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the study of blood moving through the circulatory system - Correct Answer- hemodynamics indicates the volume of blood moving during a particular time - Correct Answer-flow (also called volume flow rate) units for flow - Correct Answer-L/min indicates the speed of a fluid moving from one location to another - Correct Answer- velocity units for velocity - Correct Answer-cm/s 3 basic forms of blood flow - Correct Answer-1. pulsatile
- phasic
- steady occurs when blood moves with a variable velocity due to cardiac contraction, and appears in arterial circulation - Correct Answer-pulsatile flow occurs when blood moves with a variable velocity due to respiration, and appears in venous circulation - Correct Answer-phasic flow occurs when a fluid moves at a constant speed or velocity - Correct Answer-steady flow flow that occurs when the flow streamlines are aligned and parallel - Correct Answer- laminar when are laminar flow patterns found? - Correct Answer-normal physiological states 2 forms of laminar flow - Correct Answer-plug flow- occurs when all of the layers and blood cells travel at the same velocity parabolic- bullet-shaped profile where the velocity is highest in the center of the lumen number that predicts whether flow is laminar or turbulent - Correct Answer-Reynolds number What is the Reynolds number for laminar flow? - Correct Answer-less than 1500
flow characterized by chaotic flow patterns in many different directions and speeds - Correct Answer-turbulent flow when is turbulence commonly observed? - Correct Answer-cardiovascular pathology and elevated blood velocities turbulent flow profiles may be seen downstream from a significant _______ in a vessel - Correct Answer-stenosis sounds that are associated with turbulent flow - Correct Answer-murmur/bruit tissue vibration associated with turbulence - Correct Answer-thrill what is the Reynolds number for turbulent flow? - Correct Answer-greater than 2000 Term for blood that is moving from regions of higher energy to lower energy. - Correct Answer-energy gradient energy forms that are associated with blood - Correct Answer-1. kinetic
- pressure
- gravitational the total energy at a specific location within the circulation is the _____ of all three energy forms - Correct Answer-sum energy that is associated with a moving object - Correct Answer-kinetic 2 factors for kinetic energy - Correct Answer-1. mass of object
- the speed at which it moves form of energy that is stored - Correct Answer-pressure energy (aka potential energy) form of energy that is stored- and is elevated - Correct Answer-gravitational thickness of a fluid - Correct Answer-viscosity the tendency of a fluid to resist changes in its velocity is related to - Correct Answer- inertia narrowing in the lumen of a vessel - Correct Answer-stenosis downstream turbulence that results from stenosis - Correct Answer-post-stenotic turbulence the relationship between velocity and pressure in a moving fluid - Correct Answer- Bernoulli's Principle
venous flow in the legs correlates with movement of the diaphragm. Downward movement of the diaphragm (inspiration) _______ venous flow in the legs. Upward movement of the diaphragm (expiration) ________ venous flow in the legs. - Correct Answer-decreases; increases changes in venous return to the heart are ________ to those of venous flow in the legs - Correct Answer-opposite thickness of a fluid - Correct Answer-viscosity percentage of blood made up of red blood cells - Correct Answer-hematocrit 3 forms of energy loss - Correct Answer-viscous, frictional, and inertial relates to the tendency of a fluid to resist changes in velocity - Correct Answer-inertia inertial energy loss occurs during three events: - Correct Answer-pulsatile flow, phasic flow, and velocity changes at a stenosis structures that are thin-walled and collapsible, and are usually low-resistance - Correct Answer-veins measured pressure= - Correct Answer-circulatory (140mmHg) + hydrostatic pressure during inspiration, venous flow in the legs ______ - Correct Answer-decrease all of the following occur during expiration except A. venous return to the heart decreases B. venous flow in the legs increases C. abdominal pressure increases D. the diaphragm rises into the thoracic cavity - Correct Answer-C. - abdominal pressure decreases during expiration 2 - D: PI - Correct Answer-(RVVO): Right ventricular enlargement with paradoxical septal motion Possible fine diastolic fluttering of the tricuspid valve PHTN 2-D: - Correct Answer-T PAEDP and RVEDP RVH-Right ventricular hypertrophy RVE-Right ventricular enlargement "D" shaped left ventricle during systole and diastole; flattened septum RAE-Right atrial enlargement TR- Tricuspid regurgitation Small LV dimension Pulmonary artery dilatation
