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RACP Cardio AT > Echocardiography > Flashcards

Echocardiography Flashcards

(71 cards)

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1
Q

In Echo, how do wavelength and frequency affect resolution?

A

High frequency, shorter wavelength increase resolution

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2
Q

How does frequency affect tissue penetration?

A

Higher frequency decreases penetration

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3
Q

What is scattering and why does it happen?

A

Reflection of US beam in multiple directions due to structures less than 1 wavelength in lateral dimension

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4
Q

What is attenuation?

A

Absorption of US energy by conversion to heat

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5
Q

Depth of penetration is limited to what amount of wavelengths?

A

200 wavelengths

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6
Q

Depth of penetration for:

  1. 1 MHz transducer
  2. 2.5 MHz transducer
  3. 5 MHz transducer
A
  1. 30cm
  2. 12cm
  3. 6cm
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7
Q

Physics of M Mode

A

Single crystal rapidly alternating between transmission and receiver modes.

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8
Q

Safety of ultrasound?

A

No known adverse effects

However theoretical thermal damage and cavitation (creation of small gas filled bodies by the US beam)

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9
Q

What is image quality of 2D echocardiography affected by?

A

Axial resolution, lateral resolution and elevational resolution

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10
Q

Define axial resolution

A

Resolution along the length of the US beam

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11
Q

What affects axial resolution?

A

Frequency
Bandwidth
Pulse Length

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12
Q

Define lateral resolution?

A

resolution perpendicular to the beam

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13
Q

What affects lateral resolution?

A 
Frequency
Beam Width
Bandwidth
Aperture
Side Lobes
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14
Q

Define elevational resolution?

A

Resolution across the thickness of the tomographic slice

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15
Q

What is the Nyquist Frequency?

A

Half the Pulse repetition frequency

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16
Q

What happens when velocity exceeds the Nyquist Limit?

A

Aliasing

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17
Q

What are the factors that affect colour doppler?

A

Gains
Colour Maps
Frame Rate
Nyquist Limit

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18
Q

What is use of pulse wave doppler

A

to assess low velocity flows

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19
Q

what is the use of continuous wave Doppler

A

to assess high velocity flows

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20
Q

What walls of the LV does the A4C view?

A

Anterolateral and inferoseptal

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21
Q

What walls of the LV does the A2C view?

A

Anterior and Inferior

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22
Q

What walls of the LV does the A3C view?

A

Anteroseptal and Inferolateral

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23
Q

What are the echo features of primary TR?

A

Flail gap 15mm or more

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24
Q

What are the echo features of functional or secondary TR?

