Mixed Flashcards by Erica Miller

TEE absolute contraindications

1) perforated viscus
2) symptomatic esophageal stricture
3) esophageal tumor
4) esophageal perforation or laceration
5) esophageal diverticulum
6) active upper GI bleed

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To optimize 3D echo temporal resolution

Decrease volume size: width (lateral and elevation planes) and depth (axial plane)
Decrease scan line density
Multi-beat acquisition

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To optimize 3D echo spatial resolution

Change frequency (?increase)
Change focus
Put gain in mid range
Put compression in mid range
Get image in near field

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Major Duke criteria

2 for endocarditis:

1) positive blood culture
- positive blood culture with typical organisms
- persistently positive blood culture
- single positive blood culture for Coxiella burnetii or positive IgG titers
2) endocardial involvement
- vegetation
- abscess
- new partial dehiscence of prosthetic valve
- new valvular regurgitation

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Area length method

For LA volume
= (8 x A1 x A2) / 3 x pi x L
A1 = area apical 4 chamber
A2 = area apical 2 chamber
L = shortest length btw apical 2 and apical 4

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Mitral inflow and pulmonary flow tracing changes with increasing LA pressures

increase E
shorten deceleration time
increase E/A
decrease S wave velocity (pulm vein systole)
decrease S/D ratio

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Threshold for concentric hypertrophy/remodeling

Relative wall thickness >0.42

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Threshold for hypertrophy

> 95ml/m2 for women

>115ml/m2 for men

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Wall motion score

= sum score for segments / #segments visualized

like an average wall motion abnormality score

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Fractional shortening =

= (LVEDD-LVESD)/LVEDD x100

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Normal value for fractional shortening

> 18%

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4 grade wall motion scoring

1: normal or hyperdynamic
2: hypokinetic
3: akinetic
4: dyskinetic or aneurysmal

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LV relative wall thickness

= (2 x post wall thickness) / LVEDD

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dilated cardiomyopathy M mode finding

E point septal separation >10mm

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Mild aortic stenosis

AVA >1.5cm2
MG <20mmHg
Vel <3cm/sec

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Mod aortic stenosis

AVA 1-1.5cm2
MG 20-39mmHg
Vel 3-3.9cm/sec

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Severe aortic stenosis

AVA <=1cm2
MG >=40mmHg
Vel >=4cm/sec

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Surgical repair ascending aorta indications

> =5.5cm

>=5cm if FH dissection, >=0.5cm/yr growth rate

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Mod-sev AI echo surveillance

q1yr

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Mild AI echo surveillance

q3yr

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PHT in AI

<200msec if acute

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Vena contracta for AI severity

<0.3cm: mild AI

>=0.6cm: severe AI

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Surgery for asymptomatic chronic AI

EF <=50%
Undergoing other surgery
LVESD >50mm or >25mm/m2

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Severe mitral stenosis

MVA 1.0 - 1.5cm2
Mean grad 5-10mmHg
PHT >150msec
PASP >30mmHg

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Progressive mitral stenosis

MVA > 1.5cm2 | Mean grad <5mmHg

PHT from DT

PHT = 0.29 x DT

half velocity

V1/2 = Vmax/1.4

Wilkins score

``` Balloon valvuloplasty if <8 1 mild - 4 severe - mobility - thickening - calcification - sub valv thickening ```

Class I recs for surgery for mitral regurgitation

- Sx chronic severe primary MR and LVEF >30% | - ASx chronic severe primary MR and LVEF 30-60% and/or LVESD >=40mm

Tricuspid leaflets seen

A4C: septal and anterior Parasternal long: septal and anterior Parasternal short: posterior and (septal vs anterior)

Severe TS

Mean grad >5-7mmHg (end expiration) PHT >= 190msec TVA <= 1.0cm2

Severe TR

ERO > 40mm2 | RV >45ml

Mild MR

ERO <0.2cm2 RV <30cc RF <30% VC <0.3cm

Severe non ischemic MR

ERO >=0.4cm2 RV >=60cc RF >=50% VC >0.7cm

Severe ischemic MR

ERO >0.2cm2 | RV >=30cc

Severe pulmonic stenosis

Vmax >4m/sec

Indications for pulmonary valvotomy

- Sx and peak grad >=50mmHg or mean grad >=30mmHg | - ASx and peak grad >=60mmHg or mean grad >=40mmHg

Echo surveillance for ASx PS

q2yrs for peak grad >30mmHg, otherwise q5yrs

Acceleration time

For prosthetic valves | >100msec = pathologic obstruction

DVT (DI) for aortic valves (native and prosthetic)

<0.25 highly suggests pathologic obstruction

Aortic Patient prosthesis mismatch (PPM)

measure indexed EOA >0.85: none 0.66-0.85: moderate <=0.65: severe

Mitral valve prosthesis E velocity interp

>=0.19msec: prosthesis dysfunction

Mitral valve prosthesis VTI ratio

>=2.2: prosthesis dysfunction

Mitral valve prosthesis PHT

>=130msec highly suggestive of obstruction

Mitral PPM

Indexed EOA >1.2: none 0.91-1.20: moderate <=0.9: severe

Suspect prosthetic mitral stenosis

E velocity >1.9m/sec Mean grad >=6mmHg DI>=2.2 PHT >=130msec

Suspect prosthetic mitral regurg

E vel >1.9m/sec Mean grad >=6mmHg DI >=2.2 PHT <130msec

ERO cut offs AI

Mild <0.1 Mod 0.1 - 0.29 Sev >0.3

Rergurg vol cut offs AI

Mild <30cc Mod 30-59cc Sev >60cc

Regurg fraction cut offs AI

Mild <30 Mod 30-49 Sev >50 PHT <250

Jet width cut offs AI

Mild <25% LVOT Mod 25-64% Sev >65%

Jet area cut offs AI

Mild <5 Mod 5-59 Sev >60

Vena contracta cut offs AI

Mild <3 Mod 3-6 Sev >6

VARC2

AI severity post TAVR Mild <10% circumferential extent Mod 10-29% Severe >=30%

Normal stroke volume index

32-58cm3/m2

Simplified MR ERO

= (PISA radius)2 / 2

LVOT gradient

= 4 (MR vel)2 + LAP - SBP

Magnificent 4 in diastology

1) E' velocity: >7-10 abnormal 2) E/e' (nml EF) and E/A (dec EF): E/e' >2.8m/sec abnormal 3) TR velocity: >2.8m/sec abnormal 4) LAVI: >34ml/m2 abnormal

See an L wave?

put grade II diastolic dysfunction

dP/dt

an index of myocardial contractility = 32,000 / (time in msec to get from 1m/sec to 4 m/sec) nml >1200 abnml <1000

goal MI with contrast

0.2 - 0.3

transverse sinus

recess around great arteries

E/e' suggestive of increased filling pressure

septal E/e' >15

PVR estimate

peak TR/RVOT VTI >=0.175 correlates with PVR >2 Woods units