Echocardiography

Question 1

Indirect cardiac assessments:

Answer 1

• ECG
• MRI
• X ray
• angiography (with MRI, invasive)

Question 2

With x ray, you can see…

Answer 2

• lung function
• lung issues impact cardiac function
• general idea of cardiac size

Question 3

With angiography, you can see…

Answer 3

• inject radial label tracer, can see different vessels and heart
• heart attack, finding blockage

Question 4

Direct cardiac assessments:

Answer 4

open heart surgery

Question 5

Advantages of echo:

Answer 5

• non-invasive
• relatively quick analysis and assessment
• use at patient bedside
• measurements in real time
• gain a lot of information about cardiac function
• cheap compared to MRI

Question 6

Disadvantages of echo:

Answer 6

• requires a trained sonographer
• expensive compared to ECG/ICG
• image resolution not as good as MRI
• quality dependent on windows

Question 7

2D echocardiography appearance:

Answer 7

black and white

Question 8

What is the parasternal long axis used for?

Answer 8

• measure wall thickness
• diameter of aorta or left ventricular OT
• septum

Question 9

Grey on 2D echo:

Answer 9

cardiac tissue

Question 10

Black on 2D echo:

Answer 10

blood

Question 11

Bright white on 2D echo:

Answer 11

pericardium (fluid in it)

Question 12

IVS =

Answer 12

intraventricular septum

Question 13

What can we see from the parasternal short axis?

Answer 13

• can see valve moving

- can see more about how the heart contracts in a wringing action

Question 14

What can we see from the apical view?

Answer 14

• look from bottom up
• everything is upside down and opposite
• EDV and ESV taken here
• can calculate SV
• SV x HR = CO

Question 15

EDV:

Answer 15

• end diastolic volume
• relaxation of ventricles
• what you start with (higher)
• depend on how well blood is returning to heart
• how much blood goes into atria in to ventricles

Question 16

ESV:

Answer 16

• contraction of ventricles
• heart is ejecting blood
• ESV is smallest (systolic pressure is highest)

Question 17

Diastole:

Answer 17

ventricular relaxation

Question 18

Early diastole =

Answer 18

passive filling

Question 19

Late diastole =

Answer 19

atrial contraction

Question 20

Systole:

Answer 20

• ventricular contraction

- ejection of blood from the heart

Question 21

Cardiac diastole:

Answer 21

• all chambers are relaxed

- blood flows into the heart

Question 22

Atrial systole, ventricular diastole:

Answer 22

atria contract, pushing blood into the ventricles

Question 23

Atrial diastole, ventricular systole:

Answer 23

after the atria relax, the ventricles contract, pushing blood out of the heart

Question 24

What can we see from the subcostal view?

Answer 24

• up and through heart
• inferior vena cava
• diameter
• pressure in right side of heart

Question 25

M-mode:

Answer 25

- old school - replaced by 2D measurement - gives you clear information on one section only - structure - motion of tissues - chamber dimensions

Question 26

TDI =

Answer 26

tissue doppler imaging

Question 27

TDI is for...

Answer 27

- movement (velocity of tissue) | - right ventricle, septum, or left ventricle

Question 28

3 letters in TDI and meanings:

Answer 28

- S = systole - E = early filling/diastole - A = atrial contraction

Question 29

Doppler echocardiography is for...

Answer 29

- movement (velocity) of blood | - regurgitation

Question 30

Why would a heart remodel?

Answer 30

- exercise training | - pregnancy

Question 31

Exercise training heart remodelling:

Answer 31

- thicken walls - increase ventricular cavity/chamber size - increase overall size of the heart (cardiac hypertrophy) - chambers get larger - walls get larger

Question 32

How does heart remodelling differ between concentric and eccentric exercises?

Answer 32

- eccentric: all growth proportional to each other | - concentric: walls are thicker, may not see same change in chamber size (disproportional cardiac size change)

Question 33

Why do cardiac stress testing?

Answer 33

- abnormalities may be undetectable at rest - symptoms in patients observed during exertion - insight into dynamic cardiac function

Question 34

Expected acute changes with exercise:

Answer 34

- increase HR - increase BP - increase SV - increase CO - increase EDV - decrease ESV - progressive changes in function

Question 35

Increased HR means...

Answer 35

- heart contracts over same period of time - time of filling changes with change in HR - HR up = reduced time for early filling - atria needs to work hard (atrial contraction will be bigger)

Question 36

Why are there no changes in cardiac structure with 1 bout?

Answer 36

- need repeated bouts of exercise for chronic adaptation | - stretch in ventricles overtime will stimulate remodelling