SonoSim cardio anatomy
The subcostal four-chamber and apical four-chamber views divide the heart into anterior and posterior halves, while the parasternal long-axis view divides the heart into right and left halves. A.True B.False
A.True
Which of the following statements regarding adjunctive cardiac imaging modalities is correct? A.M-mode imaging is outdated and has no role in modern-day cardiac sonography. B.Color Doppler imaging can be used to detect valvular pathology. C.The intensity of color-flow Doppler signal does not correlate with the velocity of blood flow.
B.Color Doppler imaging can be used to detect valvular pathology. Correct. Motion-mode (M-mode) ultrasound generates an image that is similar to a tracing rather than an actual image of cardiac structures. It is useful for measuring cardiac structures, such as the ventricles, the size of the heart itself, and the thickness of its walls. Color Doppler is a useful adjunct to help visualize the velocity and direction of blood flow. In cardiac ultrasound, it is often used to study blood flowing through cardiac chambers and valves. As such, it can be used to detect valvular pathology. The intensity of color-flow Doppler signal does correlate with blood flow velocity.
With an apical four-chamber view, the left ventricle is generally the same size as the right ventricle. A.True B.False
B.False
The atrioventricular valves are attached to papillary muscles via chordae tendineae, which prevent backflow of blood to the atria during ventricular diastole. A.True B.False
B.False Correct. The atrioventricular valves have leaflets that attach to the annulus fibrosus on one end and chordae tendineae on the other. The chordae tendineae are cord-like tendons that attach to the papillary muscles, muscular projections from the ventricular walls. During cardiac contraction, the atrioventricular valves close, preventing blood backflow to the atria. The chordae tendineae and papillary muscles prevent eversion and prolapse of the atrioventricular valves during ventricular systole, not diastole.
When examining this parasternal long-axis view of the heart, which chamber is noted most anteriorly? A.Left ventricle B.Right ventricle C.Right atrium D.Left atrium E.None of the above
B.Right ventricle Correct. The right ventricle is seen closest to the chest wall in the near field. The left heart, including the left ventricle, left atrium, mitral valve, and aortic valve, is located in the far field. The echogenic structure between the right and left ventricles is the interventricular septum.
Which cardiac imaging window was used to acquire this accompanying ultrasound image? A.Suprasternal window B.Parasternal window C.Apical window D.Subcostal window E.None of the above
C.Apical window Correct. The apical four-chamber view seen in this ultrasound image is obtained using an apical window. It images the heart along its long axis, with the heart split into anterior and posterior halves. The cardiac apex is closest to the transducer, and thus at the top of the image, while the rest of the heart is seen in the far field. All four cardiac chambers can be appreciated, with the atrioventricular valves separating the atria from the ventricles and the interventricular septum dividing the heart into right and left halves.
Which of the following statements associated with this accompanying image is correct? A.It was obtained in the 3rd to 5th intercostal space with the patient in a left lateral decubitus position. B.It was obtained using an apical window. C.It was obtained using a subcostal window. D.It does not allow adequate visualization of pericardial effusions. E.None of the above
C.It was obtained using a subcostal window. Correct. The image is a subcostal four-chamber view of the heart, obtained using a subcostal, also known as a subxiphoid, window. The subcostal imaging window relies on the liver as an acoustic window and is ideally suited for characterization of pericardial effusion. The subcostal window is obtained with the patient in a supine position with the knees slightly bent. The transducer is placed just below the xiphoid process, at a 15- to 30-degree angle. The 3rd to 5th left intercostal space is traditionally used to obtain a parasternal window.
Which of the following cardiac views is demonstrated by this accompanying ultrasound image? A.Apical four-chamber view B.Parasternal short-axis view C.Parasternal long-axis view D.Subcostal view E.None of the above
C.Parasternal long-axis view
Which of the following statements correctly characterizes ventricular diastole? A.The semilunar valves open during ventricular diastole. B.Atrial contraction is primarily responsible for ventricular filling during diastole. C.The ventricular myocardium relaxes during diastole. D.All of the above E.A and B only
C.The ventricular myocardium relaxes during diastole. Correct. Ventricular diastole is the segment of the cardiac cycle when ventricular muscle relaxes and the ventricular chamber undergoes filling. As the intraventricular pressure decreases during muscular relaxation, the atrioventricular valves (the mitral and tricuspid valves) open. At this point, the atria passively fill the ventricles. Approximately 80 percent of ventricular filling occurs prior to atrial contraction. At this time, the semilunar valves (the pulmonic and aortic valves) are closed because the arterial pressure exceeds the ventricular pressure. Subsequently, while the ventricles are relaxed, the atria receive their impulse to contract from the SA node. They undergo coordinated contraction, which drives the remaining 20 percent of blood volume into the ventricle during ventricular diastole.
