Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
275 Cards in this Set
- Front
- Back
|
Which condition has a holosystolic murmur that radiates to the axilla and described as a blowing/high-pitched murmur?
|
MR murmur |
|
|
What does holosystolic mean? |
Throughout the entirety of systole |
|
|
True or false Mitral regurgitation is an incompetent valve that permits backward diastolic flow |
False, the mitral valve permits backward systolic flow from LV to MV to LA |
|
|
What are some causes of MR? |
-rheumatic fever -Annulus dilatation -mitral annular calcification -flail, prolapse and/or stenotic leaflets -vegetation during to endocarditis -elongated chordae tendineae -ruptured chordae tendineae -pap muscle fibrosis, calcification, ischemia or rupture -Prosthetic valve dysfunction -congenital anomalies |
|
|
What are some complications of MR? |
-LA volume overload (preload) -la thrombus formation -lv volume overload (preload) -lv dilation leads to hyperdynamic then leads to LV hypertrophy -pulmonary hypertension -heart failure -pulmonary edema |
|
|
What are some symptoms of MR? |
-dysrhythmias -fatigue -dyspnea (difficult breathing) -palpitations -orthopnea (shortness of breath lying flat) |
|
|
What are some treatments for MR? |
-valve repair -valve replacement -alfieri procedure (bow tie procedure |
|
|
What is the Alfieri procedure? Which condition would this procedure fix? What is another name for this procedure? |
-AKA bow tie procedure - fixes MR -a stitch closes the section of the mitral valve leaflet that doesn't close properly. The rest of the valve continues to open and close normally, allowing adequate blood flow. |
|
What does #8 represent? What will the cause this? |
Hyperkinetic ivs and LVPW because the mitral regurgitation causes the LV to have an overload of blood, and the ventricle will attempt to squeeze more often to eject the volume out. Eventually this may lead to hypertrophy |
|
What does #9 represent? What causes it? |
MR causes the aortic valve to notch. This is due to a mid-systolic closure due to a sudden decrease in the amount of volume leaving the LV (decreased cardiac output) . |
|
|
True or false A concentric MR jet will be underestimated |
False, an eccentric MR jet would be underestimated because as the jet hits the walls, the flow slows down |
|
|
Which view is good to see where the MR originates? |
SAX |
|
|
What does PISA stand for? |
Proximal isovelocity surface area |
|
|
What is another name for PISA? |
Flow convergence |
|
|
What does PISA determine? |
Used to estimate the area of an orifice through which blood flows. In cases of MR, PISA is used to determine the effective regurgitant orifice area (EROA) and the regurgitant volume |
|
|
If an MR jet extends just beyond the mitral valve leaflets, what grade on the severity scale would the MR be? |
Mild (grade 1) |
|
|
If the MR jet extends 1/3 way into the left atrium, , what grade on the severity scale would the MR be? |
Moderate (grade 2) |
|
|
If the MR jet extends 1/2 way into the left atrium, , what grade on the severity scale would the MR be? |
Moderate to severe (grade 3) |
|
|
If the MR jet extends mid-to-back wall of the left atrium, what grade on the severity scale would the MR be? |
Severe (grade 4) |
|
|
Is MR more severe or mild when the waveform is faint? |
If it's faint, it's not as severe. If it's bright and more filled in, it's severe |
|
|
How high is the peak velocity of MR? |
Typically between 4-6 m/sec |
|
|
If there is a decreased peak velocity of MR (below 4 m/sec), what would that indicate? |
An elevated left atrial pressure (lap) due to significant MR |
|
|
How do you calculate the left atrial pressure (lap)? |
Acquiring MR peak velocity Lap = systolic BP - MR gradient |
|
|
If a patient has a blood pressure of 130/80 and the MR peak velocity is 5 m/sec, what is the left atrial pressure (lap)? |
Systolic BP - MR gradient = LAP 130 - 5 = 125 |
|
|
While getting the PW of the pulmonary vein, the "S" wave is decreased (blunted) and the "D" wave is increased? What would this indicate? Is it normal, mild, moderate or severe? |
Moderate to severe MR |
|
|
While getting the PW of the pulmonary vein, the "S" wave is biphasic and above the baseline. The "D" wave is smaller than the "S" wave? What would this indicate? Is it normal, mild, moderate or severe? |
