General Cardiology Guidelines

Link to guidelines for cardiology boards

https://drive.google.com/open?id=0B0hWtBiN0PaHUEhERkpiOVZUbE0

Echo Guidelines

Here is a link with all the guidelines you need to know for the boards (I have highlighted the important stuff!)
https://drive.google.com/open?id=0B0hWtBiN0PaHSEEzeEpvUGRtSVk

Predictors of Adverse Outcomes

Endocarditis	Aortic valve >10mm vegetation (Increased risk of embolization) TV- generally good prognosis
Cardiac amyloidosis	DT < 150 ms  Other less validated markers of worse prognosis: LV wall thickness > 15 mm, RV enlargement

Peripartum Cardiomyopathy	LVEF < 30 % LVEDD ≥60mm Elevated troponin ??Abnormal dobutamine stress predicts recurrence
Cardiomyopathy	RV dysfunction Sphericity index < 0.76  Diffuse hypokinesis (RWMA more favorable prognosis) Chemotherapy induced CM (worse prognosis compared with idiopathic)

Pericardiectomy	Post radiation (worst prognosis) **idiopathic- best prognosis
LV thrombus (risk for embolization)	Large pendulous thrombus (>0.8cm2 ) Mobile thrombus
Post MV repair (Risk of SAM)	Co-aptation to septal distance (C-sept) < 2.6 cm Posterior mitral valve leaflet height > 1.5 cm Anterior leaflet/Posterior leaflet height ratio (AL/PL) < 1  Aortic Mitral angle < 130

Changes seen in rejection post transplant

Impairment of diastolic function:

-          Decrease DT >20%

-          Decrease in IVRT >20%

-          Increase in E velocity

New onset MR

>10% decrease in ejection fraction

Increased wall thickness >4mm (IVS + post wall)

Increased myocardial echogenicity

New/increasing pericardial effusion

Good to know

Angle independent	Speckle tracking
Age independent	Ar-A for LA pressure
Load independent	Dp/dt
Congenital diseases more common in women	PDA ASD Ebstein’s
If ASD >15mm on color	Qp: Qs:: 2:1
AV valves seen at same level	Primary ASD Corrected tGA
Bernoulli’s equation is based on	Law of Conservation of Energy
Continuity equation is based on	Law of Conservation of Mass
Flow across an ASD is determined by	Difference in compliance and capacity of the two ventricles
Holodiastolic flow reversal in the descending aorta seen in	Severe AI Aorto-pulmonary window
LV apex motion	Counterclockwise
LV base motion	Clockwise
Size of vegetations detected	TTE 5mm TEE 1mm
Rupture of coronary sinus aneurysms                          Right             Left             Non	RV LA RA

Named Findings

Saw tooth pattern on Doppler	Co-arctation of aorta
Broken ring	Anomalous drainage to SVC
Popcorn thrombus	RA thrombus (multilobulated)
LVOT goose neck deformity	AV canal defects
Pear shaped aorta Erlenmeyer deformity	Marfan’s
Charcoal heart	Melanoma metastases
Keshan disease	Se deficiency
Seagull sign	Restricted anterior leaflet in functional MR
Tear drop heart	Apical view in congenital absence of pericardium (elongated atria, widened ventricles)
Gerbode defect	Communication between RA and LV

Best TTE views

MV prolapse	PLAX
SAM	PLAX
Abnormal insertion of anterior mitral leaflet	PLAX
Sinus venosus ASD	Subcostal 4C
Inlet VSD	Apical 4C
RUPV	Apical 4C
PDA flow	High left PSAX
Aortic valve gradient/flow	A5C/ Apical long (3C)
Pulmonary valve flow	Basal PSAX (TEE: Aov SAX, transgastric 70 degrees)
Superior Vena Cava	Suprasternal notch
LAA	Apical 2 chamber (on TTE)
Left persistent superior vena cava	Left supraclavicular view
MV cross sectional area (annulus diameter)	Apical long (3C)
Suspected paravalvular MR	PLAX
Aortic root abscess	PSAX
MV Leaflet Tips	LV dimensions (PLAX) Mitral inflow for diastology assessment (A4C) PHT for MS (A4C)
Mitral annulus	A wave duration (for Ar-A calculation) CW for volume/flow rate measurement through the MV AV optimization
LVOT diameter	Within 1cm of AV annulus
PVF	Place sample volume 1cm in to PV
Atrial volumes	A4C

Cannot Use (Limitations of echocardiographic parameters)

Mitral E/DT/A	More than mild MS More than mild MR Hypertrophic cardiomyopathy
Propogation Velocity (Vp)	LVH (falsely fast) Small LV cavity May be normal in restrictive cardiomyopathy Normal EF
E/A	Normal EF Mitral stenosis Prosthetic valves
e'	MAC Prosthesis/surgical rings Mitral stenosis Constrictive pericarditis Regional wall motion abnormalities
Hepatic Vein Flow	TS Transplant patient High degree AV block Pericardial compression syndromes
Dp/dt	Severe MR
Mahan’s Equation (for pulmonary hypertension)	HR must be 60-100bpm
2 chamber view (TTE)	VC measurements in MR (parallel to line of co-aptation, shows wide VC even in mild MR)