Echo Final Final Review Key Terms Part I PDF

ECHO FINAL FINAL REVIEW Chapter I: SPI 1.​Sound- is a creation due to vibration of a moving structure 2.​Sound waves are made of- compressions and rarefactions 3.​Compressions- higher pressure in density 4.​Rarefactions- lower pressure in density 5.​Sound is what type of wave-...

ECHO FINAL FINAL REVIEW Chapter I: SPI 1.​Sound- is a creation due to vibration of a moving structure 2.​Sound waves are made of- compressions and rarefactions 3.​Compressions- higher pressure in density 4.​Rarefactions- lower pressure in density 5.​Sound is what type of wave- longitudinal and mechanical 6.​Transverse wave has particles that move in a- perpendicular direction 7.​Longitudinal wave has particles that move in a- parallel direction 8.​Period- time required to complete the cycle 9.​Frequency- number of cycles that occur in a particular time 10.​ Frequency range for Ultrasound: 2-10 Mhz 11.​ Frequency is inversely related to: penetration 12.​ Frequency is related to what resolution: axial 13.​ Higher frequency improves: image quality 14.​ Frequency and Period equation: F (Mhz) x Period (microseconds) = 1 15.​ Amplitude: is the average between the average and maximum; Sonographer can adjust 16.​ Power: the rate at which work is performed or energy transferred; Sonographer can adjust 17.​ Intensity: concentration of energy in a sound beam; Sonographer can adjust, key effects for bioeffects and safety 18.​ Propagation of Speed: rate of sound traveling through a medium; In soft tissue (1.54 mm/ microsecond) 19.​ Wavelength: length of a single cycle 20.​ Wavelength Formula (mm): 1.54/ Frequency (Mhz) 21.​ Pulse Duration: the time from the start to the end of a single pulse 22.​ Pulse is comprised of how many cycles: 2-4 23.​ PRP: time from the start of one pulse to the start of the next pulse; Sonographer can adjust (changes only the listening time NOT DEPTH) 24.​ PRF: number of pulse that occur in 1 second; Sonographer can adjust 25.​ PRP x PRF = 1 26.​ Duty Factor: percentage of time the system transmits a pulse; Sonographer can adjust 27.​ SPL: length or distance the pulse occupies while in space 28.​ SPL determines what resolution: axial 29.​ When the sonographer adjusts the imaging depth… what else will change: DF, PRP, PRF 30.​ Attenuation: decreases the power, intensity, and amplitude of a sound wave 31.​ Attenuation is directly related to: distance traveled and frequency 32.​ Three components of attenuation: absorption, scattering, and reflection 33.​ Absorption: converts energy to heat 34.​ Reflection has 2 types: specular and diffuse (backscatter) 35.​ Specular Reflection: reflections from a very smooth reflector (mirror) and cannot be seen well at 90 degrees 36.​ Diffuse (Backscatter) Reflection: sound returning to the transducer that is disorganized and random 37.​ Attenuation is unrelated to: speed 38.​ Attenuation of sound in blood is the same in: soft tissue 39.​ Rayleigh Scattering: the reflector is much smaller than the wavelength of sound. Sound is uniformly disturbed in ALL directions 40.​ Higher the Frequency in Rayleigh: more scattering 41.​ Reflection in ultrasound depends on: acoustic impedance at the boundary between the 2 media 42.​ Incident Intensity: intensity of a sound wave before striking the boundary 43.​ Reflected Intensity: after striking the boundary it will change in direction and return back to where it came from 44.​ Transmitted Intensity: after striking the boundary it will continue to go in the same direction that it was traveling to 45.​ Reflection = Incident angle 46.​ Incident Intensity = Reflected angle + Transmitted angle 47.​ Refractions: is transmission with a BEND 48.​ Refractions has how many mediums: 2 49.​ Refraction: if speed is 2 > speed 1 = transmission angle is GREATER than incident angle 50.