Ischemic, Pericardial, & Cardiac Tumors Flashcards by Kaitlyn Yeager

All of the following can lead to ischemic mitral regurgitation EXCEPT:

A. Papillary muscle rupture
B. Dressler’s syndrome
C. Post MI left ventricular dilatation
D. Papillary muscle infarction

Dressler’s syndrome (post MI pericarditis)

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What is the echocardiographic term sometimes used to describe patients with a hyperlipomatous interatrial septum?

A. Tense septum
B. Dagger shaped
C. Dumbbell shaped
D. Oddly hypertrophied

Dumbbell shaped

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Which of the following can cause a friction rub to be detected on physical exam?

A. Pericarditis
B. Mitral stenosis
C. Aortic stenosis
D. Systemic hypertension

Pericarditis (and resulting inflammation)

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During a pharmacological echo stress test using dobutamine which drug is given if the patient doesn’t reach target heart rate?

A. Atropine
B. Viagra
C. Verapamil
D. Inderal

Atropine

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The sac that surrounds the heart is the:

A. Membranous pericardium
B. Serous pericardium
C. Visceral pericardium
D. Fibrous pericardium

Fibrous pericardium

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Patients with constrictive pericarditis and those in cardiac tamponade will have all the following EXCEPT:

A. Dilated IVC
B. Reduced cardiac output
C. Left ventricular hypertrophy
D. Abnormal diastolic function

Left ventricular hypertrophy

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Which of the following terms refers to less than normal wall motion?

A. Akinesis
B. Dyskinesis
C. Hypokinesis
D. Hyperkinesis

Hypokinesis

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Which of the following is a complication of a myocardial infarction?

A. Atrial septal defect
B. Headache
C. Stroke
D. Pericardial effusion

Pericardial effusion

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Which of the following is a component of Beck’s Triad?

A. Decreased venous pressure
B. Systemic hypertension
C. Dilated inferior vena cava
D. Distant (muffled) heart sounds

Distant (muffled) heart sounds

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The diastolic function of hypertrophic cardiomyopathy is most commonly characterized by:

A. Delayed relaxation with E
B. Pseudo normal pattern with blunted pulmonary venous S waves
C. Restrictive filling due to myocardial hypertrophy
D. Abnormal relaxation with E>A mitral inflow velocities

Delayed relaxation with E

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Patients who develop a post infarction effusion are said to have which of the following syndromes?
A. Dressings
B. Noonan
C. Marfans
D. Dressler’s
E. Eisenmenger’s

Dressler’s

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Constrictive pericarditis involves which of the following?

A. Normal diastolic function
B. Equal LV and RV systolic pressures
C. Normal IVC size
D. Pericardial thickening and scarring

Pericardial thickening and scarring

(Restricts right sided filling)

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Patients with constructive pericarditis commonly have all the following EXCEPT:

A. Abnormal diastolic function
B. Pericardial thickening and scarring
C. Normal IVC size
D. Equal RV and LV diastolic pressures

Normal IVC size

(High right sided pressures)

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Which coronary artery supplies the interatrial septum?

A. Right coronary artery
B. Left main coronary artery
C. Circumflex coronary artery
D. Left anterior descending

Right coronary artery

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One of the most common complications of a myocardial infarction is:

A. Aneurysm formation
B. Outflow tract obstruction
C. Aortic insufficiency
D. Mitral valve rupture

Aneurysm formation

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Which is the best view for differentiating between a pericardial effusion and a pleural effusion?

A. Apical 4 chamber
B. Parasternal long axis
C. Subcostal four chamber
D. Parasternal short axis

Parasternal long axis

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Which is the best stress echo technique for revealing hibernating or stunned myocardium?

A. Supine bike exercise
B. Dobutamine
C. Treadmill exercise
D. Leg lifts

Dobutamine

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The apex of the left ventricle is fed by which coronary artery?

A. Right coronary
B. Left anterior descending
C. Left circumflex
D. Left first marginal

Left anterior descending

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Color Doppler is best used in ischemic heart disease for detecting:

A. Tricuspid regurgitation
B. Ventricular septal defects
C. Mitral regurgitation
D. Aortic regurgitation
E. Atrial septal defects

Ventricular septal defects

(Post MI)

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Blood supply of the inferior wall of the left ventricle is by which coronary artery?

