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Protocol for Restriction

1. Mitral Inflow at slow speed
2.Pulse the Hepatic Vein for reversal

1

What does a Bundle Branch Block Cause?

Paradoxical Septal Motion

2

What are the bundle Branches?

They are apart of the cardiac conduction system.If blocked they can cause arrythmia.

3

What is the SA node?

a bundle of nodal tissue located in the upper wall of the right atrium. Serves as the PACEMAKER of the heart. Generates an electrical impulse which depolarized both atria and generates the P wave on the EKG.

4

What causes paradoxical septal motion?

1. Bundle Branch Block
2. Constrictive Pericarditis

5

What do you do a VTI tracing for?

Mean gradient across a valve(avg)

6

When do you do a VTI?

1ACROSS ALL VALVE REPLACEMENTS
2. ANY STENOSIS(AoV, MITRAL , TRICUSPID, PULMONIC)

7

What is the normal mitral valve decel times?

160-240

8

What is the normal mitral valve area?

4-6 cm2

9

Normal Mitral E velocity?

.6 - 1.3

10

Normal Tricuspid inflow( E velocity)?

.3 - .6m/s

11

Normal pulmonic Flow?

.6 - .9 m/s

12

Severe Mitral Stenosis?

Greater than 220 m/s

13

Severe Mitral Valve Area for MS?

Under 1 cm2

14

Moderate and sever mitral valve area's for Mitral Stenosis?

Mild - 1.5 - 2.5
Moderate - 1.0 - 1.5
Severe - Under 1 cm

15

Normal Aov Area?

3.5 - 4

16

What is the phase called between the E and the A of the mitral valve?

Diastasis

17

Indications of severe diastolic dysfunction ?

1. ABNORMAL TISSUE DOPPLER (FIRST AND FOREMOST )
2. Septal TDI below 7
3. Decel time below 160

18

What is the gold standard for coronary artery disease?

Cardiac Cath

19

Why is a TEE useful in afib patients prior to cardioversion?

Because afib stretches the la which leads to clots in the la/la appendage. You don't want to cardiovert someone who has a clot because the clot could be expelled out of the la and into the aorta or brain.

20

What is the most common adult benign tumor?

Myxoma. The number 1 site for a myxoma is in the LA.

21

What is the most common site for thrombus?

LV apex

22

What are the indications for a TEE?

1. Rule out/source of embolism(soe) ,tumor,mass,myxoma,thrombus

2.Rule out evaluate a septal defect

3. Rule out infective endocarditis - usually affects areas of turbulent flow

23

How do you measure the PHT of a valve?

Measure the E slope in CW

24

What do you look for in Tamponade?

1. HEMODYNAMIC COMPROMISE!!!
2. Is the IVC plethoric?
3.The "M" of the RV in the subs - DIASTOLIC COLLAPSE

25

What do you take to increase the strength of contraction?

Digitalis

26

What do you take to decrease the energy needed by the heart?

Beta Blockers

27

What is mild and severe MR in regurgitant volume?

Mild - Less than 30

Severe - Greater than 60

28

What is the protocol for Mitral Regurgitation?

You have to get regurgitant volume

1. Run CW through mitral valve
2. VTI the MR to get a mean and peak
3. Drop color down to 20 and get good image
4. Click Valves - MR PISA - then get radius(pisa,) , diameter(vena contracta, and enter in the aliasing velocity(bottom number of the color scale.

29

What is ischemic CMP and what do you look for?

MI. Cardiomyopathy that results from coronary artery disease and heart attack. You look for WALL MOTION ABNORMALITY because due to the MI, a wall should be out.