ECHO

• Bubbles
• Definity

2 consecutive segments are not visualized well.

patient has RT to LT shunting. (Perform bubble study prior).

• 1. headache
• 2. back pain
• 3. nausea
• 4. chest pain
• 5. dizziness
• 6. injection site reaction

• 1. US system with TEE capability.
• 2. Patient monitoring equipment- BP, O2 Saturation, and Suctioning.
• 3. Three way stop cock.
• 4. 2 or 3 -12cc syringes with Saline/ Preservative for bubbles.
• 5. Bite block.
• 6. Cetacaine spray.
• 7. Tongue depressor.
• 8. Clean towels and washcloths.
• 9. Gloves for physician/sonographer.

• Check to make sure the Cidex has been tested for the day. Look on chart. Cidex changed every two weeks.
• Soak and scrub the endoscope and bite block in Endozyme to remove saliva and blood. (Far left sink or the "dirty sink").
• Soak endoscope and bite block in Cidex solution for 12 minutes. 
• Rinse well with running tap water or in tub for 1 x3. Tub must be dumped and refilled three different times. This is the "clean sink" and is far right.
• Hang probe in storage unit.

Yes.

• 1. Single gene defects. (Hereditary)
• 2. Environmental factors. (Stress/ Unhealthy lifestyle)
• 3. Maternal ingestion of toxic substances. (Substance abuse)
• 4. Viral exposures
• 5. Unknown
• 6. ? (Premature)

• 23 
• 43

• Formen Ovale
• Ductus Arteriosus

• 1. Truncus Arteriosus
• 2. Bulbus Cordis OR Conus Cordis
• 3. "Common" Primitive Ventricle
• 4. "Common" Primitive Atrium
• 5. Sinus Venosus

• Truncus Arteriosus 
• - Divides to form the roots of the Aorta and Pulmonic A.

• Bulbus Cordis OR Conus Cordis
• - Future RVOT and LVOT. (Outlet of Ventricles)

• "Common" Primitive Ventricle 
• - (Inlet of Ventricles)

• "Common" Primitive Atrium
• - Right & Left Atria

• Sinus Venosus
• - Proximal Vena Cava & part of Right Atrium.

4(v)2 + IVC pressure

• Antegrade PV flow:
• 80 - (AT/2) 

OR 

• Retrograde PV flow:
• 4(v)²

4(v)^{2 +} IVC pressure

4(v)² = _____ mmHg

Take systolic BP - _____ mmHg

• 5 mmHg - Normal and reactive.
• 10 mmHg - Normal and partial reactivity.
• 15 mmHg - Dialated but reactive.
• 20 mmHg - Dialated and not reactive.

• Normal 18-25 mmHg
• Mild 30-40 mmHg
• Moderate 40-70 mmHg
• Severe >70 mmHg

• A narrowing of the orifice of the TV.
• Auscultation reveals an opening snap and diastolic rumble, best heard at the Lt sternal border. (Gets louder with inspiration). 
• DIASTOLIC MURMUR

• Rheumatic Heart Disease
• Systemic Lupus Erythematosus
• Carcinoid Disease
• Loeffler's Endocaritis
• Metastatic Melanoma
• Congenital Defects

• thickened leaflets 
• dilated IVC
• doming of the TV leaflets in diastole
• enlarged RA

• a decreased E-F slope (due to slower filling and higher RA pressures).
• decreased D-E excursion
• enlarged RA

• a decrease E-F slope
• peak velocity is >1m/s
• spectral broadening of diastolic signal
• aliasing
• possible absence of "a wave"

Pressure half-time: is the time it takes for initial velocity divided by the square root of 2 OR time for trans-tricuspid flow to fall 1/2 its initial value.

P_1/2T isn't dependant on cardiac output.

• Leakage from RV into the RA during systole.
• Murmur is described as a holosystolic, high-pitched blowing sound.
• SYSTOLIC MURMUR

• Dilatation of the annulus preventing the leaflets from closing completely.
• Enlargement of RV caused by a volume overload (RVVO)
• Aortic and Mitral Valve Disease
• Pulmonary Hypertension
• RV Infarction 
• Pacemaker wires
• Heart transplant

• Congenital Ebsteins anomaly
• Rheumatic disease
• Carcinoid Disease
• trauma
• tumors
• Endocarditis
• Chordal rupture

• RA enlargement
• RV enlargement
• A FIB
• Enlarged IVC and dilatation of the other vessels coming off of the IVC.
• Leg and abdominal swelling, liver enlargement, and portal HTN.

• RVVO 
• Paradoxical septal motion
• thickened leaflets
• dilated RA and RV
• dilated IVC
• reversed flowin Hepatic V

• Mitral Valve disease
• Congenital lesions
• Cor pulmonale

• the obstruction of blood flow from RV to main Pulmonary A
• rare in adults, more common in children/infants
• flow in Pulmonary A in adults = 0.9m/s, children = 1.1m/s
• auscultation- harsh systolic ejection murmur heard best in pulmonic area. thrill may also be present, splittin of S_2.

• prominent jugular venous "a wave"
• RVH - increased pressure = thickened walls
• post stenotic dilatation of the PA

• congenital - most common
• carcinoid heart disease
• rheumatic heart disease
• sinus of valsalva aneurysm
• Ross Procedure

surgery if the systolic gradient in >50 mmHg across PV OR >70 mmHg in the RV

• RVH
• RV failure in later stages
• systolic doming
• flattening of the IVS
• increased depth of the "a wave"

• dilated RV from RVVO
• pancake septum

diastolic flutter on the TV

• Pulmonary HTN
• endocarditis
• valvotomy
• congenital defects
• carcinoid heart disease 
• trauma