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Adult Echocardiography (CCI exam) questions and answers
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Adult Echocardiography (CCI exam)questions and answers
Coarctation of the aorta is associated with? - Answer -bicuspid aortic valve
Patients with lupus will sometimes get what type of endocarditis? - Answer -Libman-
Sachs endocarditis
Prosthetic cardiac valves are classified as: - Answer -mechanical and bioprosthetic
How do you assess the right atrial pressure based on the size and collapsibility of the
inferior vena cava (IVC)? - Answer -3mmHg= normal IVC (<2cm) & (>50%) collapses
8mmHg= intermediate
15mmHg= dilated (>2cm) & no collapse (<50%)
What is the name of the valve of the coronary sinus? - Answer -Thebesian Valve
In which chamber would you see a chiari network? - Answer -Right atrium as fine
strands of tissue similar to chordea of the mitral and tricuspid valves
When is the LV volume the largest? - Answer -end diastole
When is the LA volume the largest? - Answer -end systole
What is the dimensionless index for evaluating aortic stenosis? - Answer -The
dimensionless index is a ratio of the LVOT velocity and the peak velocity across the
aortic valve.
What is the cutoff value for severe AS when using the dimensionless index? - Answer -
The cutoff value for severe AS when using the dimensionless index is <0.25
When a patient has aortic regurgitation what is the equation for calculating Left
Ventricular End Diastolic Pressure (LVEDP)? - Answer -LVEDP= Diastolic BP - the end
diastolic AR gradient
,How many scallops is the mitral valve divided into and what are their names? - Answer -
The mitral valve is divided into 6 scallops (segments). Anterior 1,2,&3 and Posterior 1,2
& 3.
When a patient has an aortic aneurysm at which point (size) do you need a surgical
consult? - Answer -When aortic aneurysms are larger than 5CM it't time for a surgical
consult.
What happens to the mitral inflow pattern in a normal patient when you have them
perform a Valsalva maneuver? - Answer -The normal mitral inflow patterns maintains
the E/A ratio (E>A) following a Valsalva maneuver but the velocities are lower.
When a patient has pulmonary regurgitation what is the equation for calculating
Pulmonary Artery End Diastolic Pressure (PAEDP)? - Answer -PAEDP = RAP+end
diastolic PR gradient
(RA pressure is obtained by looking at the IVC size and collapsibility like you do for TR
and pulmonary pressures).
In the parasternal short-axis view, at the level of the mitral valve and papillary muscle,
how many segments is the left ventricle divided into? - Answer -The left ventricle is
divided into 6 segments
Name the ventricular segments seen in the parasternal short-axis view. - Answer -1-
Inferolateral
2-Anterolateral
3-Anterior
4-Anteroseptal
5-Inferoseptal
6-Inferior
In the apical four-chamber view, which two walls of the left ventricle are seen? - Answer
-Inferoseptal and anterolateral walls of the LV are seen
In the apical two-chamber view, which two walls of the left ventricle are seen? - Answer
-anterior and inferior walls of the LV are seen
Which walls of the left ventricle are seen in the parasternal and apical long-axis views? -
Answer -Anteroseptal and inferolateral walls of the left ventricle are seen in the
parasternal and apical long axis views.
Which two aortic valve leaflets are seen in parasternal view? - Answer -The right and
noncoronary leaflets. The right leaflet is on top (superior) and the noncornary is on the
bottom (inferior)
Where is the coronary sinus located in the parasternal long-axis view (PLAX)? - Answer
-The coronary sinus lies in the posterior atrioventricular (AV) groove. This groove is
,located between the left atrial and the LV walls and lies posterior to the MV. In the
parasternal long-axis view, the coronary sinus can sometimes be seen as a small echo-
free circle.
In the PLAX where is the coronary sinus located in relation to the descending aorta? -
Answer -The coronary sinus is located anterior to the descending aorta. If the coronary
sinus is dilated, it may be mistaken for descending aorta.
