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
|
Tuesday, August 25, 2015
Number to Remember
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
Subscribe to:
Posts (Atom)