Echo II final
The peak velocity is measured at 5 m/s. Solve for the peak pressure gradient using the Bernoulli Equation. 50 mmHg 100 mmHg 20 mmHg 85 mmHg
100mg (4v^2)
Normal diameter of IVC less than ____ and collapsed by _____
2.1cm, 50%
Select normal RAP with the size of the IVC at 2 cm (collapsed more than 50%)?
3 mmHg
Normal pulmonary artery pressure shouldn't exceed?
30mmHg
Image of regurgitant jet: calculate peak pulmonary arterial pressure with peak systolic velocity of 4m/s and IVC dilated 2.3 and collapses less than 50%?
4(4^2)+15
Please calculate PASP if V max TR velocity is 3 m/s and RA pressure is = 10 mmHg 46 mmHg 36 mmHg 26 mmHg 16 mmHg
46 mmHg
A normal LV Ejection fraction ranges from: 40% to 55% 28% to 40% 55% to 75% 65% to 85%
55% to 75%
Which of the following characteristic features is not true about Systemic Hypertension: A) A patient is considered to have Systemic HTN if their blood pressure is less than 140/90 B) LV Hypertrophy (LVH) is seen related to continuous pressure overload as LV must generate pressures higher than systemic systolic pressure in order to eject blood through the aorta. C) The LV will eventually decompensate and the patient will go into Congestive Heart Failure (CHF) D) If blood supply to the kidney is compromised, or the kidney is damaged, blood pressure rises to maintain renal flow
A) A patient is considered to have Systemic HTN if their blood pressure is less than 140/90
ASs diastole begins, the anterior leaflet of the MV (or AMV) executes a rapid anterior motion coming to a peak point at: A) E B) D C) F D) A
A) E
The normal E/e ratio from the medial annulus is ___ and suggests a normal left atrial pressure: A) less than 8 B) between 1 and 2 C) between 8 and 15 D) more than 15
A) less than 8
To check for prosthetic valve dehiscence, the sonographer should look for: Doppler evidence of stenosis Abnormal rocking motion of the valve Decreased valve excursion An abnormal mass of echoes on the valve
Abnormal rocking motion of the valve
Assessment of patients with chronic hypertension should include which of tlie following? All of the above LV size for dilation LV Mass index LV diastolic function LV systolic function
All of the above
50% expansion of aorta involving all 3 layers?
Aneurysm
M-mode AMVL , this sign is present in?
Aortic insufficiency
If the two-dimensional examination demonstrates a markedly dilated and hyperkinetic left ventricle and a left atrium of normal size, one should suspect the presence of: mitral regurgitation aortic regurgitation mitral stenosis aortic stenosis
Aortic regurgitation
Patient with history of infective endocarditis at risk for?
Aortic regurgitation
Water hammer pulse and Austin flint signs of?
Aortic regurgitation
All of the following echocardiographic findings would give a definitive diagnosis of severe aortic insuffieciency except: Aortic regurgitation pressure half-time greater than or equal to 200 ms Vena contracta greater than 6 mm Holodiastolic flow reversal in the descending thoracic or abdominal aorta Regurgitant volume greater than or equal to 60 mL
Aortic regurgitation pressure half-time greater than or equal to 200 ms
________ is typically associated with thickened calcified cusps with preserved mobility and demonstrating peak Doppler velocity of less than 2.5 m/sec. coronary artery disease aortic sclerosis aortic regurgitation aortic stenosis
Aortic sclerosis
What pathology echo tech should suspect from these images? Restrictive cardiomyopathy Tamponade physiology Asymmetrical septal hypertrophy Taksotsubo cardiomyopathy
Asymmetrical septal hypertrophy
The artifactual SAM can be sometimes seen on M-Mode due to all of the following except: A pericardial effusion is present (Swinging Heart Syndrome) Mitral valve prolapse is present Being perpendicular to the mitral valve The transducer is placed too low on the chest
Being perpendicular to the mitral valve
Images in psax view showing the aortic valve :
Bicuspid aortic valve
Define pseudoaneurysm?
