Overview
This lecture is a review of echocardiography registry exam questions, covering calculations, cardiac pathologies, imaging interpretation, and related clinical concepts.
Valve & Hemodynamic Calculations
- Valvular area is confirmed using 220 divided by pressure half time (not the reverse).
- Left atrial pressure = Systolic blood pressure – mitral regurgitation gradient.
- Left ventricular end diastolic pressure = Diastolic blood pressure – aortic regurgitation end diastolic gradient.
- Pulmonary artery end diastolic pressure = Right atrial pressure + pulmonary artery end diastolic pressure.
EKG & Cardiac Pathology Identification
- Atrial flutter is indicated by sawtooth EKG patterns.
- Systolic anterior motion (SAM) describes anterior mitral leaflet motion into LVOT during systole.
- The left circumflex artery is identified in labeled cardiac anatomy.
- Most common defect with coarctation is bicuspid aortic valve.
- Mitral stenosis is most commonly caused by rheumatic disease.
- Hollow diastolic murmur refers to aortic regurgitation, not pulmonic regurgitation.
Imaging Interpretation
- Apical hypertrophic cardiomyopathy appears as an “ace of spades” pattern.
- Concentric left ventricular hypertrophy has a specific longitudinal strain pattern.
- Right ventricular volume overload shows septal flattening in diastole and rounding in systole.
- The right upper pulmonary vein is used to evaluate mitral regurgitation.
- Click identification of anterior mitral valve leaflet is required.
- Rhabdomyosarcoma is the most common cardiac tumor in children and infants.
3D Echocardiography
- 3D echo images are constructed from a series of 2D images.
- Quality depends on 2D image quality, number of images, and adequate EKG (not on using frequency >10 MHz).
- Best 3D/4D imaging occurs during suspended respiration.
Congenital & Acute Complications
- Acute RCA or circumflex occlusion can cause idiopathic hypertrophic subaortic stenosis with SAM, leading to loud systolic murmur and pulmonary edema.
- High resistance patent ductus arteriosus has small flow across the duct.
Exam & Clinical Protocols
- Physician must interpret a baseline echo study for CHF by end of the next business day.
- Correct pericardial wall order from inside out: Epicardium → Parietal pericardium → Fibrous pericardium.
Key Terms & Definitions
- SAM (Systolic Anterior Motion) — Anterior mitral valve leaflet pushed into LVOT during systole.
- LVOT (Left Ventricular Outflow Tract) — Region where blood exits the left ventricle.
- Pulmonic Regurgitation — Backward flow of blood through the pulmonary valve.
- Bicuspid Aortic Valve — Aortic valve with two leaflets instead of three.
Action Items / Next Steps
- Review additional registry questions as they are uploaded.
- Study cardiac pathology strain patterns and calculation formulas.
- Practice identifying cardiac anatomy and valve function on imaging clips.