Senior year review

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Senior year review
2015-08-15 17:20:23

Senior Year review
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  1. the expected echo/Doppler findings associated w/ cocaine use are?
    vasoconstriction, endocarditis, chf, mi, hypertrophic cardiomyopathy, increased hr, arrhythmias, O2-myocardial mismatch.
  2. T/F TTE has a low sensitivity for visualizing obstructive thrombi affecting prosthetic valves?
  3. The echo findings associated w/ hypothyroidism include?
    reduced global left ventricular systolic function
  4. T/F Fibrocalcific degeneration of a prosthetic valve is easy to distinguish from vegetation due to its distinctive appearance?
  5. All of the following are associated w/ anklyloising spondylitis?
    • dilation of ao annulus and sinus of valsalva
    • ao valve thickening
    • AR
    • thickening of aortomitral jct.
    • mv prolapse
    • LV systolic dysfuntion
    • pericarditis/pericardial effusion(rare)
  6. Congenital heart defects associated w/ Ebsteins anomaly include?
    • Atrial septal defect
    • arrhythmias
    • murmurs
  7. a penetrating aortic ulcers are considered to be?
    a type of ao dissection
  8. the combination of lv inflow tract obstruction and lv outflow tract obstruction is called?
    Shone's  complex
  9. A late systolic murmur is associated w/ ?
    pulmonary stenosis
  10. Eisenmenger syndrome is associated w/ what other defects?
  11. The echo/Doppler findings associated w/ pheochromocytoma include?
    • depressed myocontractility
    • arrhythmias
    • increased mass
  12. What are the prime characteristics of TET?
    RVOT hypertrophy, pulmonary stenosis, vsd, overriding ao
  13. Tuberous sclerosis is associated w/
  14. The expected echo findings associated w/ Fabry's disease is
    mitral valve prolapse
  15. The echo/Doppler findings for diabetes is
    dilated cardiomyopathy
  16. A common echo finding with chronic renal failure is
    pericardial effusion
  17. The classic echo finding for Pompe's disease is
    lv hypertrophy
  18. T/F Beri-beri can be a causal factor in high-output heart failure
  19. The most common echo/Doppler finding for scleroderma is
    pericardial effusion
  20. The most common echo/Doppler findings in SLE is
    pericardial effusion
  21. When trying to detect Osler-Weber-Rendu diseas, which can result in atrioventricular fistulas, it is best to use
    agitated saline cntrast
  22. Defects associated with TET in approximately 30% of cases includes
    right aortic arch
  23. What are the expected echo/Doppler findings in Ehler's-Danlos syndrome?
    • Mitral Stenosis
    • MVP
    • arterial rupture
    • Ascending Aortic Aneurysm
    • Raynaud's Phenomenon
  24. The principal echo feature of a LBBB is
    early systolic dip in the interventricular septum
  25. List the echo findings for an atrial septal defect
    • R. sided volume overload/dilation
    • RV/RA enlargement
    • Pulmonary overcirculation
    • PHTN
    • Arrhythmias
    • Paradoxical interventricular septal motion
    • Pulmonary Embolism
  26. The congenital heart defect most often associated with Downs Syndrome  (trisomy 21) is
    atriventricular septal defect
  27. The echo finding associated with hyperthyroidism is
    enhanced global left ventricular systolic function
  28. The classic echo finding associated with Noonan's syndrome is
    dysplastic pulmonary valve

    • other findings include
    • ASD's
    • hypertrophic cardiomyopahty
  29. If the blood supply to the AV node is not from the RCA it would be from the
    CX artery
  30. The Doppler finding associated with a PDA is
    holodiastolic flow reversal in the descending thoracic aorta
  31. The physical finding of cyanosis is most common in which
    PFO or Eisenmengers Syndrome
    Eisenmenger's syndrome

    Though TOF is the most common cause of cyanosis in congenital heart defects.
  32. The echo/Doppler findings associated with Friedrich ataxia include
    • LVH
    • a-fib
    • tachycardia
  33. PDA's result in
    LV volume overload
  34. Characteristics of pannus formation on a prosthetic valve includes
    small dense mass that in 305 of cases can not be distinctly visualized.
  35. The most likely PW Doppler mitral flow pattern in constrictive pericarditis is
    restrictive flow pattern

    pericarditis " heart in a can"
  36. One of the ways a chiari network can be distinguished from TV vegetation's is that
    it has random motion not synchronous with the TV
  37. What is the smallest size of vegetation that can be seen by echo
    3-6 mm

    TEE has advantage over TTE in visualization of small vegetation's.
  38. What is a frequently associated abnormality associated with a malignant cardiac tumor?
    pericardial effusion
  39. the evaluation of a healthy individual, with an normal EKG, who has had a syncopal event should include an echocardiogram, per established medical criteria.
  40. An unattached freely moving thrombus w/in the left atrium is referred to as
    a ball-valve thrombus
  41. The majority of primary cardiac tumors are malignant
    False, the majority of primary cardiac tumors are benign.
