The Ultimate Advanced PTEeXAM Study Guide: 2026 High-Yield Review & ASE Guidelines

Designed for the learner in the ICU/OR, this comprehensive review is strictly mapped to the National Board of Echocardiography (NBE) Advanced PTEeXAM Content Outline. We have decoded the NBE blueprint to make sure every high-yield topic, from quantitative valvular assessment to complex hemodynamic modeling, is covered with clinical precision, leaving no category unaddressed for the 2026 exam cycle.

1. Principles of Ultrasound

A. Nature of Ultrasound: Compression and Rarefaction
B. Frequency, Wavelength, Tissue Propagation Velocity
C. Properties of Ultrasound Waves
D. Ultrasound/Tissue Interactions

2. Transducers

A. Piezoelectric Effect
B. Crystal Thickening and Resonance
C. Damping
D. Sound Beam Formation
E. Focusing
F. Axial and Lateral Resolution
G. Arrays

3. Equipment, Infection Control, and Safety

A. Clinical Dosimetry
B. Biological Effects of Ultrasound
C. Electrical and Mechanical Safety
D. Infection Control
E. Transesophageal Echocardiographic Probe
Insertion and Manipulation
F. Contraindications to Transesophageal
Echocardiography
G. Complications of Transesophageal
Echocardiography

4. Imaging

A. Instrumentation
B. Displays
C. Imaging Modalities
D. Signal Processing and Related Factors

5. Principles of Doppler Ultrasound

A. Doppler Effect
B. Doppler Equation
C. Doppler Shift Frequencies and Influencing Factors
D. Nyquist Limit
E. Spectral Analysis and Display Characteristics
F. Pulsed-Wave Doppler
G. Continuous-Wave Doppler
H. Color Flow Doppler
I. Color M-Mode

6. Quantitative M-Mode and Two Dimensional Echocardiography

A. Edge Recognition
B. Temporal Resolution
C. Global Function

7. Quantitative Doppler

A. Types of Velocity Measurements
B. Volumetric Measurements and Calculations
C. Valve Gradients and Areas
D. Estimation of Pressures in the Cardiac Chambers and Great Vessels

8. Valvular Spectral Doppler Profiles

A. Tricuspid Valve and Right Ventricular Inflow
B. Pulmonic Valve and Right Ventricular Outflow
C. Mitral Valve and Left Ventricular Inflow
D. Aortic Valve and Left Ventricular Outflow

9. Cardiac Chamber Anatomy

A. Imaging Planes
B. Cardiac Chambers and Walls
C. Cardiac Cycle and Relation of Events Relative to ECG

10. Global Ventricular Systolic Function and Pathology

A. Assessment of Left Ventricular Systolic Function
B. Abnormal Left Ventricular Systolic Function
C. Assessment of Right Ventricular Function
D. Cardiomyopathies

11. Segmental Left Ventricular Systolic Function and Pathology

A. Myocardial Segment Identification (17-Segment Model)
B. Coronary Artery Distribution and Flow
C. Normal and Abnormal Segmental Function
D. Left Ventricular Aneurysm
E. Left Ventricular Rupture
F. Ventricular Septal Defect Post Myocardial Infarction
G. Left Ventricular Pseudoaneurysm

12. Cardiac Valves – Anatomy and Pathology (Excludes Spectral Doppler)

A. Tricuspid Valve
B. Pulmonic Valve
C. Mitral Valve
D. Aortic Valve and Root
E. Acquired Valve and Annular Diseases

13. Intracardiac Masses and Devices

A. Intracardiac Masses
B. Devices and Foreign Material

14. Pericardium and Extracardiac Structures – Anatomy and Pathology

A. Pericardium and Pericardial Space
B. Pulmonary Arteries
C. Pulmonary Veins
D. Vena Cavae and Systemic Veins
E. Coronary Arteries

1. Anatomical position of coronary ostia
2. Flow patterns
3. Reimplantation buttons

F. Aorta and Great Vessels
G. Pleural Space and Lung
H. Other Structures

15. Assessment of Perioperative Events

A. Causes of Cardiovascular Instability
B. Cardiopulmonary Bypass, including Minimally Invasive Management
C. Ventricular Assist Devices and Intra-aortic Balloon Pumps
D. Transplantation Surgery (Heart, Lung, Liver)
E. Assessment related to Coronary Surgery
F. Assessment related to Valve Surgery
G. Assessment related to Aortic Surgery (Aneurysm)

16. Congenital Heart Disease

A. Identification of Morphologic Left and Right Structures
B. Assessment Post Surgical Repair
C. Atrial Septum
D. Ventricular Septum
E. Pulmonic Valve and Right Ventricular Outflow Tract Abnormalities
F. Aortic Valve and Left Ventricular Outflow Tract Abnormalities
G. Coronary Artery Anomalies
H. Patent Ductus Arteriosus
I. Coarctation of the Aorta
J. Ebstein’s Anomaly
K. Persistent Left Superior Vena Cava
L. Tetralogy of Fallot
M. Transposition of the Great Arteries
N. Atrioventricular Septal Defect
O. Single Ventricular Procedures
P. Truncus Arteriosus
Q. Cor Triatriatum

17. Artifacts and Pitfalls

A. Two-dimensional Imaging Artifacts
B. Doppler Artifacts and Errors in Measurement
C. Pitfalls (Normal Anatomy/Variants Mistaken for Pathology)

18. Related Diagnostic Modalities

A. Epiaortic Scanning
B. Epicardial Scanning
C. Contrast Echocardiography
D. Utility of TEE Relative to Other Diagnostic Modalities

19. Ventricular Diastolic Filling and Function

A. Basic Principles
B. Echocardiographic Assessment of Left Ventricular Diastolic Function
C. Grading of Left Ventricular Diastolic Function
D. Estimates of Left Ventricular Diastolic Filling Pressures
E. Right Ventricular Diastolic Function

20. Transesophageal Echocardiography for Interventional/Hybrid Procedures

A. Intracardiac and Extracardiac
B. Endovascular