Echo 530

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Author:
lstaal1
ID:
22030
Filename:
Echo 530
Updated:
2010-06-04 23:28:29
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Module8
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Description:
Acyanotic CHD
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  1. Define: ASD
    • Atrial septal defect
    • hole or tear in atrial septum allowing communication btw Rt & Lt atrium (>5mm discontinuity of IAS)
  2. 4 main types of ASD's are:
    • Primum - 20% - AV valves (endocardial cushion defect)
    • Secundum - 70% - Central (MVP)
    • Sinus Venosus - 10% - SVC&IVC entry; PV drain problems
    • Coronary Sinus - rare
  3. MC ASD:
    Secumdum - 70% - central (MVP)
  4. The Primum ASD is at the level of ___________________ and is usually associated with ___________________ ___________________ _________________ _________________.
    • AV valves
    • partial endocardial cushion defect
  5. The secundum ASD is situated ______________________ of the septum and can be associated with __________________.
    • central
    • MVP (cleft MV)
  6. The Sinus Venosus ASD is at the entrance of the ____________ & _____________ & is associated with _______________ ________________ of the ________________ ________________.
    • IVC SVC
    • anomalous drainage
    • pulmonary veins
  7. The patient who presents with an ASD will have symptoms such as: (5-6)
    • 1. 50% asymptomatic
    • 2. dyspnea, palpatations, atrial arrhythmias, PHTN, RHF, QP/QS >2:1
  8. List 5 complications of patient with ASD:
    • 1. CHF
    • 2. PHTN
    • 3. Eisenmengers Syndrome
    • 4. Atrial Arrhythmias
    • 5. Cerebrovascular Accident (paradoxical embolis ) Rt-->Lt --> brain (cough)
  9. List the M-Mode & 2D features of significant ASD (9)
    RVE, RAE, RVVO, PAE, PHTN (flying W), T artifact, cleft MV, MVP
  10. Explain the difference one would see in the PSSX view of the RV & LV with PHTN vs. RVVO.
    • PHTN = D shape --> IVS always flat
    • RVVO = D shape --> IVS flat in SYSTOLE only
  11. The shunt of an ASD would be first Lt --> Rt. Why? What would the color flow look like?
    • Higher Lt sided pressures.
    • Color above the baseline (towards the Transducer)
  12. What is the formula for Cardiac Output?
    CO = (d2)(0.785)(TVI)(HR)/1000 = L/min
  13. The diastolic TV flow of a hemodynamically significant ASD would be increased? T/F
    True.
  14. What is Lutenbacker?
    ASD + MS = small LA d/t shunt
  15. The Qp/QS would be _________________ in a patient with significant ASD?
    1.5:1
  16. What does Qp/Qs mean?
    SV RVOT / SV LVOT
  17. The average velocity of an ASD is ____________________m/sec.
    0.3-0.9
  18. Define: VSD
    • Ventricular septal defect. Hole in IVS allowing communication between LV and RV.
    • VSD = Large Left side
    • ASD = Large Right Side
    • PDA = Large Left Side
  19. Define: Eisenmengers Syndrome
    Initially Lt--> Rt shunt, but PAP increases & > or = systemic pressure (120/80)
  20. 4 VSD locations are:
    • 1. Output - 12-3 (more anterior)
    • 2. Membransous 9-12 80% PSLX
    • 3. Inlet (more posterior)
    • 4. Muscular
  21. 3 chambers enlarged with perimembranous VSD are:
    • 1. LVE
    • 2. LAE
    • 3. RVE
  22. A small VSD would have a low velocity? T/F
    • False
    • small hole = high velocity
    • large hole = low velocity (pressure equilizing faster)
  23. RVSP = ?
    Systemic BP - 4V2
  24. Why is it important to assess RVSP in the presence of VSD?
    The patient can develop PHTN.
  25. What's the difference between + and - contrast study?
    • + Rt --> Lt shunt = bolus in Lt heart
    • - Bolus stays in Rt heart. Fresh echo free blood in contrast echo
  26. Define: PDA
    • Patent Ductus Arteriosus
    • Residual communication between LPA and Descending AO. Necessary during gestation.
  27. Describe the flow pattern of a patient with a PDA
    Ductal channel arises @ PA bifurcation near origin LPA --> lesser curve AO just opposite Lt Subclavian Artery
  28. 3 etiologies of PDA
    • 1. Premies
    • 2. Genetic Abnormality (Down's)
    • 3. Mother had Rubella
  29. What 2 chambers are enlarged with a PDA that has a Lt to Rt shunt?
    LAE, LVE
  30. why would a baby have cyanosis in their lower body?
    Rt-->Lt shunt ; desaturated blood enters systemic system below subclavian artery. 02 saturation increased in upper extremeties than lower.
  31. What can a major clinical problem with a baby who has a PDA?
    • PHTN
    • CHF
    • Eisenmengers
  32. What does ductal dependence mean?
    Antegrade flow across RVOT to show flow going through PA
  33. When doing Qp/Qs why do we have to change the measurements around for PDA?
    because we're using PDA jet
  34. Explain the difference between a partial and a complete endocardial cushion defect.
    Partial = atrail septal involvement with septal, mitral & tricuspid orifices

    Complete = both atrial and septal defective and have a COMMON AV VALVE
  35. 2D of cleft MV and consequences?
    • noncoapt AMVL
    • ASD primum

    MR ALWAYS!!!!!
  36. What is a hypoplastic Lt Ventricle?
    2D?
    LV doesn't develop d/t Mitral & AO atresia

    • Bar of tissue in mitral position
    • Thin slit-like LV
    • Thread-like AO
  37. What is the difference between congenitally corrected transposition of great arteries vs. transposition of great arteries?
    Cong corrected (adult) = inverted ventricle & transposition GA. AO anterior with normal flow pattern

    TGV --> PA with LV & AO with RV
  38. Why do we use Qp/Qs ratio for shunts?
    • Indicates the magnitude of shunt
    • 1.5:1.0 indicates a significant shunt

    • Qp = SV of Qp site = (csa)(fvi)
    • Qs = SV of Qs site = (csa)(fvi)
  39. Define: Supracristal
    lies immediately above the Pulmonary valve
  40. Define: Infracristal
    inferior and posterior to crista supraventricularis and are divided into mmb, muscular and defects that are part of endocardial cushion formation
  41. Tetralogy of Fallot is a _____________________
    malalignment
  42. PA systolic pressure = ?
    RVSP
  43. VSD is seen in __________________ only. Why?
    • systole
    • High Lt sided pressure
  44. Why is ASD flow lower than VSD flow?
    Pressure gradients
  45. When calculating:
    Systolic BP - 4V2 what velocity do you use?
    velocity of vsd jet
  46. Apical shadowing occurs in a contrast study when the volume (rate of contrast) injection is too (low / high)?
    high
  47. Swirling of ventricular contrast is seen when volume of injection rate is too (high / low)?
    too low
  48. Detection of intracardiac shunts, enhancement of doppler signals, LV opacification, and myocardial perfusion are 4 indications to perform _____________________ ____________________.
    contrast study

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