cci review echo 2 exam actual exam complete exam a
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CCI ECHO 2
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CCI REVIEW ECHO 2 EXAM ACTUAL EXAM COMPLETE EXAM
AND PRACTICE EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS
Which aortic leaflet is the superior one in the parasternal long axis view? - ANSWER:
Right leaflet (the posterior leaflet is the non coronary)
From the left parasternal window which of the following are you most likely to get
accurate velocity measurements? - ANSWER: Pulmonary artery
In the parasternal short axis view (PSAX), which tricuspid leaflets are seen -
ANSWER: Anterior and medial/ septal
Posterior can only be seen in RVIT plax
Where is the LAA on TTE? - ANSWER: Sometimes in the parasternal SAX Aortic
Valve level
(Typically seen in the apical 2ch)
Normal LAA Velocity 46 cm/ sec?
The coronary arteries come off the? - ANSWER: Sinuses of Valsalva
During which phase do the coronaries fill? - ANSWER: Early diastole
What is the structure under the arch? - ANSWER: Right pulmonary artery
What cardiac pathology is associated with bicuspid aortic valve? - ANSWER:
Coarctation of the aorta (80%)
NOTE: coarctation , MVP, and AO dissections, bicuspid AOV are all related to
Marfans
Where are the pulmonary veins located? - ANSWER: Right and left superior (upper)
pulmonary veins inferior to the LV
NOTE: Can be seen on apical 4 chamber w/ inferior angulation.
Where is the Chiari network (system) located? - ANSWER: Right Atrium
The chiari network is the Fenestrated portion of the Eustachian valve
,it is located in the Right Atrium
What frequency is usually used for TTE and TEE? - ANSWER: TTE: 2-7 MHz
TEE: 5-7MHz
At what temperature is it unsafe to use a TEE probe? - ANSWER: 40-50C or the
highest temperature
What is absolute refractory state? - ANSWER: That period when a muscle cell is not
excitable- from phase I until into phase 3 the "relative refractory period" is during
phase 3 and the muscle cell might contract if the stimulus is strong.
What does the P-R interval represent? - ANSWER: Includes P-R segment (from atrial
to ventricular depolarization)
What is a normal duration for the QRS complex? - ANSWER: 0.10 sec.
Acute Aortic Insufficiency or Aortic regurgitation is _____ because we shift up the
Starling curve. - ANSWER: Hyper-contractile (Regurgitation increases preload,
muscle tension/contractility increases and eventually results in dilitation, Volume
overloads
Chronic Aortic Insufficiency or Aortic regurgitation is _____ when we drop off the
end. - ANSWER: Failure
Does a PDA increase Left Ventricle preload? - ANSWER: Yes-when the shunt is Left
to Right.
Calculate CO: - ANSWER: CO=HR x CSA OR CO=SV x HR
Normal is 4-8 L/min depending on BSA
SV/EDV x 100
What is the Bernoulli equation? - ANSWER: 4V2 NOTE: THIS EQUATION IS USED TO
CHANGE VELOCITY TO PRESSURES
With a velocity of 0.5m/sec what is the gradient? - ANSWER: (0.5x0.5=.025 and
0.25x4=1
1mmHg NOTE: 4(0.5)2 BORNOULIS EQUATION TO CONVERT VELOCITIES TO
PRESSURES, ALSO USES THE 4 M/S = 64 mmHg
What does VTI (velocity time integral) and CSA (cross-sectional area) equal? -
ANSWER: Doppler stroke volume or SV=VTI X CSA
Mitral valve velocity during inspiration? - ANSWER: Decreases
Note: Tricuspid Valve velocity increases with inspiration
,REMEMBER I=IV ( Increase on Inspiration in VENOUS) The revers is true for the left
systemic side. Inspiration causes decreases on the left side
Inhalation of amyl nitrite causes? - ANSWER: Decreased after load
-Vasodilator
-BP drops
-less blood comes back
-HR increases
What is the Isovolemic timing on the ECG? - ANSWER: After R wave=Isovolemic
contraction
After T wave=Isovolemic relaxation
During the cardiac cycle this event NEVER happens? - ANSWER: Aortic valve open
What is the Aortic valve doing during the Q-T interval? - ANSWER: The valve is open
What is the duration of IVRT and IVCT? - ANSWER: 70 ms
Valve event - ANSWER: -Starts Mitral Valve close
-Ends Aortic Valve Opens
-70 ms duration
valve event - ANSWER: -Starts Aortic close
-Ends- Mitral Valve opens
-70 ms duration (time decreases in bradycardia)
When is Left Ventricle pressure the lowest? - ANSWER: Early diastole
Best cath technique for Left Ventricle function? - ANSWER: Left Ventricle angiogram
Angiographic techniques multiple SV x HR
What is PCW (pulmonary capillary wedge) measuring? - ANSWER: Left atrial pressure
To determine Aortic Stenosis where catheters are places? - ANSWER: One in the Left
Ventricle and one in the aorta or one in the Left Ventricle and "pulled back" across
the Aortic Valve or one catheter with two separate sensors
What does Tissue Harmonic Imaging result in? - ANSWER: Thicker valve leaflets
A secondary finding in aortic stenosis is? - ANSWER: Left ventricular hypertrophy
Note: Stenosis is a Afterload which leads to hypertrophy
, In aortic stenosis is pulse pressure wide or narrow? - ANSWER: Narrow
(Pulse pressure is the difference between systolic and diastolic pressures-it is wide in
Aortic Insufficiency ( Aortic regurgitation) and narrow in Aortic Stenosis
What is Takayasu's arteritis? - ANSWER: Also called aortic arch syndrome this disease
occurs more in young women from Asia. There is fibrosis of the arch and descending
Aortic of unknown etiology. In advances stated multiple Coarctations may occur
(look for Supravalvular Aortic Stenosis).
The normal aortic valve area is: - ANSWER: 3-4cm2
less than 1 is severe stenosis
When does VTI work better? - ANSWER: VTI works better in patients with poor Left
Ventricle function and when moderate to severe Aortic Insufficiency or Aortic
regurgitation is present than peak velocities.
Using the continuity equation when would the severity of Aortic Stenosis be
underestimated? - ANSWER: LVOT measured too large
Know that echo gradients are usually higher than cath gradients. - ANSWER: Peak
instantaneous (echo) and versus peak-to-peak (cath )
What is Noonan Syndrome? - ANSWER: Classified as a cardiofacial syndrome with
Pulmonic Stenosis, HCM and ASD (30%)
Know that Pulmonic Stenosis does NOT cause pulmonary hypertension. -
ANSWER: ...
Asked if unable to obtain Pulmonic Stenosis gradient from the parasternal window
where else you can go? - ANSWER: Subcostal short-axis
Which type of mitral deformity occurs where there is only ONE PAPILLARY MUSCLE
into which both chordae insert
OR insertion of mitral chord into a single papillary muscle? - ANSWER: Parachute
mitral valve
NOTE: MOST COMMON FORM OF CONGENITAL MITRAL STENOSIS--it is a rare cause
of mitral stenosis
Remember that in pediatric question this is not a valid answer
Longstanding Mitral Stenosis leads to all the following EXCEPT:
A. congestive heart failure
B. pulmonary hypertension
C. left ventricular dilatation
D. left atrial dilatation - ANSWER: C. Left ventricular dilatation-
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