Fun Onesies…

Question 1

EPSS

Answer 1

E point septal separation.
<5 mm is normal from peak E to septum
Larger # equals LV dilatation or systolic dysfunction.

Question 2

When is EPSS greater than reality (2)

Answer 2

• AR = regurgitation jet on anterior MV leaflet.
  – MS = restricted motion of MV leaflet.

Question 3

What is the Bentall procedure?

Answer 3

AVR and root replacement with coronary artery reimplantation

Question 4

Which is better for PFO evaluation, saline or color Doppler?

Answer 4

Saline
Leg injection >arm injection for PFO

Question 5

What structure can hamper flow/complete opacification of the RA with a bubble study?

Answer 5

Prominent eustachian valve

Question 6

Propagation, velocity a.k.a.…

Answer 6

Color in mode at LV inflow.
“slope“ of diastole
– reflects the rate of diastolic relaxation
– steep = normal.
- flatter = increased LV pressure

Question 7

Short axis septum tells us what?

Answer 7

Volume overload = septum is flat in diastole, normal circular in systole.
Pressure overload = septum, remains flat/reversed in systole, “D shape in systole”

Question 8

Where is left atrial inflow measured, what view, three things…

Answer 8

From the right superior pulmonary vein, A4C
Peak systolic/diastolic velocities and
atrial velocity and duration➡️
>0.35 ms and >20 ms = elevated LVEDP.

Question 9

Beck’s triad

Answer 9

For tamponade
-Low blood pressure.
-Bulging neck veins.
-Muffled heart beats.

Question 10

Pulses paradoxus

Answer 10

Decline in systolic blood pressure by >20 mmHg with inspiration
Remember, physiology, right Hart is filling with inspiration, this reduces cardiac output/blood pressure
TAMPONADE

Question 11

Doppler like a dagger

Answer 11

Shows a dynamic obstruction with initial concave shape and peak later in systole.

Question 12

Doppler static waveform

Answer 12

Fixed, obstructive pattern, seen in subaortic membrane, valve stenosis, super valvular stenosis.

Question 13

What is pressure recovery?

Answer 13

The variable increase in pressure downstream from the vena contracta
(site of lowest pressure/highest velocity) due to the conversion of kinetic energy/dynamic pressure to potential energy/static pressure. 

Question 14

True/False
LVOT measured larger makes AVA smaller

Answer 14

False
LVOT mismeasure is in direct proportion to mismeasure
(Too large = larger)
(Too small = smaller)