Protocols Pt 1 Flashcards
1
Q
What equation is used to calculate the aortic valve area on Doppler echocardiography?
A
- Continuity equation
2
Q
What equation is used to determine aortic valve area on a heart catheterization?
A
- Gorlin formula
3
Q
What technique is used to document motion of the disk in a St. Jude Valve?
A
- M mode
4
Q
What should NOT be included in the optimal parasternal long axis view of the left ventricle?
A
- Papillary muscles
5
Q
What should be done when evaluating the PISA radius of TR on a TTE?
A
- Color Doppler baseline should be moved down to 25-30 cm/s
6
Q
What technique should be used with obstructive hypertrophic cardiomyopathy, aortic stenosis, and prosthetic valves?
A
- Dedicated CW evaluation
7
Q
How do you measure the strain rate for a specific segment of the left ventricular wall?
A
- Take 2 to 3 tissue Doppler samples from the area of interest
8
Q
How often should the brachial pressure be recorded during a treadmill stress echo?
A
- Every 2 minutes after the start of exercise and continued until the pressure returns to resting level upon cessation of exercise
9
Q
What part of the continuity equation has the greatest effect on the results?
A
- LVOT diameter
10
Q
What must you do in order to calculate the dp/dt ratio?
A
- Use CW Doppler to record mitral regurgitation tracing
11
Q
Hos is the measurement of the dp/do of the mitral regurgitation tracing performed?
A
- Measure the time it takes for the MR velocity to go from 1 m/s to 3 m/s
12
Q
What is the most commonly performed method of estimating mitral valve are?
A
- Pressure half time
13
Q
When measuring the left ventricular end diastolic volume, you should use the cine function to do what?
A
- Find the frame just after the MV closes
14
Q
Which orthogonal plane is used to obtain a planimetry measurement of the aortic valve?
A
- Short axis
15
Q
When performing an echo with saline UEA to evaluate an eccentric jet of TR, which chamber should you monitor during UEA administration?
A
- Right atrium
16
Q
A patient presents with a biventricular pacemaker. How do you assess the patient for myocardial desynchrony?
A
- PW Doppler of the LVOT and RVOT are performed to evaluate isovolumic contraction time
17
Q
What technique is used to differentiate constrictive pericarditis from restrictive cardiomyopathy?
A
- Use tissue Doppler to assess the mitral annulus
18
Q
The difference in left ventricular length measurements obtained in the apical 4 and apical 2 chamber views should be?
A
- Less than 10%
19
Q
Which pulmonary vein is able to be evaluated by PW Doppler in the apical 4 chamber view in most patients?
A
- Right upper
20
Q
Which echocardiographic view is preferred for evaluation of the flow into the pulmonary system from a patient ductus arteriosus?
A
- Parasternal short axis
21
Q
Placing the transducer at the 5th intercostal space on the patient’s chest can lead to what?
A
- An oval appearance of the left ventricle in the short axis
22
Q
How can an echo with UEA help to confirm the diagnosis of constrictive pericarditis?
A
- Used to evaluate the IVC for the appearance of presystolic UEA reversal at the right atrial junction which is a positive sign
23
Q
What can the mean velocity of pulmonary insufficiency be used to assess?
A
- Mean pulmonary artery pressure
24
Q
What cannot be used to estimate the valve area in patients with a transcatheter aortic valve replacement?
A
- Planimetry
25
The Valsalva strain causes a reduction preload that can be demonstrated on Doppler evaluation as what?
- E to A reversal
26
What 3 Doppler measurements are normally used to evaluate a cardiac transplant for rejection?
- Mitral deceleration time
- Isovolumic relaxation time
-E velocity
27
The peak velocity of the tricuspid regurgitation get is 3.3 m/s. What is the RVSP if there is a 1.9 cm IVC collapse that is less than 50%?
- 52 mmHg
(RVSP = 4 (V x V) + RA pressure
28
List the echocardiographic views obtained in a standard stress echo
- PLAX, PSAX, Apical 4, Apical 2
29
What should you see as in indication of PLAX view being performed correctly?
- IVS and AO root appear as continuous structure within minimal angle of intersection
30
A patient is undergoing a pharmacologic stress echo and the last dose of dobutamine has been delivered with little increase in heart rate. What would most likely be administered to this patient to continue to try and increase the heart rate?
- Atropine
31
Which three orthogonal planes are used in echocardiography to evaluate the left ventricular motion?
