NICP > Echo > Flashcards

Echo Flashcards

(47 cards)

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1
Q

What equation do we refer to for the piezoelectric effect?

A

c = f λ

c= speed/propagation of ultrasound in soft tissue -1540m/s
F=frequency
λ= wavelength

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2
Q

Define ultrasound?

A

soundwaves above the level of audible hearing
-above 2MHz
-mechanical longitudinal wave
-acoustic impedance

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3
Q

What is the 25 shades of grey scale?

A

changes in interface/ density of boundaries

light = most reflection, most dense structures

dark = least reflection, least dense structures (e.g blood)

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4
Q

What effect does frequencies have on resolution and penetration?

A

high frequency = better resolution, poor penetration

lower frequencies = poorer resolution, better penetration

chnage in frequency = change in wavelength

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5
Q

What is lateral resolution?

A

ability of the ultrasound to differentiate between 2 structures

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6
Q

What is axial resolution?

A

ability of the ultrasound to differentiate between 2 structures in the path of the ultrasound beam

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7
Q

What are some emergent echo requests?

A

-haemodynamically unstable e.g cardiac tamponade
-P.E
-vegitation on valves

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8
Q

What are some reasons for an echo request needed in 24hrs?

A

-hypotensive with fluids
-dissection
-chest trauma

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9
Q

What are some reasons for cat 3 echo requests?

A

-outpatients
-needed but not urgent and wont change their outcome

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10
Q

What factors are included in a normal study?

A

-patient position
-echo windows
-machine settings
-quality of images
-views
-modalities
-measurements
-reporting

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11
Q

What is the correct patient echo postion?

A

-intercostal spaces

-left lateral (heart to fall against the rib cage, away from the lungs)

-arm raised or outstretched (opens up the intercostal spaces)

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12
Q

What does echo gel do?

A

coupling agent, water based gel

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13
Q

What is the echocardiographer positioning?

A

-in line with the patients spine

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14
Q

What are our standard echo windows?

A

-parasternal (long and short)
-apical
-subcostal
-suprasternal

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15
Q

What are the types of probe movement?

A

-movement
-rotation (around its axis)
-angulation (move it side to side)
-tilting (up and down)

Hold the probe like a pencil - right at the top of the probe

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16
Q

What are some standard echo machine settings?

A

-probe
-depth (how far we want the ultrasound to transmit and reflect back again) ( adults- 10-15cm )
-sector size - wide (FR plumets) or narrow ( FR increases)
-focus (where the ultrasound beam narrows)
-gain (amplifying the volume, time gain controls, used to amplify the picture)

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17
Q

What happens if we have a deeper depth on the probe for echo?

A

frame rate (FR) reduces = aliasing (artefact)

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18
Q

What does the parasternal long axis look at?

A

-2D view
-direct visualisation
-Lv function
-valves
-pericardium
-do not see the apex
-3rd-4th intercostal space

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19
Q

What anatomy can we see in the parasternal long axis view?

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A

-LA
-LV (cavity size, wall thickness, radial function, Postero-medial papillary muscle )
-MV( A/P leaflet and annulus appearance and function, thickness, mobility, calcification, commissural fusion, sub-valve apparatus)
-ascending thoracic aorta and descending thoracic aorta
-Aortic valve ( right and non coronary cusp, sinus of valsalva)
-interventricular septum
pericardium
-RV free wall/RVOT

20
Q

What factors are seen in the parasternal long axis view regarding the LV?

Study These Flashcards
A

EF- 60-80
Fractional shortning - 28-44
-geometry - blunt cone
-reginal
-global

21
Q

How do we measure the size of the LV during diastole?

Study These Flashcards
A

-find an R wave on our images and use that as end diastole
-5-6 in adult male

22
Q

What 3 ways does the heart contract?

Study These Flashcards
A

-radially
-circumfunctionally
-longitudinally

23
Q

What parameters does the M mode AV measure?

