DeWitt Ch. 4 Transthoracic Echocardiogram (TTE)/Diastology & More! Workbook Questions
What is the normal RV wall thickness?
1 -5 mm
What is the normal right posterior pulmonic valve a-wave dip via M-mode? (measurement)
2.7 mm
What is the normal range for the left ventricular internal dimension diastole (female)?
38-52mm
What is the normal range for the left ventricular diastolic wall thickness?
6-10mm (male)
If the inferior vena cava diameter = 1.7 cm and collapses <50% upon inspiration, then according to the 3/8/15 method the mean RAP estimate = __________.
8 mmHg
LVOT peak velocity ________ indicates LVOT obstruction (LVOTO)
> 2 m/s
Choose the statement that best describes the E/e' ratio. a. <8 usually predicts normal LV filling pressure b. <14 indicates increased LV filling pressure c. normal range 13-15 d. should not be a mirror image of the mitral inflow
A
Choose the statement that best represents the LAVi via the biplane methods of disks. a. exclude the LA appendage, pulmonary vein inlets and just beneath the mitral valve. b. increase the depth prior to acquiring measurements c. planimeter the LA from the LAX and 4C d. all of the above
A
Choose the statement that best supports the SAX LV. a. demonstrates all of the LV walls simultaneously b. LV should be oblong, not round c. RV should be larger than the left ventricle d. unnecessary view
A
Choose the statement that supports the LAX AO dimensions. a. acquire the aortic valve annulus diameter at peak systole via I-I (Internal to Internal) b. acquire the maximum aortic dimensions parallel to the LAX AO c. acquire the sinuses of Valsalva, sinotubular junction, proximal ascending aorta diameters at end systole
A
Which mitral valve M-mode finding is an indication of increased LV end-diastolic pressure (LVEDP)? a. B bump between A and C b. delayed closure c. E point to septal separation > 2 mm d. all of the above
A
Which statement is true regarding the anterior mitral valve leaflet (AMVL) and posterior mitral valve leaflet (PMVL)? a. AMVL is more mobile than the PMVL b. AMVL is less mobile than the PMVL c. PMVL is continuous with the posterior wall of the aorta d. PMVL prolapses beyond the annular plane
A
Which statement supports the end-diastolic right ventricular outflow tract proximal diameter? a. acquire from the anterior right ventricular wall to interventricular septal-aortic junction b. normal range = 1-5 mm c. required for the fractional shortening calculation d. all of the above
A
What are the best visualized walls from the 4C view.
Anterolateral, apical, and inferoseptal
According to the LV hypertrophy (LVH) severity scale, moderate LVH is defined as 11-13 mm (male). True or False?
B
Choose the statement that best supports the UEA. a. acquire the parasternal views first b. attenuation and swirling are common artifacts c. increases the strength of the signals returning from the tissue d. only available as a continuous infusion
B
Choose the statement that supports the left atrium. a. left atrial linear dimension is the most accurate assessment of left atrial size b. left atrial volume index should be assessed along with the left atrial dimension c. normal end-systolic dimension in females = 30-40 mm d. all of the above
B
When is the end diastole captured? a. aortic valve just opened b. left ventricle at largest dimension c. left ventricle at smallest dimension d. mitral valve just opened
B
Which statement best describes a LVOTO? a. early peaking, dagger shaped systolic jet b. late peaking systolic jet that sounds like a sponge being wrung out c. rounded, high velocity waveform because there is increased velocity d. very low velocity waveform because there is decreased flow
B
Which statement supports the tricuspid annular plane systolic excursion (TAPSE)? a. a measure of the peak diastolic longitudinal motion of the tricuspid valve annular motion b. a simple but good estimate of RV global function c. not angle dependent d. not load dependent
B
Choose the patient position that typically provides the best TTE left parasternal views. a. at a 45 degree angle b. flat on their back c. left lateral decubitus d. right lateral decubitus
C
Choose the statement that best supports RV diastolic function. a. acquire CWD of the tricuspid inflow b. E/A >0.8 suggests impaired relaxation c. exclude patients with Afib or moderate to severe tricuspid regurgitation d. all of the above
C
What critical info does the mitral inflow PWD provides as it pertains to diastolic function? a. A-wave deceleration time b. E-wave duration c. E-wave peak velocity d. e'-wave peak velocity
C
Choose a known diastolic function parameter. a. CWD of the mitral inflow b. CWD of the pulmonary venous inflow c. left atrial linear dimension d. tissue Doppler imaging (TDI) of the mitral valve annulus
D
Choose a statement that best describes how to acquire the LVEF. a. acquire the end-diastolic volume and end-systolic volume from the 4C and 2C. b. avoid apical foreshortening c. utilize contrast if 2+ connected segments are not well visualized d. all of the above
D
Choose the RV diastolic function parameter. a. LAVi and left atrial pressure b. linear dimensions c. TDI of PV annulus d. tricuspid inflow E/A and deceleration time
D