- Long axis, short axis, and apical
32
When recording the flow velocity in the LVOT, where should the PW Doppler cursor be placed?
- Just proximal to the aortic valve closure plane
33
The left atrial volume measurement is performed during what portion of the cardiac cycle?
- End systole
34
When assessing mitral regurgitation using the vena contracta method, what adjust ment to the machine should be made?
- Set the color velocity scale to 50-60 cm/s
35
If the heart rate is 80 bpm and the stroke volume is 50 mL, what is the cardiac output?
- 4 L/min
36
When evaluating an adult with suspected congenital heart disease, how do you identify the left atrium?
- Locate the left atrial appendage
37
What view are the vena contracta measurements for mitral and aortic regurgitation obtained?
- PLAX
38
What is the measurement of time that it takes for the velocity of mitral regurgitation to increase from 1 m/s to 3 m/s used to calculate?
- dp/dt ratio
39
What is the proper placement of the m-mode cursor for assessment of the EF% in the long axis view?
- Between the papillary muscle head an the mitral leaflet tips
40
If the mitral deceleration time is 500 msec, what is the pressure half time?
- 145 msec
41
A patient presents for an echo for pre-op evaluation for an upcoming knee surgery. He has no cardiac complaints. While performing the apical 5 chamber view, you notice a small, thinned aneursymal portion of the IVS at the basal level. The chamber sizes are within normal limits. What should you do next?
- Apply color Doppler to evaluate the area of the IVS for turbulent shunt flow into the right ventricle
42
What is the top normal peak velocity across an atherosclerotic aortic valve?
- 2.5 m/s
43
Where is the correct place to measure the LVOT diameter?
- 3 to 10 mm from the AV insertion points
44
A patient presents for a 6 month follow up after a balloon valvuloplasty of the mitral valve. What method provides the most accurate estimate of the mitral valve area?
- Pressure half time
45
If the PISA radius for the mitral regurgitation is 1.0 cm. What should you do next to assess the level of MR present?
- PW Doppler of the pulmonary veins because it is severe MR ( > 0.9 cm)
46
You are performing the PISA method of mitral regurgitation assessment on a transthoracic echo. After optimizing the color flow of the mitral valve regurgitation jet, what console adjustment should be made before freezing the image?
- Shift the color baseline down to between 20 to 40 cm/s to allow for aliasing
(TTE shift down, TEE shift up)
47
What is the correct method of needle insertion for an intravenous catheter prior to a dobutamine stress echo?
- Position the needle as parallel to the skin as possible when puncturing the vein
48
Where are the calipers placed when measuring the aortic root in PLAX?
- From outer edge of the anterior wall to the inner edge of the posterior wall
49
What is the primary advantage of using the supine exercise bike for stress testing?
- The ability to image while exercising
50
What cardiac abnormality requires the use of the continuity equation for proper calculation of aortic valve area?
- Decreased left ventricular function
51
Mitral deceleration time cannot be accurately measured in patients with what?
- Tachycardia
52
When using Doppler and Bernoulli equation to evaluate the pressure gradient at the tricuspid valve, what are you calculating?
- Peak instantaneous gradient
53
Which transducer position provides the best view of the descending thoracic aorta for assessment of diameter?
- Apical
54
What kind of patient would require a dobutamine stress test?
- Patient with hemiparesis
(someone who is paralyzed cannot bike or walk)-
55
A patient presents for an echo to rule out wall motion abnormalities. The TTE 2D exam is suboptimal. What should you do next?
- Consult the physician for permission to perform imaging with an ultrasound enhancing agent
56
Severe aortic regurgitation will _________ aortic stenosis when the aortic valve peak velocity and pressure gradient are solely used for diagnosis.
- Overestimate
57
What is the preferred Doppler measurement used to evaluate mitral valve area?
- Pressure half time
58
What should always be used in conjunction with the Doppler evaluation of the LV inflow in patients with suspected constrictive pericarditis?
- Respirometer
59
The slope between which two points of the Doppler tracing of the mitral valve are used to calculate the pressure half time?
- E and F
60
A 16 year old male presents for an echo due to a continuous murmur. The echo demonstrated left ventricular volume overload and an are of turbulent flow in the pulmonary artery throughout the cardiac cycle. What supplemental view should be performed to better evaluate this patient?
- High parasternal short axis
61
You begin your echo exam by performing the parasternal long axis view. Color Doppler demonstrates severe mitral regurgitation. What heart structure(s) should be evaluated for associated dilation before changing views?
