Review for exam 4 echo core

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lollybebe
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311720
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Review for exam 4 echo core
Updated:
2015-11-19 14:14:34
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echocardiography
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echocardiography
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  1. What causes volume overload in the heart?
    regurgitation
  2. What causes pressure overload in the heart?
    stenosis/stenotic valves
  3. When figuring equations...

    asks for a max gradient, what would be used?
    Bernoulli equation only

    4v2
  4. When does the TV close?
    .06 secs after the MV
  5. What are the ranges of pulmonary hypertension?
    • Normal:     18-25 mmHg
    • Mild:          30-40 mmHg
    • Mod:          40-70 mmHg
    • Severe:       >70mmHg
  6. What formula is used for mean PA pressure?
    80 - (acceleration of PV flow/2)

    OR

    4(v)2 with the velocity of the beginning diastolic PI velocity
  7. What formula is used for the Diastolic PA pressure?
    4(v)2  +  IVC pressure (mmHg)

    Use the velocity of the end diastolic PI velocity
  8. What pathology is associated with Wide Open TR? (2 but one main)
    #1 Ebstein's Anomaly

    2) Carcinoid Syndrome
  9. What pathology is associated with Wolf Parkinson White?
    Ebstein's Anomaly
  10. What pathology is associated with tumors that produce vasoactive substance that will cause damage to the tissues of the heart including the leaflets of the TV and possibly the PV?
    Carcinoid Syndrome
  11. Two important times of the development of the fetal heart are?
    23 days forms a single tube

    43 days forms a complete heart
  12. Order of the heart tube from cranial end to caudal end.
    • 1. Truncus Arteriosus
    • 2. Bulbus cordis or conus cordis
    • 3. the common ventricle or primitive ventricle
    • 4. the common atrium or primitive atrium
    • 5. sinus venosus
  13. What are the two types of looping?
    • d-looping/ dextro- normal
    • l-looping/ levo - abnormal
  14. d looping is looping what direction?
    to the right
  15. l looping is looping what direction?
    to the left
  16. How many sets of aortic arches are there to begin with?
    six sets
  17. What is left of the aortic arches after cardiogenesis?
    • 1. ao arch
    • 2. ductus arteriosus
    • 3. rt and lt pulmonary arteries
    • 4. MPA
    • 5. descending AO
  18. What can cause congenital heart diseases? (5)
    • 1. environmental factors
    • 2. maternal ingestion of toxic substances
    • 3. viral exposures
    • 4. single gene defects
    • 5. unknown
  19. What is the distribution of oxygenated blood from the aorta? (4)
    1. 9%- coronary arteries

    2. 62% carotid and upper body

    3. 29% descending Ao

    4. 12% lungs
  20. What is the oxygen saturation of the placenta?
    80%
  21. What chamber is considered to be the pumping chamber or the work horse in the fetal heart?
    the right ventricle
  22. What is the distribution of flow from the RV?
    88% of RV output goes to the MPA to descending Ao

    12% of RV output goes to pulmonary arteries into the lungs
  23. What are two pathologies that physicians what to keep the ductus arteriosus open?
    1.) preductal coarctation

    2.) hypoplastic right heart
  24. What happens once the baby is born?
    • 1. low resistance placenta flow removed (cord clamped)
    • 2. increases the systemic vascular resistance
    • 3. decreases the pulmonary vascular resistance
    • 4. Bradykinin and prostaglandins levels drop
    • 5. causes the ductus arteriosus to constrict
  25. bradykinin is a ...
    peptide
  26. prostaglandins is a ...
    lipid/fatty acid
  27. TR murmur
    holosystolic, high pitched blowing
  28. physiology of TR (7)
    • 1. RA enlargement
    • 2. RV enlargement
    • 3. IVC enlargement and dilation of vessels of IVC
    • 4. atrial fibrillation
    • 5. may have reversal of flow in hepatic v.
    • 6. thickening leaflets
    • 7. leg and abdominal swelling, liver enlargement and portal HTN
  29. TR is caused by a different pathology, what is it?
    RVVO
  30. What are some common causes of RVVO?
    • 1. Aortic and mitral valve diseases
    • 2. pulmonary hypertension
    • 3. RV infarction of the RCA
    • 4. PI (mod to severe)
    • 5. pacemaker wires
    • 6. heart transplant
  31. What are some less common causes of RVVO?
    • 1. congenital ebsteins anomaly
    • 2. rheumatic heart disease
    • 3. carcinoid syndrome
    • 4. trauma
    • 5. tumors
    • 6. endocarditis
    • 7. chordal rupture
    • 8. TV prolapse
  32. What is considered to be pulmonary hypertension?