  42. After cardioversion the likely hood of _______ _______ may actually increase due to atrial stunning.
    thrombus formation
  43. Which is more common form of pericarditis, chronic or acute?
  44. Atrial Fibrillation can be classed as
    valvular or non-vavlular
  45. Infective endocarditis can arise on
    • endocardium
    • chamber walls
    • vessels
    • w/in congenital defects
    • valve leaflets
    • most occur on valve leaflets on the free edge and on the upstream side of the valve.
  46. The frequency of atrial thrombus formation is
  47. An anterior space noted in the PLAX view is likely to be?
    A fat pad
  48. Compared to tumors, myocardial cysts tend to be
    large, thin-walled and seperated
  49. Hibernating myocardium may demonstrate wall motion abnormalities indefinetly?
  50. In which type of hypertrophic cardiomyopathy would you expect to see SAM of the MV leaflets
    Subaortic septal hypertrophy
  51. Men account for more cases of LVNC than women
  52. Atherosclerosis begins in what layer of the vessel
  53. In diastolic stress testing the end-point of the test is reached when
    The patient feels significant limiting dyspnea
  54. In the normal heart E' is usually > 0.08m/sec.
  55. Amyloid heart disease can be
    primary, secondary, familial, or of "senile'" types
  56. The non-compacted heart muscle presents between
    the 4th and 18th week of gestation.
  57. Right ventricular involvement in CAD may be
    seen in RV dilation
  58. Stunned myocardium is a result of
    a fairly acute ischemic event
  59. A hypertensive response to an exercise stress echo can prevent the development of hyperkinesis in the myocardium
  60. Non-compaction can involve the right ventricle and the ivs
  61. Strain rate is relatively independent of transitional motion and tethering, and is quantitative
  62. Atherosclerosis is the most common disease of the aorta
  63. Generally, the e-f slope of the mitral valve has been considered to provide a reliable assessment of mitral stenosis
  64. Characteristic findings on the M-mode exam of the pulmonic valve in patients with pulmonary stenosis inlcude
    Exaggerated A wave
  65. A loud S2 murmur can be auscultated in a patient with mitral stenosis.
  66. A 2-D echo criterion that can be very helpful in determining mitral regurgitation
    premature closure of the aortic valve
  67. The most common cause for tricuspid stenosis is
    rheumatic heart disease
  68. Disruption of the normal AV cusp coaptation  (causing secondary AI) normally is most affected by
    dilation of the sinotubular junction
  69. Takayasu's arteritis
    can involve the aortic arch, the thoracoabdominal aorta, and/or the pulmonary artery.
  70. The M-mode criterion that defines mitral stenosis the least is
    an increased A-C interval
  71. one of the effects of aortic stenosis is an increased propensity for AV endocarditis
  72. TV flow velocity measures 1.5 m/sec corresponds to
    TV stenosis
  73. The biggest difference between the two basic variants of aortic dissection is
    • the originating mechanism by which the dissection starts-
    • luminal tear vs a intramural hematoma
  74. When obtaining a continuous wave Doppler aortic valve profile from the apex through a  heavily calcified aortic valve you may
    underestimate the velocity
  75. The higher the diastolic blood pressure of a patient, the more severe the degree of aortic insufficiency
  76. Long standing MS leads to
    Congestive heart failure
  77. Complex aortic atheroma (atherosclerosis)
    means there are pedunculated or mobile components.
  78. What is the primary finding in Marfans disease
    causes extensive dilation of the AV annulus
  79. Changes in E are affected by
    Delayed myocardial relaxation
  80. Furosemide is a common drug used to treat or control
    Congestive heart failure
  81. The most anterior chamber of the heart is the
    Right Ventricle
  82. A quantitative ejection fraction has been ordered for an obese patient with poor endocardial border definition. what is the most likely way to improve the endocardial definition?
    Position the patient in a steep lateral decubitus position.
  83. In terms of overall stages of heart dysfunction, which occurs last
    Ventricular dilation
  84. Which abnormal arrhythmia would have the greatest effect on LV filling
    Atrial fibrillation
  85. When using a large sample volume in performing a Doppler examination, the operator minimizes chances of missing jets
  86. A subject has a cardiac output of 5L/min at a heart rate of 75b/min. If stroke volume remains constant, what would be the effect of an increase in heart rate to 150b/min.
    Co would increase to 10l/min
  87. The diaphragmatic surface of the heart is formed largely by
    Left ventricul
  88. there are normally how many papillary muscles in the RV
  89. Electrical depolarization spreads from
    endocardium to the myocardium to the epicardium
  90. LA volume indexed is measured in two orthogonal planes at
  91. Ventricular contract begins at the ?
    Apex of the heart
  92. the more important hemodynamic measurement in evaluating the degree of mitral stenosis is?
    Mean transvalvular gradient
  93. Peak mitral valve regurgitation velocity tells the examiner
    maximum instantaneous pressure difference between  the LV and the LA
  94. On 2-D echo the motion of the congenitally stenotic ao valve can be generally described as
  95. T/F On M-mode, mitral stenosis is often characterized by anterior motion of the posterior leaflet
  96. What is the normal valve area of the aortic valve?
    > 2cm2
  97. What is the normal area of a tricuspid valve?
  98. What is the normal valve area of the mitral valve?
  99. T/F The aortic annulus is relatively resistant to dilatation?
  100. T/F Kawasaki's disease may result in aortic arch aneurysm?
  101. Acquired ms could be from?
    inflammatory disease
  102. T/F In MS the area of fiberous continuity between the AMVL and the aortic root is frequently involved.
  103. T/F Left Sinus of Valsalve anuerysm's are fairly common?
  104. For patients with Afib and AS, peak systolic aortic velocity will be?
    Higher following long R-R intervals
  105. T/F Rheumatic heart disease is a form of congenital valvular disease?
  106. Secondary AO dilation can be a result of?
    Volume or pressure overload.