PI-Pulmonary insufficiency IVC and hepatic veins dilatation with no IVC collapse VPS 2-D - Correct Answer-Thickened pulmonic valve leaflets Systolic "doming" of the pulmonary valve leaflets Right ventricular pressure overload (RVPO)which leads to-> Right ventricular hypertrophy (RVH) Flattened IVS, "D" shaped left ventricle, due to RVPO Right atrial enlargement (RAE) ⬆️ RAP Post-stenotic dilatation of the main pulmonary artery(due to turbulant flow and the PS jet striking the pulmonary artery wall) Infundibular Pulmonary Stenosis - Correct Answer-Right ventricular hypertrophy (RVH) Narrowing of the right ventricular outflow tract Right atrial enlargement (RAE), due to ⬆️ RAP Post-stenotic dilatation of the main pulmonary artery Aortic Dissection 2-D Echo: - Correct Answer- AORTIC DISSECTION 2-D Echo: - Correct Answer-aortic dissection. (LAX, SAX, AP5, AP2, AP3 d Suprasternal) Presence of an intimal flap appearing as a thin- linear structure. Pericardial effusion/tamponade indicates a rupture of the dissection into the pericardium(bad news!). Perform a complete echo on every patient, cover all views. What is an EKG? - Correct Answer-A graphic recording of the electrical potentials generated by the heart What are the advantages of EKGs? - Correct Answer-Noninvasive, inexpensive, highly versatile, immediately available What is an echocardiography? - Correct Answer-Uses ultrasound technology to visualize the heart What are the advantages of an echo? - Correct Answer--can be used in real time to visualize the heart
- gives instant information on the myocardium, chambers, valves, pericardium What are the two types of echocardiogram? - Correct Answer-Transthoracic echo (2D) and transesophageal When do we use the 2D Transthoracic echo? - Correct Answer--ideal imaging for assessing LV size and function
- gold standard for valve morphology and motion
- imaging test of choice to detect pericardial effusions and tamponade
Stress echocardiogram - Correct Answer-Uses ultrasound to view the function of the heart before and during exercise to detect any decreased blood flow to the heart Nuclear stress test - Correct Answer--Injection of isotope which emits photons , you will see less uptake in areas supplied by stenosis arteries.
- used to assess ventricular functioning, myocardial perfusion, coronary artery disease, myocardial metabolism and viability. What is an MRI used for? - Correct Answer-Good at viewing myocardium and great vessels, assessment of congenital heart disease, cardiomyopathies and cardiac masses What is MRA angiography used for? - Correct Answer-Used to evaluate vessels and intra-vessel abnormalities, particularly congenital abnormalities
- not used for coronary arteries
- uses gadolinium What is MRI perfusion used for? - Correct Answer--used to assess pts with known or suspected CAD, bonus contrast and see areas of decreased intensity at rest as well as with stress What do we use CT for? - Correct Answer-Good at evaluation of pericardial calcification , cardiac masses, coronary calcifications What does CTA evaluate? - Correct Answer-Intra vessel abnormalities What is cardiac catheterization and coronary angiography? - Correct Answer--*gold standard in assessment of the anatomy and physiology of the heart and all its vasculature When do we use cardiac cath? - Correct Answer--to evaluate the extent and severity of cardiac disease in symptomatic pts
- to determine if medical interventions necessary
- to exclude severe disease in pts who have equivocal findings What are the types of cardiac cath angiographies? - Correct Answer--right(not common), left, coronary What is the most common risk from cardiac cath invasive procedures? - Correct Answer-Access site bleeding Where do they gain access to the heart with cardiac cath lab? - Correct Answer- Through femoral artery (L) and femoral vein (R)
What is the point of the angiography when performed with cardiac cath? - Correct Answer--Defines anatomy of coronary vessels and the extent of coronary disease
- if >50% is considered significant superior vena cava - Correct Answer- right atrium - Correct Answer- right pulmonary artery - Correct Answer- right pulmonary veins - Correct Answer- tricuspid valve - Correct Answer- right ventricle - Correct Answer- chordae tendineae - Correct Answer- inferior vena cava - Correct Answer- septum - Correct Answer- left ventricle - Correct Answer- aortic semilunar valve - Correct Answer- bicuspid valve - Correct Answer- pulmonary semilunar valve - Correct Answer- left pulmonary veins - Correct Answer- left atrium - Correct Answer- left pulmonary artery - Correct Answer- aorta - Correct Answer- pathway of a drop of blood - Correct Answer-from body→superior and inferior vena cava→right atrium→tricuspid valve→right ventricle→pulmonary semilunar valve→pulmonary artery→lungs→pulmonary veins→left atrium→bicuspid valve→left ventricle→aortic semilunar valve→aorta→body I - Correct Answer-Iodine I - Correct Answer-LAG
