RDCS Adult Echocardiography Cheat Sheet

Cheat sheet RDCS Adult Echocardiography Cheat Sheet Practice Questions Study Guide Print / Save PDF

Anatomy & Physiology 15% of exam Valve Anatomy Coronary Territories Cardiac Cycle & Hemodynamics Pressure-Volume Loop

Pathology 40% of exam Aortic Stenosis Severity Aortic Regurgitation Severity Mitral Stenosis Severity Mitral Regurgitation Severity TR, PH & RV Function Cardiomyopathy Signatures Pericardial Disease & Tamponade Aortic Disease & Masses Infective Endocarditis Congenital Shunts MI Mechanical Complications Prosthetic Valves

Clinical Care & Safety 11% of exam Patient Care & STAT Findings Safety, ALARA & Infection Control TEE Consent & Prep ALARA Principle

Measurement Techniques & Views 25% of exam Core Doppler Formulas Advanced Hemodynamics Chamber Quantification EF & Systolic Function Diastolic Function Screen IVC & RAP Estimation Standard Views & Windows

Instrumentation & Contrast 9% of exam Doppler Modes Image Optimization & Artifacts Contrast Agents PW vs CW Doppler

Quick Facts Exam AE (Adult Echo) Credential RDCS specialty Body ARDMS / Inteleos Time 3 hours Questions ~150 + hotspot items Pass score 555 (300-700 scale) Fee $300 Blueprint V24.2, Apr 2025

Valve Anatomy AN Aortic valve 3 cusps, no chordae Pulmonic valve 3 cusps, no chordae Mitral valve 2 leaflets, P1-P3 scallops Tricuspid valve 3 leaflets, most apical Anterolateral papillary Dual LAD/LCx supply Posteromedial papillary Single PDA supply

Coronary Territories AN LAD Anterior, septum, apex RCA Inferior wall, PDA source LCx Lateral wall territory Right-dominant ~85% of hearts Left-dominant ~8% of hearts Dominance defined by Vessel supplying PDA

Cardiac Cycle & Hemodynamics AN S1 Mitral + tricuspid close S2 Aortic + pulmonic close Isovolumic phases All 4 valves closed Frank-Starling Preload raises stroke volume Ohm's law analog ΔP = Q × R Poiseuille's law Resistance ∝ 1/radius⁴ Normal cardiac output 4-8 L/min

Severe AS Numbers PA 4 velocity, 40 gradient, 1 area, 0.25 index Vmax ≥4.0 m/s Mean gradient ≥40 mmHg AVA <1.0 cm² DVI <0.25

DCM vs RCM PA

DCM LV dilated, spherical Global hypokinesis EF often 15-30%

RCM Normal LV size/EF Marked biatrial enlargement E/A ≥2, DT <150 ms Dilated pump vs stiff fill

Aortic Stenosis Severity Path PA Vmax measured → Sweep multiple windows ( apical, right parasternal, SSN ) Vmax ≥4.0 m/s → Severe AS Mean gradient ≥40 → Severe AS AVA <1.0 cm² → Severe AS DVI <0.25 → Severe AS ( LVOT-independent check ) AVA low, EF <50% → Classical low-flow low-gradient AVA low, EF ≥50% → Paradoxical low-flow low-gradient SV increases ≥20% on DSE → True-severe AS confirmed

Aortic Stenosis Severity PA Severe Vmax ≥4.0 m/s Severe mean gradient ≥40 mmHg Severe AVA <1.0 cm² Severe DVI <0.25 Mild Vmax 2.6-2.9 m/s Moderate Vmax 3.0-3.9 m/s Low-flow SVi <35 mL/m² Aortic sclerosis Vmax ≤2.5 m/s, no obstruction

Tamponade Collapse Rule PA RA collapse first, over one-third RA systolic collapse >1/3 cycle Mitral E falls >25% inspiration Tricuspid E falls >40% expiration