  107. T/F Proximal Aortic dilation is uncommon, and involves the sinuses, sinotubular jct., and ascending aortic segments?
    False, Proximal Aortic dilation is common and does involve the sinuses, sinotubular jct., and the ascending aortic segments.
  108. An aortic arteritis associated with marked intimal proliferation and fibrous scarring is
    takayasus disease
  109. The most common reason for congestive heart failure is
    reduced global systolic function due to coronary artery disease
  110. T/F In the presence of an ASD one would expect to find paradoxical interventricular septal motion.
    True, with RV and RA enlargment
  111. The echocardiographic/Doppler findings for cor pulmonale are very similar to
    pulmonary hypertension
  112. T/F Bacteria tends to settle on the downstream side of the valve
    False, Bacteria tends to settle on the upstream side of the valve
  113. The most common primary malignant intracardiac tumor in adults is
  114. What are the sizing categories in a pericardial effusion?
    • small < 1.0 cm
    • moderate 1-2 cm
    • large >2 cm
  115. What is the most common primary benign cardiac tumor
  116. what is the most common primary benign valvular tumor
    papillary fibroelastoma
  117. what is the most common benign tumor found in children
  118. what is the second most common benign tumor found in children
  119. In using PW Doppler  to assess the MV inflow in the evaluation for constrictive pericarditis, you would expect to see
    MV inflow with a significant decrease  with inspiration.
  120. PW Doppler evidence of cardiac tamponade include
    inspiratory decrease in peak velocity across the mitral valve and an increase in peak velocity across the tricuspid valve
  121. In older adults papillary fibroelastomas are found most frequently found on
    the AV and MV valves
  122. T/F In pericardial construction the LV is significantly larger
  123. The most common malignant tumor that metastasizes to the heart is
  124. The pulse associated with cardiac tamponade is
    pulsus paradoxus
  125. Clinical symptoms and echo findings that you might see with metastatic tumors in the heart are
    pericardial effusion, wall thickening or protrusion into the cardiac chamber, cardiac chamber enlargement, tachycardia, heart failure, arrhythmias
  126. T/F MV vegetations tend to be larger than those found on the TV or AV
  127. TDI of the MV annulus would show a significantly increased E' in
    constrictive pericarditis
  128. In constrictive pericarditis the main result is
    impairment of diastolic filling
  129. With a large pericardial effusion, inspiration causes
    exaggerated phasic changes in the R and L ventricular stroke volumes
  130. In the setting of carcinoid tricuspid valve, the TI gradient would be
    lower than you would expect with the severe TI that results
  131. The first sign of endocarditis may be
  132. T/F M-mode is the echo mode most accurately quantify the amount of pericardial fluid in a pericardial effusion
  133. Myxomas are more frequently found on
    women between the age of 40-60
  134. The most common presenting symptom of acute pericarditis is
  135. In an EKG tracing Lead 1 interrogates which heart surface?
  136. In an EKG tracing Lead 2 & 3 interrogates which heart surface?
  137. In an EKG tracing the avR (augmented voltage Right) interrogates which surface?
  138. In an EKG tracing the avL lead interrogates which surface?
  139. In an EKG tracing the avF lead interrogates which surface?
  140. In an EKG tracing leads V1 and V2 interrogate which surface?
  141. In an EKG tracing leads V3 and V4 interrogate which surface?
  142. In an EKG tracing leads V5 and V6 interrogate which surface?
  143. How does constrictive pericarditis effect the LA and the IVC?
    The LA may or may not be dilated, while the IVC will be dilated.
  144. T/F Left atrial appendage emptying velocities are always reduced in patients with atrial fibrillation?
  145. In the presence of diastolic dysfunction  CF Doppler velpcity propegation flow will have a reduced angle of propagation.
  146. T/F Vegetations are usually seen on echo when they at least 2-3 mm in size?
    False, TTE is only able to evaluate 3-6 mm sized vegetations.
  147. MR in the setting of HOCM may be from a cause independent of the obstructive gradient if
    it remains a central jet
  148. In restrictive and infiltrative cm's the atria are
    enlarged (bi-atrial enlargement)
  149. T/F Speckle tracking is angle dependent?
  150. Sarcoidosis affects patients generally who are
    young adults, 70% are < 40 years old
  151. T/F Patients with hypertrophic cardiomyopathy may be asymptomatic
  152. T/F An MPI of > 0.4 is an indicator of an adverse prognosis in cardiomyopathy.
  153. T/F you can apical thrombus formation in hypereosinophilic syndrome
  154. T/F In an athletes heart, LV posterior (inferolateral) wall thickness may be mildly increased (up to 13 mm in thickness)