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A

AV annulus 1.7-2.5cm
sinus of valsalva 2.2-3.6cm
sinotubular junction 1.8-2.6cm
LA 3.0-4.5cm

Right coronary cusp moves towards the probe m mode goes up the page during systole, non coronary cusp moves away from the probe m mode moves down the page in diastole

diastolic closure line -should be in the middle

24
Q

What parameters does the M mode MV measure?

Study These Flashcards
A

D wave
E wave - rapid ventricular filling (valve opens and closes passively)
F wave - diastasis
A wave - 25% of EDV - active filling
c wave

MV should open and cover the LVOT

25
What parameters does M mode PLAX measure?
IVSD 0.6-1.3cm LVPWD - 0.6-1.2cm LVIDD 4.3-5.9cm LVISD - 2.6-4.0cm
26
What is Doppler?
-BART (blue away, red towards) -probe is at the top of the page -gives velocity and direction - form of pulse wave Doppler
27
what is a vena contractor?
narrowest point of blood flow jet as it exits a heart valve
28
How do we change our prove to see the RV inflow view?
tilt the probe superiorly
29
What anatomy are we looking for in RV inflow?
-RV -RA -Tricuspid valve -coronary sinus -IVC
30
What anatomy are we looking for in RV outflow?
-Pulmonary artery -pulmonary valve -RVOT (keep in PLAX position but roll patients away from you)
31
How do we adjust the probe for a PSAX view?
Rotate the probe around clockwise -want to be right angles to the structure to avoid dropout
32
What anatomy do we see in a PSAX view?
-LV -RV -anterolateral and posteromedical papillary muscles -septum (scan down - apical or papillary muscle level, scan up - (basal level) mitral valve) -only view we see all segments of the heart (circular looking view)
33
How do we move patient positioning for an apical view?
-pull the patient back a fraction -probe in V5 position, point it at the heart -5 chamber view, 4 chamber view, 2 chamber view, apical long -marker is posterior
34
What anatomy do we see in a 4 chamber apical view?
-LA -LV -RV -RA -interatrial septum -Mitral valve (anterior and posterior leaflets) -septal and anterior tricuspid valve leaflets -semi thoracic aorta -left and right pulmonary veins -lateral wall -inferior septum -apex -look at the annulus of the mitral and tricuspid valve - tricupsid valve is apically displaced towards the apex
35
What anatomy do we see in the apical 5 chamber view
Everything in 4 chamber view but aortic valve is now on show
36
What is a VTI in a 5 CV in apical view?
velocity time interval -distance the blood cells are moving through the outflow tract -how far the blood has travelled in one beat -10-25 normal
37
What does the Doppler measure in terms of diastolic dysfunction?
IVRT-60-90ms (isovolumetric relaxation time- all 4 valves are shut) EDT-140-220ms ADT>70mSec E wave 0.4-1.3m/s A wave 0.35-0.85m/s if these things take too long it means diastole has taken too long
38
What can doppler measure in pulmonary veins?
-RSPV flow -velocity
39
What is a doppler pencil probe?
more accurate than a fased array -lower frequency -1.8MHz -no images, relying on knowledge of the cardiac cycle
40
What do we see in an apical 2 chamber view?
LA LV anterior and inferior wall, basal,mid and distal levels
41
How do we change the doppler to an apical 2 chamber view
-go back to apical 5 CV position -twist
42
What do we see in an apical 3 chamber view?
same as 2 chamber view but aortic valve is back
43
How do we get our patient into an subcostal view?
hand on top of probe -supine and bent knees -relax the abdominal muscles
44
What anatomy do we see in a subcostal view?
-RV -LV -LA -RA -IVC -liver looking for ASD, PFO, IVC should collapse on inspiration if it doesnt it means the pressure is on the right side IVC-2-2.cm
45
What anatomy do we see in the suprasternal view?
-Aorta arch 1.4-2.9cm -pulmonary artery -left and right subclavian arteries -ascending and descending aorta ( 1.1-2.3cm)
46
What positions do patients need to be in for a suprasternal view?
supine -neck tilted back - to get into the suprasternal notch -20cm depth
47
What are some other sub specialities of echo?
3D echo stress echo TOE strain rate TDI speckle tracking
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