A. Left first marginal
B. Left anterior descending
C. Right coronary
D. Left circumflex

Right coronary

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Which of the following pathologies would most likely affect coronary artery circulation?

A. Aortic regurgitation
B. Mitral regurgitation
C. Pulmonic stenosis
D. Mitral stenosis

Aortic regurgitation

(These patients (with mod-sev disease) have low diastolic pressure)

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What would be a contraindication in performing a stress echo on a patient with chest pain?

A. Dyspnea on exertion
B. Unstable angina
C. Left bundle branch block (LBBB)
D. Harsh systolic murmur

Unstable angina

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By echo, a small pericardial effusion is defined as:

A. Greater than 1 cm posteriorly only
B. Greater than 2 cm all the way around the heart
C. Greater than 1 cm all the way around the heart
D. Less than 1 cm posteriorly only

Less than 1 cm posteriorly only

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A loculated pericardial effusion is rare except for patients with:

A. Associated pleural effusion
B. Connective tissue disorders
C. Post op cardiac surgery
D. Rheumatic heart disease

Post op cardiac surgery

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Criteria for a positive treadmill stress echo diagnosis includes: A. Decrease in left ventricular size from rest to immediate post B. Provoked wall motion abnormalities from rest to immediate post C. Left ventricular volume decrease from rest to peak D. Decrease in ejection fraction from rest to immediate post

Provoked wall motion abnormalities from rest to immediate post

All of the following are complications of a myocardial infarction EXCEPT: A. Pericardial effusion B. Mural thrombus formation C. Ventricular aneurysm D. Ventricular septal defect E. Atrial septal defect

Atrial septal defect

Which cardiac chamber is most likely to be involved with metastatic tumors? A. Right ventricle B. Left ventricle C. Right atrium D. Left atrium

Right atrium

During a treadmill stress echo the most common stages captured on the screen are: A. REST and IMPOST B. REST and PEAK C. REST and FINAL D. REST, PEAK, and IMPOST

REST and IMPOST

In the Parasternal long axis view a pleural effusion would be located: A. Posterior to the ascending aorta B. Posterior to the descending aorta C. Not seen in this view D. Anterior to the descending aorta

Posterior to the descending aorta

Which coronary artery supplies the left ventricular apex? A. Circumflex coronary artery B. Left main coroanry C. Left anterior descending D. Right coronary artery

Left anterior descending

By echo, a medium sized pericardial effusion is defined as: A. Less than 1 cm posteriorly only B. Greater than 1 cm all the way around the heart C. Greater than 1 cm posteriorly only D. Less than 1 cm but seen anterior and posterior

Less than 1 cm but seen anterior and posterior

The treatment of choice for cardiac tamponade is: A. Pericardiocentesis B. Pericardiectomy C. Cardiac transplantation D. Medical management

Pericardiocentesis

All of the following are indications for a stress echo EXCEPT: A. Increase in revenue compared to nuclear studies B. Evaluate cardiac arrhythmias C. Guide post MI rehab D. Aid in the diagnosis of chest pain

Increase in revenue compared to nuclear studies

Children with tuberous sclerosis complex (TSC) develop what type of cardiac tumors? A. Rhabdomyomas B. Rhabdomyosarcomas C. Right atrial myxomas D. Left atrial myxomas

Rhabdomyomas

Where do the coronaries drain? A. Coronary sinus B. Atrial appendage C. Left atrium D. Right atrium

Coronary sinus

In a patient with Dressler’s syndrome the echo is performed to rule out: A. Aortic dissection B. Constrictive pericarditis C. Left atrial thrombus D. Pericardial effusion

Pericardial effusion

All of the following can be associated with epicardial fat EXCEPT: A. Has been associated with CAD B. Posterior echo free space C. Is a measure of visceral fat D. Anterior echo free space

Posterior echo free space

Which percent stenosis is considered significant coronary artery disease? A. 70% B. 50% C. 20% D. 30%

