Number to Remember

E velocity	1m/s
A velocity	0.5-1m/s
S velocity (PVF)	0.6m/s
D velocity (PVF)	0.4m/s
Ar velocity (PVF)	≤0.35m/sec
IVRT	70-90msec
DT	150-240msec
Propogation velocity (Vp)	>50
E’ (Septal)	8cm/s
E’ (lateral)	10cm/s
EF (males)/ mean	52-72%/ 62
EF (females)/ mean	54-74%/ 64
LA volume index
Normal	16-34 cc/m2
Mild dilatation	35-41
Moderate dilatation	42-48
Severe dilatation	>48
LV mass index: linear method (males)	115 gm/m2
LV mass index: linear method (females)	95 gm/m2
Global longitudinal strain (averaged from three apical long axis views)	-20%
Sphericity Index	≥ 1.5

Valsalva in echocardiography

Definition of adequate Valsalva: Pressure of 40mmHg against a closed glottis

Uses:

Diastolic dysfunction	Phase II	Differentiate between normal and pseudonormal*
Interatrial communication (PFO/ASD)	Phase III (release of valsalva, increased RA pressure)
Hypertrophic cardiomyopathy	Phase II	Provoke gradients (exercise provokes higher gradients)

*With adequate Valsalva E velocity should decrease by 20cm/s

Decrease in E/A ratio by ≥50% is specific for increased filling pressures (pseudonormal pattern at rest)

Stress echocardiography

Monophasic response	Improvement in wall motion by one grade in two or more segments
Biphasic response	Improvement in wall motion abnormality at low dose dobutamine and subsequent worsening at higher doses
Suggestion of viability	Monophasic response
Suggestion of viability and ischemia	Biphasic response
Most predictive of functional recovery after revascularization	Biphasic response
Highest sensitivity for viability	Monophasic response
Highest specificity for viability	Biphasic response
False negatives	Single vessel disease -LCX lesion; inferolateral wall (use apical long axis) Suboptimal stress Concentric remodeling
False positives	Hypertensive response HCM Microvascular disease Tethering of stationary mitral valve (MAC/MVR): basal segments appear hypo/akinetic LBBB/pacing Post bypass: basal anteroseptum appears hypo/akinetic
False positive EKG stress test	Women Men on estrogen Digoxin therapy
EKG stress test- cannot report ischemia in	LBBB RBBB- if ST-T changes seen only in septal leads

Exercise/ Dobutamine stress echo in severe CAD (From Oh Manual)                      

	Exercise	Dobutamine
WM abnormalities	Multiple	Multiple
LV cavity	Dialtes	Usually does not dilate
LVEF	Decreases	May not decrease
ST segment depression	Common	Uncommon
Hypotension	Specific	Non specific

*LV end systolic volume may not decrease during bicycle stress echo (due to increased venous return)

Timing of echocardiographic measurements

LV dimensions	End diastole
Aortic dimensions	End diastole
LA dimensions	End systole
LVOT diameter/aortic annulus*	Mid systole
Pericardial effusion	Diastole
Mitral valve annulus	Mid diastole (one frame after maximum opening of valves)
Mitral valve anterior leaflet	Diastole

*Aortic annulus: Inner edge to inner edge

Aortic root/aorta: Leading edge to leading edge

Most common

Most common congenital heart abnormality	Bicuspid aortic valve
Second most common congenital heart abnormality	ASD
Most common location of pericardial cysts	Right cardiophrenic angle (behind RA)
Most common location of hiatal hernia on echo	Above atria
Most common location of post op effusion	Posterior and lateral
Most common location of pseudoaneurysmafter MI	Posterior>lateral>apical
Most common lesion associated with TGA	VSD
Most common type of ASD	Secundum
Most common type of VSD	Perimembranous
Most common type of cyanotic CHD	Tetrology of Fallot
Most likely cyanotic CHD to escape detection in childhood	Ebstein’s anomaly
Most common primary tumor of the heart	Myxoma
Most common primary pericardial malignancy	Mesothelioma
Most common primary malignant tumor of the heart	Angiosarcoma
Most common primary tumor associated with pericardial effusion	Angiosarcoma
Most common cause of echogenic pericardial effusion	Tuberculosis>Malignancy>Idiopathi
Most common cause of constrictive pericarditis	Idiopathic
Most common location of blunt aortic injury	Aortic isthmus just distal to the origin of the left subclavian artery> Supravalvular ascending aorta> Diaphragmatic aorta
Most common type of blunt aortic injury	Subadventitial (involving intima and media) with incomplete circumferential extension
Most common location of atherosclerosis	Descending aorta >Arch> Ascending aorta
Most common location of thoracic aorta aneurysms	Aortic root/ascending aorta: 60% Descending aorta: 40% Arch: 10% Thoracoabdominal aorta: 10%
Most common coronary artery affected by aortic dissection	Right coronary artery
Most common location of abscesses in infective endocarditis	Aortic root
Most common primary valve tumor	Papillary fibroelastoma
Most common location of papillary fibroelastoma	Aortic valve (aortic side) > Mitral
Most common cardiac manifestation of HIV	Pericardial effusion
Most common cause of primary MR (World)	Rheumatic
United States	Degenerative/Myxomatous
Most common cause of secondary MR	Ischemic
Most common cause of mitral stenosis	Rheumatic
Most common cause of AI (World)	Rheumatic
Most common cause of AS (World)	Rheumatic
Unites States	Bicuspid
Most common location of extra-adrenal cardiac mass in pheochromocytoma	AV groove
Most common complication after Ross procedure	AI
Most common complication after TOF repair	PI
Most common complication after AV canal defect repairs	MR
Most common complications of Mustard/Senning	RV failure Bradycardia
Most common location of mitral disease                                          Degenerative                                          Rheumatic	Base of leaflets Tips of leaflets
Most common location of MAC	Posterior annulus
Most common location of accessory pathway	Right lateral
Most common location of absent pericardium	Left (complete absence)
Most common complication of partial absence of pericardium	Herniation and strangulation of chambers
Most common chamber herniated	Left atrial appendage
Most common location of vegetations in endocarditis Mitral Aortic Bioprosthetic valve Metallic valve	Atrial side of valve Ventricular side of valve Leaflets Annulus
VSD	Septal Leaflet of TV >>RVOT/subpulmonic
Most common location of radiation induced calcification	Anterior MAC Aortic-mitral continuity

Doppler Flows: 2

The image on the right is suggestive of severe TR: early peaking dense jet.

Remember: cannot use peak velocity to determine severity in regurgitant lesions

Aortic regurgitation peak jet velocity must be >/= 4m/s

Mitral stenosis velocities will usually be lower than 4m/s

AS jet starts after the QRS; while MR jet starts with the QRS

Note higher velocities seen in MR