  155. What percentage of symptomatic Chaga's patients have a LV apical aneurysm?
    about 50-55%
  156. T/F In dilated CM, an aneurysmal wall segment may indicate an ischemic etiology?
  157. T/F The most common arrhythmia seen in LVNC is atrial fibrillation
  158. T/F hemochromatosis is commonly seen in restrictive cm
  159. Hemochromatosis is defined as
    Iron deposits within the myocardial cells
  160. Echo findings associated w/ hemochromatosis are
    • Increased LV wall thickness
    • diastolic dysfunction
    • restrictive CM
    • mild MR
  161. cardiac manifestations of Sarcoidosis are
    • sudden cardiac death
    • arrhythmias
    • conduction abnormalities
    • LV dysfunction/CHF
  162. Echo features associated with sarcoidosis are
    • Dilated CM
    • Regional WMA's
    • Diastolic dysfunction
    • papillary muscle dysfunction
  163. T/F Rheumatic Arthritis is the most common connective tissue disease
  164. T/F Rheumatic Arthritis affects men more than women
    False women (2-4:1)
  165. Cardiac manifestations of Rheumatic Arthritis are
    • Global LV dysfunction (myocarditis)
    • Diastolic dysfunction (impaired relaxation)
    • Valve thickening and regurgitation (valvulitis)
    • AR (aortic aneurysm/secondary phtn-RARE)
  166. T/F SLE  is more common in men than women
    • False, more prevalent in women (5-1:1)
    •           Blacks (3:1)
  167. Cardiovascular effects due to SLE include
    • Valvular involvement (thickening/ & w/o fibrosis)
    • Pericarditis (in 50% of cases)
    • Pericardial Effusion
    • PHTN
  168. SLE affects the
    Musculoskeletal and mucocutaneous systems.
  169. valvular findings associated with SLA include
    Thickening of the MV and AV leaflets
  170. Libman-Sacks disease is associated with which autoimmune disease.
  171. Echo findings associated with Antiphospholipid syndrome
    • RWMA second-degree MI
    • DCM
    • Valvular reguritation
    • PHTN
  172. Antiphospholipid syndrome may mimic which autoimmune disease?
  173. Scleroderma is what type of disease
    Connective tissue disease
  174. T/F Scleroderma affects women more than men
    True, (3:1)
  175. Scleroderma affects women between the ages of
    30-50 years old
  176. Echo features associated with Scleroderma are
    • Pericardial Effusion
    • PHTN
    • LVH w/ HTN
    • LV dysfunction
    • DCM or RCM
  177. Anklylosing spondylitis affect
    Men more than women (3:1)
  178. Cardiac Manifestations associated with Ankylosing Spondylitis are
    • Conduction abnormalities
    • Wolf-Parkinson-White Syndrome
  179. Echo features of Anklyosing Spondylitis are
    • Dilation of the ao annulus and sinus of valsalva
    • AV leaflet thickening
    • AR
    • Thickening of the aortomitral jct., (subaortic bump)
    • MVP
    • LV systolic dysfunction
  180. T/F Pericarditis is common in Reiters syndrome
  181. T/F MVP is common in patients with Psoriatic arthritis.
  182. The most common cause of death in Marfan patients is
    Aortic dissection
  183. Echo findings associated with Marfans Syndrome include
    • AO root dilation (annulus/sinus of valsalva)
    • Dilated Asc. AO
    • Aortic dissection
    • MVP
    • MR
    • Dilated/calcified mitral annulus
  184. T/F Giant Cell Arteritis affects individuals over 50 years old.
  185. Giant Cell Arteritis affects
    large and medium-sized arteries
  186. Echo findings associated with Giant Cell Arteritis include
    • Dilatation/thickening of AV and cusps
    • Pericardial Effusion
    • Aortic aneurysm/dissection
  187. T/F Takayasu Arteritis affects women < 40 years old.
  188. Echo findings associated with Takayasu arteritis are
    • Dilation of the Aorta
    • AR
    • Stenosis/occlusion of large vessels
  189. T/F Kawasaki's disease is an acute systemic vasculitis
  190. Kawasakis disease may result in
    • Coronary artery aneurysms
    • MI
    • Thrombosis
    • Stenosis
    • Pericardial Effusion
  191. T/F Hyperesinophilic Syndrome (Loefflers) results in obliteration of the LV and RV apical regions
  192. T/F Echo findings of hyperesinophilic syndrome include RCM, DCM, MR
  193. What effect does hyperesinophilic syndrome have on the mitral valve
    It may thicken or obliterate  the inferolateral inflow tract, (entraps or plasters down the posterior leaflet)
  194. The echo findings of syphilitic arteritis are
    • Dilated AO root/aneurysm
    • AR
    • Aortic dissection
    • Aortopulmonary fistula
  195. Using the Duke criteria what findings must be present to confirm definite endocarditis?
    2 major, OR, 1 major & 3 minors or five minors
  196. Using the Duke criteria was findings must be present to suspect endocarditis?
    one major plus one minor or 3 minor criteria
  197. T/F Myxomas are more coomon in men than women.
    False, found more often on the downstream side of the valve
  199. What is the second most common primary benign tumor found in children?
  200. Sarcomas affect women more than men
    False, more common in men than women.