70%

True aneurysms of the left ventricle have which of the following features? A. Wide base, walls containing myocardium and low risk for rupture B. Wide base, walls containing myocardium and high risk for rupture C. Wide base, walls containing pericardium and low risk for rupture D. Narrow base, walls containing myocardium and low risk for rupture E. Narrow base, walls containing pericardium and high risk for rupture

Wide base, walls containing myocardium and low risk for rupture

Left atrial thrombus is often seen in patients with: A. Cor triatriatum B. Ischemic heart disease C. Mitral valve prolapse D. Mitral stenosis

Mitral stenosis (Especially in the appendage)

In patients with possible cardiac tamponade echo helps to determine all of the following EXCEPT: A. Degree of diastolic dysfunction B. Hemodynamic effect upon the heart chambers and function C. Size of the pericardial effusion D. Location of the pericardial effusion

Degree of diastolic dysfunction (Difficult to determine and also not clinically relevant)

All of the following are risk factors for ischemic heart disease EXCEPT: A. Sex (male vs female) B. Smoking C. Pulmonary hypertension D. Systemic hypertension E. Age

Pulmonary hypertension

Patients with all the following diseases are susceptible to intracardiac thrombus formation EXCEPT: A. Aortic stenosis B. Dilated cardiomyopathy C. Mitral stenosis D. Ischemic cardiomyopathy

Aortic stenosis

Cardiac tamponade is rapid filling of fluid: A. Causing restrictive filling B. With diastole C. Causing restrictive systolic filling D. Causing restrictive diastolic filling

Causing restrictive diastolic filling

What type of myocardial infarction causes papillary muscle rupture? A. Anterior B. Posterior C. Inferior D. Transmural

Inferior

Heart failure is a condition where the heart is unable to do all the following EXCEPT: A. Act as an effective pump B. Under perfuse vital organs C. Increase the cardiac output D. Meet the body’s metabolic demands

Under perfuse vital organs

Normally pericardial fluid drains into the: A. Coronary sinus B. Pleural space C. Lymphatic system D. Peritoneal space

Lymphatic system

In the Parasternal long axis view a pericardial effusion would be located: A. Not seen in this view B. Posterior to the descending aorta C. Anterior to the ascending aorta D. Anterior to the descending aorta

Anterior to the descending aorta

Which of the following is a normal response to stress? A. Systolic wall thinning B. Decreased heart rate C. Increased diastolic cavity size D. Decreased systolic cavity size E. Hypodynamic wall motion

Decreased systolic cavity size

What would you look for in a patient with Kawasaki disease? A. Left atrial mass B. Dilated cardiomyopathy C. Coronary artery aneurysms D. Pericardial effusion E. Atrial septal defect

Coronary artery aneurysms

What information do you need pre op in a patient with an LV aneurysm? A. Aneurysm location B. Presence of a thrombus C. Aneurysm size D. Movement of other walls

Movement of other walls

In the majority of human hearts the posterior descending artery is a branch of which coronary artery? A. Circumflex B. Right C. Left D. Anterior descending

Right (Means they are right dominant)

Pseudoaneurysms of the left ventricle have one feature which makes them surgical emergencies: A. High rate of rupture B. Lead to increasing amounts of mitral regurgitation C. Involve the posterior wall D. Narrow neck E. Contain thrombus

High rate of rupture

Filling of the coronary arteries occurs during which phase of the cardiac cycle? A. Atrial diastole B. Ventricular systole C. Ventricular diastole D. Isovolumic contraction

Ventricular diastole

Ischemic heart disease is usually caused by: A. Coronary spasm B. Kawasaki disease C. Atherosclerosis D. Amyloid deposits

Atherosclerosis (Coronary blockage)

In order to distinguish between pleural and pericardial effusions on echo, it is helpful to identify the: A. Abdominal aorta B. Transverse aorta C. Ascending aorta D. Descending aorta

Descending aorta

The treatment of choice for constrictive pericarditis is: A. Cardiac transplantation B. Pericardiocentesis C. Pericardial tap D. Pericardiectomy

Pericardiectomy (Stripping of the pericardium)

Which of the following cardiomyopathies is characterized by ventricular dilatation and poor overall contractile function: A. Infiltrative B. Congestive C. Restrictive D. Hypertrophic

