Echocardiography Questions with Correct
Answers
Explain how reverberation-type artifacts occur? Correct Answer-
Reverberation-type artifacts occur because of multiple reflections off the
transducer or strong reflectors. The reverberation lines intensity
decreases ad the distance from the transducer increases. The
reverberation lines are equally spaced and parallel to the main sound
beam
How do you quantify pericardial effusion on Echo? Correct Answer-
Echo free space size between pericardial layers at the end of diastole.
-Trival pericardial effusion: only seen in systole
-Small pericardial effusion: < 10 mm (1.0 cm)
-Moderate pericardial effusion: 10 - 20 mm (1 - 2 cm)
-Large pericardial effusion: 21 - 25 mm (2.1 - 2.5 cm)
-Very Large pericardial effusion: > 25 mm (> 2.5 cm)
When in the cardiac cycle is the volume of pericardial fluid assessed?
Correct Answer-Diastole
How do your grade the severity of Systolic Anterior Motion of the
Mitral Valve? Correct Answer-Grade 1 (Mild): No contact between
mitral valve leaflet and septum in systole with minimum separation
distance of > 10 mm
,Grade 2 (Moderate): No contact between the mitral valve leaflet and
septum with a minimum separation < 10 mm OR contact between the
mitral valve leaflet and septum lasting < 30% of systolic time.
Grade 3 (Severe): Contact between the mitral valve leaflet and septum
lasting > 30% of systolic time.
Causes of diastolic tricuspid regurgitation and diastolic mitral
regurgitation? Correct Answer--Prolonged AV delay
-Complete heart block
-Severe pulmonary valve regurgitation or Severe aortic regurgitation
Causes of increased E-point Septal Separation (EPSS)? Correct
Answer--Aortic regurgitation
-Severe LV dysfunction
-Mitral Stenosis
How can E-point Septal Separation be used to derive the Ejection
Fraction? Correct Answer-LVEF% = 75.5 - [2.5 x EPSS (mm)]
What is normal E-point Septal Separation? Correct Answer-Normal
EPSS < 8mm correlates with EF > 50%
EPSS > 8mm is suggestive of EF < 50%
,What Doppler parameters indicate increased LV filling pressure?
Correct Answer--Ratio of transmitral E velocity to the myocardial e'
velocity (E/e') > 15
-Pulmonary vein atrial reversal velocity (PVa) > 0.35 m/s or 35 cm/s
-Pulmonary vein atrial reversal duration (a dur) - Transmitral atrial flow
duration (A dur) > 20 ms
-Pulmonary venous systolic flow (sVTI) < diastolic flow (dVTI)
-E/A ratio > 2
-Deceleration time (DT) < 140 ms
Diastole can be divided into 4 phases, name them? Correct Answer-
Isovolumetric relaxation
Early rapid diastolic filling
Diastasis
Late diastolic filling caused by atrial contraction
What are echocardiographic measures of LV relaxation? Correct
Answer-Isovolumetric relaxation time (IVRT)
Maximal rate of pressure decline (-dP/dt)
Time constant of relaxation (tau)
Define chamber compliance? Correct Answer-Compliance is the ratio of
change in volume to change in pressure (dV/dP)
, The following 2 parameters reflect diastolic filling pressures? Correct
Answer--LV end-diastolic pressure
-Mean Left Atrial Pressure (LAP) [clinically mean LAP is estimated by
the PCWP either instantaneously during RHC or many points with
indwelling right heart catheter (Swan-Ganz)]
Early diastolic filling rate is affected by? Correct Answer--Changes in
preload that affect the initial pressure difference between LA and LV
-Change in transmitral volume flow rate
-A change in atrial pressure (elevated LVEDP or a V-wave caused by
mitral regurgitation)
Late diastolic filling pressure is affected by? Correct Answer--Cardiac
rhythm (e.g atrial fibrillation/flutter)
-Atrial contractile function
-LVEDP
-Heart rate
-PR interval
-Ventricular diastolic function
E'/A' < 1 implies? where E' - annular velocity during early mitral inflow
and A' - annular velocity during atrial contraction Correct Answer-
Impaired relaxation
Also the pattern of E'/A' helps to distinguish normal LV filling pattern
from pseudo-normalized pattern of LV filling which is seen in patients
with moderate to severe diastolic dysfunction
Answers
Explain how reverberation-type artifacts occur? Correct Answer-
Reverberation-type artifacts occur because of multiple reflections off the
transducer or strong reflectors. The reverberation lines intensity
decreases ad the distance from the transducer increases. The
reverberation lines are equally spaced and parallel to the main sound
beam
How do you quantify pericardial effusion on Echo? Correct Answer-
Echo free space size between pericardial layers at the end of diastole.