  201. Rhabdosarcomas are the second most common primary malignant tumor, they occur most frequently in patients under _____ year olds.
    Twenty year olds.
  202. Metastatic tumors occur ______ times more than primary malignant tumors
  203. With inspiration what is the physiological change in the cardiac cycle?
    With inspiration interthorasic pressures increase and lower extremity venous flow decreases or stops, upper venous flow increases, with expiration lower venous flow increases and upper venous flow increases.
  204. List the normal inspirational flow changes
    Normal flow changes 15% or more in the MV, 25% or more in the TV, 10% in the LVOT &RVOT
  205. In the presence of pe what is the series of collapse
    RA In systole, rvot, rv in diastole
  206. List 5 Mmode 2D findings in the presence of contrictive pericarditis
    • Normal size/contractility of lv
    • posterior wall flattening
    • "septal bounce"
    • dilated ivc/hepatic veins
  207. Name the 4 manufactures of the single tilting disc valves
    Bjork-shiley, meditronic-hall, lillehei-kastor, omnicarbon
  208. Name the 3 manufactors of bileaflet tilting disc prosthetics
    St Jude medical, Carbomedics, Duramedic jyros
  209. Name 2 manufactures of bioprothetic valves
    Hancock, Carpentier-Edwards
  210. T/ F Fibric calcification may resemble endondocarditis in prosthetic valves, and may be impossible to distinguish between a vegetation
  211. What type of valve is most commonly used in the TV position.
  212. Name 2 vasodiolaters used in stress echos
    Dipyridamole, Adenosine
  213. List 3 ejection phase indexes
    • Simpsons bi-plane
    • fractional shortening
    • Velocity of shortening
    • CO &SV
  214. List 3 non-direct ejection indexes
    • dp/dt
    • Systolic time intervals
    • Acceleration time of AV flow
  215. List 3 indirect methods in evaluation of systolic function
    • EPSS
    • Aotic root motion (nl >14mm)
    • Shape of mmode tracing of ao valve
  216. List 5 symptoms of DCM
    CHF, low output state, dyspnea, fatigue, arrhytmias, sudden cardiac death
  217. Name 5 diagnostic features of DCM
    • increased LVEDP,
    • decressed LV systolic/diastolic features
    • MR
    • PHTN
    • LV enlargement
  218. T/F DCM affects women more than men
    False, men and in any age group
  219. List 3 key predictors of poor prognosis in DCM
    • end-diastolic volume > 75 ml/m2
    • end-systolic volume > 55ml/m2
    • EF% < 40%
  220. Name 3 primary symptoms in hypertrophic cm
    Dyspnea on excertion, syncope, angina, cp
  221. Presenting symptoms in RCM
    Dyspnea, R. Heart failure, Cardiomegaly
  222. T/F In RCM, in the early stages (diastolic evaluation) the MV E/A will show a delayed relaxation.
  223. T/F In later stages of RCM, the E/A ratio is > 2, with a shortened deceleration time.
  224. T/F In patients with RCM one may observe a E wave respiratory varience of < 25%.
    True, in restrictive CM there is minimal respiratory E wave variation.
  225. What is the normal ESV for men and women?
    • ESV FOR MEN 34ml (18ml/m2)
    • ESV FOR WOMEN 29ML (18ml/m2)
  226. What is the normal EDV for men and women?
    • EDV men 111ml (58 ml/m2)
    • EDV women 80 ml (50ml/m2)
  227. T/FAortic dissection oc curs in women more than men.
  228. The "B," bump on an m-mode tracing of the mitral valve is indicitive of what
    Increase LVEDP.
  229. What is the normal velocity ration between the LVOTvti and the AOvti
    • Normal near 1, little or no obstruction
    • a ratio of 0.5 = area 1/2 the normal
    • a ratio of0.25 = area 1/4 of normal
  230. What is the equation for LVEDP in the presence of AI
    LVEDP=Diastolic BP-4v2 (AI jet)
  231. What are the 2D echo findings in the presence of AI
    • LV volume overload
    • LV contractility (hypo/hyper, dependent on chronic acute state)
    • LA dilation
    • LV remodeling
  232. List the m-mode findings in ai
    • increased EPSS
    • Decreased MV excursion
    • fluttering of the AMVL
  233. A PW Doppler finding in the presence of severe AI is
    holodiastolic reversal in the desc. thoracic AO
  234. What are the ranges in AI using PHT
    • mild >400m/sec
    • moderate 200-400m/sec
    • severe <200m/sec

