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400 question knowledge Flashcards

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1
Q

Normal IVRT

A

70-100

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2
Q

Normal E/A ratio

A

1

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3
Q

Normal E wave decel time

A

160-250

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4
Q

Increase frame rate by…

A

decreasing depth, reducing sector angle, decrease line density.

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5
Q

Continuity equation is based on

A

Law of Conservation of Mass

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6
Q

Near Field Zone Length formula

A

Transducer diameter squared / wavelength x 4

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7
Q

Attenuation is greater at _____ frequencies due to _____ wavelength.

A
  1. Higher

2. Shorter

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8
Q

Attenuation is greatest in ____, and next greatest in ____

A
  1. Air

2. Bone

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9
Q

Half Intensity depth

A

Depth at which energy is reduced by half.
Measure of attenuation.
6cm/frequency

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10
Q

Calculate PRF

A

77,000/depth in cm

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11
Q

3 ways to increase lateral resolution:

A
  1. Increase transducer diameter.
  2. Increase frequency.
  3. Focusing.
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12
Q

Increasing frequency will ______ axial resolution.

A

Increase

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13
Q

Duty Factor

A

Pulse Duration/PRP

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14
Q

Persistence

A

Process of keeping prior frames on the console. Smooths the image.

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15
Q

Nyquist Limit

A

PRF/2

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16
Q

You can increase the aliasing velocity by…

A

Increasing the frequency of the beam.

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17
Q

Where does mirror artifact occur?

A

Occurs deeper than the structure.

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18
Q

Sound travels faster in a medium with ________ density and ______ stiffness.

A
  1. Low

2. High

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19
Q

Doppler Shift Equation

A

Fd= (2 x Fo x V x cos theta) / C

Fd= Doppler Shift (Hz)
Fo= Frequency (Hz)
V= velocity (m/s)
C= speed of sound in medium (1540m/s)
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20
Q

Attenuation Coefficient

A

Frequency/2

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21
Q

How do you find the attenuation?

A

Attenuation = attenuation coefficient x depth

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22
Q

Impedance

A

Impedance = density x propagation speed

Measured in rayls

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23
Q

With respect to amplitude, intensity is…

A

Amplitude squared

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24
Q

Volumetric flow rate decreases with… (3 things)

