ECHO

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  1. Contrast refers to:

    1.
    2.
    • Bubbles
    • Definity
  2. Definity is technically used when...
    2 consecutive segments are not visualized well.
  3. DO NOT give definity when...
    patient has RT to LT shunting. (Perform bubble study prior).
  4. Adverse events due to definity:
    1.
    2.
    3.
    4. 
    5. 
    6.
    • 1. headache
    • 2. back pain
    • 3. nausea
    • 4. chest pain
    • 5. dizziness
    • 6. injection site reaction
  5. Equipment needed for TEE:
    1.
    2.
    3.
    4.
    5.
    6.
    7.
    8.
    9.
    • 1. US system with TEE capability.
    • 2. Patient monitoring equipment- BP, O2 Saturation, and Suctioning.
    • 3. Three way stop cock.
    • 4. 2 or 3 -12cc syringes with Saline/ Preservative for bubbles.
    • 5. Bite block.
    • 6. Cetacaine spray.
    • 7. Tongue depressor.
    • 8. Clean towels and washcloths.
    • 9. Gloves for physician/sonographer.
  6. TEE Probe Cleaning:
    • Check to make sure the Cidex has been tested for the day. Look on chart. Cidex changed every two weeks.
    • Soak and scrub the endoscope and bite block in Endozyme to remove saliva and blood. (Far left sink or the "dirty sink").
    • Soak endoscope and bite block in Cidex solution for 12 minutes. 
    • Rinse well with running tap water or in tub for 1 x3. Tub must be dumped and refilled three different times. This is the "clean sink" and is far right.
    • Hang probe in storage unit.
  7. If they have an arterial sheath on the Rt side can they roll onto the Lt side?
    Yes.
  8. Etiology of congenital heart disease: 
    1.
    2.
    3.
    4.
    5.
    • 1. Single gene defects. (Hereditary)
    • 2. Environmental factors. (Stress/ Unhealthy lifestyle)
    • 3. Maternal ingestion of toxic substances. (Substance abuse)
    • 4. Viral exposures
    • 5. Unknown
    • 6. ? (Premature)
  9. The hear is the firest organ to complete its development.

    - Single tube = _____ days
    - Complete heart = _____ days
    • 23 
    • 43
  10. What are the two exceptions to a normal fetal heart versus a normal adult heart?
    • Formen Ovale
    • Ductus Arteriosus
  11. Heart Tube Segments:
    1.
    2.
    3.
    4.
    5.
    • 1. Truncus Arteriosus
    • 2. Bulbus Cordis OR Conus Cordis
    • 3. "Common" Primitive Ventricle
    • 4. "Common" Primitive Atrium
    • 5. Sinus Venosus
  12. 1st Heart Tube Segment:
    • Truncus Arteriosus 
    • - Divides to form the roots of the Aorta and Pulmonic A.
  13. 2nd Heart Tube Segment:
    • Bulbus Cordis OR Conus Cordis
    • - Future RVOT and LVOT. (Outlet of Ventricles)
  14. 3rd Heart Tube Segment:
    • "Common" Primitive Ventricle 
    • - (Inlet of Ventricles)
  15. 4th Heart Tube Segment:
    • "Common" Primitive Atrium
    • - Right & Left Atria
  16. 5th Heart Tube Segment:
    • Sinus Venosus
    • - Proximal Vena Cava & part of Right Atrium.
  17. RVSP =
    4(v)2 + IVC pressure
  18. Mean PA Pressure =
    • Antegrade PV flow:
    • 80 - (AT/2) 

    OR 

    • Retrograde PV flow:
    • 4(v)2
  19. Diastolic PA Pressure =
    4(v)2 + IVC pressure
  20. What is the RVSP when given a VSD velocity and a BP?
    4(v)2 = _____ mmHg

    Take systolic BP - _____ mmHg
  21. These IVC pressures are categorized as what?

