CUT 401 Adult echocardiography 2 Quiz 4 review sheet

Question 1

1. What is myocarditis?

Answer 1

1) Inflammation of the myocardium results in myocardial damage.

2) Begins as diffuse or local myocardial infiltration that produces a myocardial toxin & leads to inflammation.

3) An autoimmune response causes myocardial degeneration and damage that can lead to necrosis.

Question 2

4. What is pericardial effusion? What is pleural effusion?

Answer 2

Pericardial effusion:

• Abnormal amount/type of fluid between parietal and visceral layers of the pericardium.

** Pleural effusion:**

• Fluid accumulation between the layers of the lung pleura.

Question 2

3. Know the causes of myocarditis?

Answer 2

1) Infectious agents: (viruses, bacteria, parasites, fungi), Coxsackievirus B (most common), Environmental toxins

2) Drugs adverse reactions to medications: or vaccines (e.g., cocaine, lithium

3) Autoimmune diseases: (lupus)

4) Chronic from a previous infection.

Question 3

2. How is myocarditis diagnosed?

Answer 3

1) Definitive diagnosis depends on endomyocardial biopsy

2) Needs to prove inflammation.

Question 4

5. How is the pericardial thickness measured?

Answer 4

1) Normal pericardial thickness is 1–2 mm.

2) TEE can measure it, but CT is the gold standard

Question 5

6. What is the function of the pericardium?

Answer 5

1) Can prevent hypertrophy

2) Decreases friction between the pericardial layers,

3) Lubricates the heart

4) Maintains the heart in the pneumothorax

5) Prevents acute dilatation of chamber

6) Protects the heart from minor injuries

7) Provides vasoactive substances that regulate heart friction & coronary arteries.

Question 6

7. What are the clinical signs and symptoms of pericarditis?

Answer 6

1) Cough

2) Dyspnea: pain with breathing

3) Elevated cardiac enzymes (troponin)

4) Fever

5) Pericardial rub

6) Positional chest pain

Question 7

8. How does pericarditis present on EKG?

Answer 7

1) Widespread ST elevation

2) PR depression

3) vs focal ST elevation in MI

Question 8

9. What is constrictive pericarditis?

Answer 8

1) Thickening, scarring, and possibly calcification of parietal/visceral pericardium.

2) Layers become dense & adhere to one another

3) Pericardial fluid is lacking

4) Obliterates the pericardial space

5) Leads to noncompliant heart, diastolic dysfunction & equalized elevated chamber pressures.

Question 9

10.How does physiologic pericardial fluid appear on echo?

Answer 9

1) Echolucent space in the posterior atrioventricular groove.

2) Normal amount is 15–50 mL.

3) If small fluid is visualized only in systole

Question 10

11.What are the echo findings of severe pericardial effusion?

Answer 10

1. Large echolucent space >20mm
2. Circumferential
3. possibly echogenic with fibrin strands
4. floating strands indicate inflammation or clotted blood.

Question 11

12.How does pericardial effusion associated with metastases present on echo?

Answer 11

1. Common after lung or breast cancer.
2. hemorrhagic.
3. may have fibrin
4. tumor cells

Question 12

13.How does epicardial fat pad appear on echo?

Answer 12

1) Speckled/granular appearance

2) Best seen in** PLAX** or subcostal

3) Anterior echo-free space near RV free wall.

4) Fat pad remains the same size throughout the cardiac cycle.

Question 13

14.What are the clinical signs of cardiac tamponade?

Answer 13

1) Beck’s Triad: IJV distension, hypotension, muffled heart sounds
2) Caught
3) Dyspnea
4) Electrical alternans
5) Hepatomegaly
6) Pericardial friction rub
7) Pulsus paradoxus (>10 mmHg drops in SBP during inspiration)
8) Sweating
9) Syncope
10) Tachycardia

Question 14

15.How does infective endocarditis present on echo?

Answer 14

The Vegetation may appear

1) Irregularly shaped

2) Echogenic vegetations, mobile, “shaggy” appearance, sessile or pedunculated, may cause regurgitation or stenosis.

Question 15

16.Know the Duke Criteria for diagnosis of infective endocarditis?