A
  1. Decreased pressure gradient
  2. Decreased vessel radius
  3. Increased viscosity
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25
The Bernoulli Equation employs what law?
Law of conservation of ENERGY.
26
Severe MR jet area cut off
>= 40%
27
Severe MR jet to LA area ratio
>= 4
28
Severe MR vena contracta
Diameter of >= 0.7 cm
29
Severe MR ERO
>= 0.4 cm squared
30
Pulmonary vein sign of severe MR
Systolic flow reversal
31
3 ways to increase lateral resolution:
1. Increase transducer diameter. 2. Increase frequency. 3. Focusing.
32
Increasing frequency will ______ axial resolution.
Increase
33
Duty Factor
Pulse Duration/PRP
34
Persistence
Process of keeping prior frames on the console. Smooths the image.
35
Nyquist Limit
PRF/2
36
You can increase the aliasing velocity by...
Increasing the frequency of the beam.
37
Acute severe MR jet will have this shape...
V
38
AVA via continuity equation
A1V1=A2V2 AVA = (LVOT area x LVOT velocity)/Ao velocity
39
AREA=
0.785 x Dsquared
40
Gorlin equation will ______ AVA, compared to continuity
Underestimate
41
Formula for peak flow rate from PISA
2 (pi) (r squared) x aliasing velocity (cm/s)
42
ERO formula
[2 (pi) (r squared) x aliasing velocity (cm/s)] / regurgitant velocity
43
MR ERO cut offs
mild < 0.2, mod 0.2-0.4, severe >0.4
44
When given angle of inlet, how do you account for that in peak flow calculations with PISA?
You change formula to be: | [2 (pi) (r squared)] x [angle of inlet/180] x aliasing velocity
45
ERO (using PISA)
ERO = peak flow rate / peak inflow velocity
46
Regurgitant Volume (using PISA)
Reg Vol = ERO x MR VTI
47
ERO (when given volumes and VTI's)
ERO = Regurgitant volume / regurgitant VTI
48
AI ERO cut offs
mild < 0.1, mod 0.1-0.29, Severe > 0.3
49
Regurgitant Fraction
Reg Fraction = Regurgitant Volume / total flow
50
Pulmonary Hypertension severity
Mild mPAP 25-40 Mod mPAP 41-55 Severe mPAP >55
51
Stroke Volume
SV = LVOT area x LVOT VTI
52
Sinus Venosus ASD is associated with...
anomalous return of Right upper pulmonary vein into the Right Atrium
53
Primum ASD is associated with...
Cleft anterior leaflet of the mitral valve.
54
Normal Pressure Half Time in prosthetic valve
65-80ms
55
Prosthetic Valve AI with PHT < 200ms is c/w
Severe AI
56
Elevated E:A ratio is c/w
elevated LA pressures.
57
Best view to evaluate paravalvular leak in mechanical MVR
PLAX
58
Most common benign tumor in the heart is...
Papillary Fibroelastoma
59
Most common metastatic malignant tumor of the heart is...
melanoma
60
Most common primary malignant tumor of heart is...
rhabdomyoma
61
Features of Tetralogy of Fallot
1. VSD 2. RVOT obstruction / pulmonary stenosis 3. Overriding Aorta 4. RVH
62
Pentalogy of Fallot
Tet plus an ASD
63
Most common location for accessory pathway in Ebstein's anomaly is...
Right Lateral.
64
In pLAX, a defect in the basal anteroseptum is c/w
Outlet Muscular VSD
65
In pLAX, a defect in the mid anteroseptum is c/w
Travecular VSD
66
In SAX @ level of aortic valve, a defect in the area around the valve/LVOT from 9o'clock to 12 o'clock would be a ...
Membranous VSD
67
In SAX @ level of aortic valve, a defect in the area around the valve/LVOT from 12:00 to 3:00 would be a ...
Outlet Muscular VSD
68
In SAX @ level of MV, a mid septal defect would be a...
Inlet Muscular VSD
69
In SAX @ level of MV, a anteroseptal defect would be a ...
Trabecular VSD
70
In SAX @ level of pap muscles a septal defect would be a
Trabecular VSD
71
In Apical 4, a basal inferoseptal defect would be a ...
Inlet VSD
72
In Apical 4 a mid to distal Inferoseptal defect would be a...
Trabecular VSD
73
In Apical 5 a basal anteroseptal defect would be a ...
Membranous VSD
74
In Apical 5 a mid anteroseptal defect would be a
Trabecular VSD
75
Outlet VSD are associated with...
Severe progressive AI, should be surgically corrected.
76
Another name for an Outlet VSD is...
Supracristal VSD
77
The only ASD that can be closed percutaneously is...
Secundum
78
Largest Secundum that can be closed by a device...
40mm
79
Secundum ASD's are associated with...
Mitral Valve Prolapse
80
Primum ASD's are associated with...
AV valve abnormalities (cleft MV most commonly) Left Axis Deviation LVOT obstruction
81
Unroofed CS is associated with...
Persistent Left SVC.
82
Indications for VSD closure:
1. Qp/Qs > or = 2 2. clinical evidence of LV volume overload 3. h/o IE