Choose the statement that best describes strain imaging. a. adds info about global and regional function b. longitudinal strain via speckle tracking is very useful c. precision and expert timing are essential d. all of the above
D
Choose the statement that best describes the left ventricular outflow tract (LVOT) dimension. a. measure within 5-10 mm of the aortic valve orifice b. normal mid-systolic diameter = 18-22 mm c. zoom in and optimize the blood tissue interface d. all of the above
D
Choose the statement that best supports the main pulmonary artery. a. best visualized from the LAX RVIT b. gives rise to the coronary arteries c. normally 4 x 6 cm d. normally smaller than the aorta
D
Choose the statement that best supports the mitral inflow E-wave peak velocity. a. increases with age b. is not affected by changes in LA pressure c. is not affected by changes in LV relaxation d. represents the early diastolic LV-LV PG (pressure gradient)
D
Choose the statement that represents the left atrial appendage. a. decompression chamber b. filling and emptying are directly affected by left ventricular function c. prone to thrombus d. all of the above
D
Choose the statement that supports the right atrial single plane area-length volume. a. acquire from the 4C with emphasis on the right heart b. include the right atrial area via planimetry c. include the right atrial major dimension d. all of the above
D
When should agitated saline be available? a. interatrial shunt b. intrapulmonary shunt c. persistent left superior vena cava d. all of the above
D
Which of the following might be related to left atrial enlargement? a. atrial fibrillation b. severe and chronic diastolic dysfunction c. stroke d. all of the above
D
Which statement supports PWD of pulmonary venous flow? a. acquire sample ~3-4 cm into right or left upper pulmonary vein b. decrease sweep speed to 25 mm/s c. utilize large PWD gate d. utilize small PWD gate, ~1-2 cm into pulmonary vein.
D
Which statement supports the mitral inflow E-wave deceleration time? a. affected by LV relaxation, diastolic pressure and stiffness b. must return to baseline during acquisition because it is a measurement of time, not slope c. utilized to recognized the filling pattern (normal, impaired, pseudonormal, restrictive) d. all of the above
D
Which statement supports the right ventricular outflow tract (RVOT)? a. RVOTdistal is acquired from the RV anterior wall to the aortic valve b. RVOTdistal normal range = 17-27 mm c. RVOTprox normal range = 21-35 mm acquired just distal to the pulmonic valve d. all of the above
D
Why is the M-mode sweep acquired? a. ensure continuity from the posterior aortic root wall to the AMVL b. rule out early mitral valve closure and mitral valve prolapse c. rule out hemodynamic compromise in the presence of pericardial effusion d. all of the above
D
What is the equation for ejection fraction?
EF% = [(LVIDV - LVISV)/LVIDV] x 100
A good place to start searching for the apical window is along the left sternal border at the fourth intercostal space. True or False?
False
According to the ASE, M-mode dimensions are recommended over 2D dimensions to avoid capturing oblique angles of the ventricle. True or False?
False
According to the ASE, an aortic valve peak velocity less than or equal to 2.5 m/s with mild thickening and/or calcification indicates aortic stenosis. True or False.
False
Acquire the inferior vena cava diameter at rest, during normal respiration, ~1-2 cm, distal to the left atrium. True or False?
False
Aortic sclerosis always leads to aortic stenosis. True or False?
False
Descending aorta can be seen from the 2C as a separate structure, anterior to the left atrium. True or False?
False
Doppler sweep speed should be decreased from 50 to 25 mm/s for the diastolic function parameters. True or False?
False
During LAVi acquisition, the LA length is acquired from the 4C and 2C, and the two measurements should be within 1 mm of each other. True or False?
False
In order to locate the LAX RVIT, angle the transducer more lateral and superior from the LAX LV. True or False?
False
Infundibulum is the smooth-walled, funnel shaped portion of the right ventricular inflow tract at the entrance of the pulmonary trunk. True or False?
False
Interatrial septum bows slightly toward the left atrium because the right atrial pressure is slightly greater. True or False?
False
Left atrial size is not gender dependent. True or False?
False
Left ventricular ejection fraction (LVEF) is the % of the left ventricular size reduction from diastole to systole. True or False?
False
Mitral valve planimetry has a low correlation with the anatomical mitral valve area. True or false?
False
Normal embryonic variants known as the eustachian valve and Chiari network may be visible in the right ventricle. True or False?
False
Normal end-diastolic right ventricular wall thickness is 6-10mm True or False?
False
Pulmonary venous S-wave increases and D-wave decreases when the LA pressure increases and/or compliance decreases. True or False?
False
RV dilation is reported if the RV is larger than the LV, or if the basal diameter is <41 mm and the mid diameter is < 35 mm. True or False?
False
Right ventricle is more anterior, more trabeculated, more triangular, and larger than the left ventricle. True or False?
False
Spectral Doppler of the mitral valve is always indicated from the LAX LV due to the excellent Doppler angle. True or False?
