressure of TR
C) end diastolic velocity of PI
D) peak systolic velocity of PI - ✔️✔️C) end diastolic velocity of PI; PA end diastolic
pressure = 4 (end diastolic pressure velocity of PI)^2 + RA pressure; normal PAEDP +
4-12mmhg
You identify a PFO on an echo and the cardiologist asks you to calculate the LAP. How
will you perform this calculation? - ✔️✔️Measure the peak velocity across the PFO,
calculate the peak pressure gradient across the defect and add the RAP.
If _________________ is present, the RVSP calculation from the TR gradient is
inaccurate as the measurement of the PAP.
A) CHF
B) PI
C) PS
,D) PHTN - ✔️✔️C) PS; The PA pressure is used to assess the pressure in the lungs. If
the PV is stenotic, the flow velocity and resistance increase the pressures within the RV,
TR is then related to the increased pressure at the valve instead of the lungs.
Which of the following correctly describes how AS is evaluated by catheterization?
A) the catheter is placed at the AV to assess the peak pressure gradient
B) Doppler ultrasound is used to assess the flow velocity in the LVOT and at the AV
C) the catheter is placed in the LV and then advanced through the AV to assess the
pressure difference
D) the intracoronary transducer is inserted into the aorta to assess the peak pressure -
✔️✔️C)
Which of the following correctly describes how to measure the acceleration time of the
PV waveform?
A) measure the time from onset of sys to the systolic peak
B) trace the waveform from start to finish
C) measure the slope of the line from the onset of systole to the systolic peak
D) measure the distance from the onset of sys to the systolic peak - ✔️✔️A)
A patient presents for a 6 month follow up echo for a reported AVA of 1.0cm^2. On
today's exam, the continuity equation demonstrates an AVA of 1.6cm^2. Which of the
following could explain the variation in measurements?
A) improved EF% from the last exam
B) overestimated aortic velocity on current exam
C) overestimated LVOT diameter on prior exam
D) overestimated LVOT diameter on current exam - ✔️✔️D)
Which of the following can be used to differentiate subvalvular from valvular AS?
A) CW Doppler
B) TDI of aortic annulus
C) M-mode of the LV
D) M-mode of the aortic cusps - ✔️✔️D)
Which of the following correctly describes how to manipulated the transducer from the
PLAX to the RVOT - ✔️✔️tilt superiorly w/ a slight clockwise rotation
Which sonographic view best demonstrates the LV inflow across a bioprosthetic MV?
A) subcostal
B) PLAX
C) PSAX
D) apical - ✔️✔️D) the LV inflow across a mechanical MVR would best be evaluated in
4C but regurg is best performed in subcostal view dt valve masking from the apparatus
in the apical view. A bioprosthetic valve is composed of less dense material and
, produce less artifact to obstruct flow visualization in the standard preferred apical view
from MV assessment.
The difference in LV length measuremens obtained in the 4C and 2C should be:
A) less than 20%
B) less than 10%
C) less than 5mm
D) less than 1 cm - ✔️✔️B) less than 10%
The dobutamine infusion for a stress echo is typically stopped when the HR reaches
85% of the calculated maximum HR. Which of the following is a secondary reason the
infusion will be stopped?
A) systolic BP below 100mmHg
B) diastolic BP below 100 mmHg
C) systolic BP above 140mmHg
D) motion abnormality in at least 1 wall segment - ✔️✔️A) Infusion endpoints:
Primary - when HR reaches 85% of maximum calculated HR.
Maximum allowable dose of dobutamine received. WMA in 2 or more adjacent
segments. Systolic BP greater than 200mmHg or less than 100mmHg, Diastolic BP
>120mmHg
Which of the following measurements are required to calculate end diastolic pressure of
the LV?
A) systolic BP and end diastolic velocity of AI
B) systolic BP and peak diastolic velocity of AI
C) diastolic BP and peak diastolic velocity of AI
D) diastolic BP and end diastolic velocity of AI - ✔️✔️D) LVEDP = diastolic BP - end
diastolic pressure gradient of AI
Ex: BP 120/66mmHg, end diastolic velocity of AI 3m/s
4(3)^2 = 36mmHg end diastolic pressure of the AI 66 - 36 = 30mmHg LVEDP
What is the first parameter to consider when assessing a pt for diastolic dysfunction?
A) LV EF
B) TR
C) mitral valve e velocity
D) mitral valve e' velocity - ✔️✔️A) when evaluating a pt for LVDD, you must know if
the EF% is normal and there is no evidence of myocardial disease.
What Doppler measurements are normally used to evaluate a cardiac transplant for
rejection? - ✔️✔️Mitral decel time, IVRT time and E velocity
The American Society of Echo recommends that, whenever possible, all 2D and 3D
measurements of the LV be take at the interface between:
A) compacted and non compacted myocardium
B) endocardial lining and blood
C) blood and myocardium