Congestive

Atrial myxomas are usually attached to: A. Mitral valve leaflets B. Fossa ovalis area of the atrial septum C. Posterior left atrial wall D. Left atrial appendage

Fossa ovalis area of the atrial septum

Myocardial ischemia means what? A. Actual tissue death B. The patient has a blocked artery C. Low coronary reserve D. Lack of oxygen to myocardium

Lack of oxygen to myocardium

A shared problem in patients with constrictive pericarditis and those in cardiac tamponade is: A. Decreased cardiac output B. Pericardial thickening and scarring C. Dilated IVC D. Abnormal diastolic function

Decreased cardiac output (Restricts right sided filling which in turn decreases left sided filling and cardiac output)

Patients with pericarditis and pericardial effusions can classically present with what type of chest pain? A. Angina B. Positional C. Exertional D. Nocturnal

Positional

By echo, a large pericardial effusion is defined as: A. Greater than 1 cm all the way around the heart B. Greater than 2 cm all the way around the heart C. Less than 1 cm all the way around the heart D. Greater than 1 cm posteriorly only

Greater than 2 cm all the way around the heart

Which of the following best describes epicardial fat by echo? A. Posterior echo free space B. Posterior and anterior echo free space C. Inferior echo free space D. Anterior echo free space

Anterior echo free space

Filling of the main coronary arteries occurs during which part of the cardiac cycle? A. Isovolumic contraction B. Ventricular systole C. Atrial diastole D. Ventricular diastole

Ventricular diastole

Pseudoaneurysms of the left ventricle have which of the following features? A. Wide base, walls containing myocardium and low risk for rupture B. Narrow base, walls containing pericardium and low risk for rupture C. Narrow base, walls containing pericardium and high risk for rupture D. Wide base, walls containing pericardium and low risk for rupture E. Narrow base, walls containing myocardium and low risk for rupture

Narrow base, walls containing pericardium and high risk for rupture

Which of the following is considered a risk factor for ischemic heart disease? A. Pulmonary hypertension B. Hypolipidemia C. Chronic obstructive pulmonary disease D. Systemic hypertension

Systemic hypertension

What part of the heart is most likely to be affected by cardiac contusion? A. Left ventricle B. Left atrium C. Aorta D. Right ventricle

Right ventricle

Which of the following best describes stable angina? A. Due to coronary spasm B. Relieved by rest or Nitroglycerin C. Chest pain at rest D. Chest pain after drinking cold water

Relieved by rest or Nitroglycerin

All of the following are components of Beck’s Triad EXCEPT: A. Distant (muffled) heart sounds B. Systemic hypertension C. Systemic hypotension D. Distended neck veins

Systemic hypertension

During a stress echo, only one of these left ventricular segments can be seen in the apical 2 chamber view: A. Mid-anterior B. Apical-septal C. Mid-anteroseptal D. Basal-septal

Mid-anterior

Before a cardioversion a TEE might be indicated to rule out: A. LA myxoma B. Marantic endocarditis C. LV thrombus D. LA appendage thrombus

LA appendage thrombus

Which of the following best describes unstable angina? A. Chest pain after drinking hot water B. Chest pain at rest C. Relieved by rest or nitroglycerin D. Due to coronary spasm

Chest pain at rest

The lateral left ventricle wall in the apical 4 CH view is fed by which coronary artery: A. Left first marginal B. Left circumflex C. Right coronary D. Left anterior descending

Left circumflex

Which coronary artery supplies blood to the anterior portion of the right ventricle? A. Left main coronary artery B. Circumflex coronary artery C. Left anterior descending D. Right coronary artery

Right coronary artery

Chronic pericarditis can lead to calcification and adhesions of the pericardium which may restrict cardiac filling. This pericardial disease is known as: A. Restrictive pericarditis B. Cardiac tamponade C. Infiltrative pericarditis D. Constrictive pericarditis

Constrictive pericarditis

In a patient with a carcinoid tumor the sonographer must devote a special attention to the: A. Mitral valve B. Tricuspid valve C. Abdominal aorta D. Aortic valve

Tricuspid valve (Most often have right sided valve abnormalities)

In patients with large pericardial effusions the motion of the pericardium may be: A. Increased B. Paradoxical C. Damped D. Unchanged