83
Pulmonary Vein tracing S1 wave is determined by...
atrial relaxation
84
D wave deceleration time in pulmonary vein tracings should be...
170-260ms
85
Reduced D wave decel time (pulmonary veins) means...
High left atrial pressures
86
Prolonged D wave decel time (pulmonary veins) means...
Mitral stenosis
87
Normal E wave propagation velocity by color M mode inside the LV is
>50cm/s
88
Increased tau is c/w
LV diastolic dysfunction, stiffness, slow relaxation
89
Ventricular Asynchrony is measured by...
Time delay between ventricles measured as delay from Q wave to flow at PA or Ao, then take difference between ventricles.
90
Features of Partial AV Canal Defect
1. Primum ASD 2. Cleft MV 3. Widened antero-septal tricuspid commisure
91
Features of Complete AV Canal Defect
1. Primum ASD 2. Cleft MV 3. Widened antero-septal tricuspid commisure 4. Inlet VSD
92
Cutoffs for SEVERE MR pneumonic
4,4,5,6,7 | Jet Area, ERO, Reg Fx, Reg Vol, VC
93
Jet Area cutoff Severe MR
Jet Area > 40%
94
ERO cutoff Severe MR
ERO > or = 0.4 cm squared
95
Regurgitant Fraction cutoff Severe MR
Reg Fx > or = 50%
96
Regurgitant Volume cutoff Severe MR
Reg Vol > or = 60 cc/bt
97
Vena Contracta cutoff Severe MR
VC > or = 0.7 cm
98
Cutoffs for Mild MR pneumonic
2,2,3,3,3, | Jet Area, ERO, Reg Fx, Reg Vol, VC
99
Jet Area cutoff Mild MR
Jet Area < 20%
100
ERO cutoff Mild MR
ERO < 0.2 cm squared
101
Regurgitant Fraction cutoff Mild MR
Reg Fx < 30%
102
Regugitant Volume cutoff Mild MR
Reg Vol < 30 cc/bt
103
Vena Contracta cutoff Mild MR
VC < 0.3 cm
104
Pressure Half Time in AI, mild/mod/severe
mild AI PHT > 500ms mod AI PHT < 300ms sev AI PHT < 193 ms
105
Regurgitant Fraction formula
RF = Reg Vol / stroke volume or foward flow volume
106
ERO formula
ERO = Regurgitant volume / VTI of regurgitant jet
107
Jet Area cutoff Severe AI
Jet Area > or = 65%
108
ERO cutoff Severe AI
> or = 0.3 cm
109
Regurgitant fraction cutoff Severe AI
Reg Fx > or = 50%
110
Regurgitant Volume cutoff Severe AI
Reg Vol > 60 cc/bt
111
Vena Contract cutoff Severe AI
VC > or = 0.6 cm
112
Mild AI cutoffs in order of pneumonic
25, 0.1, 30, 30, 0.3
113
Jet Area cutoff mild AI
< 25%
114
ERO cutoff mild AI
< 0.1 cm squared
115
Regurgitant Fraction cutoff mild AI
Reg Fx < 30%
116
Regurgitant Volume cutoff mild AI
Reg Vol < 30 cc/bt
117
VC cutoff mild AI
0.3 cm
118
severe AI cutoff in order of pneumonic
65, 0.3, 50, 60, 0.6
119
Fractional Shortening formula
(EDV-ESV)/EDV
120
VCF (velocity of circumferential shortening) formula
VCF = Fractional Shortening / Ejection Time
121
Wall stress formula
WS = (end systolic pressure x radius)/wall thickness
122
In pulmonary venous flow tracing, S1 is related to
Left Atrial relaxation
123
In pulmonary venous flow tracing, S2 is related to
RV ejection and mitral annular descent.
124
Tachycardia ______ LV relaxation.
Improves
125
In abnormal LV relaxation, LA pressures are normally _____, and LVEDP is normally __________
1. normal | 2. High
126
Incidence of PFO in normal population
25%
127
With Pulmonary A-V fistulae, as in hepato-pulmonary syndrome, or P-AVMs bubbles appear in the Left Heart in...
3-5 beats.
128
Restrictive Pattern E/A ratio
E/A > 2
129
Restrictive Pattern Decel Time
Decel time < 150 ms
130
Restrictive Pattern IVRT
IVRT < 70 ms
131
Axial Resolution formula
Axial Resolution = Spatial Pulse Length / 2
132
Spatial Pulse Length =
SPL = # cycles x wavelength
133
Wall Motion Score Index codes
``` Normal = 1 Hypo = 2 Akinesis = 3 Dyskinesis = 4 Aneurysmal = 5 ```
134
WMSI of ____ is c/w severe LV dysfunction
> or = 2
135
Intensity =
Intensity = Power / Area
136
Power =
Power = Amplitude squared
137
Turbulent Flow is proportional to...(3 things)
1. Denisty 2. Vessel Diameter 3. Velocity
138
Turbulent Flow is inversely proportional to (1 thing)
Viscosity (Less viscous -> more turbulent)
139
L-TGA can be associated with (3 things)
1. VSD 2. PS 3. Heart Block
140
Dimensionless Index Severe AS
< 0.25
141
Formula of dimensionless index in AS
DI = LVOT velocity / AV velocity
142
Austin Flint murmur
Diastolic rumble at the apex, assoc. with AI hitting anterior leaflet of MV. Causes fluttering of the anterior leaflet of the MV.
143
Normal LA volume
22ml +/- 6
144
Mild LA dilation
29-33 ml
145
Moderate LA dilation
34-39 ml
146
Severe LA enlargement
>40 ml
147
Ideal thickness of matching layer