- Left atrium
62
Which echocardiographic view best demonstrates color flow through a muscular VSD?
- Subcostal 4 chamber
63
What is best evaluated using a supine exercise bicycle?
- Diastolic dysfunction
64
What is best evaluated using an upright bike or treadmill?
- CAD
65
How do you measure the left ventricular mass?
- Trace the epicardium and endocardium at end diastole and measure LV length
66
How do you perform the isovolumic relaxation time (IVRT)?
- Place the PW Doppler cursor between the aortic and mitral valves to record both flow patterns and measure time from aortic valve closure to mitral valve opening
67
What information is necessary to estimate the systolic pressure in the pulmonary artery in a patient with a patent ductus arteriosus (PDA)?
- Systolic BP and a peak velocity across the PDA
68
What are the normal values for isovolumic relaxation time (IVRT)?
- 80 to 100 ms
69
Which transducer position/view works best for the 2D evaluation of all three of the sinuses of Valsalva?
- PSAX
70
While performing the parasternal long axis view of the heart, you notice dilation of the aortic root. Which 2D echocardiographic view will help to best evaluate the extent of this aortic abnormality?
- Suprasternal long axis
71
TTE only has 70-85% sensitivity for vegetation because it cannot identify vegetations less than _____ in size.
- 0.3 cm
72
If you are scanning in the apical 4 chamber view and want to view the coronary sinus, which way will you tilt the transducer?
- Slightly posterior
73
What is normal peak atrial reversal velocity on a pulmonary vein waveform?
- Less than 30 cm/s
74
What can be used to differentiate subvalvular from valvular aortic stenosis?
- M-mode of the aortic cusps
(Elevated velocity and restricted valve opening = valvular stenosis)
75
A patient presents for a 6 month follow up echo for a reported EF% of 62% and an AVA of 1.0 cm2. On today's exam, the EF% is unchanged and the continuity equation demonstrates an AVA of 1.6 cm2. What could explain the variation in measurements?
- Overestimated LVOT diameter on current exam
76
Overestimating the LVOT diameter will have what effect on AVA calculation?
- Will cause a larger AVA calculation
77
What can help confirm that swirling of UEA in the apex of the left ventricle is related to abnormal wall motion in the apex?
- Increase the rate of contrast injection
78
What is the best method used to measure EF% in the parasternal long axis?
- Measure left ventricular chamber size at end systole and end diastole
79
When imaging from the PLAX view, if the left ventricle is not horizontal across the screen, what two things can you do?
- Move transducer to a higher parasternal window
- Turn patient up more on left side
80
A patient presents for an echo for a suspected myxoma. Which part of the heart should you evaluate first?
- Left atrium
81
How is aortic stenosis evaluated by catheterization?
- The catheter is placed in the LV and then advanced through the aortic valve to assess the pressure difference
82
When estimating right atrial pressure, a 2.7 cm IVC that demonstrates no collapse with respiration indicates a pressure of approximately ____ mmHg.
- 15
83
The ASE recommends that, whenever possible, all 2D and 3D measurements of the left ventricle be taken at the interface between what?
- Compacted and non compacted myocardium
84
Microbubble contrast evaluation of the left ventricle is performed when standard 2D images are suboptimal. Suboptimal images are defined as?
- Inability to detect two or more continuous segments in any of the three apical windows
85
The Qp/Qs ratio is used to evaluate the severity of what abnormality?
- VSD
86
What is the preferred approach for needle placement during a pericardiocentesis?
- Subxiphoid
87
What is a potential cause for underestimation of aortic stenosis when calculating the AVA with the continuity equation?
- Suboptimal parasternal view causing overestimation of the LVOT diameter
88
A patient presents with a history of lower extremity arteritis and supravalvular stenosis in the aortic root. What supplemental 2D echo view should be used to further evaluate the patient for additional findings?
- Long axis at the SSN
89
What it he best view to evaluate coarctation of the aorta?
- SSN
90
What is the correct method to measure the acceleration time of the pulmonary valve waveform?
- Measure the time from the onset of systole to the systolic peak
91
What is the correct way to perform the PISA method of mitral regurgitation evaluation?
- Assess the distance from the valve tops to the yellow-blue color interface
92
The parasternal echo view will demonstrate the most accurate Doppler evaluation of which valve?