​ Refraction: if speed 2 < speed 1 = transmission angle is LESS than incident angle 51.​ Range equation: Time of Flight in soft tissue is 13 microseconds = 6.5(2 depth)= 13 52.​ Axial resolution: ability to distinguish 2 structures that are parallel to the main beams axis = short SPL 53.​ Axial Resolution = SPL (mm)/ 2 54.​ Axial Resolution in Soft Tissue = 0.77 x # cycles/ F (MHZ) 55.​ Lateral Resolution: separated structures that are side by side and perpendicular to the main beam 56.​ Lateral resolution will vary with: depth 57.​ Lateral resolution is best focused at the: NZL (focal point) because it's the narrowest point 58.​ Contrast Resolution: viewing different shades of gray 59.​ Decreasing Dynamic Range = fewer shades of gray and INCREASING Contrast 60.​ Increasing Dynamic Range = more shades of gray and DECREASING Contrast 61.​ Narrower the sound beam = better quality image 62.​ Focal point: narrowest diameter 63.​ NZL (Fresnel Zone): area between the transducer and focal point 64.​ FZL: zone deeper than the focal point and beyond NZL 65.​ Focal Zone: surrounds the focus and images are relatively good 66.​ Unfocused CW Transducer: end of the NZL, beam diameter is ½ transducer diameter or at 2 NZL the beam diameter is EQUAL to transducer diameter 67.​ Focal Depth: distance from transducer to focal point 68.​ Focal Depth is determined by: transducer diameter and frequency 69.​ Focal Depth: use Electronic Phased Array for multi-focusing (to view shallow and deeper depths) 70.​ Sound Beam divergence: spread of sound beam across the far zone 71.​ Divergence is determined by: transducer diameter and frequency 72.​ Larger diameter crystals: produce higher frequency and diverge less in far field 73.​ Smaller diameter crystals: produce a lower frequency that diverge more in far field 74.​ Matching Layer: purpose is to increase the transmitted US between active element and skin 75.​ Matching Layer is: ¼ of wavelength thick 76.​ Backing material: bonds to the active element and reduces the ringing of the PZT 77.​ Backing Material advantage: can shorten the SPL and PD 78.​ Phased Array: adjusts the focus or is multi-focus; focusing and steering are electric 79.​ Real Time Imaging: production of a motion picture and is dependent on Temporal Resolution/ FR 80.​ Real Time Imaging has TWO factors: imaging depth and speed of medium 81.​ Temporal Resolution: shallow depth improves TR 82.​ If Imaging Depth is doubled: the FR is ½ of it 83.​ Single Focus Transducer: uses only 1 scan line = Improved TR 84.​ Multi Focus Transducer: uses multiple scan lines = Degraded TR 85.​ Smaller the SECTOR SIZE: less scan lines = Improved TR 86.​ Bandwidth: range of frequencies that are above or below the MAIN frequencies 87.​ CW transducer: frequency of transducer is determined by it voltage applied by PZT 88.​ Pulse Transducer: frequency is determined by propagation of speed and its thickness 89.​ Harmonics (Second Harmonic): created reflected sound that is double the FUNDAMENTAL frequency 90.​ Tissue Harmonic: harmonic will not show when the beam is WEAK, OFF-AXIS, or appearance of SIDE LOBES 91.​ Pulse Inversion: positive and negative pulses are transmitted down the scan line; disadvantage is the FR is ½ the fundamental frequency 92.​ Pulse Inversion degrades: TR while improving spatial resolution 93.​ Doppler Shift: greater the velocities = Greater Doppler Shift 94.​ Doppler Shift measures ONLY: frequency 95.​ What extracts the doppler frequency: Demodulator 96.​ Doppler Shift relationships: Directly related to frequency and Inversely related to speed of sound 97.​ CW Doppler (2 crystal) : accurately measured BUT subjected to the Range Ambiguity artifact (overlapping of echos) 98.​ PW Doppler (1 crystal): range resolution (NO range ambiguity) BUT subjected to aliasing (errors in HIGH velocities) 99.