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Question 1

Normal Volume Pericardial Fluid

Answer 1

10 to 50mls / 1-2cm
>100mls suggests effusion
>500mls large effusion

Question 2

Stress Echo Ischaemia

Answer 2

Biphasic Response: improves at low level stress then reduces at peak stress ‘hibernating’ can improve with stents
Peak HR: 75% (220-age)
Dobutamine 5mcg/kg/min every 3 mins 10,20,30,40
atropine 0.25mg every min up to 1mg

Question 3

Stress Echo AS

Answer 3

True Low flow AS:
Valve area unchanged <1.0cm2
Mean gradint increase to 35-40mmHg

Functional AS:
Valve area usually >1.2cm2
Mean gradient <40mmHg at peak

Question 4

Nuclear Imaging

Answer 4

Myocardial perfusion imaging high degree of sensitivity and specificity
ischaemia and LVEF

Question 5

Cardiac MRI

Answer 5

Gold standard quantification LVEF
Quantification structures and vols
Excellent visualisation of right heart

Limitations:
Expensive
powerful magnets no PPM or ICD
No contrast agent with poor renal function
Not useful identifying types cardiac masses

Question 6

Cardiac CT

Answer 6

Multislice tech, calcium score
Very fast
Uses X-rays
Must be able to hold breath
Useful imaging cardiac masses

Question 7

Stress Echo MS

Answer 7

Asymptomatic MS with MVA severe or no severe
Latent severe MS only seen at exercise
SPAP:
> 60mHg at peak
mean gradient:
>15 mmHg within 2 mins

Question 8

Signs of PE

Answer 8

McConnells (RV wall akinesia but sparing apex)

Acute rise systemic pulmonary venous pressure
pulmonary artery dilated
RV/RA dilated
IVC fixed dilated
D shape septum
Watch for thrombus in right heart of straddling PFO

Question 9

Barlows Disease

Answer 9

Mitral valve thickening
Annular dilatation
Prolapse
Linked to arrhythmia phenomenon sudden closure of mitral valve

Question 10

Cardiac Tamponade

Answer 10

SOB
Tachycardia
Hypotension
Raised JVP
Quiet heart sounds
Collapse RA/RV diastole
Pericardial effusion
RVOT LVOT inflow variation >10%

Mitral Inflow >25%
Tricuspid inflow >40%

RA collapse lasting >1/3 of systole

Risk - cardiac arrest (PEA)

Question 11

Turner Syndrome

Answer 11

Bicuspid AV
Aortic coarctation
ASD (Partial anomalous pulmonary venous drainage)

Question 12

Noonan’s Syndrome

Answer 12

Co-arctation
Cardiomyopathy
ASD
PS

Question 13

VSD velocities

Answer 13

High velocity >4m/s - restrictive defect
with normal BP - low/normal RV press

Low velocity <3m/s - non restrictive
with normal BP - raised right heart pressure

Double check TR to assess RV pressures (if don’t match consider double chamber right heart with 2 pressures)

BP - 4(Vmax)2 = RV pressure

Question 14

Contrast Types

Answer 14

Agitated Saline
Right side heart
Bubble study (shunts)

Transpulmoary Contrast
Left side heart
Thrombus, LV, endocardial definition

Normal 1.4
Transpulmonary contrast 0.2

Question 15

Friedreichs Ataxia

Answer 15

Autosomal recessive inherited neuro degenerative disease

Sub aortic membrane

Concentric LVH

Question 16

Strain Imaging

Answer 16

Load dependent - and varies with age/sex so not straight forward

Strain = deformation over time

Abnormal <16%
Normal >18%

Question 17

Transpulmonary Contrast Agents

Answer 17

Designed to pass through lungs and reach left heart
Small 1-10um
Micro bubbles resonate emitting ultrasound signals at higher harmonics
Micro bubbles are fragile so use low MI (<0.6)

MI Flash Myocardial Perfusion
Micro bubbles are fragile
brief high MI pulse (MI flash)
Assess myocardial perfusion by how quickly microbubbles replenished
Normal within 5 cycles at rest
Stress within 2-3 cycles