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Echo3 quiz2

Specialty exams and cath info

4 TEE probes: • Omniplane/Multiplane • Biplane (obsolete) • Single plane (obsolete) • Pediatric
4 Transducer Positions – TEE: • Transgastric 40-45cm • Mid-esophageal 30-40cm • Upper esophageal 20-25cm • Descending thoracic aorta
8 TEE Indications: 1. Thrombus, CSOE (cardiac source of emboli) 2. Infective endocarditis 3. Prosthetic heart valve dysfunction 4. Diseases of the Ao 5. Pre-cardioversion 6. Intracardiac masses 7. Congenital heart disease 8. Complications with an MI
5 Contraindications – TEE: 1. Uncooperative/unwilling patient 2. Known esophageal pathology 3. Upper GI bleeding 4. Unstable respiratory status 5. Trachea may obstruct view
TEE Supplies – 8 items: 1. BP cuff/device 2. EKG monitor 3. Pulse ox 4. Crash cart 5. Drugs – Versed, sterile saline 6. Emesis basin 7. Topical Lidocaine, Surgilube, gauze, bite guard 8. Cidex to disinfect probe afterward
3 Complications – TEE: 1. Esophageal perforation (rare) 2. Transient vocal cord paralysis (rare) 3. Sore throat (most common complaint)
New contrast agents were developed to improve LV ___________________________ endocardial border resolution
Agitated saline can be used as a contrast agent to look for _______ _______ during a TEE/TTE interatrial shunts
3 common contrast agents Smaller than a RBC are: • Imigent • Optison • Definity
3 Indications – Contrast: 1. Better LV endocardial resolution for poor echocardiographic images 2. Improved assessment of LV function 3. Assessment for thrombus, atypical deformities
2 Contraindications – Contrast agents: • Pregnancy • Known liver disease
5 techniques for optimum image using contrast agents: 1. Use harmonic setting 2. Low mechanical index (.3-.5) 3. Focus mid screen 4. 12-15cm depth (minimal visual of LA) 5. Low frequency
6 Indications, Stress Echo: 1. Chest pain of unknown origin 2. SOB 3. Abnormal EKG 4. Exercise related dysrhythmias 5. Previous non-diagnostic stress EKG 6. Increased risk factors (age, smoking, HTN, obesity)
3 Types – Stress Echo: 1. Treadmill Stress Echocardiogram 2. Supine Bicycle Stress Echocardiogram 3. Pharmacological (Dobutamine) Stress Echocardiogram
4 Images obtained at rest and post in a stress echo: 1. AP4 2. AP2 3. PLAX 4. PSAX
When are images obtained in a Pharmacological Stress Echocardiogram? rest, low dose, peak dose, post infusion
5 Stress Echocardiogram Advantages: 1. Office or hospital based 2. Easy addition to routine treadmill EKG 3. Immediate diagnostic testing 4. Low cost (½ to ¾ less than nuclear) 5. No radiation
5 Stress Echocardiogram Disadvantages: 1. Poor endocardial tissue definition 2. Obesity 3. COPD 4. Barrel chest 5. Breathing obstructing views post exercise!