​ Aliasing happens when: Nyquist limit is ½ of the PRF 100.​Less chance of aliasing occurs: at shallow SV when the Nyquist Limit is HIGHER or Greater Velocity Scale 101.​Color Flow Doppler: doppler shifts are coded into colors and IDENTIFIES blood flow/ velocities of the structure 102.​Color Flow has: Range resolution BUT subjected to aliasing 103.​Color doppler reports: MEAN velocities 104.​Color Maps: convert velocities into COLORS 105.​Aliasing in Color Doppler in the vessel: RED→ LIGHT BLUE→ DARK BLUE in center 106.​Doppler Packets: are multiple pulses; must balance velocity measurements and TR to determine packet size 107.​Spectral analysis (measures velocities of individual signals of CW: use FFT 108.​ Spectral analysis of PW: us Autocorrelation 109.​B mode: from standard shades of gray to alternative color display 110.​Overall gain: adjusts the overall brightness of the image  111.​ Zoom Function: magnifies a specific area; Axial resolution is the most powerful here Chapter II: Artifacts 1.​Simple Reverberation: bouncing of the signals, object will appear below the structure and twice as deep 2.​Comet Tail: bouncing of the signals at multiple levels, object will appear below the structure 3.​Near Field Clutter: usually appears as a cloud at the apex and can be reduced by THI 4.​Mirror Imaging: common in the pericardium, Goal Return Time is longer, and strong reflector 5.​Acoustic Shadow and Enhancement: more power would result in a brighter structure 6.​Refractive Artifact: different ultrasound speeds and results is a partially duplicated structure, and most common in the AV 7.​Refractive Artifacts: duplicated partial image of the object and GRT requires extra time 8.​Refractive Artifact: easily eliminated by alternating the transducers angle and position 9.​Beam Width Artifact: highly reflective object at the wide base of the beam and will originate from the focal zone 10.​ How to mitigate the Beam Width Artifact: adjust the focal zone toward the level of interest and diminish the gain 11.​ Side Lobe Artifact: (calcification) strong reflector, less attenuation, and extra angulation can see the Side Lobe Artifact 12.​ How to mitigate the Side Lobe: TURN on harmonic imaging 13.​ Suboptimal Imaging: related to LOW SNR, grainy appearance, and frequency not correct 14.​ Range Ambiguity: returning echos generated from the transmitted are violated; treatment is adjust by INCREASING imaging depth/ PRF 15.​ Wall Drop Artifact: poor specular reflection at 90 degrees; IAS and Lateral wall dropout 16.​ Refractive Shadowing: beam is bended away and registration will become BLACK 17.​ Enhancement: TGC banding is increased; treatment bring TGC to opposite direction 18.​ Speed Error Artifact: assumption the propagation of speed of sound is constant 19.​ Smaller SV: will provide more clarity of the spectral signal 20.​ Normal SV: 2-3 mmm 21.​ SV for slow flow: 3-5 mm eg. Pulmonary/ Hepatic vein or IAS 22.​ Sweep Speed: change number of cardiac cycles and use a HIGHER sweep speed of 100 mm/s 23.​ LOWER sweep speed we can see: inspiration and expiration cycles 24.​ Wall Filter: recommended to use a lower WF because it will not record the correct frequency 25.​ Tissue Doppler Imaging: records tissue movement; amplitude and brightness of the signal 26.​ Tissue Doppler: use larger SV and lower velocity scale 27.​ TDI range: less than or equal to 25 cm/s 28.​ To capture slow flow with color: reduce the velocity scale or Nyquist to 40 cm/s + WF is 4 cm/s 29.​ WF can be enlarged by raising the: Nyquist Limit or Color scale 30.​ If aliasing exceeds the Nyquist Limit… how would you resolve: USE CW because of the change in the velocity scale and frequency 31.​ Mirror Imaging: Doppler angle would be too close to 90 degrees and have increased gain 32.