One of the best features of a ball and cage prosthetic valve is:

a. durability

b. low gradient

c. no need for blood thinners

d. low chance of infection

What is a common associated defect with someone that has Ebsteins?

atrial septal defect

What is a common finding on m-mode for a patient with Ebstein's?

a. delayed tricuspid closure

b. early tricuspid closure

c. tricuspid valve not seen

d. tricuspid valve seen with the mitral valve

Which valve separates the areas of greatest pressure differences?

Mitral valve

LAD lies in the ___ or __

anterior inverventricular groove or sulcus

Which aortic leaflet is the superior one in the parasternal long axis view?

right leaflet

Which aortic leaflet is the posterior one in the parasternal long axis view?

noncoronary leaflet
From the left parasternal window which of the following are most likely to get accurate velocity
measurements?

a. LVOT

b. Mitral stenosis

c. pulmonary artery

d. mitral regurgitation

Tricuspid leaflets are seen in the __

RVIT

The names for the tricuspid leaflets in the RVOT are __ and __.

posterior and anterior

Where is the LAA on the TTE?

Sometimes in the PSAX AO valve level (better seen in AP 2CH.

The coronary arteries come off the:

a. descending aorta

b. coronary sinuses

c. pulmonary artery

d. sinuses of Valsalva

During which phase do the coronaries fill?

a. early systole

b. late systole

c. early diastole

d. late diastole
C

The frame after the MV closes?

End diastole

The frame in the cardiac cycle where the dimension is the largest?

end diastole

Frame preceding MV opening?

end systole

frame when the cardiac dimension is the smallest?

end systole

The normal LVIDd in males is __.

4.2-5.8 cm

The normal LVIDd in females is __.

3.8 to 5.2 cm

The normal SWT and PWT in males is __.

0.6-1.0 cm

The normal SWT and PWT in females is __.

0.5-0.9 cm

The normal LVIDs in males is __.

2.4-4.0 cm
The normal LVIDs in females is __.

2.2-3.5 cm

Normal LA dimensioni in a male is __.

3.0-4.0 cm

Normal LA dimension in a female is __.

2.7-38 cm

Normal LA area in a male and female is __.

< or = 20 cm squared

Normal LA volume in a male and female is __.

16-34 mL

You measure the aortic valve annulus during __

mid-systole

You measure the aortic valve at the __

hinge point of aortic leaflets

You measure the Ao sinuses, Ao sinotubular junction, and ascending aorta during __

end-diastole

You measure the Ao sinuses at __

the maximal diameter in the sinuses of valsalva

You measure the Ao sinotubular junction at the __

transition between the sinuses of Valsalva and the tubular portion of the ascending aorta
You measure the Ascending AO at the __

largest diameter of the ascending aorta

The best images of the ascending aorta are often obtained from the __

suprasternal window

The three vessels coming off the aortic arch are the __, __, and __

innominate (brachiocephalic)MOST PROXIMAL, left carotid, and left subclavian MOST DISTAL

A coarctation of the aorta is associated with __

bicuspid aortic valves

Most aortic coarctations occur after the take-off of the __ or within the __

left subclavian artery; isthmus

The best window used to find a coarctation of the aorta is the __

SSN

Secondary findings with bicuspid aortic valve is a __

coarctation of the aorta

In the SSN view, the black circle beneath the arch is the __

right pulmonary artery

The two pulmonary veins are called the __ and __ in the AP 4CH

right lower pulmonary vein; left lower pulmonary vein

The pulmonary veins are best seen in the __

When in the apical 4CH view, you rotate the transducer __ to obtain the apical LAX (3CH)

counterclockwise 120 degrees

The coronary sinus is located in the __

posterior AV groove

To visualize the coronary sinus in the AP 4CH view, you should tilt the transducer __

posterior

The valve that sits at the opening of the coronary sinus is the __

Thebesian

The valve that sits inferior to the IVC is the __

Eustachian

The portion of the pulmonary venous PW Doppler that represents the atrial systole is the __

a wave

The temperature of a TEE probe is considered unsafe if it reaches __

40-45 degrees C

ME 4 chamber is seen at __ degrees on TEE

ME LAX is seen at __ degrees on TEE

120
ME AV SAX is seen at __ degrees on TEE

60

ME 2 CH is seen at __ degrees on TEE

90

The normal electrical activation is __, __, __, __, __

SA node, AV node, Bundle of His, bundle branches, purkinje fibers

The __ has special neuromyocardial cells and is considered the heart's pacemaker

SA node

The __ has electrical impulses that pause to prevent simultaneous contraction of the atria and ventricles

AV node

The __ has the fastest intrinsic rate

SA node

The __ is the period =when a muscle cell is not excitable; during phase 1-3

absolute refractory period

The __ is during phase 3 and the muscle cell might contract if the stimulus is strong

relative refractory period

P wave represents __ or __

atrial contraction or systole

The P-R interval includes the P-R segment from __ to __

atrial to ventricular depolarization

ventricular systole or depolarization stage

The T wave is __ or __

ventricular diastole or depolarization stage

The normal duration for the QRS complex is __ or __

60-100 beats/min or 3-5 big boxes

PR interval is __ or __

less than 1 big box or less than 0.2 seconds

__ states that the greater the load the greater the force of contraction

Frank-Starling Law

The __ determines the force of contraction

preload

Preload means that the load (volume) exerted on the ventricle at __

end diastole

Acute AI is __ because we shift up the Starling curve

hypercontractile

Chronic AI is __ failure when we drop off the end

failure

When you have increased preload you could experience: __, __, __, or __
regurgitation, ASD, VSD, and fluid overload

__ determines the tension the myocardium must generate

afterload (pressure)