2 Complications – Stress Echocardiogram: 1. Could cause acute MI 2. Sudden death
Four 3D Advantages with full acquisition: 1. Able to acquire and image full 3D image of heart 2. Can cut/slice areas and look inside (crop box) 3. Image can be rotated to see all structures 4. Can image trabeculations vs. thrombus
Three 3D Disadvantages: 1. EKG must be decent or will not acquire correctly 2. Artifact – respirations can cover image 3. Poor 2D image = poor 3D image
Gold Standard utilization for coronary artery stenosis: Cardiac Catheterization
2 cardiac catheterization incision sites: 1. Most commonly femoral junction 2. Can utilize upper extremity arteries
Cardiac Catheterization Technique – 5 steps: 1. Femoral incision is made 2. Guide wire inserted to the level of the aorta 3. Catheter is inserted over guide wire 4. Dye injected into coronary arteries 5. Simultaneously, X-rays are taken (fluoroscope) to look for filling defects
Cardiac Cath lab can be utilized to determine _______ ________and _________ of valves pressure curves, gradients
Cath Technique, L side: 1.Insertion same as ____ ____ 2.Aortic valve: Catheter is placed into the ___ and pulled back into ____to record pressure differences 3.MV: Catheter is placed into __ and pulled back into __ to record MV pressure gradients 1.coronary cath 2. LV, aorta 3. LA, LV
Cath Technique, Right side: 1. _____ _____ used to obtain pressure gradients in right side of heart 2. PV: catheter is placed into __ and drawn back for pressure gradients 3. TV: catheter is placed into __/__for pressure gradient 1. Femoral vein 2. PA 3. RV/RA
Gold Standard for AoV area: Peak-to-peak gradient
Cath lab uses ____________ pressure gradients: Peak-to-peak
Peak-to-peak gradients – 4 characteristics: 1. Difference between peak LV and peak aortic pressures 2. Do not occur simultaneously 3. Will generally be lower than echo 4. GOLD STANDARD for AoV area
Echo lab pressure gradient: Peak instantaneous gradient
Peak instantaneous gradient – 3 characteristics: 1. Method used by echo lab with CW Doppler 2. Converting max Doppler velocity by Bernoulli’s equation 3. Usually exceeds peak to peak method
Cath averages _____________________ and ____________ to calculate mean gradient maximum instantaneous pressure, peak to peak gradient
From cath lab, _____________ is used to determine AoV area Gorlin formula
From Echo lab, ______________ is used to determine AoV area continuity equation
_____ Doppler and _____ catheterization gradients correlate the best! Mean, mean
Cath Assessment in Mitral Stenosis determines _______ _______ gradient across MV (Hallmark finding) transvalvular diastolic
Cath Assessment: AS 1. _________ pressure gradient 2. _________________ pressure gradient 3. AVA determined by the ___________ 4. Pressure waveforms show ________ gradients between the ventricle and great vessels between __-__mmHg 1. Peak to peak 2. Mean transvalvular 3. Gorlin formula 4. systolic, 10-100mmHg
Mitral Regurgitation determined by _________ _________ *Radiopaque dye (contrast) injected into LV and amount of reflux into LA is graded (1+ – 4+) Pressure waveforms show elevation in _______ _______ into LA left ventriculography, systolic pressures
Cath Assessment: AI Regurgitant volume determined by _____ _____ *Contrast injected above the AoV to evaluate for reversal of flow into LV during _____ supravalvular aortography, diastole
Cath Assessment: AI Pressure waveforms show _____ in end diastolic LV pressures and _____ end diastolic pressures of the AoV elevation, decreased
Cath Assessment: TS 1. TVA determined by __________ 2. Increased mean ______ PG between the RA & RV (increases with inspiration) 3. Pressure waveforms show elevated _____ pressures above _____ pressures during diastolic filling 1. Gorlin formula 2. diastolic 3. atrial, ventricular
Cath Assessment: TI 1. Regurgitant volume determined by __________ 2. Increased right atrial pressure and right ventricular _______ pressure 3. Pressure waveforms will show elevation in ______ pressures in the LA or RA 1. right ventriculography 2. diastolic 3. systolic
Cath Assessment: PI 1. Regurgitant volume determined by _______ ________ 2. *Shows reflux into the RV during ________ 3. Pressure waveforms show ______ in end diastolic RV pressures and ______ end diastolic pressures of the pulmonic valve 1. pulmonary angiography 2. diastole 3. elevation, decreased
Four methods of determining cardiac output: 1. Thermodilution – injection of chilled saline into RA. 2. Indicator Dilution –Rarely used today. 3. Fick method 4. Angiography
Cath Assessment of Left global & systolic function is done by: left ventriculography
Created by: lefut