Module Review & Final Exam
Closing review for Cardiac Diagnostics II. This lesson distills the 3 prior lessons into the highest-yield material and is paired with a 50-question final exam under the Quiz tab. Topic coverage is aligned with the RESC 2331 study guide — everything you'll be tested on lives in these tables.
How to use this review: read top-to-bottom, then take the exam. If you blank on any value or concept below, jump back to the relevant lesson before sitting the quiz.
1. Ultrasound Physics
Two concepts the study guide tests directly:
| Concept | Definition |
|---|---|
| Reflection | Ultrasound waves bounce back when they hit a boundary between different tissues |
| Refraction | Ultrasound waves bend / change direction as they pass through media with varying densities |
Minimum frequency for diagnostic ultrasound: ≥ 20,000 Hz. The piezoelectric crystal in the transducer converts electrical energy into sound waves and back again.
2. Echocardiography Transducer Positions
Four standard windows — patient position and structures visible are both testable.
| Position | Patient Position | Structures Identified |
|---|---|---|
| Parasternal | Left lateral decubitus | LV, RV, aortic valve, mitral valve |
| Apical (Point of Maximal Impulse) | Left lateral decubitus or sitting upright | LA, LV, mitral valve, aortic valve |
| Suprasternal | Supine | Aortic arch, great vessels |
| Subcostal | Supine | Inferior vena cava, right atrium, left atrium |
Rule of thumb: Parasternal and Apical = left lateral decubitus. Suprasternal and Subcostal = supine.
TEE Patient Position
Transesophageal Echocardiogram (TEE): patient lies in left lateral decubitus. An endoscope is inserted into the esophagus for superior visualization of valves and upper chambers. Requires sedation, topical anesthetic, and NPO (fasting).
3. Echocardiography Special Modes
| Mode | What It Does |
|---|---|
| M-Mode | Displays heart motion in a 1-D format; vertical axis = depth, horizontal axis = time; provides detailed timing information |
| Doppler / Color Flow | Assesses blood flow direction and velocity |
| BART | Blue Away, Red Toward — color coding of Doppler flow direction |
| Green (turbulence) | Turbulent or high-velocity flow |
BART mnemonic (testable): Blue = flowing away from transducer · Red = flowing toward transducer.
4. Contrast / Bubble Study & Stress Echocardiography
| Test | Key Facts |
|---|---|
| Bubble study | Agitated saline injected IV; identifies intracardiac shunts (abnormal connections between chambers) |
| Bubbles in LA after RA injection | Indicates Atrial Septal Defect (ASD) |
| PFO detection | Small bubbles crossing from RA → LA on Valsalva |
| Stress echocardiogram | Evaluates heart function under stress; diagnoses CAD / myocardial ischemia; evaluates treatment effectiveness |
| Pharmacologic stress agent | Dobutamine (for patients who cannot exercise) |
5. Cardiac Catheterization
Vascular Access
| Site | Key Detail |
|---|---|
| Femoral artery | Primary access vessel; identified by the inguinal ligament |
| Radial artery | Alternative; preferred for shorter recovery time |
| Guidewire | Left in place throughout the procedure to allow rapid catheter exchange |
Coronary Angiography & Catheters
Coronary angiography uses radiopaque contrast dye to visualize coronary arteries under fluoroscopy.
| Catheter | Use |
|---|---|
| Judkins Right | Right coronary artery |
| Judkins Left | Left coronary artery |
| Pigtail | Left ventricle |
Common cardiac catheter sizes: 5–6 French (F) — "French" is a universal unit of measure for catheter diameter.
6. Cardiac Imaging: Diagnostic Interventions
| Procedure | Purpose |
|---|---|
| Electrophysiology Study (EPS) | Stimulates or measures cardiac electrical activity; maps and diagnoses arrhythmias |
| Cardiac Mapping | Records electrical potentials from the heart; assesses activation times and electrical amplitude |
| Radionuclide Studies (Blood Pool Imaging) | Uses a radioactive isotope to identify blood pooling in heart chambers; measures ejection fraction |
7. Therapeutic Cardiac Interventions
Ranked by frequency of exam appearance:
| Intervention | Notes |
|---|---|
| Cardiac stent placement | Most common therapeutic intervention |
| Balloon angioplasty | Uses an inflatable balloon to open narrowed coronary arteries |
| Ablation | Destroys abnormal electrical tissue causing arrhythmias |
| Atherectomy | Mechanically removes plaque from the artery wall |
8. Cardioversion vs. Defibrillation
| Feature | Cardioversion | Defibrillation |
|---|---|---|
| Shock type | Synchronized | Unsynchronized |
| Sync with | R waves | Not synchronized |
| Used for | Tachyarrhythmias (e.g., SVT, A-flutter, A-fib) | Life-threatening pulseless rhythms (V-fib, pulseless V-tach) |
| Energy | Lower, titratable | Maximum energy |
Memory cue: Cardioversion = Controlled = Synchronized. Defibrillation = Desperate = Unsynchronized.
