Interactive Echocardiography

Question 1

Why is echocardiography important?

Answer 1

It allows non-invasive diagnosis of cardiac diseases

Question 2

Most cardiac problems are visible on which view?

Answer 2

RPS long axis 4 chamber view = home view

Question 3

How do you use echocardiography to find the long axis 4-chamber view?

Answer 3

• Scanning through the right chest wall
• Right ventricular wall first (i.e. most dorsally on the scanner), followed by the myocardium of the AV septum, the myocardium of the left ventricular free wall
• Tricuspid and mitral valves are also visible

Question 4

How does blood appear on ultrasound?

Answer 4

Black

Question 5

The end of diastole is marked by what on the ECG?

Answer 5

The start of the QRS complex

Question 6

The end of systole is marked by what on the ECG?

Answer 6

End of the T-wave

Question 7

How do the left and right ventricles appear on ultrasound

Answer 7

• RV should be about 1/3 of the size of the left

- LV wall measurements are ¼ - 1/3 of the chamber diameter

Question 8

How do the left and right atria appear on ultrasound

Answer 8

The LA should look quite ‘boxy’ and is normally slightly bigger than the RA

Question 9

What is the simplest, most commonly used measurement of systolic function (pump function)?

Answer 9

Fractional shortening

Question 10

Describe fractional shortening

Answer 10

looks at systolic and diastolic internal diameter of the left ventricle, then the difference between those expressed as a % of the diastolic diameter gives us fractional shortening

• Index of pump function
• Normal should be above 25%

Question 11

When is fractional shortening not a reliable indicator of systolic function?

Answer 11

• Significant mitral regurgitation
• Wall motion abnormalities
• Right sided heart disease associated with pressure overload

Question 12

Which 3 parts of the heart should be assessed on the normal/home views?

Answer 12

• Chamber sizes relative to each other
• Wall thickness relative to chambers
• Systolic function

Question 13

What is simpsons method of discs used for?

Answer 13

Simpson’s method of discs traces around the whole ventricle and summates each disc and creates a volume
- Normal volumes can be looked at as well as the differences in systolic and diastolic volumes
EDV – ESV = total ventricular stroke volume

Question 14

What is the index of sphericity?

Answer 14

Attempt to quantify subjective assessment of rounding of LV

• Look at the diastolic length of the LV at its maximum length
• Normal = 2 (twice as long as it is wide)

Question 15

What are the two differentials if fluid is seen surrounding the heart?

Answer 15

Pleural or pericardial effusion

Question 16

What is doppler used for?

Answer 16

Looks at blood flow through the heart

Question 17

When using doppler what must you ensure?

Answer 17

That you are as parallel to the blood flow as possible

Question 18

On a colour flow doppler, which colour represents towards and which represents away?

Answer 18

BART
Blue = away
Red = towards
E.g. Aortic outflow would appear blue and mitral inflow would appear red

Question 19

What are two features of aortic stenosis?

Answer 19

Turbulent flow

Thick hypertrophic walls

Question 20

How is the severity of narrowing in aortic stenosis proportional to the velocity of blood?

Answer 20

• More severe = higher velocity of blood

- Fluid moves faster through an obstruction

Question 21

How can the severity of aortic stenosis be measured?

Answer 21

By looking at the pressure gradient between the left ventricle and aorta
- How much extra pressure does the LV have to generate to get blood out and into the aorta?