Tuesday, August 25, 2015

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

Monday, August 24, 2015

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