A

Tenting Area >3cm

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25
What is the normal aortic valve area?
3-4cm2
26
What is the peak velocity across the aortic valve which suggests severe stenosis?
>4m/sec
27
What is the peak velocity across the aortic valve which suggests mild stenosis?
<3m/sec
28
What indexed aortic valve area represents severe stenosis?
<0.6cm2/m2
29
What are the echo features of mild aortic stenosis?
Valve area >1.5cm2 Transvalvular Velociy 2.0-2.9 Mean Gradient <20mmhg
30
What are the echo features of moderate aortic stenosis?
Valve area 1.0 - 1.5cm2 Transvalvular Velociy 3.0-3.9 Mean Gradient 20-39mmhg
31
What are the echo features of severe aortic stenosis?
Valve area <1.0cm2 Transvalvular Velociy >4 Mean Gradient 40mmhg
32
What are the features of severe aortic regurgitation on echocardiography?
Four of the following - Vena contracta >6mm - Flail Valve - Central Jet Width >65% of LVOT - Holodiastolic flow reversal in descending aorta - Large flow convergence - Enlarged LV with normal ED - Pressure half time <200ms OR 2-3 criteria with one or more of the following: - Regurg fraction >50% - Regurg Volume 60ml - EROA >30mm2
33
What are the four echocardiographic measurements to assess LV systolic function?
Longitudinal shortening Anterior mitral leaflet motion Thickening of wall segments Change in cavity area
34
Velocity of blood formula?
Velocity = wavelength * frequency
35
Wavelength formula?
Wavelength = 1.54 * frequency (MHz)
36
What is the general resolution of echo images?
1-2 wavelengths
37
What is the formula for acoustic impedance?
Acoustic impedance = density of the object * propagation velocity
38
What is the size that induces scattering?
Less than 1 wavelength
39
What are the physics characteristics of a sound wave?
``` Frequency Period Wavelength Propagation Speed Amplitude Intensity ```
40
What are the qualitative measures to assess valve regurgitation?
Valve morphology Colour flow regurgitant jet CW signal of regurgitant jet Other - AR holodiastolic flow reversal, MR large flow convergence zone
41
What are the semi quantitative measures to assess regurgitant murmurs?
Vena contracta width Upstream vein flow Inflow Other - AR pressure half time, TR Pisa radius, MR TVI mitral/TVI aortic
42
What are the quantitative measures to assess regurgitant valvulopathy?
Effective regurgitant orifice area Regurgitant volume Cardiac chamber and vessel enlargement
43
What are the qualitative echocardiogram features of severe AR?
Valve morphology - flail, coapt defect Colour flow regurgitant jet - large central jet CW signal of regurgitant jet - dense Other - AR holodiastolic flow reversal in descending aorta >20cm/s
44
What are the qualitative features of severe MR and TR?
Valve morphology - coapt defect, flail leaflet, papillary muscle rupture Colour flow regurgitant jet - large central or adhering eccentric jet reaching posterior LA wall CW signal of regurgitant jet - dense, triangular Other - large flow convergence zone (MR)
45
What are the semi quantitative measures that support severe AR?
Vena contracta width - >6mm | Pressure half time <200ms
46
What are the semi quantitative measures that support severe MR?
Vena contracta width - 7mm or more Systolic pulmonary vein flow reversal E wave dominant >1.5m/s TVI mitral/aortic >1.4
47
What are the semi quantitative measures that support severe TR on echo?
Vena contracta width 7mm or more Hepatic vein systolic flow reversal Inflow E wave dominant >1 PISA radius >9mm
48
What are the quantitative measures that support severe AR on echo?
Effective regurgitant orifice area - >30mm2 Regurgitant volume - >60ml LV enlargement
49
What are the quantitative measures that support severe TR on echo?
Effective regurgitant orifice area - >40mm2 Regurgitant volume - >45ml RV RA IVC enlargement
50
What are the quantitative measures that support severe primary MR on echo?
Effective regurgitant orifice area >40 Regurgitant volume >60 LV LA enlargement
51
What are the quantitative measures that support severe secondary MR on echo?
Effective regurgitant orifice area - >20mm2 | Regurgitant volume >30ml
52
What is the placement of the cursor for M mode assessment of LV Size and EF?
Plax Base of heart Perpendicular (Up one intercostal space if not perpendicular)
53
What is the ERO associated with severe AR?
>0.3
54
What is the regurgitant volume associated with severe AR?
>60mls
55
Formula for mitral valve area with pressure half time.
Valve area = 220/pressure half time Valve area = 760/deceleration time
56
Surface area of sphere | Surface area of half sphere (Pisa method)
4 Pi r squared | 2 Pi r squared
57
What is the formula using Pisa to estimate mitral valve area in Ms?
MVA = 2 Pi r squared * Vr/Vmax * angle/180
58
Stroke volume equation
SV = 0.785 * D squared * VTI
59
MVA by the continuity equation.
MVA = (0.785 * D LVOT squared * LVOT VTI) / MV VTI
60
Regurgitation volume formula
RV = EROA * MR VTI
61
EROA formula from PISA
6.28 * r squared * nyquist limit / peak MR velocity
62
How does the eccentricity index assist in determining RV pressure vs volume overload?
Eccentricity index >1 only in end diastole indicates volume overload only Index >1 in end systole and end diastole indicates pressure overload
63
What is normal RA volume in men and women?
34ml/m2 men | 28ml/m2 women
64
What is the use of RV TDI S wave peak velocity in Pulmonary hypertension?
Prognostic value
65
What is the normal S wave value with TDI of the RV?
<11.5cm/s
66
What is the normal duration of the RV IVRT?
<110ms
67
Effective orifice area formula from SV and Transvalvular VTI
EO = SV/ transvalvular VTI
68
Formula for axial resolution?
Axial resolution = spatial pulse length / 2
69
Spatial pulse length formula?
SPL = wavelength * number of cycles
70
How does the potential trigger for takotsubo (physical vs emotional) influence outcome?
Physical trigger is associated with higher mortality
71
In retrospective data, what interventions are associated with improved outcomes for takotsubo cardiomyopathy?
ACE/ARB Antiplatelets No effect from b blocker on retrospective reviews

RACP Cardio AT (13 decks)

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