Set 1

Question 1

What is the most common associated defect with Ventricular Septal Defects?

Answer 1

Pulmonic stenosis (PS) with VSDs

Question 2

What is the most common associated defect with a Sinus Venosus Atrial Septal Defect?

Answer 2

Partial Anomalous Pulmonary Venous Return

Question 3

What is the most common associated defect with Ebstein’s Anomaly?

Answer 3

Secundum ASDs with Ebstein’s Anomaly

Question 4

What is the most common associated defect with Bicuspid Aortic Valves?

Answer 4

Coarctation of the aorta with Bicuspid Aortic Valves

Question 5

How do you assess the right atrial pressure based on the size and collapsibility of the inferior vena cava (IVC)?

Answer 5

Right atrial pressure based on the size and collapsibility of the IVC uses the following criteria based on the 2010 ASE RV Guidelines:

3 mmHg = normal IVC (<2cm) & collapses (>50%)
8 mmHg = intermediate
15 mmHg = dilated (>2cm) & no collapse (<50%)

Question 6

What is the name of the valve of the coronary sinus?

Answer 6

Thesbian valve

Question 7

In which chamber would you see a chiari network?

Answer 7

Chiari networks are seen in the right atrium as fine strands of tissue similar to chordae of the mitral and tricuspid valves

Question 8

When is the left ventricular volume the largest?

Answer 8

The left ventricular volume is largest at end diastole (when we measure it)

Question 9

When is the left atrium volume the largest?

Answer 9

The left atrium volume is largest at end systole.

Question 10

What is the dimensionless index for evaluating aortic stenosis?

Answer 10

The dimensionless index is a ratio of he LVOT velocity and the peak velocity across the aortic valve

Question 11

What is the cutoff value for severe AS when using the dimensionless index?

Answer 11

The cutoff value for severe AS when using the dimensionless index is < 0.25

Question 12

When a patient has aortic regurgitation, what is the equation for calculating Left Ventricular End Diastolic Pressure (LVEDP)?

Answer 12

LVEDP = Diastolic BP - the end diastolic AR gradient

Question 13

How many scallops is the mitral valve divided into and what are their names?

Answer 13

The mitral valve is divided into 6 scallops (segments)

Anterior 1, 2, & 3
Posterior 1, 2, & 3

Question 14

When a patient has an aortic aneurysm, at which point (size) do you need a surgical consult?

Answer 14

When aortic aneurysms are larger than 5cm, its time for a surgical consult

Question 15

What happens to the mitral inflow pattern in a normal patient when you have them perform a Valsalva maneuver?

Answer 15

The normal mitral inflow pattern maintains the E/A ratio (E>A) following a Valsalva maneuver, but the velocities are LOWER

Question 16

When a patient has pulmonary regurgitation, what is the equation for calculating Pulmonary Artery End Diastolic Pressure (PAEDP)?

Answer 16

PAEDP = RAP + end diastolic PR gradient

RA pressure is obtained by looking at the IVC size and collapsibility like you do for TR and pulmonary pressures

Question 17

In the parasternal short axis view, at the level of the mitral valve and papillary muscle, how many segments is the left ventricle divided into?

Answer 17

The left ventricle is divided into 6 segments at the level of the mitral valve and papillary muscle.

Question 18

Name the ventricular segments seen in the parasternal short axis view

Answer 18

The ventricular segments are the:

1. Anterior
2. Anteroseptal
3. Inferoseptal
4. Inferior
5. Inferolateral
6. Anterolateral

(Anterior is on top and then proceeds to the left)

Question 19

In the apical four chamber view, which 2 walls of the left ventricle are seen?

Answer 19

In the apical four chamber view, the inferoseptal and anterolateral walls of the left ventricle are seen

Question 20

In the apical 2 chamber view, which 2 walls of the left ventricle are seen?

Answer 20

In the apical 2 chamber view, the anterior and inferior walls of the left ventricle are seen

Question 21

Which walls of the left ventricle are seen in the parasternal and apical long axis views?

Answer 21

The anteroseptal and inferolateral walls of the left ventricle are seen in the parasternal and apical long axis views

Question 22

Which two aortic valve leaflets are seen in the parasternal and apical long axis views?

Answer 22

The right and non coronary leaflets are seen in these views. The right leaflet is on top (superior) and the non coronary is on the bottom (inferior)

Question 23

Where is the coronary sinus located in the parasternal long axis view?

Answer 23

The coronary sinus lies in the posterior atrioventricular (AV) groove. This groove is located between the left atrial and the left ventricular walls and lies posterior to the mitral valve. In the parasternal long axis view, the coronary sinus can sometimes be seen as a small echo free circle

Question 24

In the PLAX where is the coronary sinus located in relation to the descending aorta?

