Echocardiography Quiz

Echocardiography has been widely accepted as one of the most dramatic revolutions in cardiology. Its impact has been as profound as the revolution that occurred with the introduction of the electrocardiogram by Einthoven.

The learning outcomes include understanding the basics of echocardiography, the different cardiac windows used in echocardiography, the use of echocardiography in assessment in the context of the Cardiology Clinic, and the role of echocardiography in Point of Care Ultrasound.

After its initial development in cardiology, echocardiography became part of the arsenal of other specialties, mainly in the settings of anaesthesia, resuscitation, and paediatric cardiology.

'Echo' refers to the use of ultrasound to examine the heart.

http://www.revespcardiol.

The different types of echocardiography include trans-thoracic, trans-oesophageal, stress, contrast, and 3D echocardiography.

Echogenicity of tissue refers to its ability to reflect or transmit ultrasound waves. In echocardiography, echogenicity is important for creating images.

Different types of transducers/probes include linear-array, curved-array, and phased-array transducers.

The 'PART' maneuver (Pressure, Alignment, Rotation, Tilting) is used for ultrasound probe manipulation in echocardiography.

Proper orientation of the ultrasound image is essential for accurate identification of anatomical structures in echocardiography.

Formal echocardiography involves multiple views and techniques to provide a comprehensive structural and functional assessment of the heart, resulting in a quantitative report. Basic echo in the resuscitation setting aims to answer focused clinical yes/no questions, such as identifying pericardial effusion, an enlarged RV, LV size, and LV systolic function.

The cardiovascular complications of Marfan’s Syndrome include dilatation of the ascending and sometimes descending aorta, incompetence of aortic and mitral valves, aneurysm, and dissection of the aorta.

The optimal management of Marfan’s Syndrome includes regular clinical review, echocardiogram, additional imaging if required (TOE, MRI, CT), b blockers/ACEI, and surgical referral if aortic root at Sinus of Valsalva exceeds 5.5 cm or 5% growth per year.

A transoesophageal echocardiogram is performed when it's difficult to get a clear picture of a patient’s heart with a standard echocardiogram or if there is a reason to see the heart and valves in more detail.

The learning outcomes related to echocardiography include understanding the basics of echocardiography, the different cardiac windows used, the use of echocardiography in assessment in the context of the Cardiology Clinic, and the role of echocardiography in Point of Care Ultrasound.

Medicine is not available in another form, Cannot tolerate medication by another route, Constant or high blood level of medicine is needed, A rapid onset of effect is needed, Some medications are more effective via IV, Rarely, to ensure compliance.

Increased cost and time to administer the medicine, Requires trained staff to administer (plus location), Rapid onset of action, Volume of fluid needed to dilute the medicine, Can cause discomfort/pain to the patient, Health risks.

Increased cost and time to administer the medicine, Requires trained staff to administer (plus location), Rapid onset of action, Volume of fluid needed to dilute the medicine, Can cause discomfort/pain to the patient, Health risks.

Medicine is not available in another form, Cannot tolerate medication by another route, Constant or high blood level of medicine is needed, A rapid onset of effect is needed, Some medications are more effective via IV, Rarely, to ensure compliance.

Guidelines for the safe administration of intravenous drugs are not specified in the provided text.

The effects of varying basic pharmacokinetic parameters (e.g. clearance) upon the plasma concentration of IV drugs following bolus, continuous or intermittent infusions are discussed.

The types of intravascular devices (including delivery devices and drivers) that may be used to deliver drugs and fluids are not specified in the provided text.

The potential hazards and complications of intravenous therapy mentioned in the text include fear/phobia/pain, infection/sepsis, thrombophlebitis, extravasation/infiltration, emboli, anaphylaxis/hypersensitivity, overdose, and visual infusion phlebitis score (1-5) Red man syndrome.

The types of intravascular devices (IVDs) mentioned in the text include peripheral venous catheters, central venous catheters (CVCs) - peripherally inserted CVCs, skin-tunneled CVCs (e.g. Hickman and Broviac lines), and arterial catheters.