False
The goal of the ultrasound enhancement agent (UEA) is to decrease the strength of the signals returning from the microbubbles. True or False?
False
The only way to determine timing of the cardiac cycle is with the EKG. True or False?
False
Tissue harmonic imaging is not recommended during the agitated saline study. True or False?
False
Typically, the transducer indicator is toward the patient's right shoulder during SAX. True or False?
False
When the transducer is angled more lateral from the 4C, the aortic valve is visualized. True or False?
False
What is the tricuspid valve leaflet that is not visualized in the LAX RVIT?
Medial/Septal
Dilated coronary sinus can easily be confused with the descending aorta; however, the coronary sinus is located within the ____________ and the aorta is a separate structure posterior to the left atrium.
Myocardium
3C RVIT is a very useful view that yields the peak tricuspid regurgitation velocity. True or False?
True
Abnormal cut-off for the peak tricuspid regurgitation velocity is >2.8 m/s. True or False?
True
According to the IAC, a limited TTE should be performed when the patient recently had a complete TTE and there is no clinical reason to suspect changes other than the specific area of interest. True or False?
True
Aortic valve non-coronary cusp is adjacent to the interatrial septum in the SAX BASE. True or False?
True
Biplane method of disk summation provides a reliable estimate of left ventricular volume and LVEF. True or False?
True
End-diastolic and end-systolic left ventricular dimensions can be acquired from the LAX LV. True or False?
True
For LAVi acquisition, planimeter the LA blood-tissue interface 1-2 frames prior to the mitral valve opening. True or False?
True
IVC diameter and collapsibility index can be assessed via 2D echo or M-mode. True or False?
True
If LVEF is reduced, the mitral inflow pattern can usually predict an elevated left atrial pressure. True or False?
True
If diastolic function is normal, the E/A ratio remains normal with Valsalva maneuver. If a pseudonormal mitral inflow pattern is present, the E/A ratio becomes abnormal with Valsalva maneuver. True or False?
True
If indicated, acquire the end-diastolic pulmonic regurgitation (EDPR) velocity and calculate the EDPR gradient with the Modified Bernoulli equation. True or False?
True
If the tricuspid regurgitation envelope is not filling in adequately, reposition the patient, try a different window, or administer agitated IV saline or contrast to improve the signal. True or False?
True
In the absence of mitral valve disease, left atrial enlargement usually reflects increased left atrial pressure, is a sign of diastolic dysfunction, and is an indicator of left atrial pressure severity and chronicity. True or False?
True
LAX AO is typically located more proximal to the sternum and up an intercostal space from the LAX LV. True or False?
True
LV diastolic function evaluation is vital in patients with potential diastolic dysfunction and the results should be included in the report, particularly those with dyspnea or heart failure. True or False?
True
LV dimensions should be acquired perpendicular to the structures, in a straight line, just beyond the tips of the mitral valve leaflets, with the calipers placed at the myocardial wall/cavity interface and wall/pericardium interface. True or False?
True
M-mode dimensions should be acquired with the leading-edge-to-leading-edge technique. True or False?
True
Normal LA volume index (LAVi) is < 34 mL/m^2 True or False?
True
Normally, TDI of the mitral annulus is a mirror image of the mitral inflow PWD waveform. True or False?
True
Pulmonary venous flow is dependent on the pressure difference b/w the pulmonary veins and LA, as well as other factors. True or False?
True
RV systole pressure has a strong correlation with the noninvasively acquired LA pressure. True or False?
True
SUB DAO and SUPRA LAX help rule out dilation of the aorta. True or False?
True
Sonographer can use the central venous pressure or the inferior vena cava diameter and inspiratory collapse to estimate the mean right atrial pressure (RAP). True or False?
True
TAPSE < 17 mm indicates decreased right ventricular function. True or false?
True
TDI of the mitral annulus measures the Doppler frequency shift of the moving myocardium. True or False?
True
Valsalva maneuver can unmask abnormal inflow in the presence of a pseudonormal mitral inflow pattern. True or False?
True
Choose the statement that best describes the initial LAX LV. a. acquire at an increased depth b. include the entire cardiac structure and surroundings c. rule out extracardiac abnormalities d. all of the above
d
Venous return, stroke volume, and cardiac output __________ during the strain phase of Valsalva and __________ during the release phase.
decrease/increase
According to the ASE, left ventricular diastolic dysfunction is usually the result of __________.
impaired relaxation and increased chamber stiffness
If LVEF = 60%, TDI e' (lateral wall) = 15 m/s, E/e' (average lateral and septal wall) = 10, LAVi = 28 mL/m^2, and peak TRV = 2.4 m/s; how would you report diastolic function?
normal diastolic function
In the absence of right ventricular outflow tract obstruction, acquire the peak tricuspid velocity and calculate the ____________.
right ventricular systolic pressure
How is the 2C acquired?
rotate 60-90 degrees counter clockwise from the 4C