Break in aortic wall with blood collection
please calculated Qp/QS ratio if LVOT diameter = 1.98 cm VTI (LVOT) =20 cm RVOT diameter= 2.32 cm VTI (RVOT) =22 cm a) 0.5 b)2.2 c) 1.5 d) 1.8
C) 1.5
Pulmonary vein inflow is studied by placing a _____ Doppler curser at the entry of the pulmonary veins in the left atrium identified on ___ view : A) PW, subcostal 4 ch B) CW , suprasternal C) PW , A4 ch D) CW, PLAX
C) PW , A4 ch
Echo findings of Grade 4 diastolic dysfunction pattern includes all of the following except: A) the E/A ratio is >2 B) high LA pressure C) a reversal to grade 1 or grade 2 on reducing the preload by performing Valsalva maneuver D) E/e ratio > 15 at medial annulus
C) a reversal to grade 1 or grade 2 on reducing the preload by performing Valsalva maneuver
Echo findings of Grade 3 diastolic dysfunction (reversible restrictive) pattern includes all of the following except: A) the E/A ratio is more than 2:1 B) Isovolumic relaxation time less than 70 ms C) deceleration time more than 240 ms D) a reversal to grade 1 or 2 on reducing preload by performing valsava maneuver.
C) deceleration time more than 240 ms
Echo findings of Grade 2 diastolic dysfunction pattern includes all of the following except: A) Presence of LA enlargement or LV hypertrophy B) The E/A ratio is between 1 and 2 C) isovolumetric relaxation time (IVRT) less than 70 ms D) deceleration time (DT) between 160-240ms
C) isovolumetric relaxation time (IVRT) less than 70 ms
Blood Pressure = _________________x __________________ Cardiac Output x Peripheral Vascular Resistance Cardiac Output x Heart Rate Stroke Volume x Peripheral Vascular Resistance Stroke Volume x Heart Rate
Cardiac Output x Peripheral Vascular Resistance
Increased LV end diastole volume raises suspicion for?
Chronic AR
A Starr-Edwards valve: Has one or two moving discs opening and closing Not noticeable on the 2D image Consists of a ball within a metal cage An example of a bioprosthetic heart valve
Consists of a ball within a metal cage
Radius in PISA will be measured in ___ shell?
Convergent
Clinical symptoms associated with aortic valve stenosis does not include: Shortness of breath Syncope Chest pain Cyanosis
Cyanosis
The primary hemodynamic parameters recommended to assess the severity of the aortic stenosis are all of the following except: A. Valve area by continuity equation B. Mean transvalvular gradient C. Peak transvalvular velocity D. Pressure Half Time formula
D. Pressure Half Time formula
Diagnose the following Doppler image: decreased ventricular compliance mitral stenosis pseudonormalization systolic notching
Decreased ventricular compliance
Echocardiographic findings of significant aortic stenosis include all of the following except: Thickened left ventricular walls Reduced separation of the aortic valve cusp Doppler systolic velocities greater than 4 m/s Diastolic fluttering of the anterior mitral leaflet
Diastolic fluttering of the anterior mitral leaflet
tear in aortic intima
Dissection
Image of TV low near the apex:
Ebstein anomaly
Primary Congestive Cardiomyopathy is often difficult to distinguish from: End Stage Ischemic Heart disease and/or Long-standing Aortic Insufficiency or Mitral Regurgitation Amyloid restrictive cardiomyopathy Hypertrophic cardiomyopathy Constrictive pericarditis
End Stage Ischemic Heart disease and/or Long-standing Aortic Insufficiency or Mitral Regurgitation
Two indirect signs of AR?
Flow reversal in descending AO and flutter of AMVL
What is the m mode finding of pulmonary hypertension?
Flying W sign
Large vegetations are particularly associated with: Acute rheumatic fever Connective tissue disease Fungal infection or endocarditis of the tricuspid valve Bacterial endocarditis of the aortic valve
Fungal infection or endocarditis of the tricuspid valve
The echocardiogram most likely reveals: Grade 4: Irreversible restrictive pattern Grade 1: Impaired relaxation pattern Grade 3: Reversible restrictive pattern Grade 2: Psuedonormalized pattern
Grade 1: Impaired relaxation pattern
What is the sonographic findings of supravalvular stenosis?
Hourglass appearance
RAP estimated by ultrasound from size and collapsibility of?
IVC
Myocardial demand of Oxygen will ___ in AR?
Increase
Echocardiographic findings in Dilated Cardiomyopathy include all of the following except: Regurgitation of the A-V valves (MR, TR) Dilatation of all the cardiac chambers (left and right ventricles and atria) Increased Cardiac Output An Enlarged, Hypokinetic LV
Increased Cardiac Output
Cardiac window for parasternal view found in?
L parasternal border
Which is needed to calculate continuity of aortic valve area?