The methods of administering intravenous medications mentioned in the text include continuous infusion (bolus injection, stable drugs, short half-life, time-dependent effects, needs dedicated IV site) and intermittent infusion (unstable drugs, long half-life, concentration-dependent effects, less compatibility concerns, rapid response required, incompatibilities).

The complications of IV drug administration mentioned in the text include fear/phobia/pain, infection/sepsis, thrombophlebitis, extravasation/infiltration, emboli, anaphylaxis/hypersensitivity, overdose, and visual infusion phlebitis score (1-5) Red man syndrome.

The pharmacokinetics of intravenous drugs mentioned in the text include bioavailability, fraction of unchanged drug that reaches the systemic circulation, infusion vs repeated injections, plasma drug concentrations, clearance, plasma steady state concentration (Css), and clinical impact.

The effect of varying basic pharmacokinetic parameters on the plasma concentration of IV drugs following bolus, continuous, or intermittent infusions includes the time taken to reach the steady state, the steady state plasma concentration, and the impact of increasing or decreasing the dose of a drug.

In intravenous administration, factors contributing to the clearance (CL) of a drug include the volume of blood or plasma cleared of drug in a unit of time, and the impact of clearance on the steady state plasma concentration and the time taken to reach that steady state.

The learning outcomes related to intravenous drug therapy mentioned in the text include explaining the indications/contraindications for, the advantages/disadvantages of, and the risks associated with intravenous drug therapy, identifying the types of intravascular devices that may be used to deliver drugs and fluids, and interpreting the effects of varying basic pharmacokinetic parameters upon the plasma concentration of IV drugs following bolus, continuous, or intermittent infusions.

The Vaughan Williams classification categorizes anti-dysrhythmic drugs into four classes: Class I (sodium channel blockers), Class II (beta-adrenergic blockers), Class III (potassium channel blockers), and Class IV (calcium channel blockers). An example of a drug from each class includes: Class I - Lidocaine, Class II - Propranolol, Class III - Amiodarone, Class IV - Verapamil.

The learning outcomes for the treatment of dysrhythmias include: 1. Understanding the Vaughan Williams classification of anti-dysrhythmic drugs, 2. Recognizing that some drugs are unclassified on this scheme, 3. Knowing the mechanism of action and uses of the Class I group of drugs, 4. Recognizing the term 'use-dependent' block, 5. Understanding the mechanism of action and uses of the Class II group of drugs, 6. Knowing the mechanism of action and uses of the Class III group of drugs, 7. Understanding the mechanism of action and uses of the Class IV group of drugs, 8. Knowing the mechanisms of action and uses of the unclassified drugs.

Dysrhythmias arise from four broad categories of events: Ectopic pacemaker activity, Delayed after-depolarizations, Circus re-entry, and Heart block.

The spontaneous electrical discharge of the SAN (Sinoatrial Node) is from the combined effect of a decrease in K+ outflow, 'funny' Na+ current, and slow inward Ca2+ current.

Dysrhythmia (arrhythmia) in the heart could be due to changes in the heart cells, changes in the conduction of the impulse through the heart, or combinations of these factors.

Dysrhythmias (arrhythmias) are broadly classified based on the site of the origin of the abnormality as Atrial (supraventricular), Junctional (associated with the AV node), or Ventricular.

The reminders of the basic physiology related to dysrhythmias include the spontaneous electrical discharge of the SAN, the major changes that could lead to dysrhythmia in the heart, and the broad classification of dysrhythmias based on the site of the origin of the abnormality.

Disopyramide, lignocaine, and flecainide.

They are used for ventricular dysrhythmias and prevention of atrial fibrillation triggered by vagal overactivity.

It is used for the treatment and prevention of ventricular tachycardia and fibrillation during and immediately after myocardial infarction.

They block β-1 receptors, slowing the heart and decreasing cardiac output.

They are used in tachycardia associated with the Wolff-Parkinson-White syndrome and other supraventricular and ventricular tachyarrhythmias.

They block cardiac voltage-gated L-type calcium channels, reducing the force of contraction of the heart.

It is used to terminate supraventricular tachycardias by hyperpolarizing cardiac conducting tissue and slowing the heart rate.

The potential additions include HCN (pacemaker) Channel Blockers (Class 0) and potential upstream target modulators like statins and ACE inhibitors (Class VII).