Which of the following statements regarding coronary artery anatomy is correct? A.Cardiac veins draining the heart coalesce at the coronary sinus. B.The coronary sinus is located along the posterior surface of the heart, along the left atrioventricular groove. C.The coronary sinus returns deoxygenated blood into the right atrium. D.All of the above E.None of the above
D.All of the above
Which of the following statements regarding anatomic planes of the heart is correct? A.The long-axis plane divides the heart into right and left sections. B.The short-axis plane divides the heart into superior and inferior sections. C.The four-chamber plane divides the heart into anterior and posterior sections. D.All of the above E.None of the above
D.All of the above Correct. Echocardiography imaging planes are defined relative to the heart itself, rather than anatomical planes of the body. A long-axis plane divides the heart into right and left sections. A short-axis plane divides the heart into superior and inferior sections. The four-chamber plane divides the heart into anterior and posterior sections.
Which of the following statements accurately describes the right heart? A.The right ventricle lies between the atrioventricular sulcus and interventricular sulcus. B.The right atrium is superiorly positioned compared to the right ventricle. C.During systole, the right ventricle pumps blood into the pulmonary arterial trunk. D.All of the above E.A and B only
D.All of the above Correct. The anteriorly positioned right heart accounts for much of the anterior (sternocostal) surface of the heart. The right heart comprises the superiorly positioned right atrium and inferiorly positioned right ventricle. The right ventricle lies between the atrioventricular groove (coronary sulcus) and the interventricular sulcus. The right atrium is located on the opposite side of the atrioventricular groove from the right ventricle. During diastole, the right atrium moves blood into the right ventricle. During systole, the right ventricle pumps blood into the pulmonary arterial trunk, which in turn delivers blood into the pulmonary circulation.
Which of the following statements correctly characterizes the heart's anatomic position? A.The bulk of the heart is positioned slightly to the left of midline. B.The majority of the anterior surface of the heart consists of the right ventricle. C.The heart's right border consists of the right atrium. D.All of the above E.A and B only
D.All of the above Correct. The heart is positioned centrally in the thorax, deep to and slightly to the left of the sternum. The heart sits atop the diaphragm at the level of the xiphoid process. A majority of the anterior surface of the heart consists of the right ventricle. The left heart accounts for most of the posterior surface of the heart. The right atrium makes up the right border of the heart, and the left ventricle and part of the left atrium make up the left border of the heart.
Which of the following statements regarding the pericardium is correct? A.The pericardium covers the heart and the proximal aspects of the great vessels. B.The pericardium is divided into the fibrous and serous pericardial layers. C.The serous pericardial layer is subdivided into visceral and parietal layers. D.All of the above E.A and B only
D.All of the above Correct. The pericardium covers the heart and is often referred to as the pericardial sac. The heart and the proximal roots of the great vessels are contained within it. The pericardium is divided into external and internal layers. The external layer is termed fibrous pericardium, and the internal layer is termed serous pericardium. The serous pericardium is further subdivided into the parietal layer, which adheres to the inner surface of the fibrous pericardium, and the visceral layer, which is part of the heart's epicardial layer.
Which of the following statements correctly characterizes valvular anatomy? A.The aortic valve is classified as a semilunar valve. B.The mitral valve is a bicuspid valve. C.The pulmonic valve is classified as an atrioventricular valve. D.All of the above E.A and B only
E.A and B only
Which of the following statements regarding echocardiography imaging conventions is correct? A.The ultrasound screen probe indicator can be repositioned by selecting different imaging preset modes. B.The probe indicator is placed on the right side of the ultrasound screen (from a viewer's perspective) when observing traditional echocardiography convention. C.All medical specialties have uniformly adopted historical echocardiography imaging conventions. D.All of the above E.A and B only
E.A and B only
Which of the following statements regarding ventricular systole is correct? A.Ventricular systole corresponds to the onset of the QRS complex on an electrocardiogram. B.Ventricular systole normally causes the aortic and pulmonic valves to open. C.The atrioventricular valves normally open during early-to-mid systole. D.All of the above E.A and B only
E.A and B only
Which statement accurately characterizes echocardiography image windows? A.Image windows are discrete locations on the body that yield unobstructed views of the heart. B.Cardiac image windows include subcostal, apical, and parasternal locations. C.Each cardiac window reliably and uniformly enables ultrasound image acquisition. D.All of the above E.A and B only
E.A and B only
Which of the following statements correctly characterizes left ventricular systole? A.Left intraventricular pressure rises. B.The left atrioventricular valve closes during left ventricular systole. C.Blood flows back into the left ventricle from the coronary sinus during systole. D.All of the above E.A and B only
E.A and B only Correct. As ventricular systole begins, the pressure within the ventricles increases as the muscular walls contract and decrease ventricular volume. With this pressure rise, the atrioventricular valves close, preventing backflow to the atria. When the pressure in the ventricles exceeds the pressure within the pulmonary artery and aorta, the respective pulmonic and aortic valves open, and blood flows into them from the ventricles. A network of veins covers the heart surface and returns blood into the coronary sinus, which is located along the posterior surface of the heart along the left atrioventricular groove. The coronary sinus returns this deoxygenated blood into the right atrium.