LVOT
When obstruction occurs in IHSS you will find an increase in velocity in the _________________. The velocity of the jet increases gradually and peaks in late systole when the obstruction is at max called ___________________waveform. Descending Thoracic Aorta, "bullet shaped" LVOT, "bullet shaped" LVOT, "dagger-shaped" Aortic Valve, "dagger-shaped"
LVOT, "dagger-shaped"
Diagnose the following 2D image: Dilated RV Dilated LV Left ventricular hypertrophy Right ventricular hypertrophy
Left ventricular hypertrophy
Diagnose the following M-mode: Left ventricular hypertrophy Systolic anterior motion of the MV Pericardial effusion Mitral valve prolapse
Left ventricular hypertrophy
Genetic cause for AI?
Marfan's syndrome
The echocardiogram below reveals: PW Doppler Pulmonary venous flow examination Measuring A' on the lateral annulus tissue doppler trace Measuring E' on the medial annulus tissue doppler trace Normal Mitral inflow pattern E velocity
Measuring E' on the medial annulus tissue doppler trace
The most common type of subvalvular aortic stenosis is: Membranous septum Muscular septum Diffuse fibromuscular 'Hourglass' aorta
Membranous septum
What is the deceleration time of E wave in grass 1 diastolic function?
More than 2201
Best view for planimetry of TV?
PSAX
The best view to differentiate perimebranous, infracristal and infundibular VSD is: PSAX at level of aortic valve PLAX Apical 4 subcostal 4 chamber
PSAX at level of aortic valve
Optimal view to evaluate pulmonary valve
Parasternal
Image shows (calcification of aortic valve) the ___ view with a ____ AV?
Plax, stenosis
TAPSE evaluates ___ function measured in ___ modality?
Right ventricle, M mode
PHT of regurgitate jet less than 200ms considered?
Severe
AV area less than 1cm aortic area will have ?
Severe stenosis
What type of Prosthetic heart valve is being imaged? Bjork-Shiley Starr-Edwards Carpentier-Edwards St. Jude
St.Jude
Often, the best two-dimensional view for examining patients with chronic obstructive pulmonary disease is: suprasternal apical subcostal parasternal
Subcostal
Best view to record IVC and hepatic to RA?
Subcostal view
The common causes of impaired myocardial relaxation are all of the following except: Supernormal Left Ventricular Diastolic Function in Triathletes Myocardial ischemia Increasing age Early stages of LV hypertrophy
Supernormal Left Ventricular Diastolic Function in Triathletes
Best window to image the aortic arch?
Suprasternal
Image of ascending aorta in ___ view ___ flow?
Suprasternal, anterograde
Least common type of AS?
Supravalvular
____________ is a temporary heart condition that is brought on by stress. It has the same symptoms as a heart attack but is not caused by any underlying cardiovascular disease. It is also known as stress cardiomyopathy, apical ballooning, or broken heart syndrome. Takotsubo cardiomyopathy Hypertrophic cardiomyopathy Constrictive pericarditis Restrictive cardiomyopathy
Takotsubo cardiomyopathy
All the following statements about endocarditis are true EXCEPT: -May be accompanied -The absence of vegetation's on the echo excludes the diagnosis of endocarditis suspected on clinical grounds -TTE can miss vegetations < 2 mm - vegetation's are irregular shaped, highly mobile masses attached to the free edge of a valve leaflet
The absence of vegetation's on the echo excludes the diagnosis of endocarditis suspected on clinical grounds
All of the following statements about endocarditis are true EXCEPT: TTE can miss vegetations < 2 mm Vegetations are irregular shaped, highly mobile masses attached to the free edge of a valve leaflet The absence of vegetations on an echo excludes the diagnosis of endocarditis suspected on clinical grounds may be accompanied with fever
The absence of vegetations on an echo excludes the diagnosis of endocarditis suspected on clinical grounds
differential diagnosis of vegetation/endocarditis can be all of the following EXCEPT: Tumors, thrombus or imaging artifacts Calcifications Valvular prolapse Myxomatous
Valvular prolapse
Apical 4 chamber view in a TRUE atrial septal defect, the edges of the septum of the defect are bright and thick and it's called: A) T sign b)Refraction artifact c) false echo drop out d) V sign
a) T sign
The most common benign tumor of the heart: a) myxoma b) rhabdomyoma c) lipoma d) fibroma
a) myxoma
To check for prosthetic valve dehiscence, the echocardiographer should look for: abnormal rocking motion of the valve decreased valve excursion an abnormal mass of echoes on the valve Doppler evidence of stenosis
abnormal rocking motion of the valve
The EPSS measurement that correlates best to severe diastolic dysfunction in a patient with Dilated Cardiomyopathy would be? above 12 mm with a EF < 35% 6 mm with normal EF 6 - 12 mm with an EF of 35% 6 - 12 mm with a EF of 70%
