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- Anatomy and Physiology (5%-10%)
- Technique (10%-20%)
- Valvular Heart Disease (15%-25%)
- Pericardial Disease (2%-8%)
- Systemic & Pulmonary Hypertensive Heart Disease (1%-3%)
- Cardiomyopathies (5%-15%)
- Ventricular Function (10%-20%)
- Cardiac Tumors (2%-5%)
- Miscellaneous (5%-10%)
- Congenital Heart Disease in the Adult (3%-7%)
- Diseases of the Aorta (3%-7%)
- Doppler (3%-7%)
- Stress Echo (0%-3%)
I. Anatomy and Physiology (5%-10%) (go to top)
A. Ventricular Wall Segments (as Recommended by the American Society of Echocardiography)
B. Nomenclature
1. Subdivisions of ventricles
a. inflow tract
b. outflow tract
2. Valves
3. Great vessels
C. Coronary Sinus (vs. Descending Aorta)
D. Coronary Arteries
E. Normal Pressures (in All Four Cardiac Chambers and Great Vessels)
1. Phases of cardiac cycle
a. electrical/mechanical systole
b. filling phases of diastole
2. Timing of events (relative to ECG)
F. Pulmonary Veins
G. Miscellaneous
II. Technique (10%-20%) (go to top)
A. Use of Equipment Controls
B. Recognition of Technical Artifacts
C. Recognition of Setup Errors
D. Use of Contrast Agents
E. Provocative Maneuvers
F. Best Approach for Doppler Studies
G. Miscellaneous
H. Two-dimensional Study
I. M-mode Patterns
J. CPR
K. Transesophageal Echocardiography
III. Valvular Heart Disease (15%-25%) (go to top)
A. Mitral Valve
1. Physiology/hemodynamics
2. Mitral stenosis
a. M-mode
b. two-dimensional study
c. Doppler study
d. effects on:
(1) atria
(2) ventricles
(3) cardiac vessels
3. Mitral regurgitation
a. M-mode
b. two-dimensional study
c. Doppler study
d. effects on:
(1) atria
(2) ventricles
(3) cardiac vessels
(4) pulmonary veins
e. mitral prolapse
f. chordal rupture
g. flail leaflet
h. mitral annular calcification
i. mixed mitral valve disease (MS/MR)
B. Aortic Valve
1. Physiology/hemodynamics
2. Aortic stenosis
a. M-mode
b. two-dimensional study
c. Doppler study
d. effects on:
(1) atria
(2) ventricles
(3) cardiac vessels
e. etiologies
(1) congenital
(2) rheumatic
(3) degenerative
f. mixed lesions (AS/AR)
g. distinctions between aortic stenosis and sclerosis
3. Aortic regurgitation
a. M-mode
b. two-dimensional study
c. Doppler study
d. effects on:
(1) atria
(2) ventricles
(3) cardiac vessels
e. etiologies
(1) congenital
(2) rheumatic
(3) infectious
(4) secondary (e.g., aortic root abnormality)
(5) flail
f. mixed (AS/AR)
C. Tricuspid Valve
1. Physiology/hemodynamics
2. Tricuspid stenosis
a. M-mode
b. two-dimensional study
c. Doppler study
d. effects on:
(1) atria
(2) ventricles
(3) cardiac vessels
e. etiologies
(1) rheumatic
f. with mixed lesions
3. Tricuspid regurgitation
a. M-mode
b. two-dimensional Study
c. Doppler Study
d. effects on:
(1) atria
(2) ventricles
(3) cardiac vessels
e. etiologies
(1) rheumatic
(2) carcinoid
(3) tricuspid prolapse
(4) chordal rupture
(5) flail leaflet
D. Pulmonary Valve
1. Physiology/hemodynamics
2. Pulmonary stenosis
a. M-mode
b. two-dimensional study
c. Doppler study
d. effects on:
(1) atria
(2) ventricles
(3) cardiac vessels
e. etiologies
(1) congenital
(2) carcinoid
3. Pulmonary regurgitation
a. M-mode
b. two-dimensional study
c. Doppler study
d. effects on:
(1) atria
(2) ventricles
(3) cardiac vessels
e. etiologies
(1) carcinoid
(2) pulmonary hypertension
f. mixed PS/PI
E. Endocarditis
1. Physiology/hemodynamics
2. Involvement of adjacent cardiac structures
3. M-mode patterns
4. Two-dimensional study
F. Prosthetic Valves
1. Mechanical
a. types
(1) ball-and-cage
(2) disc in cage