9. Pacemakers
| Feature | Detail |
|---|---|
| Lead types | Unipolar vs. Bipolar; bipolar leads = better sensing and pacing |
| Voltage | Low-voltage shocks |
| Indication | Symptomatic bradycardia |
| ICD | Implantable cardioverter-defibrillator; treats life-threatening ventricular arrhythmias |
10. Cardiac Rehabilitation
| Concept | Key Fact |
|---|---|
| VO2 max | Indicates cardiac output and pump capacity; essential for assessing fitness levels |
| Mortality benefit | ~15% reduction in mortality and recurrent MIs |
| Phase I | Inpatient; started soon after the acute event |
| Phase II | Outpatient; 3×/week × 3–4 months; ECG monitored |
| Phase III | Non-ECG monitored maintenance; health clubs / gyms |
11. Tilt-Table Testing
| Parameter | Value |
|---|---|
| Purpose | Identifies vasodepressor and orthostatic hypertension patients as a cause of syncope |
| Angle | 60–80 degrees |
| Duration | 20–45 minutes |
| Provocative agent | Isoproterenol (if no reaction at baseline) |
12. Hemodynamic Monitoring Catheters
| Catheter | Tip Location | Access |
|---|---|---|
| Arterial line (A-line) | Radial or femoral artery | Direct arterial puncture |
| CVP catheter | Right atrium | Jugular or subclavian vein |
| Swan-Ganz (PAP catheter) | Pulmonary artery | Central vein → floats into PA |
Strain-gauge pressure transducer = the device that converts catheter-measured pressures into numbers on the monitor.
Swan-Ganz Port Color Coding
| Port Color | Measures |
|---|---|
| Blue | CVP / RAP (Central Venous Pressure / Right Atrial Pressure) |
| Yellow | PAP (Pulmonary Arterial Pressure) |
| Red | PCWP (Pulmonary Capillary Wedge Pressure) |
13. Normal Hemodynamic Values
| Parameter | Normal Range |
|---|---|
| Blood Pressure (systolic) | 90–140 mmHg |
| Blood Pressure (diastolic) | 60–90 mmHg |
| MAP | 80–100 mmHg |
| CVP | 2–6 mmHg |
| PAP | 25/10 mmHg |
| PCWP | 5–10 mmHg |
| Cardiac Output (CO) | 4–8 L/min |
| Cardiac Index (CI) | 2.5–4 L/min/m² |
| SVR | 900–1,400 dynes·sec/cm⁵ |
| PVR | 110–250 dynes·sec/cm⁵ |
Fluid overload → hemodynamic values increase. CVP, PAP, and PCWP all rise.
14. PCWP, CO, and Resistance Formulas
| Concept | Key Point |
|---|---|
| PCWP clinical use | Distinguishes cardiogenic vs. non-cardiogenic pulmonary edema |
| PCWP balloon rule | Must inflate balloon to measure; do NOT leave inflated after measurement |
| Thermodilution (CO) | Inject 10 mL of cold saline (or D5W); thermistor detects temperature change |
| CO formula | CO = SV × HR |
| CI formula | CI = CO ÷ BSA |
| SVR formula | SVR = [(MAP − CVP) ÷ CO] × 80 |
| PVR formula | PVR = [(mean PAP − PCWP) ÷ CO] × 80 |
| ×80 factor | Converts mmHg to dynes·sec/cm⁵ |
| PVR | Resistance in the lungs |
| SVR | Resistance in the body's vasculature |
What to Memorize Cold for the Exam
If you can recall this list, you'll pass:
- Reflection = bounce back · Refraction = bend/change direction
- 4 transducer positions — Parasternal & Apical = left lateral decubitus · Suprasternal & Subcostal = supine
- BART — Blue Away, Red Toward · Green = turbulence
- Bubble study = intracardiac shunts · Bubbles in LA = ASD
- TEE = left lateral decubitus + sedation + fasting
- Cardiac cath primary vessel = femoral artery · identified by inguinal ligament
- Short recovery = radial artery · Guidewire = left in for catheter exchange
- Contrast dye for coronary angiography · sizes 5–6 French
- Catheters — Judkins Right/Left + Pigtail (LV)
- EPS = measures/stimulates electrical activity · Cardiac mapping = activation times + amplitude
- Radionuclide = isotope + ejection fraction
- Most common therapeutic intervention = stent
- Cardioversion = synchronized · syncs with R waves · for tachyarrhythmias
- Defibrillation = unsynchronized · for pulseless rhythms (V-fib, pulseless V-tach)
- Bipolar pacemaker leads = better sensing/pacing · treats symptomatic bradycardia
- VO2 max = cardiac output + pump capacity
- Tilt-table = vasodepressor/orthostatic hypertension · 60–80° · 20–45 min · Isoproterenol if no reaction
- CVP tip = right atrium · PAP tip = pulmonary artery
- Strain-gauge transducer = measures pressure
- Normal values — MAP 80–100 · CVP 2–6 · PCWP 5–10 · CO 4–8 · CI 2.5–4 · SVR 900–1400 · PVR 110–250
- PCWP = cardiogenic vs. non-cardiogenic pulmonary edema · inflate balloon · don't leave inflated
- Fluid overload → hemodynamic values increase
- ×80 converts to dynes·sec/cm⁵ · SVR = MAP−CVP · PVR = PAP−PCWP
Once you can recite this list, head to the Quiz tab — the 50-question final exam tests every concept above.