Wavelength/4
148
V pacing and LBBB create this wall motion abnormality.
Apical septal abnormality.
149
Near field length formula
Near Field Length = Transducer diameter squared (mm) x frequency (MHz) / 6
150
Percentage of chronic A fib pts with clot in LAA
10-15%
151
Things that cause diastolic MR
Long PR
152
Restrictive pattern 1. IVRT 2. E wave (high or low V) 3. A wave (high or low V) 4. Decel time
1. IVRT is short. 2. E wave is high/tall 3. A wave is low/small 4. Decel time is short
153
What is bandwidth.
The range of frequencies a transducer can operate over.
154
Center frequency
The frequency in the middle of the bandwidth. So bandwidth from 2-4 MHz? Center freq = 3
155
Fractional Bandwidth formula
Bandwidth/center frequency
156
Uhl's anomaly
Parchment of the RV. Thinning. Dilated RV
157
Down's syndrome congenital cardiac defect
Complete AV canal
158
Noonan's syndrome congenital cardiac defect
Pulmonary Stenosis
159
Holt Oram congenital cardiac defect
ASD
160
Fetal Alcohol cardiac defect
VSD
161
Turner's congenital cardiac defect
Coarctation of the Aorta
162
Most common primary cardiac malignancy
Angiosarcoma
163
Angiosarcoma
most common primary cardiac malignancy usually in RA presents with pericardial eff/tamponade
164
Doppler shift equation
Fd= [2Fo x velocity x cos theta] / propagation speed Fo in Hz, velocities in m/s
165
PRP formula
PRP = (13 microseconds/cm) x depth cm
166
Frame time formula
Frame Time = PRP x # lines in sector
167
Frame Rate
Frame Rate = 1/Frame time
168
Worst case penetration is...
200 wavelengths
169
Max depth penetration is equal to
200 x wavelength
170
Wavelength =
Wavelength = velocity / frequency
171
Lipomatous Hypertrophy of Atrial Septum (LHAS)
LHAS is infiltration of fat into interatrial septum > 2cm
172
Dimensionless Index
LVOT VTI/ Ao VTI
173
Severe AI Dimensionless Index
< 0.25
174
%Reflection
= [z2-z1]squared / [Z2 + Z1]squared
175
Class I recommendations for AVR in AS... (3)
1. Severe AS undergoing CABG 2. Symptomatic severe AS 3. Severe AS undergoing other valve or aortic surgery
176
M mode sign of constriction.
Early and late diastolic notching of the septum.
177
MPI formula
MPI = [IVCT + IVRT] / Ejection Time
178
Resistance Formula
Resistance = (8 x length x viscosity) / (pi x r to the 4th)
179
Cosine 0
1
180
Cosine 30
0.86
181
Cosine 60
0.5
182
Cosine 90
0
183
Mean Gradient (from peak gradient measurement)
Mean Gradien = 0.7 x peak gradient
184
Relative Wall Thickness formula
RWT = (2 x posterior wall thickness) / LVEDd
185
TAPSE cut off for RV dysfxn
< 1.6 cm
186
Strain formula
change in length / initial length
187
Normal Strain
-20%
188
E to E prime ratio
< 8 normal | >15 ~ PCWP >20
189
Indications for surgery in MS
Any degree of LV dysfunction ( EF < 60% or LVESD > 40mm)
190
TS gradients
Normal < 2 mmHg, Severe > or = 7 mmHg
191
TVA (using PHT)
TVA = 190 / PHT | PHT > 190 c/w severe TS
192
Mean PV gradient when should go for valvuloplasty
30-40 mmHg
193
Duke's Major Criteria
1. positive BCx's 2. typical organism for IE in 2 Cx's 3. echo e/o valve issue (veg, new reg, dehiscience) 4. Abscess
194
PPM via EROAi
EROAi > 0.85 = no PPM EROAi 0.66 -0.85 = moderate PPM EROAi < 0.65 = severe PPM
195
PPM vs Obstructed prosthesis
Both have increased velocity, increased mean gradients and low dimensionless index (< 0.25) But... Obstructed prosthesis has prolonged acceleration time (>100ms) and rounded contour while PPM has low accel time (< 100 ms) and triangular contour.
196
MPI numbers
< 0.4 normal mild LV dysfxn 0.4-0.5 mod LV dysfxn 0.6-0.9 Severe LV dysfxn >1
197
Normal Dp/Dt
>1200
198
Indications for Aortic aneurysm repair
Asc. Ao 5.5 cm or 5 cm in Marfan's or bicuspid valve enlarging by > 1 cm / yr symptomatic traumatic or infxs or if going for Ao valve surgery and asc ao is > 4.5cm
199
Shone's Syndrome
1. Supravalvular membrane (mitral valve) 2. Parachute MV 3. Subaortic valvular stenosis 4. Coarctation of the aorta
200
Focal length
(Transducer diameter squared x frequency) / 6
201
6 ways to get rid of aliasing
1. Shift the nyquist scale 2. Use a lower frequency transducer 3. Select a new view with a shallower sample volume. 4. Switch to CW 5. Select a new view with angle closer to 90 degrees 6. Move the baseline.

Echocardiography (2 decks)

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