    the steeper the PHT slope the more severe the AI
  235. What is the equation for regurgitant volume
    • RV= Total SV-Forward SV
    • Total SV= antegrade flow through the leaking valve
    • Forward SV=flow through other non-leaking valve
  236. What is the equation for Regurgitant fraction
    (Regurgitant volume/Total SV) X 100
  237. List the 3 primary appropriatness criteria for an echo evaluation?
    • Initial evaluation of known or suspected AS
    • Routine annual evaluation of symptomatic severe AS
    • Reevaluation if there is a change in clinical status
  238. With 2D or M-mode evaluation of AO cusp separation what does a separation of <11mm indicate
    AVA of < 0.75cm2
  239. What are the velocities across a stenotic AO valve
    • Sclerotic </= 2.5 m/sec
    • Mild 2.6-3.0 m/sec
    • Moderate 3.1-4.0m/s
    • Severe < 4.0m/s
  240. List the valve areas for a stenotic AO valve
    • Nl >2.0cm2
    • Mild 1.5-2.0 cm2
    • Moderate 1.0-1.5cm2
    • Severe <1.0cm2
  241. List the meanpressure gradients for MS
    • mild <5mmHg
    • moderate 5-10mmHg
    • severe >10mmHg
  242. List the mean pressure gradients for AS
    • mild < 20mmHg
    • moderate 20-40mmHg
    • severe >40mmHg
  243. List the MVA for MS
    • Mild >1.5cm2
    • Moderate 1-1.5cm2
    • Severe <1.0cm2
  244. List the EROA for MR
    • Mild <0.20cm2
    • Moderate 0.20-0.29cm2
    • Moderate/Severe 0.30-0.39cm2
    • Severe >0.40cm2
  245. What is approximate size of contrast bubbles
  246. Of the two which format is a unitless measurement Strain Rate or Strain
  247. What is the unit of measure in Strain Rate
    -s or /s
  248. Is strain angle dependent
  249. This rare abnormality of the sinus of valsalva appears as a cystic space between the LA and the AO
    Fibrosa of aneurysm
  250. Arrhythmogenic RV dysplasia is a progressive genetic disease that results in
    Replacement of the muscle of the RV with fat and fibrosis
  251. This progressive genetic disease is a leading cause of deaths in young athletes?
  252. The echo findings related to ARVD include
    • RVOT/RVIT dimensions
    • (RVOT >30mm)
    • Most common finding RVOT enlargement and trabecular disarray.
  253. T/F there are 2 forms of hemochromatosis
    • T 1st degree is a in appropriate absorption of iron by the body
    • 2nd degree is due to blood transfusion, iron therapy, hemolytic anemias
  254. Libman-Sacks vegetations are found in what autoimmune disease and where are they most frequently found
    SLE, upstream side of the MV or either side of the AO
  255. Name three disease states that share dialtion of the AO as a common finding
    • Sypholitic Arteritis
    • Giant Cell Arteritis
    • Takayasu's Arteritis
  256. What is the equation for Fraction Shortening
  257. What is the normal dimension for EPSS
    approx 6mm, >8mm = EF% of 50%
  258. What is the normal ao root motion range
  259. What is the leading reason for hopitalization of patient s> 65 years old
  260. List the 4 NYHA classifications of CHF
    • I. Asymmptomatic
    • II. Symptomatic w/ moderate excertion
    • III. Symptomatic w/ mild excertion
    • IV. Symptomatic at rest
  261. Define CHF
    The hearts inability to meet the metabolic demands of the body
  262. What is the backward heart failure theory
    LV/RV sys.fxn decreases, LV volume increases, LV pressure increases, LAP increases, LA contraction increases, pressures upstream of the LA increase reulting in leakage of fluid into the interstiatial spaces
  263. What is the Forward heart failure theory
    Co is decreased resulting in decreased perfusion of orgons, resulting in reduced renal func., results in an increase in extra-cellular fluid, leads to organ tissue congestion, leading to HF
  264. What are the symptoms of low-cardiac output failure
    • Pale
    • Cold,
    • Cyanotic extremities
    • NARROW pulse pressure
  265. What are the symptoms of high output heart failure
    • Warm Flushed extremities
    • Normal or Wide pulse pressure
  266. What is the equation for mean arterial pressure
    MAP=(2(DBP)+ SBP)/3
  267. List 4 conditions that could result in high output heart failure
    Beri-Beri, Anemia, Paget's disease, Pregnancy
  268. What is the definition of cardiomyopathy
    • A primary disease of the myocardium,
    • does not include HTN, CAD, MI
  269. T/F is chronic ischemia considered a form of CM
    True, ischemic cardiomyopathy
  270. Name the 3 forms of cardiomyopathy
    • Dilated
    • Hypertrophic
    • Restrictive (infiltrative)
  271. What is the leading cause of DCM in the western hemisphere
  272. List the forms of HCM
    • hypertrophic
    • hypertrophic obstructive cm
    • asymmetrical septal hcm (ASH)
    • concencetric hcm
    • isolated apical hcm
    • atypical hcm
    • asymmetrical apical hypertrophy (AAH)
  273. What is the wall thickness that deterrmines HCM
  274. In what race of people is asymmetrical apical hypertrophy more common in
  275. What are the echo findings associated with HCM
    • SAM (obstructive)
    • Hyoerdynamic LV
    • MV apparatus displacement
    • Atrial dilation
  276. List 3 look alikes of HCM
    • Hypertensive HCM (long standing HTN, hyperdynamic LV w/SAM, LVOT obstruction)
    • Hypovolemia
    • End stage HCM(no HTN, SAM or LVOT obstruction)
  277. In the presence of LVOT obstruction (due to SAM or other cavitary obstruction) what would be observed in an M-mode tracing of the AO
    A early closure of the AO valve
  278. T/F In RCM th E' is increased and is greater than 10cm/sec
    False, in RCM the E' is reduced usually <10cm/sec
  279. Amyloidosis is an infiltrative CM, as a result the LV wall is usually thickened at what point does the wall dimemsions indicate a poor prognosis
