Podcast
Questions and Answers
Which of the following describes the left atrial appendage (LAA)?
Which of the following describes the left atrial appendage (LAA)?
- A valve regulating flow between the left atrium and left ventricle.
- A small, ear-shaped outpouching of the left atrium's muscular wall. (correct)
- A primary component of the ventricular septum.
- The main source of blood supply to the sinoatrial node.
Where is the left atrial appendage (LAA) located in relation to other cardiac structures?
Where is the left atrial appendage (LAA) located in relation to other cardiac structures?
- Posterior to the right ventricle, near the pulmonary artery.
- Superior to the aortic arch, adjacent to the superior vena cava.
- Inferior to the mitral valve, within the left ventricle.
- Anteriorly in the atrioventricular groove, near the left circumflex artery. (correct)
What is the primary function of the left atrial appendage (LAA) in normal cardiac physiology?
What is the primary function of the left atrial appendage (LAA) in normal cardiac physiology?
- To provide structural support to the mitral valve leaflets.
- To directly control the heart rate via specialized pacemaker cells.
- To act as an essential modulator of intravascular volume. (correct)
- To filter blood entering the heart from the pulmonary veins.
Which hormones are released by the left atrial appendage (LAA) to regulate blood pressure and fluid balance?
Which hormones are released by the left atrial appendage (LAA) to regulate blood pressure and fluid balance?
During which period of embryonic development does the left atrial appendage (LAA) form?
During which period of embryonic development does the left atrial appendage (LAA) form?
What is the embryological origin of the left atrial appendage (LAA)?
What is the embryological origin of the left atrial appendage (LAA)?
In a study analyzing left atrial appendage (LAA) morphologies, which variant was found to be the most common?
In a study analyzing left atrial appendage (LAA) morphologies, which variant was found to be the most common?
Among the described morphologies of the left atrial appendage (LAA), which is the least prevalent?
Among the described morphologies of the left atrial appendage (LAA), which is the least prevalent?
Which diagnostic method uses sound waves to create moving pictures of the heart?
Which diagnostic method uses sound waves to create moving pictures of the heart?
What is the primary clinical goal of performing cardioversion in patients with atrial fibrillation?
What is the primary clinical goal of performing cardioversion in patients with atrial fibrillation?
Why might cardioversion be considered in addition to improving symptoms for atrial fibrillation?
Why might cardioversion be considered in addition to improving symptoms for atrial fibrillation?
Which medication is associated with a longer duration for acute cardioversion?
Which medication is associated with a longer duration for acute cardioversion?
Which of the following best describes synchronized cardioversion?
Which of the following best describes synchronized cardioversion?
In what situation is synchronized cardioversion typically used?
In what situation is synchronized cardioversion typically used?
What is the key difference between synchronized cardioversion and defibrillation?
What is the key difference between synchronized cardioversion and defibrillation?
What is the primary purpose of performing a transesophageal echocardiogram (TEE) before synchronized electrical shock cardioversion?
What is the primary purpose of performing a transesophageal echocardiogram (TEE) before synchronized electrical shock cardioversion?
When preparing for a transesophageal echocardiogram (TEE) during synchronized electrical cardioversion, what is a key responsibility of the sonographer regarding equipment?
When preparing for a transesophageal echocardiogram (TEE) during synchronized electrical cardioversion, what is a key responsibility of the sonographer regarding equipment?
What immediate preparations should a sonographer undertake before initiating a cardioversion procedure?
What immediate preparations should a sonographer undertake before initiating a cardioversion procedure?
What does the measurement of left atrial appendage (LAA) emptying velocity indicate?
What does the measurement of left atrial appendage (LAA) emptying velocity indicate?
If a transesophageal echocardiogram (TEE) reveals "smoke" within the left atrial appendage (LAA), what does this typically indicate?
If a transesophageal echocardiogram (TEE) reveals "smoke" within the left atrial appendage (LAA), what does this typically indicate?
What is the normal measurement for LAA?
What is the normal measurement for LAA?
What are the components that can be visualized during transesophageal echocardiography (TEE)?
What are the components that can be visualized during transesophageal echocardiography (TEE)?
