Physics
Diastology
Pericardial Diseases
Quantitative Echocardiography
Congenital Heart Disease / Anatomic Variants
100
Give three synonyms for axial resolution
Longitudinal
Axial
Radial
Range
Depth
100
How do you determine the Te' and what happens to it with diastolic dysfunction
R to onset of e', and it is prolonged
100
Define pulsus paradoxus
Inspiratory decrease of arterial pressure of at least 10 mm Hg with venous pressure that remains steady or increases
100
The Doppler Equation
Change in frequency = 2ft (v x Cos θ) / c
V = Change in F / (Cos θ x c/2Ft)
•v = velocity of red blood cells
•theta = angle between Doppler beam and direction of blood flow
•c = speed of ultrasound in blood
100
What abnormality does this patient likely have?
Persistent left superior vena cava
200
Which properties of the ultrasound beam are determined by the source, the medium, and both the source and medium?
velocity - medium
length and wavelength - source and medium
period, frequency (time) and strength (amplitude, power, intensity) - source
200
What happens to peak E velocity and decel time as the PW Doppler sampling volume is moved from above the mitral annulus to the tips of the mitral valve.
Peak E increases and decel time decreases
200
What is Beck's Triad
1. Hypotension
2. Increased jugular venous pressure
3. Muffled heart sounds
200
Two situations in which the assumptions of the simplified Bernoulli equation are violated
1. Prosthetic valves with high force required to open valve
2. Tubular Obstructions greater than 4 cm + orifaces less than 0.1 cm2
3. Significant proximal velocity
4. Abnormal blood viscosity
1.Leads to significant flow acceleration (inertial force)
2.Leads to significant viscous friction
3.High cardiac output, subaortic obstruction, significant AI, intracardiac shunts
4.Crit >60 can lead to significant increase in 1/2p
200
Name this defect, be specific, and what valve abnormality is it associated with?
Ostium Secundum ASD, MVP/MVR
300
Regarding refraction and Snell's law, when the velocity in the 2nd medium is greater than the velocity in the 1st, the angle of transmitted beam will be (blank) than the incident beam.
Greater than
sin θT / sin θI = V2 / V1
V2 > V1 --> θT > θI
300
Draw an L wave and explain what it represents
Triphasic mitral inflow and it is continued flow into the LV from the pulmonary veins in mid diastole seen in advanced diastolic dysfunction
300
What is annulus reversus?
e' velocity higher in the medial wall than the lateral wall seen in constrictive pericarditis.
300
Equation and brief explanation of assessing stenotic mitral valve area with PISA
MVA = ((2∏r2) x aliasing velocity) / (peak transmitral velocity)
1. during diastole
2. On the atrial side
3. PISA radius should be measured when transmitral velocity is highest
4. using BART convention PISA is measured where color flips from blue to red
300
Name this structure:
Thebesian Valve
400
Continuous wave Doppler has a (blank) Q factor due to (blank) bandwidth.
High
Qfactor = RF / BW
400
Give 4 criteria for grade 2 diastolic dysfunction according to Swaminathan
e' < 10
E/e' 9-12
E/A 0.8-1.5
DT 160-200
Ardur - Adur >30
400
Describe the atrial volumes in tamponade, constrictive pericarditis, restrictive cardiomyopathy
Tamponade - collapsing
Constrictive - small
Restrictive - Very large
400
Equation and brief explanation of assessing flow through ASD
Qp/Qs (greater than 1.5 considered significant) = (CSA(RVOT) x VTI(RVOT) / (CSA(LVOT) x VTI(LVOT)
400
This defect is commonly seen in what congenital syndrome?
TOF
VSDs
1. Supracristal / subarterial / outlet / subpulmonic / doubly committed / infundibular
2. Infracristal / perimembranous
3. Muscular
4. Atrioventricular canal / Inlet
TOF
500
As you increase crystal thickness, what happens to the focal length
Decreases
RF = V / 2T
Velocity (in crystal)
Increased T --> Decreased RF
Wavelength = velocity / frequency
Decreased frequency --> Increased wavelength
Near field / focal length = radius2 / wavelength
Increased wavelength --> Decreased focal length
500
According to the 2016 ASE guidelines (not Swaminathan), how should you grade someone with:
-decreased EF
-E/A 0.12
-Average E/e' 12
-TR velocity of 2.4 m/s
-LA volume index unknown
Cannot Determine
500
CW Doppler findings for LV inflow in restrictive cardiomyopathy (respiratory variation, E:A, and DT)
Little RV
E:A >2.0
DT <160 ms
500
The full Bernoulli equation
Pressure Difference = 1/2 p (V22 - V12) + p ∫(dv/dt)*ds + R(u, v)
500
What type of AV canal defect is this (partial, transitional, complete) and what is the most common congenital syndrome associated with it?
Complete and Down
Partial - two AV valves, OP ASD, cleft mitral
Transitional - OP ASD, small VSD, two distinct valves
Complete - OP ASD, inlet VSD, common AV valve