Answer 15

**Major: **

1) Positive blood cultures: for infective endocarditis aka bacteremia like (streptococcus Bovis)

2) Evidence of endocardial involvement: like new valvular regurgitation, dehiscence of prosthetic valve.

Minor:

1) Predisposition ( underlying cardiac defect )

2) Fever of unknow origin

3) Vascular phenomena: (like thromboembolic events TIA’s CVA’s)

4) Immunologic Phenomena

5) Microbiologic evidence: (not meeting the major criteria)

Question 16

17.What is an Osler Node? What is a Roth spot? What is Janeway Lesion? What
are they associated with?

Answer 16

1) Osler nodes: Painful red lesions on hands & feet (immune response to bacteria ).

2) Roth spots: Retinal hemorrhages with pale centers.

3) Janeway lesions: Non-tender erythematous lesions on palms/soles caused by septic embol, there distal & flat with no pain

4) All associated with infective endocarditis.

Question 17

18.Where are the vegetations of the atrioventricular valves most commonly located?
How about semilunar valves?

Answer 17

1) AV valves: atrial side

2) Semilunar valves: ventricular side

Question 18

19.Which type of imaging provides the best evaluation for infective endocarditis?

Answer 18

TEE has better image quality & higher sensitivity.

Question 19

20.Which size vegetation can be seen on TTE?

Answer 19

1) Vegetations >2–3 mm can be seen on TTE.

2) TEE can detect >1 mm.

Question 20

21.Which complication can a vegetation cause?

Answer 20

1. Abscess
2. Aneurysm (destructive valvular lesions)
3. Changes in prosthetic valve hemodynamic
4. Paravalvular leaks
5. Perforation (destructive valvular lesions)
6. Pericardial effusion
7. Prolapse (destructive valvular lesions)
8. Valve dehiscence (Rocking motion)

Question 21

22.How does cardiac tamponade appear on PW Doppler?

Answer 21

1. Exaggerated respiratory variation of mitral and tricuspid inflow
2. Theres secondary pressure difference with respiration
3. ↑ with expiration) & ↓ MV inflow with inspiration

Question 22

23.What are the clinical signs of constrictive pericarditis?

Answer 22

1) Ascites
2) Dyspnea
3) JVD (an increased JVP & Kussmaul’s sign)
4) Pericardial knock murmur
5) Pulsus paradoxus ( exaggerated drop in SBP >10 mmHg w/inspiration)
6) Right heart failure symptoms

Question 23

24.How do the complications of left sided versus right sided vegetations differ?

Answer 23

Left-sided (MV): embolism (stroke, renal emboli)

Right side (TV) : pulmonary embolism (esp. in IV drug users

Question 24

25.What is the least likely potential site for vegetation formation?

Answer 24

**1) Least likely at sites not exposed to high-velocity jets,** 2) Chambers wall of the ventricles 3) IVS 4) APEX All of these are less likely to occur.

Question 25

26. How does myocarditis begin and how does it progress?

Answer 25

1) Begins with infiltration producing myocardial toxin & leads inflammation 2) Autoimmune causes myocardial degeneration damage, which leads to necrosis → can lead to HF.

Question 26

27.What are the echo findings associated with myocarditis?

Answer 26

1) Dilated/hypertrophied ventricles 2) Pericardial effusion 3) RWMA (Right wall motion abnormality) 4) Systolic or diastolic dysfunction 5) Valvular Regurgitation

Question 27

28.What are the echo findings of cardiac tamponade?

Answer 27

1) Dilated IVC & HV 2) IVS bounce 3) Paradoxical septal motion 4) RA collapse (only during inspiration in late diastole) the longer the collapse the more severs the tamponed 5) RV diastolic collapse (Hallmark sign) 6) Respiratory variation in chamber sizes 7) Swinging heart

Question 28

29.How do vegetations affect the valves?

Answer 28

* Can cause 1) Abscess 2) Aneurysm 3) Flail/ruptured leaflets or chordae tendineae 4) Perforation 5) Prosthetic Valve Dehiscence (detachment) 6) Regurgitation 7) Stenosis

Question 29

30. How do vegetations look on echo?

Answer 29

1) Echogenic 2) Irregular shape 3) Mobile 4) Sessile or pedunculated 5) Shaggy 6) Swinging 7) Thickened