​ Beam Width ARTIFACTS: spectral signals overlap; treatment would be to adjust the focal zone and gain  33.​ Click artifact: valve opens and closes with creating a peak signal in the same direction as the blood flow. 34.​ Click artifact usually appears in: mechanical valves and appears to be amplified 35.​ Spectral Broadening: has a large SV with high sensitivity BUT reduced resolution or OVERGAIN 36.​ Color overgain: speckles or noise with color; bring color gain DOWN 37.​ Color aliasing: turbulent flow usually indicates a stenotic lesion eg. MS 38.​ Color Mirror Image: usually seen in IVC or Subcostal 39.​ Color Doppler Shadowing: can be showing in 2D and Color Doppler with BLACK in the middle 40.​ Side Lobe Artifact with COLOR: color signals are shown on the side due to a strong reflector OR regurgitation 41.​ Electrical Interference Artifact: a device used to record TEE in surgery or BROKEN PROBE Chapter III: 2D Measurements 1.​What measurement is the most preferred: Volumetric 2.​Linear Measurement is preferred over what: M mode 3.​Proximal RVOT: 17MM 22.​ Bernoulli Principle: law of conservation of energy and can be demonstrated in a stenotic lesion 23.​ Mean Velocity can be calculated by: tracing the VTI/ time 24.​ Bernoulli equation = 4V(2)^2 calculates velocity at the narrowing of the vessel 25.​ RVSP = 4V(2)^2 + RAP (velocity from TR signal) 26.​ If no PS: RVSP = PASP 27.​ RAP: Dilation and Collapse (Normal is 0.7 39.​ EROA: narrowest part of the flow BUT cannot determine the severity on its own so we need to TRACE the area 40.​ Flow Convergence: will have a dome appearance with high velocities demonstrated by color due to aliasing 41.​ In Flow Convergence when Blue (lower velocity) becomes Red (higher velocity) = Flow EXCEEDS Nyquist Limit 42.​ PISA Radius: clears the flow convergence by shifting the baseline to the direction of the jet 43.​ PISA radius can calculate the EROA: 6.28 x R^2 x Aliasing velocity/ Peak velocity of REGURGITATION 44.​ Coanda Effect: Eccentric jet where it imposes in the receiving chamber and will lose energy 45.​ Recruitment Effect: overestimation of the central jet 46.​ (SV) Flow volume: CSA x VTI 47.​ Flow Rate: CSA x Velocity 48.​ CSA: 0.785 x D^2 49.​ Cardiac Output: SV x HR 50.​ Continuity Equation: law of conservation of mass/ volume = flow in ONE area must be equal in the SECOND area if they’re no SHUNTS  51.​ Continuity (AVA) = 0.785 x D^2 of LVOT x VTI of LVOT / VTI of AV 52.​ SV of MV = CSA (0.785 x D^2) x VTI 53.​ Mitral Regurgitation Volume = MV SV - AO SV which assesses the severity of the regurgitation 54.​ Aortic Regurgitation Volbe = AO SV - MV SV 55.​ Regurgitation Volume = EROA x REGURGE VTI 56.​ EROA (in AR/MR) = REGURGITATION VOLUME/ VTI of REG JET Chapter IV: LV Geometry and Systolic Function 1.​D Shaped LV can indicate: IVS flattening; LV D shaped in end systole/ diastole = RV pressure overload or ONLY in diastole = RV volume overload 2.​Flatten IVS during systole and diastole indicates: Pulmonary HTN 3.​RV D shape in diastole indicates: RV volume overload 4.​LV wall thickness (Anteroseptal wall is thinned out): OLD MI and will have an impact on LV systolic function (EF) 5.​True Aneurysm: usually seen at the apex and the wall of the myocardium is DEAD so it will bulge out 6.​Pseudoaneurysm: neck is NARROW (½ size of the aneurysm; high risk of rupture of the wall and can cause a THROMBUS to form 7.​Spontaneous contrast: precursor of thrombus 8.​LV Geometry: RWT (7 and Lateral annulus >10 NORMAL values  19.​ Fractional Shortening M mode: LVEDD - EVESD/ LVEDD 20.​ MPI = IVCT + IVRT / ET Chapter V: Diastolic Dysfunction 1.​Supernormal Filling: LV vigorously sucks the blood from the LA; causing the E wave to be double (X2) the A wave. A wave which represents the LA has little blood left to contract causing the IVRT (>100 MS) to be short 2.