    5 mmHg
    10 mmHg
    15 mmHg
    20 mmHg
    • 5 mmHg - Normal and reactive.
    • 10 mmHg - Normal and partial reactivity.
    • 15 mmHg - Dialated but reactive.
    • 20 mmHg - Dialated and not reactive.
  22. Pulmonary Hypertension:

    Normal ___ mmHg
    Mild ___ mmHg
    Moderate ___ mmHg
    Severe ___ mmHg
    • Normal 18-25 mmHg
    • Mild 30-40 mmHg
    • Moderate 40-70 mmHg
    • Severe >70 mmHg
  23. Tricuspid Stenosis
    • A narrowing of the orifice of the TV.
    • Auscultation reveals an opening snap and diastolic rumble, best heard at the Lt sternal border. (Gets louder with inspiration). 
    • DIASTOLIC MURMUR
  24. Causes of TS:



    (6)
    • Rheumatic Heart Disease
    • Systemic Lupus Erythematosus
    • Carcinoid Disease
    • Loeffler's Endocaritis
    • Metastatic Melanoma
    • Congenital Defects
  25. 2-D findings of TS
    • thickened leaflets 
    • dilated IVC
    • doming of the TV leaflets in diastole
    • enlarged RA
  26. M-Mode findings of TS
    • a decreased E-F slope (due to slower filling and higher RA pressures).
    • decreased D-E excursion
    • enlarged RA
  27. Doppler findings of TS:
    • a decrease E-F slope
    • peak velocity is >1m/s
    • spectral broadening of diastolic signal
    • aliasing
    • possible absence of "a wave"
  28. Quantitation of TS:
    Pressure half-time: is the time it takes for initial velocity divided by the square root of 2 OR time for trans-tricuspid flow to fall 1/2 its initial value.

    P1/2T isn't dependant on cardiac output.
  29. Tricuspid Regurgitation
    • Leakage from RV into the RA during systole.
    • Murmur is described as a holosystolic, high-pitched blowing sound.
    • SYSTOLIC MURMUR
  30. Causes of TR:
    • Dilatation of the annulus preventing the leaflets from closing completely.
    • Enlargement of RV caused by a volume overload (RVVO)
    • Aortic and Mitral Valve Disease
    • Pulmonary Hypertension
    • RV Infarction 
    • Pacemaker wires
    • Heart transplant
  31. Less common causes of TR:
    • Congenital Ebsteins anomaly
    • Rheumatic disease
    • Carcinoid Disease
    • trauma
    • tumors
    • Endocarditis
    • Chordal rupture
  32. Physiology of TR:
    • RA enlargement
    • RV enlargement
    • A FIB
    • Enlarged IVC and dilatation of the other vessels coming off of the IVC.
    • Leg and abdominal swelling, liver enlargement, and portal HTN.
  33. Echo findings of TR:
    • RVVO 
    • Paradoxical septal motion
    • thickened leaflets
    • dilated RA and RV
    • dilated IVC
    • reversed flowin Hepatic V
  34. Pulmonary hypertension is caused by:

    (3)
    • Mitral Valve disease
    • Congenital lesions
    • Cor pulmonale
  35. Pulmonic Stenosis
    • the obstruction of blood flow from RV to main Pulmonary A
    • rare in adults, more common in children/infants
    • flow in Pulmonary A in adults = 0.9m/s, children = 1.1m/s
    • auscultation- harsh systolic ejection murmur heard best in pulmonic area. thrill may also be present, splittin of S2.

  36. Physiology of PS
    • prominent jugular venous "a wave"
    • RVH - increased pressure = thickened walls
    • post stenotic dilatation of the PA
  37. Causes of PS:
    • congenital - most common
    • carcinoid heart disease
    • rheumatic heart disease
    • sinus of valsalva aneurysm
    • Ross Procedure
  38. Treatment of PS
    surgery if the systolic gradient in >50 mmHg across PV OR >70 mmHg in the RV
  39. M-Mode findings of PS
    • RVH
    • RV failure in later stages
    • systolic doming
    • flattening of the IVS
    • increased depth of the "a wave"
  40. 2-D findings of PI
    • dilated RV from RVVO
    • pancake septum
  41. M-Mode findings for PI
    diastolic flutter on the TV
  42. Causes of PI:
    • Pulmonary HTN
    • endocarditis
    • valvotomy
    • congenital defects
    • carcinoid heart disease 
    • trauma

Card Set Information

Author:
jrw10
ID:
325910
Filename:
ECHO
Updated:
2016-11-22 03:14:29
Tags:
ECHO
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Description:
ECHO
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