Answer 24

The coronary sinus is located anterior to the descending aorta. If the coronary sinus is dilated, it may be mistaken for the descending aorta

Question 25

How would you angle to view the coronary sinus in the apical 4 chamber view?

Answer 25

From the apical 4 chamber view you would angle posterior in order to visualize the coronary sinus, which is located posterior to the mitral annulus

Question 26

Why is it important to know the location of the coronary sinus and the descending aorta?

Answer 26

The coronary sinus and the descending aorta are important landmarks that can help differentiate pericardial effusions from pleural effusions: Pericardial: lie posterior to the coronary sinus and anterior to the descending aorta Pleural: lie posterior to the descending aorta in the PLAX

Question 27

What would cause the coronary sinus to become dilated?

Answer 27

The coronary sinus dilated due to: increased pressure in the right atrium (as in severe tricuspid regurgitation) or increased flow into the coronary sinus in some congenital malformations (as in Persistent Left Superior Vena Cava (PLSVC)

Question 28

Name the three major coronary arteries

Answer 28

The three major coronary arteries are the right, left anterior descending (LAD), and circumflex arteries. The latter two arteries branch from the left main coronary artery (which is not considered a major artery because it is very short)

Question 29

Where are the coronary arteries located on the surface of the heart?

Answer 29

The coronary arteries are located on the outer, epicardial surface of the heart as follows: The right coronary artery (RCA) arises from the right aortic root sinus, follows the right atrioventricular junction, and descends along the posterior interventricular groove. The left anterior descending coronary artery (LAD) follows the anterior interventricular groove. The circumflex coronary artery (Circ) courses along the left atrioventricular junction.

Question 30

Name the cardiac walls supplied by the right coronary artery

Answer 30

Inferior wall Inferoseptal Right ventricular apex Right ventricular free wall

Question 31

Name the cardiac walls supplied by the left anterior descending artery

Answer 31

Anterior wall Anteroseptal Left ventricular apex

Question 32

Name the cardiac walls supplied by the circumflex artery

Answer 32

Anterolateral wall Inferolateral wall

Question 33

While scanning a 43 year old man with a history of an old myocardial infarction, you notice that the anterior cardiac walls is akinetic. Which coronary artery is most likely to have been involved in the infarction?

Answer 33

The left anterior descending (LAD) coronary artery, which supplies blood to the anterior cardiac walls is most likely to have been involved. This artery also supplies the anterior portion of the ventricular septum and the left ventricular apex

Question 34

In the apical four chamber view of another patient, the distal ventricular septum and left ventricular apex are hypocontractile. Which coronary artery is most likely to be diseased?

Answer 34

The left anterior descending (LAD) coronary artery is the most likely choice. In some patients with *distal septal hypocontractility* the proximal portion of the septum moves normally because it is supplied by the right coronary artery.

Question 35

What are the normal systolic and diastolic pressures (mean) in the right atrium?

Answer 35

Right atrial pressures (mean) = 6 mmHg

Question 36

What are the normal systolic and diastolic pressures in the right ventricle?

Answer 36

Right ventricular pressures = 25/5 mmHg

Question 37

What are the normal systolic and diastolic pressures in the pulmonary artery?

Answer 37

Pulmonary artery pressures = 25/10 mmHg

Question 38

What are the normal systolic and diastolic pressures (mean) in the left atrium?

Answer 38

Left atrial pressures (mean) = 10 mmHg

Question 39

What are the normal systolic and diastolic pressures in the left ventricle?

Answer 39

Left ventricular pressures = 120/7 mmHg

Question 40

What are the normal systolic and diastolic pressures in the aorta?

Answer 40

Aortic pressures = 120/80 mmHg

Question 41

When is the pressure in the left ventricle at its lowest?

Answer 41

The left ventricle pressure is lowest in early diastole, just after the mitral valve opens. After that, the left ventricular pressure rises as the chamber fills in diastole

Question 42

What is the normal mean pulmonary artery wedge pressure?

Answer 42

The normal mean pulmonary artery wedge pressure is 10 mmHg, which equals the left atrial pressure. The PA wedge pressure is NOT the same as the PA pressure.

Question 43

How is the pulmonary wedge pressure determined?

Answer 43

A Swan-Ganz catheter is positioned in the pulmonary artery and a small balloon is inflated at the catheters tip. The balloon is then floated and wedged into a smaller pulmonary artery A pressure reading is obtained distal to the balloon The inflated balloon prevents the tip of the catheter from sensing the pulmonary pressure, and the left atrial pressure is recorded as it is reflected across the pulmonary bed.