​If you do not have Impaired Relaxation: NO Diastolic Dysfunction 3.​Impaired Relaxation: the LV is unable to relax due to stiffness so it cannot receive as much blood from the LA; E wave will appear smaller than the A wave increasing the IVRT (>100 MS) and DT (>240 MS) = (E/A IS 2.8 = Pulmonary HTN 17.​ High LAP can result in: bowing or concurring toward the RA 18.​ Valsalva Maneuver: reduces venous return to the Atrium and will cause a drop in the Atrial pressure; this maneuver will unmask elevated pressures 19.​ Valsalva will use what method: strain method by holding their breath and strain similar to a bowel  movement to INCREASE the venous return (if they’re is an elevated LA pressure) 20.​ Valsalva Maneuver: the E/A ratio must change by 50% and is used in Grade II commonly to unmask the high LAP 21.​ Color Doppler M mode: Flow propagation: marker of impaired relaxation; Normal value is >45 cm/s commonly used in Grade I 22.​ Diastolic Dysfunction with LOW EF criteria: Avg E/e >14, TR velocity > 2.8 m/s, LA Volume > 34 ml/m^2 = BASED OFF OF HIGH LAP (Grade III E/e’ >2 AUTOMATICALLY HIGH LAP) 23.​ Use Valsalva: when you cannot determine the grade of Diastolic Dysfunction or LAP 24.​ Diastolic Stress Test: look for RVSP >70 MMHG is abnormal and TR velocity > 2.8 m/s is abnormal = Pulmonary HTN 25.​ Diastolic Dysfunction in A fib: DT 11 = HIGH LAP but cannot grade the dysfunction 26.​ Diastolic Dysfunction in Tachycardia: will cause the fusion of the E/A wave which can be resolved by applying a carotid massage to separate the E and A wave Chapter VI: Wall Motion Abnormality 1.​Regional Wall Motion: can cause is Ischemic HD and systolic dysfunction 2.​Know the segments of all views: Main Apical, Mid, and Basal of the LV 3.​Dyskinesia: bulging in systole outward movement 4.​Hypokinesia: normal movement of LV wall but thickness is reduced to 30 percent 5.​Akinesia: absent motion and thickness is reduced to 10 percent 6.​Aneurysmal: geometrical distortion; outward movement in systole and diastole 7.​Wall Motion Index: can be a predictor of Wall Motion grading and Congestive HF 8.​Know the coronary arteries of each segment 9.​Thinning of the LV: Old MI 10.​ Tardokinesia: delayed in onset contraction (inward motion or thickening) that is seen in stress echo 11.​ SERP: occurs in early diastole in a stress echo commonly in the Apical and Mid Septum distribution of the LAD Coronary artery 12.​ LBB Block: known to cause Regional WMA; delayed activation of the LV leads to early right to left movement of the septum “jerky septum” 13.​ Septal Flash: inward and outward motion of the septum of the lateral wall  14.​ Septal Beaking: seen in M mode as a short inward movement at onset QRS and peaks at the same time as inward motion of the Inferolateral wall 15.​ RV Pacing: can produce WMA at the site of the Pacing wire insertion 16.​ RV Volume Overload: D shape at the end of diastole and septal flattening during diastole 17.​ RV Pressure Overload: D shape of the LV at end of diastole and systole with septal flattening in M mode 18.​ Pseudo-Dyskinesia: In PSAX the inferior wall is evident due to diastolic flattening but there is no evidence of systolic bulging (TRUE DYSKINESIA) Chapter VII: Ischemic HD 1.​The LV shape can be changed in size and shape due to: MI or CMP 2.​Cardiac Remodeling changes the shape and size of the LV after a heart attack resulting in: deteriorating cardiac function and eventually HF 3.​Ischemic CMP: most common dilated CMP; heart cannot pump properly due to MI damage brought on by ischemia and can lead to Congestive HF 4.​When Ischemia is prolonged for time: cardiac muscle is damaged resulting in cardiac remodeling 5.