Constrictive vs Restrictive PA

Constriction Septal bounce present Medial e′ ≥8 cm/s Hepatic reversal, expiration

Restrictive CM No septal bounce Medial e′ <8 cm/s Hepatic reversal, inspiration Pericardial vs myocardial disease

Pulmonary HTN Probability Path PA TR Vmax ≤2.8 m/s → Low PH probability ( no other signs present ) TR Vmax 2.9-3.4 m/s → Intermediate probability ( check secondary signs ) TR Vmax >3.4 m/s → High PH probability RVSP needed → 4 × TR Vmax² + RAP

Aortic Regurgitation Severity PA Severe vena contracta ≥0.6 cm Severe PHT <200 ms Severe descending Ao flow Holodiastolic reversal Severe EROA ≥0.30 cm² Severe regurgitant volume ≥60 mL/beat Severe regurgitant fraction ≥50% Jet width/LVOT severe ≥65%

True vs Pseudoaneurysm PA

True aneurysm Neck ratio >0.5 Myocardial wall intact Low rupture risk

Pseudoaneurysm Neck ratio ≤0.5 Pericardium + thrombus wall High rupture risk Neck ratio determines risk

Mitral Stenosis Severity PA MVA formula 220 / PHT (ms) Severe MVA ≤1.5 cm² Very severe MVA <1.0 cm² Severe mean gradient ≥10 mmHg Severe PHT ≥150 ms Severe PASP ≥50 mmHg Wilkins favorable Score ≤8 Wilkins unfavorable Score ≥12

Primary vs Secondary MR PA

Primary MR Leaflet/chordal disease EROA severe ≥0.40 cm² Type II, prolapse/flail

Secondary MR Normal leaflets, tethered EROA severe ≥0.30 cm² Type IIIb, ischemic Valve disease vs LV/annulus

Mitral Regurgitation Severity PA Primary severe EROA ≥0.40 cm² Secondary severe EROA ≥0.30 cm² Primary severe RVol ≥60 mL/beat Secondary severe RVol ≥45 mL/beat Severe vena contracta ≥0.7 cm Carpentier Type II Prolapse or flail Carpentier Type IIIb Ischemic tethering

Classical vs Paradoxical LFLG-AS PA

Classical LFLG Reduced EF <50% Dobutamine raises flow True vs pseudo-severe test

Paradoxical LFLG Preserved EF ≥50% Small, hypertrophied LV CT calcium score confirms Low EF vs small stiff LV

TR, PH & RV Function PA RVSP formula 4 × TR Vmax² + RAP PH high probability TR >3.4 m/s PH low probability TR ≤2.8 m/s Severe TR Vena contracta ≥0.7 cm Severe TR sign Hepatic systolic reversal TAPSE abnormal <17 mm RV FAC abnormal <35% Severe PS Gradient >64 mmHg

Cardiomyopathy Signatures PA HCM wall thickness ≥15 mm HCM (family history) ≥13 mm LVOT obstruction Gradient ≥30 mmHg Septal reduction threshold Gradient ≥50 mmHg ASH ratio Septum:posterior ≥1.3 DCM LVEDD >58-60 mm RCM filling E/A ≥2, DT <150 ms Amyloid strain sign Apical sparing pattern

Pericardial Disease & Tamponade PA Effusion small <10 mm Effusion large >20 mm Earliest tamponade sign RA systolic collapse >1/3 cycle Most specific sign RV diastolic collapse Mitral E variation >25% with inspiration Tricuspid E variation >40% with expiration IVC plethora >21 mm, <50% collapse Constriction hallmark Septal bounce

Aortic Disease & Masses PA Aneurysm threshold ≥4.5 cm Surgery, typical patient 5.5 cm Surgery, bicuspid valve 5.0 cm Surgery, Marfan/Loeys-Dietz 4.5-5.0 cm Rapid growth ≥0.5 cm/yr Myxoma LA stalk, fossa ovalis Papillary fibroelastoma Valve surface frond