- Pulmonary
93
Which echo view should be used to evaluate flow velocity in the descending aorta?
- SSN
94
On the Doppler tracing of a pulmonary vein, the peak velocity of the _____ indicates the peak flow during ventricular systole and the peak velocity of the ____ indicates the peak flow during atrial systole.
- S wave, A wave
95
Which sonographic view best demonstrates the LV inflow across a bioprosthetic mitral valve?
- Apical
96
Which view is utilized to get the best view of an AV canal defect?
- Apical
97
During evaluation of a possible PFO with saline UEA, when do you stat counting heartbeats to determine when shunt flow occurs?
- Begin counting betas once the UEA opacifies the right atrium
98
The mitral deceleration time is 300 msec. What is the valve area?
- 2.5 cm2
(MVA = 759/Xmsec)
99
You identify a PFO on an echo and the cardiologist asks you to calculate the left atrial pressure. How will you perform this calculation?
- Measure the peak velocity across the PFO, calculate the peak pressure gradient across the defect and add the right atrial pressure
100
When you have no parasternal window, how do you evaluate the flow velocity through the pulmonary valve?
- Use the subcostal view
101
When estimating the regurgitant volume of mitral regurgitation, the radius of the jet on the ventricle side of the valve, the velocity time integral of the mitral regurgitation and what are required?
- Peak velocity of mitral regurgitation
(ERO = 6.28 x radius2 x aliasing velocity / PSV mitral regurgitation)
102
If spectral broadening and the opening click of the aortic valve are demonstrated on the PW Doppler tracing of the LVOT, what o you need to do?
- Move the cursor slightly away from the aortic valve
103
When is imaging performed during a stress echo using a supine exercise bike?
- During peak exercise
104
What effect does handgrip exercise have?
- Increases systemic blood pressure and cardiac output
105
When performing planimetry on the mitral valve in PSAX, the ____ should be traced.
- Inner edge of the leaflet tips
106
If the aortic velocity is 4 cm/s and the systemic BP is 120/80, what is the peak LV pressure?
- 184 mmHg
(Pressure gradient = 4(4m/s)2)
107
What is the best way to measure pulmonary artery diameter?
- PSAX, inner to inner diameter in end diastole
108
With proper positioning, the left atrium in the apical 2 chamber view should have a length within ______ of the length measurement obtained in the 4 chamber view/
- 5 mm
109
How do you properly record a PW Doppler tracing from the hepatic veins?
- A 3 to 5 mm sample volume placed in the hepatic veins about 1 to 2 cm from the junction with the IVC during normal respiration
110
How is the cardiac index calculated?
- Cardiac output / body surface area
111
What will an optimal LVOT tracing demonstrate?
- A clear spectral window and the closing click of the aortic valve
112
If what is present, the RVSP calculation from tricuspid regurgitation gradient is inaccurate as the measurement of the pulmonary artery pressure?
- Pulmonary stenosis
113
You begin the echo exam by performing the PLAX view. Color Doppler demonstrates suspected severe mitral regurgitation. What method of mitral regurgitation assessment can be used in this view?
- Vena contracta width
(7 mm or greater indicates severe MR)
114
A patient is referred for an echo due to a history of Osler - Weber - Rendu Syndrome. What exam would best evaluate the cardiovascular abnormalities?
- Echo with saline UEA
(Syndrome associated with pulmonary AV malformation; if bubbles appear in LA in 4 to 8 cycles after injection AVM is present)
115
What is used to assess tricuspid annular plane systolic excursion (TAPSE) and longitudinal strain of the right ventricle?
- Focused apical view
116
You are performing an echo on a patient with suspected mitral stenosis. The deceleration time is 500 msec. What is the mitral valve area?
- 1.5 cm2
(PHT = Deceleration time X 0.29)
117
A patient presents with mitral stenosis. The cardiologist asks you calculate the MVA using the continuity equation. What measurements must you obtain to make this calculation?
- LVOT diameter, VTI of MV flow and LVOT flow
118
What Doppler measurement is necessary to calculate the end diastolic pressure in the pulmonary artery?
- End diastolic velocity of pulmonary regurgitation
119
What window provides the best evaluation of aortic stenosis using the pedoff probe?
- SSN
120
What 2D echocardiography views can be used to diagnose MVP?
- PLAX
121
What view is the best to evaluate motion of the right ventricular free wall (lateral wall)?
- Apical 4 chamber
122
What is Perfluorocarbon ultrasound enhancing agent used to evaluate?
