CUT 401 Adult echocardiography 2 Quiz 5 review sheet:

Question 1

1. Know the 2D echo findings in chronic pulmonary hypertension (PHT)?

Answer 1

1) Dilated IVC >2.1 cm with loss of inspiratory collapse

2) D-shaped LV

3) PA dilatation (>2.1 cm)

4) Paradoxical septal motion

5) RA dilatation

6) RV dilatation with flattened IVS

7) RV hypertrophy (>5mm wall thickness)

8) RV WMA

Question 2

2. Know which view a flattened IVS can be visualized best?

Answer 2

• PSAX (Parasternal short axis)

At the level of Papillary muscle

Question 3

3. Know which view can best visualize coarctation of the aorta?

Answer 3

• Suprasternal notch & Subcostal views

Question 4

4. Know the Doppler characteristics of pulmonary hypertension (PHT)?

Answer 4

1) Early peaking PV waveform

2) “Flying W” sign

3) Mid-systolic notching of PA waveform

4) Shortened acceleration time:

• Mild: 80–100ms
• Moderate: 60–80ms
• Severe: <60ms

5) Varying degrees of TR and PR

Question 5

5. Know the difference between systemic and pulmonary hypertension?

Answer 5

1) Systemic hypertension affects LV: causes LVH

2) Pulmonary hypertension affects RV: causes RVH

or

• Systemic hypertension affects LV:
  1) causes LVH (Left ventricle hypertrophy)
  2) Impaired diastolic function
  3) Normal systolic function
• Pulmonary hypertension affects RV:
  causes RVH

Question 6

6. What are the Pulmonary Artery Pressure values for mild, moderate and severe PHT?

Answer 6

1) Normal: 18–25 mmHg
2) Mild: 30–40 mmHg
3) Moderate: 40–70 mmHg
4) Severe: >70 mmHg

Question 7

7. Know the types of wall motion and what akinesis is associated with?

Answer 7

???????
* Akinesis of the **free wall **of the RV is seen in Pulonary Emoblism (McConnell sign)

Question 8

8. What can atrial myxoma mimic?

Answer 8

• Can mimic mitral stenosis (MS) or tricuspid stenosis (TS) on Doppler

Question 9

9. Know how an atrial myxoma looks on 2D and Doppler echo?

Answer 9

1) Heterogeneous
2) irregular, mobile mass
3) Arises from Fossa Ovalis of IAS
4) May prolapse across the mitral annulus into LV (diastole)
5) Tumor Plop sound
6) Evaluate with color flow and PHT

Question 10

11. What is the most common primary malignant intracardiac tumor?

Answer 10

1) Angiosarcoma

2) Occurs: RA or Pericardium

Question 10

10. Know how **lipomatous hypertrophy **looks on 2D echo?

Answer 10

Dumbbell” appearance of atrial septum

2) Fatty infiltration/Thickness that spares fossa ovalis

Question 11

12. What are the complications of RA thrombus?

Answer 11

• Pulmonary embolize ????

Question 12

13. What is the Eustachian valve and where is it located?

Answer 12

1. Embryologic remnant that lies at the junction of the IVS & RA
2. Directs oxygenated blood to foramen ovale in fetal circulation but does not have any significant after the closure of the foramen ovalve
3. Can present thickness, Length & shape

Question 13

14. What is the most common tumor to metastasize to the heart?

Answer 13

1. Melanoma
2. Nonprimary calcification
3. Highest rate of
   pericardial metastases

Question 14

15. Are primary or secondary heart tumors more common?

Answer 14

• Secondary (nonprimary) tumors are 20–40x more common

Question 15

16. What is the most common abnormality of the aorta?

Answer 15

• Dilation is the most common abnormality of the aorta.

Question 16

17. In which views do we visualize each part of the aorta?

Answer 16

1) PLAX: Aortic root and ascending aorta

2) High Parasternal: Ascending aorta

3) SAX: AV, aortic root, ascending aorta

4) Apical 5CH / Apical 3CH: AV, aortic root, ascending aorta

5) Apical 2CH: Descending aorta

6) Subcostal: AV, aortic root, descending aorta, abdominal aorta

7) Suprasternal notch: Ascending aorta, aortic arch and branches, descending aorta

Question 17

18. How much should the diameter of the aortic root exceed for an aortic aneurysm to be diagnosed?

Answer 17

1) Diameter increased by at least 50% compared with normal

2) Aneurysm is diagnosed when exceeding the expected diameter by 50%

3) Ascending aorta > 5.0 cm

4) Men > 4 cm

5) Women > 3.8 cm

Question 18

19. What is aortic dissection?

Answer 18

1) An intimal tear in the aortic wall in which blood enters a false lumen/channel between the intima and media.

2) Life-threatening

3) Tear may extend further or rupture

Question 19

21. How does pulmonary hypertension affect the heart?

Answer 19

1) Causes RV dilatation & hypertrophy

2) Paradoxical septal motion

3) RA enlargement

Question 20

22. What is a Sinuses of Valsalva aneurysm?

Answer 20

1) Dilatation of a sinus of Valsalva causing protrusion into adjacent chambers

2) Most commonly congenital malformation causes a saccular dilation of the sinus

Liked

a) Marfan syndrome
b) Ehlers Danlos
c) bicuspid AV

Question 21

20. Know how aortic dissection looks on 2D and Doppler echo?

Answer 21

?????

Question 22

23. Know where each of the Sinuses of Valsalva aneurysms protrude?

Answer 22

Right coronary sinus → protrudes into RVOT (most common)

Left coronary sinus → protrudes into LA

Noncoronary sinus → protrudes into RA

Question 23

24. How does pulmonary embolism present on echo and what is the sonographic sign associated with it?

Answer 23

1) PA dilation & ↑ increase PA pressure

2) RV dilatation & dysfunction

3) McConnell sign (sign is an acute Pulmonary embolism): akinesis of RV free wall with hyperdynamic apex

Question 24

25. How does pulmonary hypertension affect the TV?

Answer 24

1) Causes annular dilatation → TR annulus 2) Normal TVA = 7–9 cm² Maybe can’t find the info ????????

Question 25

26. What is the most common primary benign cardiac neoplasm?

Answer 25

* Myxoma

Question 26

27. Know how coarctation of the aorta looks on Doppler in echo?

Answer 26

Doppler will demonstrate: 1) Increased velocity >1.5 m/s at the site of coarctation/narrowing 2) Monophasic, tardus parvus waveform flow distal to coarctation 3) Low velocity, low resistance monophasic flow in the abdominal aorta

Question 27

28. Know how papillary fibroelastoma, sarcoma, rhabdomyoma, and myxoma look on echo and how to differentiate between them?

Answer 27

1) Papillary fibroelastoma: small, mobile mass on valves 2) Sarcoma: variable appearance, usually RA 3) Rhabdomyoma: intramyocardial, multiple, pediatric 4) Myxoma: heterogeneous, mobile, attached to IAS

Question 28

29. Which views are used to diagnose Sinuses of Valsalva aneurysm?

Answer 28

1) PLAX, PSAX, and TEE for detailed visualization 2) TEE provides best image quality

Question 29

30. How does Marfan syndrome present on echo?

Answer 29

1) Dilatation of ascending aorta and sinuses of Valsalva 2) Effacement of sinotubular junction Associated with: 1) Aortic insufficiency 2) Aortic root dilatation, 3) MR 4) MVP 5) Risk of aortic dissection