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Contrast refers to:
Definity is technically used when...
2 consecutive segments are not visualized well.
DO NOT give definity when...
patient has RT to LT shunting. (Perform bubble study prior).
Adverse events due to definity:
2. back pain
4. chest pain
6. injection site reaction
Equipment needed for TEE:
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.
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.
If they have an arterial sheath on the Rt side can they roll onto the Lt side?
Etiology of congenital heart disease:
1. Single gene defects. (Hereditary)
2. Environmental factors. (Stress/ Unhealthy lifestyle)
3. Maternal ingestion of toxic substances. (Substance abuse)
4. Viral exposures
6. ? (Premature)
The hear is the firest organ to complete its development.
- Single tube = _____ days
- Complete heart = _____ days
What are the two exceptions to a normal fetal heart versus a normal adult heart?
Heart Tube Segments:
1. Truncus Arteriosus
2. Bulbus Cordis OR Conus Cordis
3. "Common" Primitive Ventricle
4. "Common" Primitive Atrium
5. Sinus Venosus
1st Heart Tube Segment:
- Divides to form the roots of the Aorta and Pulmonic A.
2nd Heart Tube Segment:
Bulbus Cordis OR Conus Cordis
- Future RVOT and LVOT. (Outlet of Ventricles)
3rd Heart Tube Segment:
"Common" Primitive Ventricle
- (Inlet of Ventricles)
4th Heart Tube Segment:
"Common" Primitive Atrium
- Right & Left Atria
5th Heart Tube Segment:
- Proximal Vena Cava & part of Right Atrium.
4(v)2 + IVC pressure
Mean PA Pressure =
Antegrade PV flow:
80 - (AT/2)
Retrograde PV flow:
Diastolic PA Pressure =
What is the RVSP when given a VSD velocity and a BP?
= _____ mmHg
Take systolic BP - _____ mmHg
These IVC pressures are categorized as what?
5 mmHg - Normal and reactive.
10 mmHg - Normal and partial reactivity.
15 mmHg - Dialated but reactive.
20 mmHg - Dialated and not reactive.
Normal ___ mmHg
Mild ___ mmHg
Moderate ___ mmHg
Severe ___ mmHg
Normal 18-25 mmHg
Mild 30-40 mmHg
Moderate 40-70 mmHg
Severe >70 mmHg
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).
Causes of TS:
Rheumatic Heart Disease
Systemic Lupus Erythematosus
2-D findings of TS
doming of the TV leaflets in diastole
M-Mode findings of TS
a decreased E-F slope (due to slower filling and higher RA pressures).
decreased D-E excursion
Doppler findings of TS:
a decrease E-F slope
peak velocity is >1m/s
spectral broadening of diastolic signal
possible absence of "a wave"
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.
T isn't dependant on cardiac output.
Leakage from RV into the RA during systole.
Murmur is described as a holosystolic, high-pitched blowing sound.
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
Less common causes of TR:
Congenital Ebsteins anomaly
Physiology of TR:
Enlarged IVC and dilatation of the other vessels coming off of the IVC.
Leg and abdominal swelling, liver enlargement, and portal HTN.
Echo findings of TR:
Paradoxical septal motion
dilated RA and RV
reversed flowin Hepatic V
Pulmonary hypertension is caused by:
Mitral Valve disease
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 S
Physiology of PS
prominent jugular venous "a wave"
RVH - increased pressure = thickened walls
post stenotic dilatation of the PA
Causes of PS:
congenital - most common
carcinoid heart disease
rheumatic heart disease
sinus of valsalva aneurysm
Treatment of PS
surgery if the systolic gradient in >50 mmHg across PV OR >70 mmHg in the RV
M-Mode findings of PS
RV failure in later stages
flattening of the IVS
increased depth of the "a wave"
2-D findings of PI
dilated RV from RVVO
M-Mode findings for PI
diastolic flutter on the TV
Causes of PI:
carcinoid heart disease
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