    >/= 15mm =0.4 years of survival
  280. In what infiltrative CM would you observe a highly echoic IVS.
    Fabry's disease
  281. What % of LV filling occurs in the early rapid phase
    upto 70%
  282. What is diastasis
    a period of minimal flow between the LA and the LV in diastole
  283. In the late diastolic filling phase (atrial kick) how much filling occurs
    • approx. 25% in older people
    • less than 20% in younger people
  284. List the phases of diastole
    • IVRT
    • Early Rapid filling
    • Diastasis.Late diastolic filling (atrial kick)
  285. In regards to a normal cardiac cycle how much of it does diastole consume
  286. T/F Relaxation is a passive process
    F no it uses energy
  287. LVEDP is reflection of what
    the pressure w/in the ventricle at end-diastole
  288. LAP is a reflecytion of what
    The average pressure w/in the LA during diastole
  289. What ia a normal Qp/Qs ratio
  290. What is a normal E/A ratio
  291. As we age the LV complianc eis reduced this results in a switch in the E/A ratio at what age is this "normally"accomplished
    60 years
  292. Name the stages of diatolic dysfunction
    • Normal
    • G.1 Imparied relaxation
    • G.2 Pseudonormal
    • G.3 Restricted reversible
    • G.3 Restricted Fixed
  293. What is a normal E/E' ratio
    E/E' <8
  294. What E/E' ratio is impaired relaxation indicated
    E/E' >15
  295. A E'<0.08m/sec is normal
    False, E'<0.08m/sec indicates LV dysfunction
  296. What is the equation for MPI?
  297. What is the normal decel time of the E wave
  298. T/F In constrictive pericarditis the diastolic filling is impaired
    False, the diastolic filling is rapid and abrupt, "Heart in a Can"
  299. T/F in patients with Constrictive pericarditis one would expect to see an effusion
    False, usually there is no effusion in pericarditis
  300. T/F Congenital Absence of the pericardiom is more common in women than men
    False, Men more than women
  301. T/F Total absence of the pericardium is more dangerous than partial
    False, partial is more dangerous due to possibility of herniation
  302. What are the minimum BP's one would expect to see in systemic HTN
    • Systolic > 140mmHg
    • Diastolic  > 80mmHg
  303. There are two types of HTN, primary and secondary, in which type can one potentially identify the cause
    • Secondary, the etiology can be id'd
    • Primary the etiology is not known
  304. Which form of HTN is more common
    Priamry 90-95% of cases
  305. Priamry HTN develops due to
    reduction of the diameter of the vessels, increased blood flow
  306. Secondary HTN is related to
    ASD, VSD, PDA's
  307. Systemic HTN can result in
    MR, MS, LV systolic and diastolic dysfunction
  308. What echo/doppler findings are associated with pulmonary HTN
    • RVH
    • RV dilatation
    • D-shaped LV
    • Dilated IVC/Hepatic vein (w/o collapse)
    • PA dilation (1.5-2.1cm is normal)
    • Deviation of the IAS
    • Mid-systolic notching of the RVOT
  309. What are the levels of PHTN pressures
    • mild 30-40mmHg
    • Moderate 40-70mmHg
    • Severe >70mmHg
  310. What are the echo findings related to Cor pulmonale
    • RVH
    • Paradoxical septal motion
    • RV enlargement
    • Decreased Systolic fxn 
  311. Define Eismengers syndrome
    Reversal of a L>R shunt due to severe PHTN (>120mmHg)
  312. T/F Dressler's Syndrome is a form of CM
    False, it is a form of Post MI, pericardial disease
  313. T/F Pericardial disease can be due to viral, fungal, and bacterial infection.
  314. What is considered as a normal amount of pericardial fluid
  315. What two terms are used to explain the extent of the heart that is involved in a PE
    • Localized/Loculated
    • Circumferential
  316. What is the most common form of TAPVC
  317. List the three forms of TAPVC
    • Supracardiac (PV connects to a vein above the RA)
    • Cardiac (PV's connect to a common vein to RA)
    • Infracardiac(Pv's connect to a vein that descends below tha diaphraghm)
  318. For a pt. to survive TAPVC what must they have
    A PFO or ASD
  319. In PAPVC what is the most common form
    PAPVC (RUPV to SVC to RA)
  320. What must be present to form a PAPVC
    At least one connection to the LA
  321. What is scimitiar syndrome
    anomalous PV connected to IVC
  322. What is the most common PAPVC
    single PV from Lung to LA (Left more common)
  323. What does the ligament of Marshall develop from
    It along with the Left intercostal vain develop from the remanents of the L inominate vein
  324. What is the most common systemic venous anomaly
    Persistent L. SVC
  325. T/F a PLSVC to the LA is common
  326. If the pt. had a PLSV connection to the LA what symptom would you observe
  327. If there is a PLSVC what effect does this have on the coronary sinus
    It will be dilated
  328. What is the most common ASD, the 2nd most common
    • Ostia Secundum is the most common
    • Ostia PRimum is the second most common
  329. List all the ASD's
    • Primum
    • Secundum
    • Coronary Sinus Defect
    • Sinus Venosus Defect
  330. When does the atrial septum begin to develop
    the 28th day, inutero
  331. T/F a chamber ratio of >/=1.5 is a poor prognosis in the presence of Ebsteins anomaly 
  332. What is the formula for chamber ratio
  333. T/F PDA's occur in girls more than boys
    False, Girls > boys
  334. What is the most common LVOT obstruction, valvular, subvalvualr or supravalvular
  335. In BAV wha is the most common commisural fusion
    R to L
  336. What is the most common congenital cause of AS and AI
  337. What is the most common casue of infant mortality
  338. T/F Coarctation of the Aorta occurs in girls more than boys
    False, Boys >girls
  339. What is the most common cyanotic defect in newborns
  340. What is the most common hempdynamic factor in TOF
    The severity of the RVOT obstruction
  341. Which type of Truncus arteriosus is the most common
    Type I, Trunk to MPA to branches
  342. In truncus arteriosus what is the most common arrangement of the coronary arteries
    LCA from the RCA
  343. What is the second most commn cyanotic defect in newborns
  344. Which type of aortopulmonary window is the most common
    Type I, small prox window, between the smilunar valves and the PA bifurcation
  345. What is the most common acquired heart disease world wide
    Acqiured rheumatic heart disease
  346. What is a normal dimensionless index, what is the formula for the Dimensionless index
    • <1
  347. The non-compacted fetal heart muscle
    allows for oxygenation and nutrition of the cells by diffusion of blood in the spongy-like heart muscle.