Damped

What might be the first indication of metastatic cardiac disease? A. Left atrial mass B. Myxoma C. Pericardial effusion D. Right atrial mass

Pericardial effusion

A 52 year old woman develops a systolic murmur after a myocardial infarction. What is the most likely etiology? A. Pseudoaneurysm B. Pericarditis C. Ruptured papillary muscle D. Ventricular septal defect

Ventricular septal defect

Ischemic heart disease can be caused by all of the following EXCEPT: A. Muscular bridges over coronaries B. Coronary artery disease C. Coronary artery spasm D. Congenital coronary anomalies E. Carotid artery stenosis

Carotid artery stenosis

Papillary muscle dysfunction usually results from: A. Rheumatic heart disease B. Dressler’s syndrome C. Ischemic heart disease D. Bacterial endocarditis

Ischemic heart disease

A pericardial effusion can often be seen in patients with: A. Renal failure B. Aortic stenosis C. Atrial flutter D. Myocardial infarction

Renal failure

A left ventricular thrombus is usually in an area of: A. Abnormal wall motion B. Ventricular enlargement C. Ventricular hypertrophy D. Hyperkinesis

Abnormal wall motion

Normal response to stress includes all of the following EXCEPT: A. Decreased heart rate B. Normal diastolic dimensions C. Hyperdynamic wall motion D. Decreased systolic cavity size E. Systolic thickening

Decreased heart rate

What would you expect to see on the echo of a patient with myocarditis? A. Dilated aortic root B. Pleural effusion C. Pericardial effusion D. Ventricular dysfunction

Ventricular dysfunction (Can be either global or regional)

For differentiating between a pericardial effusion and a pleural effusion echo uses the landmarks of the descending aorta and the: A. Ascending aorta B. Inferior vena cava C. Coronary sinus D. Coronary artery

Coronary sinus

Which of the following terms refers to a decrease in wall motion? A. Hypokinesis B. Dyskinesis C. Hyperkinesis D. Akinesis

Hypokinesis

The size of the left ventricular aneurysms during systole: A. Can’t tell most of the time B. Remain the same C. Decrease D. Increase

Increase (Commonly referred to as “systolic bulging”)

Which of the following terms refers to wall motion opposite of normal? A. Hyperkinesis B. Dyskinesis C. Akinesis D. Hypokinesis

Dyskinesis

Which echo finding is associated with a friction rub? A. Pericardial effusion B. Aortic dissection C. Mitral stenosis D. Cor pulmonale

Pericardial effusion

The most common cardiac valve tumor is a: A. Myxoma B. Lipoma C. Fibroelastoma D. Angiosarcoma

Fibroelastoma

The most sensitive way to diagnose cardiac tamponade is: A. Right ventricular systolic collapse B. Right ventricular diastolic collapse C. Respiratory variation of mitral inflow D. M-mode of the left atrial wall motion

Respiratory variation of mitral inflow

Which of the following is the most common complication following a myocardial infarction? A. Ventricular septal defects B. Pseudoaneurysm formation C. Papillary muscle rupture D. Sudden death E. Aneurysm formation

Aneurysm formation

Myocardial infarction means what? A. Low coronary reserve B. The patient has a blocked artery C. Lack of oxygen to myocardium D. Actual tissue death

Actual tissue death

Which of the following terms refers to an increase in wall motion? A. Hypokinesis B. Akinesis C. Hyperkinesis D. Dyskinesis

Hyperkinesis

Decreased myocardial contractility can be caused by all the following EXCEPT: A. Marantic endocarditis B. Viral myocarditis C. Dilated cardiomyopathy D. Coronary artery disease

Marantic (non-bacterial) endocarditis (Causes valvular disease and rarely leads to decreased myocardial contractility)

Disease processes which could cause infiltrative cardiomyopathies do NOT include: A. Carcinoid B. Amyloidosis C. Sarcoidosis D. Hemochromatosis

Carcinoid

When performing an echo on a patient with known heart failure you should pay particular attention on all the following EXCEPT: A. Chamber size B. Chamber function C. QP/QS evaluation D. Diastolic function

QP/QS evaluation

Ischemic, Pericardial, & Cardiac Tumors Flashcards

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