How would you angle to view the coronary sinus in the apical 4-chamber view? -
Answer -You would angle posterior in order to visualize the coronary sinus, which is
located posterior to the mitral annulus.
Why is it important to know the location of the coronary sinus and the descending
aorta? - Answer -The coronary sinus and descending aorta are landmarks that can help
differentiate pericardial effusions from pleural effusions. Pericardial effusions lie
posterior to the coronary sinus anterior to the descending aorta. Pleural effusion lies
posterior to the descending aorta in PLAX.
What would causes the coronary sinus to become dilated? - Answer -The coronary
sinus dilates due to increased pressure in the RA. (as in severe tricuspid regurgutaion)
or increased flow into the coronary sinus in some congenital malformations (as in
Persistent Left Superior Vena Cava (PLSVC)).
Name the three major coronary arteries? - Answer -Right coronary, left anterior
descending (LAD), and circumflex.
Where are the coronary arteries located on the surface of the heart? - Answer -The
coronary arteries are located on the outer, epicardial surface of the heart as follows:
The right coronary artery (RCA) arises from the right aortic-root sinus, follows the right
atrioventricular junction, and descends along the posterior interventricular groove.
The left anterior descending coronary artery (LAD) follows the anterior interventricular
groove.
The circumflex coronary artery (Circ) courses along the keft atrioventricular junction.
Name the cardiac walls supplied by each of the coronary arteries. - Answer -Right
Coronary Artery=
a) Inferior wall
b) Inferoseptal
c) Right Ventricular apex
d) Right ventricular free wall
Left Anterior Descending Artery=
a) Anterior wall
b) Anteroseptal
c) Left ventricular apex
, Circumflex artery
a) Anterolateral wall
b) Inferolateral wall
While scanning a 43-year-old man with a history of an old myocardial infarction, you
noticed that the anterior cardiac wall is akinetic. Which coronary artery is most likely to
have been involved in the infarction? - Answer -The left anterior descending (LAD)
coronary artery, which supplies blood to the anterior cardiac wall., is most likely to have
been involved. This artery also supplies the anterior portion of the ventricular septum
and the left ventricular apex.
In the apical 4-chamber view of another patient, the distal ventricular septum and left
ventricular apex are hypocontractile. Which coronary artery is most likely to be
diseased? - Answer -The left anterior descending (LAD) coronary artery is the most
likely choice. In some patients with distal septal hypocontractility, the proximal portion of
the septum moves normally because it is supplues by the right coronary artery.
What are the normal systolic and diastolic pressures in the four cardiac chambers and
the great vessels? - Answer -1. Normal pressure:
Right atrial (mean) = 6mmHg
RV = 25/5 mmHg
Pulmonary artery = 25/10mmHg
Left atrial (mean) = 10mmHg
LV = 120/7mmHg
Aortic = 120/80mmHg
When is the pressure in the left ventricle at its lowest? - Answer -The left ventricle
pressure is lowest in early diastole just after the MV opens. After that the left ventricular
pressure rises as the chamber fills in diastole.
What is the normal mean pulmonary artery wedge pressure? - Answer -10mmHg, which
equals the left atrial pressure. The PA wedge pressure is NOT the same as the PA
pressure.
How is the pulmonary artery wedge pressure determined? - Answer -A Swan-Ganz
catheter is positioned in the pulmonary artery, and a small balloon is inflated at the
catheter's tip. The balloon is then floated and wedged into a smaller pulmonary artery. A
pressure reading is obtained distal to the balloon. The inflated balloon prevents the tip
of the catheter from sensing the pulmonary pressure, and the left atrial pressure is
recorded as it is reflected across the pulmonary bed.
To visualize the anterior wall of the left ventricle, which two-dimensional view would you
use? - Answer -The anterior and inferior walls of the left ventricle are best visualized in
the apical two-chamber view.
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