Phase 3-early repolarization sodium/potassium pump - sodium & potassium are pumped out. Phase 4 - resting membrane potential- sodium & calcium remain outside of cell -- potassium remain inside. - Correct Answer-Action potential Mitral SV-Aortic SV / mitral SV x 100% Aortic SV - Mitral SV / aoryic SV x 100% - Correct Answer-Mitral & Aortic Regurgitation fraction Decreases Sympathetic - atria & ventricles Parasympathetic- vagus nerve mostly atrial - Correct Answer-How does vagus nerve stimulation affect the HR? Always Regurgitant lesion is first. - Correct Answer-MR or AS which will be first? First- closure of Mitral & tricuspid valves Second - closure aortic A2 & pulmonic P2 valves Third - early diastolic ventricular inflow Fourth - atrial contraction - Correct Answer-Heart Sounds 4th - Correct Answer-Patient with A-fib what heart sound is missing? Anterior interventricular sulcus - Correct Answer-Where does the LAD originate? Power (watts)
Beam area (cm)^2 - Correct Answer-Intensity equation (Amplitude) ^2 =dB - Correct Answer-Power equation Wavelength mm= propagation speed / frequency 1.54/frequency =wavelength mm - Correct Answer-Wavelength equation
cycles in a pulse x period = Pulse Duration (us) - Correct Answer-Pulse duration
equation
of cycles x wavelength mm= SPL mm - Correct Answer-SPL equation
Prpxprf - Correct Answer-PRF equation High PRF - Correct Answer-Shallow image = Lower PRF - Correct Answer-Deep image =
Imaging depth increases - Correct Answer-As PRP increases Imaging depth decreases - Correct Answer-As PRP decreases Impedance (Rayls) = density x propagation speed - Correct Answer-Impedance Equation SPL/2=mm - Correct Answer-LARRD equation TGC's - Correct Answer-What will you adjust if you cannot see the reflectors in the near field on your image? TGC's - Correct Answer-What will you adjust if you cannot see reflectors in the far field on your image? 2 x reflector speed x incident frequency x cos angle/ propagation speed - Correct Answer-Doppler shift equation CW, transducer with lower frequency, new view, increase scale, baseline shift,reduce the Doppler shift, raise niquist limit - Correct Answer-Eliminating Aliasing Multiple pulses are called a packet Color Doppler measures "mean" velocity PW & CW measures peak velocity Color flow measures mean velocity - Correct Answer-Doppler packets 1/2 the PRF - Correct Answer-Niquist frequency 90 degrees Increase color gain Decrease scale - Correct Answer-No color High pass filter & wall filter - Correct Answer-What 2 words describe ghosting & low velocity flows? Doppler gain set too high & angle is set close to 90 degrees - Correct Answer-Image is mirrored above & below the baseline what causes that? Peak rare fraction pressure /frequency - Correct Answer-Memechanical index equation EDV-ESV SV/EDVx100% SVxHR 4v^2 - Correct Answer-Stroke Vol. EF
.7 - Correct Answer-Vena contracta severe MR 1.5 - Correct Answer-Mitral inflow velocity 0.4 cm^2 - Correct Answer-ERoA severe MR LV systolic function 1200 mmhg/sec - Correct Answer-dP/dt measures MR asses what!? Posterior & apical filling - Correct Answer-Chagas' disease B notch - Correct Answer-Dilated CM has a what on m mode? Has a speckled appearance .. Amyloidosis Ground glass appearance Infiltrative myocarditis (bright) Decreased LV compliance - Correct Answer-Restrictive/ infiltrative cm Dilated - 15 - 25% Hypertrophic - 60 - 70% - Correct Answer-EF for dilated CM EF for Hypertrophic CM Pseudo normal pattern - Correct Answer-Patient has a normal MV inflow but pul. Veins show decreased S & D they have 18 - 30 norm 70 severe - Correct Answer-Pulmonary artery pressure Systolic BP- MR gradient - Correct Answer-LAP equation Cad,ruptured pap, aneurysm formation, - Correct Answer-Ischemic heart disease Peak + RV& LV - - Correct Answer-What is peak pressure vs RVSP & LVSP Eisenmenger syndrome - Correct Answer-PDA does close what pathology happens? Overriding aorta Perimembranous vsd Ps
RVH - Correct Answer-Tetralogy of fallout (4) Mustard procedure - Correct Answer-Great vessels are switched Papillary fibroblastoma - Correct Answer-Most common benign tumor
Angiosarcoma - Correct Answer-Most common malignant tumor in RA LA - Correct Answer-Myxomas are mostly in AV septal defects, VSD , priming ASD cleft MV - Correct Answer-Trisomy 21 is
1 for left to Right Shunt <1 for right to left shunt - Correct Answer-QP/Qs for ASD I - Correct Answer-Iodine I - Correct Answer-LAG