(3) tilting-disc
b. dysfunction
(1) stenosis
(2) regurgitation
(3) thrombosis
2. Tissue types (bioprostheses)
3. Means of evaluation
a. M-mode
b. two-dimensional study
c. Doppler study
d. other
IV. Pericardial Disease (2%-8%) (go to top) A. Constrictive
1. Physiology/hemodynamics
2. Etiologies
3. Echocardiographic manifestations
B. Effusion
1. Physiology/hemodynamics
a. tamponade
2. Etiologies
3. Differentiation from pleural effusion
C. Tumor
1. Primary
2. Metastatic
D. Miscellaneous
1. Adhesions
2. Nonspecific thickening
3. False positives
V. Systemic & Pulmonary Hypertensive Heart Disease (1%-3%) (go to top) A. Systemic
1. Physiology/hemodynamics
2. Echocardiographic findings
B. Pulmonary
1. Physiology/hemodynamics
2. Doppler assessment
a. from tricuspid regurgitant jet
b. from pulmonary artery acceleration time
3. Image findings
VI. Cardiomyopathies (5%-15%) (go to top) A. Hypertrophic
1. With/without obstruction
2. Associated abnormalities
a. mitral annular calcium
b. mitral regurgitant/left atrial enlargement
c. fibrous scarring of septum
d. thickening of anterior mitral valve leaflet
3. Methods of evaluation
a. provocative maneuvers
(1) amyl nitrite
(2) Valsalva
b. M-mode
c. two-dimensional study
d. Doppler study (specifically for localizing site of obstruction and accessing LVOT gradients)
B. Dilated
1. Etiologies
a. idiopathic
b. ischemic
c. alcoholic
2. Associated findings
a. mitral regurgitation
b. other chamber enlargement
c. thrombus
C. Restrictive
1. Etiologies
2. Diastolic function
VII. Ventricular Function (10%-20%) (go to top) A. Wall Motion Abnormalities
B. Associated Findings
1. Thrombi
2. Changes in appearance of involved myocardium
3. Aneurysm
4. Valve dysfunction
5. Pericardial effusion
6. Cardiomyopathy
7. Ruptured myocardium
8. Right ventricular involvement
C. Diastolic Function
D. Normal LVF
VIII. Cardiac Tumors (2%-5%) (go to top)
A. Benign (e.g., Myxoma)
B. Malignant
1. Primary vs. secondary (metastatic)
C. Pericardial Involvement
D. Differentiation from Other Masses or Artifacts
E. Complications
IX. Miscellaneous (5%-10%) (go to top)
A. Arrhythmias and Conduction Disturbances
1. Effect on valve motion
2. Production of wall motion abnormalities
3. Effect on Doppler flow velocity waveforms
B. Parameters of Left Ventricular Function
C. Right Side Volume Overload
D. Other
X. Congenital Heart Disease in the Adult (3%-7%) (go to top)
A. Categories
1. Aortic valve
a. bicuspid
b. supravalvular/subvalvular stenosis
2. Pulmonic stenosis
3. Cleft mitral valve
4. Atrial septal defect
a. types
b. means of assessing
(1) contrast
(2) Doppler
c. physiology/hemodynamics
(1) associated chamber enlargement
(2) direction for shunt flow
5. Ventricular septal defect
a. types
b. means of assessing
(1) contrast
(2) Doppler
c. physiology/hemodynamics
(1) associated chamber enlargement
(2) directions for shunt flow
6. Endocardial cushion defect
7. Ebstein’s anomaly
8. Patent ductus arteriosus
9. Tetralogy of Fallot
10. Status, postoperative congenital heart disease
11. Coarctation of the aorta
XI. Diseases of the Aorta (3%-7%) (go to top)
A. Marfan’s Syndrome
B. Miscellaneous Aortic Dilatation
C. Aortic Aneurysm
D. Aortic Dissection
E. Sinus of Valsalva Aneurysms
F. Coarctation of the Aorta
XII. Doppler (3%-7%) (go to top)
A. General Information
B. Formulas for Measurement
1. Modified Bernoulli equation
2. Pressure half-time formula
3. Doppler formula
C. Color Flow Mapping
XIII. Stress Echo (0%-3%) (go to top)
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