​Speckle Tracking: demonstrates a strain pattern to assess the systolic function of the LV; Red and >-20 is considered healthy and Blue is unhealthy on the Bulls Eye Chart (assessed in A4CV, A3CV, A2CV) 6.​When the Septal segment is affected on the Bull’s Eye: Hypertrophic CMP 7.​Global Problem on the Bull’s Eye: Dilated CMP GLS is -6.7 8.​Cherry on Top of the Bull’s Eye: Amyloidosis (Apical and Mid segments are spared) 9.​Most accurate Stress TEST: treadmill with echocardiography to reveal ISCHEMIA 10.​ Dobutamine Stress Test: will increase contractility and dobutamine dose will drop 11.​ Ischemic Response Global: for Treadmill = INCREASED EDV, DECREASED ESV, RISE OF EF 12.​ Ischemic Response Global: for Dobutamine = 13.​ INCREASED EDV, DECREASED ESV, DROP OF EF 14.​ Hypertensive Response to Exercise: Systolic BP 220 MEN OR 190 WOMEN + Diastolic BP of >90 MMHG = DURING EXERCISE  15.​ Hypotension during STRESS: Systolic BP 35 8.​RV 3D EF: can only get the EF of RV with 3D; >45 % only 9.​RV Volume overload M mode: enlarged RV, flatten septum, paradoxical motion of septum in SYSTOLE 10.​ RV Pressure overload M mode: flatten od septum in systole and diastole 11.​ PASP = RVSP if there is NO PS; RVSP = 4(V)^2 + RAP 12.​ RAP NORMAL = < 2.1 DILATION & > 50 % IN COLLAPSIBILITY CAPTURED IN IVC  13.​ RVSP CALCULATES THE VSD GRADIENT = LVSP - VSD (4 x Peak V^2 of PV) 14.​ PADP IN CW = PR (EDV) GRADIENT + RAP, no TS 15.​ PAMP IN CW = PR PEAK GRADIENT + RAP 16.​ PAMP IN PW = 80 - (0.5 x PV ACC TIME) 17.​ If PAMP is high: can result in Pulmonary HTN which effects the RV inferior wall 18.​ McConnel’s Sign: pulmonary pressure is so HIGH and can cause Pulmonary Embolism; RV is dilated = RV Infarction and MID RV free wall is akinetic Chapter VIII: Aortic Stenosis 1.​AS fluid dynamics: acceleration of flow of the narrowing, turbulent flow, narrowest diameter with MAX velocity 2.​Vena Contracta: narrowest diameter with MAX velocity 3.​Geometrical Area Orifice: the MAX opening that is physiological 4.​Effective Orifice Area: MAX pressure gradient between LV and AV 5.​Normal AV: has 3 cusps RCC, NCC, LCC; closes in diastole and opened in systole 6.​Normal AV M mode: In the Aortic Root needs to have an anterior and posterior movement; Central closure line in diastole 7.​Rheumatic AV: thickening of the leaflet tip and narrowing that leads to COMMISSURAL FUSION; and there are still 3 leaflets present 8.​Bicuspid AV (Congenital): weakened valve that is can experience calcification or degenerative; leads to COMMISSURAL FUSION with 2 leaflets present 9.​Bicuspid AV (Degenerative) and Rheumatic AV: common in patients 70 y/o 10.​ Decompensated AS: gradual progression of stenosis and orifice is ½ than Normal; Increased LV pressure (afterload) and LVH will increase it to compensate for this and LVH will decrease the LV END DIASTOLIC pressure AND LEAD TO ISCHEMIA = Decreased contractility and lead to HF 11.​ Calcific AS (Degenerative): Sclerosis with increased echogenicity at the base of the valve leaflets; without significant LVOT obstruction; 25 % of patients >65 y/o patients have this 12.​ Calcific AS (Degenerative): has restricted leaflet opening during systole 13.​ Calcific AS (Degenerative): In M mode Aortic leaflet is parallel and thickened; AV closure has reverberation lines 14.​ Bicuspid AV: 4 B.​Mean PG 40 C.​AVA >1.5 1.0-1.5 4.0 cm 27. Subvalvular AS: less turbulent flow to open AV, LVOT fixed obstruction (valve does NOT change) 28. Subvalvular AS in M mode: early systolic notching (early systolic closure) 29. HOCM AS in M mode: mid systolic notching with Dynamic LVOT Obstruction- gets WORSE as systole proceeds 30. Fixed AS Obstruction: peaks in EARLY to MID systole, triangular shape 31. LVOT OBSTRUCTION HOCM “Dagger Shape”: peaks in LATE systole and stenosis continues throughout SYSTOLE 32. LOW Gradient of AS