Advanced Echocardiography - 8\valvular Heart Disease

Front 1

What causes a pressure overload pattern and turbulent flow?

Back 1

Stenotic Valves

Front 2

Does a spectral doppler waveform of a stenotic valve travel in the same direction as normal? Does it have the same shape as normal?

Back 2

Same Direction
Different Shape (> Velocity)

Front 3

Does a spectral doppler waveform of a regurgitant valve travel in the same direction as normal? Does it have the same shape as normal?

Back 3

Different Direction
Different Shape (> Velocity)

Front 4

What effect does stenosis have proximal to the stenotic valve?

Back 4

Pressure Overload Pattern / Increased Afterload
Ventricular Hypertrophy or Atrial Dilatation

Front 5

What effect does stenosis have at the level of the stenotic valve?

Back 5

Leaflet Doming
< Orifice Area
< Cardiac Output / > Velocity

Front 6

What effect does stenosis have distal to the stenotic valve?

Back 6

Turbulent Flow
< Pressure

Front 7

Is a pressure gradient seen across a normal, open valve?

Back 7

No, pressures will be the same on either side due to laminar flow

Front 8

Is a pressure gradient seen across a stenotic, open valve?

Back 8

Yes, pressures will be different due to the reduced valvular orifice affecting flow velocity and pressure

Front 9

How can maximum pressure gradient across a stenotic valve be obtained using an ultrasound machine?

Back 9

CW Doppler Waveform
Trace the PG

Front 10

How can maximum pressure gradient across a stenotic valve be obtained visually using an equation?

Back 10

CW Doppler Waveform
Bernoulli the peak velocity
- PG = 4(V)2

Front 11

How can mean pressure gradient across a stenotic valve be obtained using an ultrasound machine?

Back 11

CW Doppler Waveform
Trace the PG

Front 12

Which of the following best correlates with cath lab pressure gradient findings: mean PG or max PG?

Back 12

Mean PG

Front 13

What effect does regurgitation have proximal to the regurgitant valve?

Back 13

Volume Overload Pattern / > Preload
Chamber Dilatation

Front 14

Increased preload is caused by what kind of pattern?

Back 14

Volume Overload Pattern
(Regurgitation)

Front 15

Increased afterload is caused by what kind of pattern?

Back 15

Pressure Overload Pattern
(Stenosis)

Front 16

Name 5 causes of MS

Back 16

1) Rheumatic Fever
2) MAC
3) Congenital Defect (MV Atresia, Parachute MV)
4) LA Mass/Tumor/Veg
5) Prosthetic Valve Dysfunction

Front 17

Name 4 complications of MS

Back 17

1) Chain Reaction (Lungs, R Heart, Liver, Kidneys, etc)
2) > LA Thrombus Risk
3) > Endocarditis Risk
4) < Cardiac Output

Front 18

Name 6 symptoms of MS

Back 18

1) Dyspnea
2) Hemoptysis
3) Fatigue
4) Chest Pain
5) Syncope
6) Right Heart Failure

Front 19

Name 4 treatments for MS

Back 19

1) Catheter Balloon Valvuloplasty
2) Commissurotomy
3) MV Repair
4) MV Replacement

Front 20

Describe the classic shape of a MV leaflet when MS is present

Back 20

Diastolic doming of the anterior MV leaflet causes a 'hockey-stick'-like
(Pressure from the proximal chamber pushing on the underside of the leaflets while they are open)

Front 21

How thick must MV leaflets be to qualify as MS?

Back 21

> 3mm

Front 22

Name 5 ways MS can present on M-mode

Back 22

1) < E-F slope (0-30 mm/sec is severe)
2) < A wave (Anterior MV leaflet)
3) < D-E Excursion (<= 15mm)
4) Bright/Thickened leaflets
5) LAE

Front 23

What is a common pulmonary finding in patients with chronic MS?

Back 23

Pulmonary HTN

Front 24

How does pulmonary HTN present in 2D echo?

Back 24

PSAX - flattening of IVS, possibly with paradoxical wall motion / D-shaped LV in systole and/or diastole

Front 25

Pulmonary HTN can develop into chronic RVH, which in turn can eventually develop into what?

Back 25

RV Dilatation & Failure

Front 26

What is an occasional finding in patients with chronic MS?

Back 26

Pericardial Effusion

Front 27

Name 6 findings common on M-mode for patients with MS and pulmonary HTN

Back 27

1) RVH
2) RVE
3) Flattened IVS
4) Small LV with possible paradoxical septal motion
5) No A wave at PV
6) Mid-Systolic closure of PV (flying-W appearance)

Front 28

What additional 2D echo findings may present in patients with chronic MS and pulmonary HTN?

Back 28

PA Dilatation
IVC / Hepatic Vein Dilatation
Sniff Test Failure (no collapse)

Front 29

Name 4 methods for determining MV area

Back 29

1) Deceleration Slope (E/F) - Continuity
2) PISA
3) P1/2t
4) Planimetry

Front 30

What is P1/2t?

Back 30

The time required for the PG across the valve to reduce by 1/2