__ is the resistance against which the ventricle must pump

afterload

When you have increased after load (pressure), you could experience: __, __ or __

hypertension, AS, PS, PHTN

An echo finding for preload is __

dilation

An echo finding for after load is __

hypertrophy

A __ doesn't allow for calculation of the EF

chest x-ray

SV =

EDV - ESV

normal SV is __

70-100 mL

EF =

SV/EDV x 100
CO =

SV x HR

normal EF =

> 55%

normal CO is __

4-6 mL

Bernoulli equation =

4V squared

__ occurs when the Doppler shift exceeds the Nyquist limit

aliasing

Nyquist limit =

1/2 the PRF

You will hit the Nyquist limit faster if you have a __ frequency transducer

higher

How do you eliminate aliasing on PW spectral Doppler?

a. increase PRF

b. switch to a lower frequency transducer

c. switch to a higher frequency transducer

d. switch to continuous wave Doppler

D ; could also lower the frequency transducer

What does VTI x CSA equal?

What is calculated by tracing the Doppler spectral display?

VTI

What is represented by how far the blood travels in centimeters with each ejection?

VTI

Normal VTI of the MV is __ and for the AoV is __

12 cm and 20 cm

CSA = ___

or ___

3.14 x (diameter divided by 2) squared or 0.785 x (Dsquared)

When you're breathing, during inspiration, there is an __ in venous return.

increase

When you're breathing, during expiration, there is a __ in venous return

decrease

When you're standing, there is a __ in venous return and SV

decrease

When you're squatting there is an __ in venous return, SV, and CO

and there is an __ in AS and __ in MR

increases, increases, decreases

When you have a handgrip, there is a __ in HR, CO, and arterial pressure
__ in AS and __ in MR

increases, decreases, increases

When you strain during valsalva, there is a __ in venous return, SV, and CO

Most murmurs __ during strain and IHSS __

decreases, decrease, increase

When you release during valsalva, there is a __ in venous return, CO, and BP

increase

When you do sit ups, there is an __ in HR, CO, and SV

increase

Amyl nitrite is a __

vasodilator

When you use a vasodilator such as amyl nitrite, there is a __ in peripheral resistance

decrease

When you use amyl nitrite, there is a _ in HR

_ forward flow murmurs, __ AR/MR

Increase, increases, decreases

Does venous return increase or decrease with inspiration?

increase

Inhalation of amyl nitrite causes:

a. increased preload

b. decreased preload
c. increased after load

d. decreased afterload

MV velocity during inspiration:

a. increases

b. decreases

c. remains the same

d. gets obstructed by air

TV velocity during expiration:

increases

On the ECG, isovolumic contraction is __

after the R wave

On ECG, isovolumic relaxation is __

after the T wave

On the Wiggers diagram, when is the MV open?

a. 3-4

b. 4-1

c. 1-2

d. 2-3

What is the duration of the IVRT and IVCT?

70 msec
The duration of isovolumic relaxation time will be increased with:

a. tachy

b. brady

c. increased sweep speed

d. increased wall filter

During the cardiac cycle this even NEVER happens:

a. AO valve is open & MV is open

b. AO valve is open & mitral valve is closed

c. AO valve is closed & MV is open

d. Ao valve is closed & MV is closed

The correct order for the cardiac cycle is:

mechanical diastole, electrical diastole (atrial kick), electrical systole, mechanical systole

The LA volume is the highest at

end systole

The LV volume is the highest at

end diastole

What are elastic, thick walled blood vessels?

arteries

Arteries expand during __ and recoil during __ to keep blood moving forward

systole, diastole
What are thinned walled blood vessels that collapse easily?

veins

What are able to expand rapidly to accommodate for large volumes of blood?

veins

What contains the majority of circulating blood?

veins

How much of the blood volume is plasma?

54%

How much of the blood volume is RBCs?

45%

How much of the blood is WBCs or platelets?

1%

What are the normal pressures in the pulmonary artery?

a. 8/3

b. 25/10

c. 40/20

d. 120/20

Where is the O2 saturation the lowest?

a. RA

b. IVC
c. PA

d. coronary sinus

O2 saturation in pulmonary veins is

95%

O2 saturation in the pulmonary arteries is

75%

__ blood starts in the pulmonary veins and continues to the end of the systemic arteries

oxygenated

__ blood starts at the systemic veins and continues to the pulmonary arteries

deoxygenated

Best cath technique for LV function

LV angiogram

LV angiogram is also called __, __, or __

ventriculography

selective angiography

angiocardiography

__ method measure O2 consumption divided by the difference in O2 content between arterial and
pulmonary system (CO)

Fick

Angiographic technique multiplies the __ and __

__ measures O2 saturation in various chambers *able to detect shunts by changes in O2 saturation

Oximetry

Shunt size is calculated by the differences in __ and __ blood flow

pulmonary and systemic

What is PCW (pulmonary capillary wedge) measuring?

LA pressure

PCW is measured via

Swan-Ganz Catheter

To determine AS the catheters are placed:

one in __ and one in __

One in __ and one pulled back across __

One catheter with two separate sensors

LV & AO

LV & AOV

High gain destroys __

resolution

The goal is even brightness of tissue throughout the image by use of

TGC

Low frequency gives you better

Penetration
High frequency gives you better

resolution

In __ imaging, you transmit and receive at the same frequency

fundamental

In __ imaging, you transmit one frequency and receive at the 2nd harmonic

*twice the transmit frequency

harmonic

Tissue harmonic imaging causes the __

valves leaflets to look thicker

Apical swirling of echo contrast for LVO is caused by:

a. high MI

b. negative jet

c. too much contrast

d. 2D focus too low

Swirling in the LV apex is caused by __ and __

MI too high; contrast injected too low

Attenuation of contrast is caused by the amount of contrast injected is too __ or was injected too __

high; fast