What is the purpose of using sterile gel packets, bite-guard, bite-guard strap, extra gloves, Hurricaine spray with extension tip and Xylocaine gel?
What is the purpose of using sterile gel packets, bite-guard, bite-guard strap, extra gloves, Hurricaine spray with extension tip and Xylocaine gel?
When should you secure the probe and ECG wires before cardioversion?
When should you secure the probe and ECG wires before cardioversion?
Flashcards
Left Atrial Appendage (LAA)
Left Atrial Appendage (LAA)
Small ear-shaped outpouching of the muscular wall of the left atrium.
LAA Location
LAA Location
Lies anteriorly in the atrioventricular groove, close to the left circumflex artery.
LAA Function
LAA Function
An essential modulator of intravascular volume.
Natriuretic Peptides
Natriuretic Peptides
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LAA Releases:
LAA Releases:
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LAA Development
LAA Development
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Cardioversion
Cardioversion
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"chicken wing" LAA
"chicken wing" LAA
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Pharmacologic Cardioversion definition
Pharmacologic Cardioversion definition
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Synchronized Cardioversion definition
Synchronized Cardioversion definition
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Transesophageal Echocardiogram
Transesophageal Echocardiogram
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LAA Emptying Velocity
LAA Emptying Velocity
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Study Notes
Atrial Appendage Anatomy
- A small, ear-shaped outpouching is often how the LAA is described.
- It lies anteriorly in the atrioventricular groove, close to the left circumflex artery.
- The LAA lies adjacent to the free wall of the left ventricle and is closely associated with left ventricular function.
- Originates during the fourth week of embryonic development as a remnant of the embryonic left atrium.
Atrial Appendage Function
- The LAA acts as an essential modulator of intravascular volume.
- Cardiac distension, sympathetic stimulation, and angiotensin II stimulate ANP and BNP.
- ANP and BNP stimulate vasodilation, which lowers blood pressure.
- They also stimulate Renin, which decreases Ang II and Aldosterone while increasing GFR, leading to blood volume reduction, natriuresis, and diuresis.
- The LAA releases atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)
- Natriuretic peptides are hormones regulating blood pressure and fluid balance.
LAA Morphologies
- The "chicken wing" is the most common LAA variant.
- "Cactus” was seen in 30% of patients.
- The "windsock" was found in 19% of patients.
- "Cauliflower" shape is present in just 3% of patients.
Imaging Techniques
- Transthoracic Echocardiography
- Transesophageal Echocardiography (TEE)
Transesophageal Echocardiography (TEE) components
- Ostium
- Neck
- Body
- Lobe
- Pectinate Muscles
Cardioversion Methods
- Pharmacologic Cardioversion uses drugs to restore sinus rhythm.
- Dofetilide
- Propafenone: 3-8 hours
- Flecainide: 3-8 hours
- Amiodarone: 8-24 hours
- Ibutilide
- Synchronized Electrical Shock Cardioversion terminates life-threatening tachycardic arrhythmia using transthoracic electrical current.
- Used on hemodynamically unstable patients with a pulse.
- Treats both hemodynamically unstable ventricular and supraventricular rhythms.
Transesophageal Echocardiogram
- Performed before synchronized electrical shock cardioversion.
- Checks for pre-existing clot:
- Intracardiac thrombus
- Left atrial appendage
- Interatrial septum
Sonographer's Role During Synchronized Electrical Shock Cardioversion
- Mount probe, inspect it for defects, and ensure dials, steering, and locking mechanisms are in working order.
- Power down and place the probe in its carrying device Position the equipment to the patient's left.
- EKG cables and electrodes
- Leave the probe in carry-case/container until procedure initiation
- Have sterile gel packets, bite-guard, bite-guard strap, extra gloves, Hurricaine (Xylocaine) spray, and Xylocaine gel ready.
- Have bubble study supplies and/or ultrasound enhanced agent prepared.
- Sonographer's role includes:
- Video clips
- Still images
- Doppler and M-mode
- Measurements (2-D and Doppler)
- Secure the probe and EKG wires before cardioversion.
Atrial Appendage Thrombus
- Left atrial appendage (LAA) emptying velocity is a marker of left atrium contractile function, measuring 60 ±14 cm/sec.
- LAA flow pattern through quadriphasic wave pattern
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