  348. Peak systolic strain
    Varies with preload
  349. Peak strain rate is insensitive to changes in
    ventricular loading conditions.
  350. T/F Endocarditis occurs in women more than men.
    False, Men > women
  351. T/F Aortic dissections occur in men more than women.
    True , 2X more likely in men.
  352. T/F Rheumatoid Arthritis occurs in women more than men.
  353. T/F Ankylosing Spondolitis occurs more often in men than women.
  354. T/F Sarcoidosis occurs in men more than women.
  355. Papillary Fibroelastomas occur most frequently in people ____ old or older.
  356. What form of malignant tumors is most commonly found in adults
  357. T/F Sarcomas occur more in women than men.
    False, Men more than women
  358. Name the two most common forms of sarcomas.
    Angiosarcomas, Rhabdosarcomas
  359. Rhabdosarcomas occur in individuals that are ________ or younger.
    20 years old and younger
  360. What is the most common benign pericardial tumor, and what ages do they affect the most
    Pericardial Cysts, 30-40 year olds
  361. What is the most common CHD to be found in the 1st 3 decades of life
  362. T/F VSD's occur in men more than women.
  363. T/F Subarterial occur in Asians more than any other race of people.
  364. Inlet VSD's are associated with what other pathophysiologies.
    Overriding +/or straddling
  365. What chamber area ratio in the presence of Ebsteins anomaly is indicative of a poor prognosis/
    >/= 1, is a poor chamber ratio
  366. What is the difference between Classic MVP and Non-classic MVP
    In classic and non-classic MVP the excursion is > 2mm, while the valve thickness is > 5mm in classic MVP and <5mm in non-classic
  367. Name the four types of endocardial cushion defects
    • Complete
    • Partial
    • Transitional
    • Intermediate
  368. What are the characteristics of the four AVSD's
    • Complete, single orifice w/ both VSD and ASD
    • Partial, No VSD, but has a ASD primum
    • Transitional, ASD w/small inlet vsd, 2 separate orifices.
    • Intermediate, has a small tongue of tissue dividing the orifice w/ a VSD and a ASD.
  369. Which of the two, transitional or intermediate is considered a complete AVSD and a partial AVSD
    A Intermediate is considered a complete AVSD while a transitional is considered a partial AVSD.
  370. List the three Rastelli classes for a complete AVSD
    • Rastelli A, multiple chordae and paps
    • Rastelli B, Chordal attachment to the septal wall of the RV, (RARE)
    • Rastelli C, chordal attachment to the RV freewall
  371. What is the most common site for PS
    At the valvlar level
  372. What are the key differences in Pulmonary atresia Type I and Type II
    • Type I, is RV hyploplastic w/ RV to Coronary fistulas (RV Coronary dependent circulation)
    • Type II, Severe PS with RV dilation (severe TI, RA and IVC/SVC dilation.
  373. In pulmonary atresia what must the patient have
    A PDA, for pulmonary flow
  374. Are PDA's more common in girls than boys
    yes, 2X more common
  375. What is ductal dependence
    When survival of the infant is dependent on maintaining an open PDA
  376. Are males or females mostly affected by HLHS
  377. What CHD is the leading cause of infant mortality
  378. T/F Coarctation of the AO is more common in females than males
    false, Males
  379. In what % of cases of coarctation is there a case of BAV
  380. Of the three types of interrupted AO arch which one is more common
    Type B, LCA and LSCA
  381. Of the four types of Truncus Arteriosus which is the most common
    Type I, the MPA arises from the truncal root and then bifircates into the R & L pulmonary arteries.
  382. In truncus arteriosus what is the most common coronary arrangement
    LCA from the RCA
  383. What are the two main CHD that result in cyanosis?
    • TOF 1st
    • TGA 2nd