Mixed Deck — All ARDMS ECHO Topics Flashcards

The RVOT acceleration time (AT) is used to estimate mean pulmonary artery pressure. Which formula applies?

Answer: mPAP = 79 − (0.45 × AT)

mPAP ≈ 79 − (0.45 × RVOT AT in ms) is a validated formula; shorter AT corresponds to higher pulmonary artery pressure.

What is the advantage of using transesophageal echocardiography (TEE) over transthoracic echocardiography (TTE)?

Answer: TEE provides clearer images of posterior cardiac structures

Transesophageal echocardiography (TEE) offers a significant advantage over transthoracic echocardiography (TTE) by providing superior image quality, particularly for posterior cardiac structures. Placing the transducer in the esophagus positions it much closer to the heart, bypassing the ribs, lungs, and chest wall. This proximity and lack of acoustic impedance result in higher resolution images, which are crucial for evaluating structures like the left atrium, mitral valve, and aorta.

What does the velocity-time integral (VTI) of the LVOT represent?

Answer: Stroke distance (distance blood travels per beat)

LVOT VTI represents the stroke distance — the column of blood ejected per heartbeat — and when multiplied by LVOT CSA gives stroke volume.

What is the most common etiology of isolated severe tricuspid regurgitation in the United States?

Answer: Functional (secondary to RV dilation/annular dilation)

Functional TR caused by RV dilation and tricuspid annular dilation (from pulmonary hypertension or LV dysfunction) is the most common cause of severe TR in the US.

Which parameter best differentiates severe mitral regurgitation from moderate on echocardiography using the PISA method?

Answer: EROA ≥ 0.40 cm² and regurgitant volume ≥ 60 mL

Severe primary MR criteria include EROA ≥0.40 cm² and regurgitant volume ≥60 mL per ASE/AHA/ACC guidelines.

A ventricular septal defect (VSD) with left-to-right shunt produces which hemodynamic finding on echo?

Answer: LV and LA volume overload

Left-to-right VSD shunting causes increased pulmonary flow returning to the left heart, resulting in LV and LA volume overload.

In echocardiography, which chamber of the heart is closest to the transducer in a standard parasternal long-axis view?

Answer: Right ventricle

In a standard parasternal long-axis echocardiographic view, the transducer is placed on the chest, typically near the sternum. Due to the heart's anatomical position within the chest, the right ventricle is the most anterior chamber and therefore lies closest to the transducer. This orientation allows for clear visualization of the left ventricle, left atrium, aortic valve, and mitral valve.

Which echocardiographic finding best distinguishes severe from moderate aortic regurgitation?

Answer: Vena contracta width ≥ 0.6 cm

A vena contracta width ≥0.6 cm is a reliable quantitative parameter for severe aortic regurgitation per ASE guidelines.

Which congenital anomaly is characterized by absence or severe hypoplasia of the left-sided cardiac structures?

Answer: Hypoplastic left heart syndrome (HLHS)

HLHS features severe hypoplasia of the left ventricle, mitral valve, aortic valve, and ascending aorta, requiring staged surgical palliation or transplant.

In Doppler echocardiography, what is spectral broadening?

Answer: Widening of the spectral envelope due to a range of velocities in the sample volume

Spectral broadening occurs when a wide range of velocities exists within the sample volume, filling in the normally clear spectral window.

The pressure half-time (PHT) method calculates mitral valve area using which formula?

Answer: MVA = 220 / PHT

MVA = 220 / PHT (ms), where PHT is the time for the mitral E-wave peak pressure gradient to fall by half.

Which Doppler measurement is used to calculate cardiac output in echocardiography?

Answer: Stroke volume × heart rate

Cardiac output is calculated by multiplying stroke volume (derived from LVOT VTI and diameter) by heart rate.

A quality assurance (QA) program in an echocardiography lab should include which of the following?

Answer: Ongoing peer review of studies, measurement reproducibility assessment, and protocol compliance monitoring

A comprehensive QA program includes peer review, measurement variability assessment, protocol adherence, turnaround time tracking, and correlation with clinical outcomes.

What is the recommended surveillance echocardiography interval for an asymptomatic patient with severe mitral valve prolapse and moderate mitral regurgitation?

Answer: Every 1–2 years

Current guidelines recommend echocardiographic surveillance every 1–2 years for asymptomatic patients with moderate MR due to MVP to monitor for progression to severe MR or LV dysfunction.

Which color flow Doppler finding is characteristic of mitral regurgitation?

Answer: Systolic mosaic jet from LV into LA

Mitral regurgitation appears as a systolic color flow jet directed from the LV back into the left atrium.

Stroke volume (SV) using echocardiography is calculated as:

Answer: LVOT VTI × LVOT cross-sectional area

SV = LVOT VTI × LVOT CSA (π × r²), combining the stroke distance with the outflow tract cross-sectional area to yield volume per beat.

What is the primary purpose of an accreditation program such as the Intersocietal Accreditation Commission (IAC) for echocardiography laboratories?

Answer: To ensure echocardiography laboratories meet standards for quality patient care and diagnostic accuracy

IAC accreditation verifies that echo labs meet defined standards for personnel qualifications, equipment, protocols, quality improvement, and safety.

The interventricular septal bounce in constrictive pericarditis is most pronounced during which phase of respiration?

Answer: Early inspiration

The abrupt septal shift (bounce) in constrictive pericarditis occurs at early inspiration when sudden changes in ventricular filling due to ventricular interdependence are greatest.

What echocardiographic sign is consistent with cardiac tamponade physiology?

Answer: Dilated IVC without respiratory variation, diastolic RV collapse, and exaggerated respiratory variation in tricuspid and mitral inflow

Tamponade is evidenced by a plethoric IVC, diastolic RV free wall collapse, early diastolic RA collapse, and >25–40% respiratory variation in AV valve inflow velocities.

What finding on CW Doppler of the aortic valve suggests dynamic LVOT obstruction (HOCM)?

Answer: Dagger-shaped (late-peaking) signal with mid-systolic notch

Dynamic LVOT obstruction produces a late-peaking, dagger-shaped CW Doppler signal due to progressive systolic narrowing of the outflow tract.