Congenital
Ventricular septal defect, overriding aorta, right ventricular hypertrophy and pulmonary atresia are echo findings related to this congenital cardiac disease.
What is Tetralogy of Fallot.
This is a small filamentous structure that can be seen on the aortic valve and is commonly mistaken as endocarditis.
What is Lambl's excrescence?
Coronary artery disease, alcohol and viral infection are some of the most common causes of this cardiomyopathy.
What is dilated cardiomyopathy.
Echo findings:
Four-chamber dilationDecreased global LV systolic function
Diastolic dysfunction
Decreased LV wall thickening
Poor coaptation of MV and TV resulting in significant MR (nearly 100% functional MR) and TR (nearly 90%).
4v2 is commonly used to calculate this echo finding.
What is right ventricular systolic pressure?
Example
TR Velocity = 2.0 m/s
4 (2.0)2 = 4 (4) = 16 mmHg
*Make sure to have a full TR envelope when measuring and reporting RVSP
This echo view best shows the presence of a PDA.
What is PSAX at aortic level.
Focus on the Pulmonary artery with color Doppler.
Can also be visible from the suprasternal notch views with color Doppler.
Name the three tricuspid valve leaflets.
What are anterior, posterior and septal?
Interventricular wall thickness >1.5 with an IVS/PWLV >1.3:1, SAM and small hypercontractile LV are indicative of this cardiomyopathy.
What is asymmetrical septal hypertrophy?
Measure at least 5 consecutive Doppler signals from the highest window when the patient is in this rhythm.
What is atrial fibrillation?
Throughout exam caliper your peak velocities. At the end of the exam pick your best window/Doppler signals and measure at least 5 Doppler signals. Make sure to leave them averaged in the report.
What is coarctation of the aorta?
A congenital narrowing of the aorta.
Suprasternal/high left parasternal window are best views, 2D, Color and spectral Doppler should be used to demonstrate coarctation.This structure is best visualized in the parasternal long axis view within the pericardium. When dilated it is most often associated with left persistent SVC.
What is the coronary sinus?
50 year old male, RE: Decreased exercise tolerance, no previous echo
Echo findings
LVH, ground glass appearance of the myocardium and restrictive diastolic function.
What is an infiltrative cardiomyopathy?
When assessing Qp:Qs this Doppler should be performed.
What is PW Doppler of the LVOT and RVOT.
Qp:Qs Breakdown
Remember it's a pulmonary to systemic ratio
ASD/VSD
Calculate Qp using RVOT diameter and RVOT TVI.
Calculate Qs using LVOT diameter and LVOT TVI.
Qp/Qs = Stroke Volume RVOT/Stroke Volume LVOT>1.5/1 is a significant shunt
*For PDA this is reversed.
This is the most difficult septal defect to visualize in echo.
What is sinus venosus ASD?
This is most often associated with anamolous pulmonary veins. When performing a TEE and a sinus venosus ASD is present be sure to work with physician to thoroughly assess pulmonary vein anatomy.
The most common type of ASD and it's location.
What is ostium secundum?
Defect located in the mid-portion of the interatrial septum.
Subcostal window is best view. Optimize image by zooming in on IAS and reducing the color scale. Pan through the septum with color Doppler.
Reversible cardiomyopathy that involves a localized portion of the heart, most often the apex.
What is Takatsubo or "broken heart" syndrome?
Hypokinesis of the LV apex with normal or hypercontractile function of the basal segments with no know associated coronary artery disease.
Inspiratory leftward shift of the interventricular septum, medial tissue Doppler > lateral tissue Doppler and no respiratory flow variation in the SVC would be indicative of this cardiac physiology.
What is constrictive physiology
Echo findings:
Inspiratory leftward shift of the interventricular septum
>25% Insp. flow variation of the mitral valve inflow
>40 % Insp. flow variation of tricuspid valve inflow
End diastolic expiratory flow reversal of hepatic veinsDilated IVC with reduced inspiratory collapse
No inspiratory flow variation in SVC
Reversal of a congenital shunt from left-to-right to right-to-left secondary to irreversible elevation of severe pulmonary hypertension.
What is Eisenmenger's Syndrome?
Echo findings consistent with severe PHTN.
Severe RV enlargement
SPAP >120 mmHg and/or > systemic pressure (another reason why it's important to take a blood pressure at the beginning of an exam)
RVOT acceleration time <60 msec
Dilated IVC with reduced or no inspiratory collapse.
M-mode is still one of the most optimal echo tools to assess for this cardiac pathology associated with hypertrophic obstructive cardiomyopathy and/or asymmetrical septal hypertrophy.
What is systolic anterior motion of the mitral valve?
Insert picture
PLAX and PSAX at the mitral level are best views to assess SAM with M-mode. Also use apical 3 chamber and 5 chamber views focused on LVOT with 2D and color Doppler.
Presence of septal contact and length of contact helps with the clinical management of these patients.
LVH, SAM, severe MR, late peaking aortic valve Doppler signal and aliasing LVOT Doppler signals are echo findings of this cardiomyopathy.
What is obstructive hypertrophic cardiomyopathy?
Dedicated view of 3 chamber with color to demonstrate where obstruction is, pulse down septum starting at apex and moving down towards LVOT just to demonstrate where obstruction is (no measurements, label images to help reader), CW through obstruction at rest and with Valsalva to get highest gradient and measure it as a peak instantaneous gradient
*Gradient of 50 mmHg at rest or with Valsalva is considered clinically significant