Infective Endocarditis PA Vegetation location Upstream, low-pressure surface Definite IE 2 major criteria TEE sensitivity ~90-96% TTE sensitivity ~40-70% native valve Most common complication Perivalvular abscess High embolic risk Vegetation >10 mm

Congenital Shunts PA Secundum ASD ~75% of ASDs Perimembranous VSD ~80% of VSDs Qp/Qs significant ≥1.5 Qp/Qs favors closure ≥2.0 PDA Doppler sign Continuous systolic-diastolic flow Ebstein threshold Displacement ≥8 mm/m² PFO bubble timing <3 cycles = intracardiac

MI Mechanical Complications PA Free-wall rupture 1-4 days post-MI Papillary muscle rupture 2-7 days post-MI VSD rupture 3-5 days post-MI True aneurysm neck Ratio >0.5 Pseudoaneurysm neck Ratio ≤0.5 WMSI normal 1.0

Prosthetic Valves PA Normal aortic gradient <20 mmHg Severe aortic gradient >35 mmHg Normal mitral gradient <5-6 mmHg Severe mitral gradient >10 mmHg Severe aortic PPM iEOA <0.65 cm²/m² Severe mitral PPM iEOA ≤0.9 cm²/m² Normal washing jets Small, symmetric, expected

Patient Care & STAT Findings CL H&P purpose Directs technical focus Elevated BNP Suggests high filling pressure TEE consent Physician-obtained, written TEE prep Confirm NPO interval STAT: tamponade Notify physician immediately STAT: dissection Type A = emergency STAT: mobile thrombus High embolic risk STAT: new RWMA Suggests acute MI

Safety, ALARA & Infection Control CL ALARA principle Lowest output, shortest time MI limit 1.9 non-ophthalmic MI limit, ophthalmic 0.23 TI = 6 model 43°C tissue elevation Contrast cavitation risk MI >0.7 TEE probe class Semi-critical device TEE reprocessing High-level disinfection, every use WRMSD prevalence ~53-90% of sonographers

MVA 220 Rule ME MVA equals 220 over PHT PHT in milliseconds Severe MVA ≤1.5 cm² Very severe <1.0 cm²

Diastolic Function Grading Path ME Normal EF, screen 4 vars → Count abnormal criteria 0-1 of 4 abnormal → Normal diastolic function 2 of 4 abnormal → Indeterminate study 3-4 of 4 abnormal → Dysfunction present, grade it E/A ≤0.8 pattern → Grade I impaired relaxation E/A 0.8-2, gray zone → Check 3 supportive criteria ≥2 of 3 supportive positive → Grade II pseudonormal E/A ≥2 → Grade III restrictive ( overrides other criteria )

Core Doppler Formulas ME Modified Bernoulli ΔP = 4V² CSA (circular) 0.785 × D² Stroke volume SV = CSA × VTI Cardiac output CO = SV × HR Continuity equation AVA = CSA×VTI_LVOT / VTI_AV Dimensionless index VTI_LVOT / VTI_AV

dP/dt Constant ME 32 mmHg over 1-to-3 m/s time Normal ≥1200 mmHg/s Impaired <1000 mmHg/s Measured on MR CW jet

Advanced Hemodynamics ME PISA/EROA 2πr² × Valias / peak V Regurgitant volume EROA × VTI MVA (pressure half-time) 220 / PHT dP/dt 32 / time (1→3 m/s) Qp/Qs RVOT flow / LVOT flow RVSP 4 × TR Vmax² + RAP

Chamber Quantification ME LVIDd, men 4.2-5.8 cm LVIDd, women 3.8-5.2 cm Wall thickness severe, men ≥1.7 cm Wall thickness severe, women ≥1.6 cm RWT concentric >0.42 LV mass index limit 115 g/m² men, 95 women LAVi abnormal >34 mL/m²