-Trival pericardial effusion: only seen in systole
-Small pericardial effusion: < 10 mm (1.0 cm)
-Moderate pericardial effusion: 10 - 20 mm (1 - 2 cm)
-Large pericardial effusion: 21 - 25 mm (2.1 - 2.5 cm)
-Very Large pericardial effusion: > 25 mm (> 2.5 cm)
When in the cardiac cycle is the volume of pericardial fluid assessed?
Correct Answer-Diastole
How do your grade the severity of Systolic Anterior Motion of the
Mitral Valve? Correct Answer-Grade 1 (Mild): No contact between
mitral valve leaflet and septum in systole with minimum separation
distance of > 10 mm
,Grade 2 (Moderate): No contact between the mitral valve leaflet and
septum with a minimum separation < 10 mm OR contact between the
mitral valve leaflet and septum lasting < 30% of systolic time.
Grade 3 (Severe): Contact between the mitral valve leaflet and septum
lasting > 30% of systolic time.
Causes of diastolic tricuspid regurgitation and diastolic mitral
regurgitation? Correct Answer--Prolonged AV delay
-Complete heart block
-Severe pulmonary valve regurgitation or Severe aortic regurgitation
Causes of increased E-point Septal Separation (EPSS)? Correct
Answer--Aortic regurgitation
-Severe LV dysfunction
-Mitral Stenosis
How can E-point Septal Separation be used to derive the Ejection
Fraction? Correct Answer-LVEF% = 75.5 - [2.5 x EPSS (mm)]
What is normal E-point Septal Separation? Correct Answer-Normal
EPSS < 8mm correlates with EF > 50%
EPSS > 8mm is suggestive of EF < 50%
,What Doppler parameters indicate increased LV filling pressure?
Correct Answer--Ratio of transmitral E velocity to the myocardial e'
velocity (E/e') > 15
-Pulmonary vein atrial reversal velocity (PVa) > 0.35 m/s or 35 cm/s
-Pulmonary vein atrial reversal duration (a dur) - Transmitral atrial flow
duration (A dur) > 20 ms
-Pulmonary venous systolic flow (sVTI) < diastolic flow (dVTI)
-E/A ratio > 2
-Deceleration time (DT) < 140 ms
Diastole can be divided into 4 phases, name them? Correct Answer-
Isovolumetric relaxation
Early rapid diastolic filling
Diastasis
Late diastolic filling caused by atrial contraction
What are echocardiographic measures of LV relaxation? Correct
Answer-Isovolumetric relaxation time (IVRT)
Maximal rate of pressure decline (-dP/dt)
Time constant of relaxation (tau)
Define chamber compliance? Correct Answer-Compliance is the ratio of
change in volume to change in pressure (dV/dP)
, The following 2 parameters reflect diastolic filling pressures? Correct
Answer--LV end-diastolic pressure
-Mean Left Atrial Pressure (LAP) [clinically mean LAP is estimated by
the PCWP either instantaneously during RHC or many points with
indwelling right heart catheter (Swan-Ganz)]
Early diastolic filling rate is affected by? Correct Answer--Changes in
preload that affect the initial pressure difference between LA and LV
-Change in transmitral volume flow rate
-A change in atrial pressure (elevated LVEDP or a V-wave caused by
mitral regurgitation)
Late diastolic filling pressure is affected by? Correct Answer--Cardiac
rhythm (e.g atrial fibrillation/flutter)
-Atrial contractile function
-LVEDP
-Heart rate
-PR interval
-Ventricular diastolic function
E'/A' < 1 implies? where E' - annular velocity during early mitral inflow
and A' - annular velocity during atrial contraction Correct Answer-
Impaired relaxation
Also the pattern of E'/A' helps to distinguish normal LV filling pattern
from pseudo-normalized pattern of LV filling which is seen in patients
with moderate to severe diastolic dysfunction
