CCI Review Echo 2
Right leaflet (the posterior leaflet is the non coronary) - ANS -Which aortic leaflet is the superior
one in the parasternal long axis view?
Pulmonary artery - ANS -From 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 RVOT plax - ANS -In 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? - ANS -Where is the LAA on TTE?
Sinuses of Valsalva - ANS -The coronary arteries come off the?
Early diastole - ANS -During which phase do the coronaries fill?
Right pulmonary artery - ANS -What 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 - ANS -What 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. - ANS -Where 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 - ANS -Where is the Chiari network (system) located?
TTE: 2-7 MHz
TEE: 5-7MHz - ANS -What frequency is usually used for TTE and TEE?
40-50C or the highest temperature - ANS -At 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. -
ANS -What is absolute refractory state?
Includes P-R segment (from atrial to ventricular depolarization) - ANS -What does the P-R
interval represent?
0.10 sec. - ANS -What is a normal duration for the QRS complex?
Hyper-contractile (Regurgitation increases preload, muscle tension/contractility increases and
eventually results in dilitation, Volume overloads - ANS -Acute Aortic Insufficiency or Aortic
regurgitation is _____ because we shift up the Starling curve.
Failure - ANS -Chronic Aortic Insufficiency or Aortic regurgitation is _____ when we drop off the
end.
Yes-when the shunt is Left to Right. - ANS -Does 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 - ANS -Calculate CO:
4V2 NOTE: THIS EQUATION IS USED TO CHANGE VELOCITY TO PRESSURES - ANS
-What 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 - ANS -With a velocity of 0.5m/sec what is
the gradient?
Doppler stroke volume or SV=VTI X CSA - ANS -What 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 - ANS -Mitral 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) - ANS -Inhalation of amyl nitrite causes?
After R wave=Isovolemic contraction
After T wave=Isovolemic relaxation - ANS -What is the Isovolemic timing on the ECG?
Aortic valve open - ANS -During the cardiac cycle this event NEVER happens?
The valve is open - ANS -What is the Aortic valve doing during the Q-T interval?
70 ms - ANS -What is the duration of IVRT and IVCT?
-Starts Mitral Valve close
-Ends Aortic Valve Opens
-70 ms duration - ANS -Valve event
-Starts Aortic close
-Ends- Mitral Valve opens
-70 ms duration (time decreases in bradycardia) - ANS -valve event
Early diastole - ANS -When is Left Ventricle pressure the lowest?
Left Ventricle angiogram
Angiographic techniques multiple SV x HR - ANS -Best cath technique for Left Ventricle
function?
Left atrial pressure - ANS -What 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 - ANS -To determine Aortic
Stenosis where catheters are places?
, Thicker valve leaflets - ANS -What does Tissue Harmonic Imaging result in?
Left ventricular hypertrophy
Note: Stenosis is a Afterload which leads to hypertrophy - ANS -A 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 - ANS -In 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). - ANS -What is Takayasu's
arteritis?
3-4cm2
less than 1 is severe stenosis - ANS -The 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. - ANS -When does
VTI work better?
LVOT measured too large - ANS -Using the continuity equation when would the severity of
Aortic Stenosis be underestimated?
Peak instantaneous (echo) and versus peak-to-peak (cath ) - ANS -Know that echo gradients
are usually higher than cath gradients.
Classified as a cardiofacial syndrome with Pulmonic Stenosis, HCM and ASD (30%) - ANS
-What is Noonan Syndrome?
... - ANS -Know that Pulmonic Stenosis does NOT cause pulmonary hypertension.
Subcostal short-axis - ANS -Asked 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 - ANS -Which type of mitral
deformity occurs where there is only ONE PAPILLARY MUSCLE into which both chordae insert
Right leaflet (the posterior leaflet is the non coronary) - ANS -Which aortic leaflet is the superior
one in the parasternal long axis view?
Pulmonary artery - ANS -From 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 RVOT plax - ANS -In 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? - ANS -Where is the LAA on TTE?
Sinuses of Valsalva - ANS -The coronary arteries come off the?
Early diastole - ANS -During which phase do the coronaries fill?
Right pulmonary artery - ANS -What 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 - ANS -What 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. - ANS -Where 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 - ANS -Where is the Chiari network (system) located?
TTE: 2-7 MHz
TEE: 5-7MHz - ANS -What frequency is usually used for TTE and TEE?
40-50C or the highest temperature - ANS -At 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. -
ANS -What is absolute refractory state?
Includes P-R segment (from atrial to ventricular depolarization) - ANS -What does the P-R
interval represent?
0.10 sec. - ANS -What is a normal duration for the QRS complex?
Hyper-contractile (Regurgitation increases preload, muscle tension/contractility increases and
eventually results in dilitation, Volume overloads - ANS -Acute Aortic Insufficiency or Aortic
regurgitation is _____ because we shift up the Starling curve.
Failure - ANS -Chronic Aortic Insufficiency or Aortic regurgitation is _____ when we drop off the
end.
Yes-when the shunt is Left to Right. - ANS -Does 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 - ANS -Calculate CO:
4V2 NOTE: THIS EQUATION IS USED TO CHANGE VELOCITY TO PRESSURES - ANS
-What 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 - ANS -With a velocity of 0.5m/sec what is
the gradient?
Doppler stroke volume or SV=VTI X CSA - ANS -What 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 - ANS -Mitral 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) - ANS -Inhalation of amyl nitrite causes?
After R wave=Isovolemic contraction
After T wave=Isovolemic relaxation - ANS -What is the Isovolemic timing on the ECG?
Aortic valve open - ANS -During the cardiac cycle this event NEVER happens?
The valve is open - ANS -What is the Aortic valve doing during the Q-T interval?
70 ms - ANS -What is the duration of IVRT and IVCT?
-Starts Mitral Valve close
-Ends Aortic Valve Opens
-70 ms duration - ANS -Valve event
-Starts Aortic close
-Ends- Mitral Valve opens
-70 ms duration (time decreases in bradycardia) - ANS -valve event
Early diastole - ANS -When is Left Ventricle pressure the lowest?
Left Ventricle angiogram
Angiographic techniques multiple SV x HR - ANS -Best cath technique for Left Ventricle
function?
Left atrial pressure - ANS -What 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 - ANS -To determine Aortic
Stenosis where catheters are places?
, Thicker valve leaflets - ANS -What does Tissue Harmonic Imaging result in?
Left ventricular hypertrophy
Note: Stenosis is a Afterload which leads to hypertrophy - ANS -A 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 - ANS -In 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). - ANS -What is Takayasu's
arteritis?
3-4cm2
less than 1 is severe stenosis - ANS -The 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. - ANS -When does
VTI work better?
LVOT measured too large - ANS -Using the continuity equation when would the severity of
Aortic Stenosis be underestimated?
Peak instantaneous (echo) and versus peak-to-peak (cath ) - ANS -Know that echo gradients
are usually higher than cath gradients.
Classified as a cardiofacial syndrome with Pulmonic Stenosis, HCM and ASD (30%) - ANS
-What is Noonan Syndrome?
... - ANS -Know that Pulmonic Stenosis does NOT cause pulmonary hypertension.
Subcostal short-axis - ANS -Asked 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 - ANS -Which type of mitral
deformity occurs where there is only ONE PAPILLARY MUSCLE into which both chordae insert