EF & Systolic Function ME EF formula (EDV-ESV) / EDV Normal EF, men 52-72% Normal EF, women 54-74% Teichholz formula [7.0/(2.4+D)] × D³ Fractional shortening (LVIDd-LVIDs)/LVIDd, normal 25-45% Normal GLS ≤ -18%

Diastolic Function Screen ME Septal e′ abnormal <7 cm/s Lateral e′ abnormal <10 cm/s Average E/e′ abnormal >14 LAVi abnormal >34 mL/m² TR velocity abnormal >2.8 m/s Grade III cutoff E/A ≥2

IVC & RAP Estimation ME IVC normal ≤2.1 cm, collapse >50% RAP normal ~3 mmHg IVC plethoric >2.1 cm, collapse <50% RAP elevated ~15 mmHg RAP indeterminate ~8 mmHg

Standard Views & Windows ME PLAX Marker toward right shoulder PSAX MV level Fish-mouth mitral orifice A4C + A2C Simpson's biplane EF A5C LVOT + aortic Doppler Subcostal 4-chamber Best for ASD, effusion Suprasternal notch Aortic arch, coarctation

BART Doppler Colors IN Blue Away, Red Toward Blue = away from probe Red = toward probe Mosaic = aliasing/turbulence

PW vs CW Doppler IN

PW Range resolution: yes Nyquist-limited (PRF/2) Normal-velocity flow

CW Range resolution: no No Nyquist, no alias High-velocity jets Location vs high velocity

Doppler Modes IN PW Doppler Range resolution, Nyquist-limited Nyquist limit PRF / 2 CW Doppler No range, no aliasing Ideal intercept angle ≤20° BART mnemonic Blue away, red toward

Image Optimization & Artifacts IN Gain Uniform brightness control TGC Depth-selective brightness Reverberation artifact Equally spaced parallel lines Mirror-image artifact Duplicate past diaphragm Side-lobe artifact False off-axis echo Speed of sound assumed 1,540 m/s

Contrast Agents IN Definity Perflutren lipid microsphere Optison Albumin shell, perflutren core Lumason Sulfur hexafluoride microsphere Shunt contraindication Removed 2016-2017 Observation after dosing ≥30 minutes

Common Traps

Gain vs TGC Gain: uniform brightness ≠ TGC: depth-selective brightness

Teichholz vs Biplane EF Teichholz: legacy single dimension ≠ Biplane Simpson: current ASE standard

Sclerosis vs Mild AS Sclerosis: Vmax ≤2.5, no obstruction ≠ Mild AS: Vmax 2.6-2.9 m/s

Posterior vs Inferolateral Wall Posterior: retired ASE term ≠ Inferolateral: current segment name

RA vs RV Collapse RA: earliest, most sensitive ≠ RV: later, most specific

Annulus Reversus Direction Normal: lateral e′ > medial ≠ Constriction: medial e′ > lateral

Classical vs Paradoxical LFLG Classical: reduced EF <50% ≠ Paradoxical: preserved EF, small LV

Last Minute 1 . Severe AS: Vmax ≥4.0 m/s 2 . Severe AS: AVA <1.0 cm² 3 . MVA = 220 / PHT 4 . Diastolic dysfunction: 3+ of 4 abnormal 5 . RVSP = 4×TR² + RAP 6 . TAPSE <17 mm = reduced RV 7 . RA collapse >1/3 cycle = tamponade 8 . True aneurysm: neck ratio >0.5 9 . Pseudoaneurysm: neck ratio ≤0.5 10 . Posteromedial muscle: single blood supply 11 . Pathology 40%, Measurement 25% weight 12 . Pass score: 555 on 300-700 scale

ARDMS Adult Echocardiography (RDCS) Practice Questions 200 questions Study Guide 40 topics Cheat Sheet 180 facts Flashcards 50 cards Videos 1 video Blogs 2 blogs Free CE Podcast

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