Free RDCS Adult Echo Cheat Sheet 2026: Exam Quick Reference

Anatomy & Physiology

15%of exam

Valve Anatomy Coronary Territories Cardiac Cycle & HemodynamicsPressure-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 ControlTEE Consent & PrepALARA 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

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

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

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

4 velocity, 40 gradient, 1 area, 0.25 index

Vmax ≥4.0 m/sMean gradient ≥40 mmHgAVA <1.0 cm²DVI <0.25

DCM vs RCM

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

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

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

RA collapse first, over one-third

RA systolic collapse >1/3 cycleMitral E falls >25% inspirationTricuspid E falls >40% expiration

Constrictive vs Restrictive

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MVA equals 220 over PHT

PHT in millisecondsSevere MVA ≤1.5 cm²Very severe <1.0 cm²

Diastolic Function Grading Path

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

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

32 mmHg over 1-to-3 m/s time

Normal ≥1200 mmHg/sImpaired <1000 mmHg/sMeasured on MR CW jet

Advanced Hemodynamics

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

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

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

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

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

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

Blue Away, Red Toward

Blue = away from probeRed = toward probeMosaic = aliasing/turbulence

PW vs CW Doppler

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

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

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

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)

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