- Delineate walls of left ventricle and other ventricular abnormalities
123
What is the first parameter to consider when assessing a patient for diastolic dysfunction?
- Left ventricular ejection fraction
124
What can be use to assess pulmonary artery pressure?
- End diastolic velocity of pulmonary insufficiency
125
On the apical 4 chamber view, the LV apex appears rounded and the apical walls are thicker than the rest of the ventricle. What describes this?
- The LV is foreshortened and the patient should be rolled into a steeper left lateral decubitus position
126
If a patient demonstrates MR with a velocity of 6 m/s and their blood pressure measures 150/80 mmHg, what is the estimated left atrial pressure?
- 6 mmHg
(LA pressure = systolic BP - MR pressure gradient
150 - 4(6)2
127
If you are scanning the patient in the apical 4 chamber view, how will you manipulate the transducer to obtain a 5 chamber view?
- Tilt slightly anterior
128
What measurements are required to calculate end diastolic pressure of the left ventricle?
- Diastolic BP and diastolic velocity of AI
(LVEDP = diastolic BP - end diastolic pressure gradient of AI)
129
A patient presents for an echo due to a recent stroke. Considering there is a normal septum, which of the following could be a potential cause?
- Aortic valve stenosis
130
Which aortic cusps are seen on the PLAX view?
- Non and rightHo
131
How is the target heart rate calculated for a stress echo?
(220 - age in years ) X 0.85
132
Which Doppler measurement of flow through a stenotic aortic valve best correlates with the same value obtained during a heart catheterization?
- Mean pressure gradient
133
Which echocardiographic view is best for evaluation of flow changes caused by a possible subaortic membrane?
- Apical 5 chamber
134
What abnormalities should indicate supplemental evaluation of the abdominal aorta?
- Takayasu arteritis and bicuspid aortic valve and severe AI
135
A patient presents with aortic stenosis. LVOT velocity 1 m/s, LVOT diameter of 2 cm, AV velocity of 4 m/s. What is the AVA?
- 0.8 cm2
(AVA = 0.785 (LVOT d)2 x LVOT PSV/AV PSV)
136
What it the best view to evaluate the left atrial appendage?
- Apical 2 chamber
137
You document AI in the 5 chamber view that has a pressure half time of 230 ms. What additional transducer positions should be used with PW Doppler to determine the severity of the AR?
- SSN and subcostal
138
What modality is considered most accurate for assessing the thickness of the pericardium?
- CT/MR
139
What calculation is used to evaluate the effects of a VSD on the pulmonary and systemic flow?
- Qp/Qs
140
If the LVOT Doppler tracing is obtained from a location that is too far from the aortic valve, what effect does it have on the continuity equation?
- The AVA will be underestimated
141
What orthogonal plane is most commonly used to obtain a planimetry measurement of the mitral valve area?
- Short axis
142
How do you visualize all three hepatic veins on the same image?
- Subcostal transverse view, angled toward the patient's right shoulder
143
How do you manipulate the transducer from the parasternal long axis view of the left heart to visualize the right ventricular outflow tract?
- Tilt superiorly with a slight clockwise rotatoin
144
You are performing the PISA method of MR assessment on a TEE. After optimizing the color flow of the MR jet, what console adjustment should be made before freezing the image?
- Shift the color baseline up to between 20 - 40 cm/s
145
What exam would best demonstrate hibernating myocardium caused by chronic ischemia?
- Low doses of dobutamine
146
The dobutamine infusion for a stress echo is typically stopped when the heart rate reaches 85% of the calculated maximum heart rate. What is a secondary reason the infusion will be stopped?
- Systolic BP above 200 mmHg or below 100 mmHg
- Wall motion abnormalities in 2 or more adjacent segments
- Maximum dose received
- Diastolic BP greater than 120 mmHgW
147
What is important to do when measuring the pressure half time of the mitral tracing in order to optimize the measurement?
- Increase the sweep speed
148
What must be used to evaluate prosthetic valves because they are usually at least slightly stenotic and produce high velocity values?
- CW Doppler
149
The first image on an echo should be taken at increased depth to exclude what?
- Pericardial and pleural effusion
150
How do you measure left atrial volume?
- LA length is measured from the center of the mitral annulus to the inner edge of the posterior LA wall
151
When measuring the vena contracta of an AI jet, it is important to do what?
- Take three to five measurements and report the average