Which of the following statements correctly characterizes sonographic estimation of left ventricular wall motion? A.Ejection fraction refers to the percentage of blood expelled from the left ventricle during systole. B.Normal left ventricular ejection fraction ranges from 35 to 45 percent. C.It is possible to qualitatively classify left ventricular ejection fraction as normal, mild-to-moderately reduced, and severely reduced with reasonable precision. D.A and B E.A and C
E.A and C
Which of the following statements regarding color Doppler imaging is correct? A.Color-flow Doppler demonstrates the direction and velocity of blood flow. B.Blue color represents blood flow that is perpendicular to the transducer surface. C.Color-flow Doppler can be used to detect valvular pathology. D.All of the above E.A and C only
E.A and C only
Which of the following statements correctly describes characteristics of the left heart? A.The left heart is larger than the right heart. B.The left atrium receives deoxygenated blood from the pulmonary veins. C.The left heart forms most of the posterior surface of the heart. D.All of the above E.A and C only
E.A and C only Correct. The left heart consists of the superiorly positioned left atrium and inferiorly positioned left ventricle. The left atrium and left ventricle sit predominantly at the back of the heart. The left ventricle has a rounded, bulging appearance and comprises the bulk of the posterior surface of the heart. The left heart is larger than the right heart, particularly because left ventricular chamber size and thickness exceeds that of the right ventricle. The left atrium accounts for most of the posterior surface of the heart above the atrioventricular groove (coronary sulcus). The left atrium receives oxygenated blood from the pulmonary circulation via two left and two right pulmonary veins.
Which of the following statements regarding left ventricular ejection fraction is correct? A.The subcostal four-chamber view enables assessment of left and right ventricular contractility. B.Qualitative assessment of left ventricular ejection fraction is unreliable and does not correlate with quantitative assessments. C.A normal left ventricular ejection fraction is approximately 55 to 70 percent. D.All of the above E.A and C only
E.A and C only Correct. The subcostal four-chamber view is a great view to evaluate overall left and right ventricular systolic function and is used as a supplement to the other echocardiographic views for this purpose. The ejection fraction refers to the percentage of blood expelled from the left ventricle during systole. A normal ejection fraction is 55 to 70%, meaning that between end-diastole and end-systole the left ventricle pumps this percentage of its volume out (Pfisterer). Studies have documented that clinicians can qualitatively classify left ventricular systolic function as normal, mild-to-moderately reduced, and severely reduced with reasonable precision.
The parasternal window is ideally suited for evaluation of which of the following elements? A.Tricuspid valve morphology and function B.Left ventricular size and function C.Left ventricular regional wall motion D.Mitral valve morphology and function E.All of the above
E.All of the above
Which of the following statements correctly characterizes cardiac anatomy? A.A majority of the anterior surface of the heart consists of the left atrium. B.The left ventricle and part of the left atrium make up the left border of the heart. C.A majority of the anterior surface of the heart consists of the right ventricle. D.All of the above E.B and C only
E.B and C only
Which of the following statements correctly characterizes left and right heart physiology? A.The left ventricle has less muscle mass, but greater contractile force than the right ventricle. B.The right ventricle normally has less muscle mass than the left ventricle. C.The right ventricle is quite compliant and can accommodate changes in venous return. D.All of the above E.B and C only
E.B and C only
Which view typically benefits from left-lateral oblique patient positioning? A.Subcostal view B.Parasternal view C.Apical view D.All of the above E.B and C only
E.B and C only
Which of the following statements correctly characterizes the heart's conduction system? A.The AV node is the primary cardiac pacemaker. B.The P wave on an electrocardiogram arises from electrical depolarization of the atria. C.Electrical transmission moves from the bundles of His, to Purkinje fibers, and into myocardial cells. D.All of the above E.B and C only
E.B and C only Correct. The primary pacemaker of the heart is located in the right atrium and is known as the sinoatrial (SA) node. Once an electrical impulse has been initiated in the SA node, it travels via internodal tracts and directly through atrial muscle. This generates the P wave in an electrocardiogram. The internodal tracts transmit the electrical impulse to a second node, the atrioventricular (AV) node. Specialized electrical pathways, the left and right bundles of His, within the ventricles rapidly distribute conducted electrical impulses to cardiac muscle cells via Purkinje fibers.
Which of the following statements regarding the gross anatomy of the heart is correct? A.The superior vena cava and aortic outflow tract are located at the apex of the heart. B.The cardiac apex is located at the most superior portion of the heart. C.The cardiac base is located at the most inferior portion of the heart. D.All of the above E.None of the above
E.None of the above Correct. The heart's central axis is angled obliquely within the thorax. Its inferior tip is known as the apex, which is rotated counterclockwise to about the 5 o'clock position within the thorax. The heart's base is positioned along the same axis as the apex. It sits opposite the apex at a 10 o'clock position. It is the most superior and posterior portion of the heart. The base gives rise to the ascending aorta, pulmonary arterial trunk, and superior vena cava.