above 12 mm with a EF < 35%
________ is the 'load' to which the heart must pump against. ______ goes down when aortic pressure and systemic vascular resistance decreases through vasodilation. afterload; preload afterload; afterload systole; diastole preload, afterload
afterload; afterload
In patients with chronic SHTN the ascending aorta should be evaluated for which of the following? coarctation all of the above dissection dilation or aneurysm
all of the above
Echocardiographic signs of outflow tract obstruction in hypertrophic cardiomyopathy include all of the following except: high systolic velocity in the left ventricular outflow tract systolic anterior motion of the mitral valve midsystolic notching of the aortic valve an increased E point-to-septal separation
an increased E point-to-septal separation
The most common type of ventricular septal defect is the: a) inlet VSD b) perimembranous VSD c) Muscular VSD d) supracristal VSD
b) perimembranous VSD
The most common type of atrial septal defect is: a) primum b) secundum c) fenestrated d) sinus venosus
b) secundum
A ventricular septal defect with right-to-left shunting is consistent with: a)Ebstein's anomaly b) tretralogy of fallot c) Eisenmenger's syndrome d) A double outlet right ventricle
c) Eisenmenger's syndrome
People with high blood pressure are more likely to develop ________, because high blood pressure puts added force against the artery walls. Over time, this extra pressure can damage the arteries, making them more vulnerable to the narrowing and plaque buildup associated with atherosclerosis. constrictive pericarditis coronary artery disease Sinus of Valsalva aneurysm endocarditis
coronary artery disease
All the following statements are true about myxomas except: a) the appearance Is typically round or oval, with a smooth well-defined border b) When a clinical diagnosis of cardio myxoma has been made, surgery should be performed with delay, Because of the high risk of sudden deaths from thromboembolism or valvular obstruction c) Most commonly originate from the left atrium, often arising in the interatrial septum in the region of the fossa ovalis d) Neoplasms consisting of mature fat cells E) More common in middle-aged woman
d) Neoplasms consisting of mature fat cells
The most common malignant cardiac tumor is: a) teratoma b) rhabdomyooma c) carcinoma d) angiosarcoma
d) angiosarcoma
Large vegetations are particularly associated with: bacterial endocarditis of the aortic valve connective tissue disease acute rheumatic fever fungal infection or endocarditis of the tricuspid valve
fungal infection or endocarditis of the tricuspid valve
Which is the commonest type of bicuspid aortic valve? fusion of the left and right coronary cusps fusion of the right and noncoronary cusps anterior - posterior commissure fusion of the left and noncoronary cusps
fusion of the left and right coronary cusps
The primary factor causing systemic hypertension is: mitral stenosis aortic stenosis increased peripheral resistance decreased peripheral resistance
increased peripheral resistance
Vegetations are always found on the ______side of the valve, so in the case of Aortic Regurgitation caused by vegetations, they are seen on the ______side of the valve. low pressure/ atrial low pressure/ventricular high pressure/ ventricular high pressure/ atrial
low pressure/ventricular
Normal diastolic function is dependent on: BP and HR rapid ventricular contraction and HR Cardiac output and HR rapid ventricular relaxation and a compliant chamber
rapid ventricular relaxation and a compliant chamber
Sources of error for AS calculations include all of the following except: Not properly aligned jet with ultrasound beam error related to LVOT diameter measurements Recording of MR jet instead removing CSA from the simplified continuity equation
removing CSA from the simplified
Image indicates (hourglass aortic):
supravalvular aortic stenosis
Differential diagnosis of vegetation/endocarditis can be all of the following EXCEPT: myxomatous degeneration valvular prolapse calcifications tumors, thrombus or imaging artifacts
valvular prolapse
The term cardiomyopathy is used to describe variety of cardiac diseases that affect the myocardium variety of cardiac diseases that affect the pericardium variety of cardiac diseases that affect the endocardium pericardial effusion
variety of cardiac diseases that affect the myocardium
56 y.o male presented with fever, night sweats and malaise to ER. The echocardiogram reveals: vegetation on mitral valve bioprosthesis degeneration calcification on mitral valve thrombus in LA
vegetation on mitral valve
The Qp/Qs ratio is used to evaluate the severity of: ventricular septal defect tamponade subarctic stenosis systemic hypertension
ventricular septal defect