    Why?
    > 30 mmHg in RV

    normal RV pressure is 25/10
  33. What are 3 causes of pulmonary hypertension?
    1. MV disease

    2. congenital lesions

    3. cor pulmonale or right heart failure
  34. What is Ebstein's Anomaly?
    the ventricle becomes atrialized because valves attached in wrong spot
  35. Physiology of Carcinoid syndrome (6)
    • 1. foreshortened chordae
    • 2. retracted leaflets
    • 3. thickened tricuspid valve leaflets that are retracted.
    • 4. dilation of RV
    • 5. right heart failure
    • 6. wide open TR and PI
  36. What are some cardiac signs of carcinoid syndrome? (2)
    elevated venous pressure

    and

    systolic and diastole murmurs (TR and PI)
  37. What are 4 clinical signs of carcinoid syndrome?
    1. episodes of facial flushing

    2. abdominal pain

    3. diarrhea

    4. renal and hepatic failure
  38. What is the cardiac treatment of carcinoid syndrome?
    valve replacement
  39. Murmur of TS
    opening snap, diastolic rumble
  40. 5 physiology of TS
    • 1. enlarged RA
    • 2. dilated IVC
    • 3. possible reversal of flow in hepatic V
    • 4. thickened leaflets increased with history of rheumatic fever
    • 5. doming of TV leaflets in diastole
  41. Quantitation of TS (2)
    Velocity: > 1.0 m/s

    • narrowing of opening
    •       normal: 7-9 cm2
    • stenotic: < 7 cm2
  42. Echo findings of TS (4)
    • 1. CW PSV= > 1.0 m/s
    • 2. PW: a decreased E-F slope
    • 3. PW: possible absence of "a" wave
    • 4. Aliasing
  43. Causes of TS (6)
    • 1. Rheumatic heart disease
    • 2. systemic lupus erythematosus
    • 3. carcinoid syndrome
    • 4. loeffler's endocarditis
    • 5. metastatic melanoma
    • 6. congenital lesions
  44. Murmur of PS
    harsh systolic ejection murmur
  45. 7 physiology of PS
    • 1. RVH
    • 2. post-stenotic dilation of the PA
    • 3. flattening of the IVS 
    • 4. increased depth of the "a" wave (normal depth is 2-3 mm.)
    • 5. systolic doming of leaflets
    • 6. RV failure in later stages
    • 7. prominent jugular venous A wave
  46. Assessment of PS (2 but one main)
    • 1. CW through PV in PSAX AV level 
    •             Adults: >0.9 m/s
    •            Children:    > 1.1 m/s
  47. 5 causes of PS
    • 1. congenital = most common
    • 2. carcinoid syndrome
    • 3. rheumatic heart disease
    • 4. sinus of valsalva aneurysm: producing an RVOT obstruciton
    • 5. Ross Procedure: surgery to take PV and put into AV position
  48. What velocity would it need to be to produce a 50 mmHg systolic gradient through the PV?
    > or = to 3.6 velocity using CW through PV
  49. When would they do surgery for PS?

    When would they not do surgery?
    PV systolic gradient > 50 mmHg

    OR RV > 70 mmHg 

    Would NOT:  if PV > 70 mmHg
  50. Murmur of PI
    low-pitched, mid-diastolic murmur
  51. Physiology of PI (5)
    • 1. dilated RV
    • 2. flattened IVS
    • 3. red flash
    • 4. diastolic flutter on TV in m-mode
    • 5. CW measure AT/acceleration time
  52. 6 causes of PI
    • 1. pulmonary HTN
    • 2. bacterial endocarditis
    • 3. valvotomy
    • 4. congenital defects
    • 5. carcinoid syndrome
    • 6. trauma
  53. IVC assessment of pressure
    • 5 mmHg = IVC normal and reactive
    • 10 mmHg = IVC normal and partial reactive
    • 15 mmHg = IVC dilated and reactive
    • 20 mmHg = IVC dilated and not reactive

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