A normal pulmonary vein flow |
|
|
While getting the PW of the pulmonary vein, the "S" wave is below the baseline and the "D" wave is increased. What would this indicate? Is it normal, mild, moderate or severe? |
The "S" wave would be considered reversed and is known as pulmonary venous flow reversal. This indicates severe MR |
|
|
What is mitral valve prolapse? |
When the AMVL and/or PMVL slip or sink into the LA while the MV is closed (during systole) |
|
|
What is Barlow Syndrome? |
Another name for mitral valve prolapse |
|
|
What are other names for mitral valve prolapse? |
Barlow Syndrome, floppy valve syndrome, or systolic click |
|
|
What is a systolic click murmur? |
Another name for mitral valve prolapse |
|
|
True or false The exact cause of mitral valve prolapse is unknown |
True |
|
|
What is a symptom of Marfan syndrome? |
Mitral valve prolapse |
|
|
What are some causes of mitral valve prolapse? |
1. Exact cause isn't known 2. Myxomatous degeneration (creates extra tissue) 3. Hereditary (prevalent in women under 40) 4. Connective tissue disorders like: Marfan syndrome, lupus, ehler's danlos 5. Heart abnormalities like: patent ductus arteriosus, secundum atrial septal defect, interatrial septal aneurysm, myocarditis, Ebstein anomaly, Wolfe-Parkinson-White syndrome, large pericardial effusion 6. Skeletal abnormalities like: pectus excavatum (hollow chest), pectus carinatum (barrelled chest), straight back or scoliosis 7. Improper placement of transducer during M-Mode |
|
|
Describe the murmur of mitral valve prolapse |
Mid-systolic click with/without a systolic murmur |
|
|
What are signs/symptoms or complications of mitral valve prolapse? |
1. Often asymptomatic 2. Progressive MR 3. Risk of endocarditis (especially with MR) 4. Ruptured chordae tendineae and/or papillary muscle 5. Embolism 6.sudden death |
|
What is this an example of? |
Mitral valve prolapse |
|
|
What is the best view to evaluate mitral valve prolapse? Which view won't you diagnose MVP? |
LAX is the best view Don't diagnose in 4 chamber |
|
|
How can you provoke mitral valve prolapse to help diagnose it? |
Images acquired while patient is supine, sitting, standing, during Valsalva maneuver or during amyl nitrite administration |
|
|
How can you determine if there is mitral valve prolapse? |
Leaflets must prolapse beyond an imaginary line drawn across the MV annulus |
|
|
If the leaflet tips point toward the LV, is it MVP or flail MV? |
Mitral valve prolapse |
|
|
If the leaflet tips point toward LA, is it MVP or flail MV? |
Flail MV |
|
|
How can you differenciate between MVP and a flail MV? |
|
|
What is #1? |
Mid-to-late systolic prolapse of the AMVL and/or PMVL greater than 2mm below the C-D points |
|
What is #2? |
Holosystolic prolapse of the AMVL and/or PMVL greater than or equal to 3mm below the C-D points |
|
What is this an example of? |
Holosystolic mitral valve prolapse |
|
|
If the AMVL prolapses, what direction is the MR jet going? |
Posterior directed jet |
|
|
If the PMVL prolapses, what direction will the MR jet be going? |
Anterior directed MR jet |
|
|
What is tricuspid stenosis? |
A narrowing, thickening, and/or obstruction of the tricuspid valve that impedes diastolic flow |
|
|
Which valve condition has a murmur described as a diastolic "rumble" that varies with respiration and has an opening snap? |
Tricuspid Stenosis |
|
|
What is the most common cause of tricuspid stenosis? |
Rheumatic fever |
|
|
Can Ebstein anomaly cause TS? |
Yes. |
|
|
Which heart disease only affects the right side of the heart? |
Carcinoid heart disease |
|
|
Describe the involvement of carcinoid heart disease in the TV |
The TV leaflets are thick and rigid with no change in position from diastole to systole. |
|
|
What can carcinoid heart disease cause? |
TS, TR, PS, PI |
|
|
Give examples of secondary TS |
-RA clot or tumor -infective endocarditis -systemic lupus erythematosus |
|
|
Can intracardiac wires/pacemakers cause TS? |
Yes, they can obstruct the TV flow |
|
|
True or false TS is usually an isolated disease state |
False, it's not usually isolated. There will be other issues |
|
|
What are some signs and symptoms of TS? |
Patient may experience: peripheral edema, Abdominal swelling, right upper quadrant pain, jaundice and ascites |
|
|
Where can you get the best image of diastolic doming of the TV leaflets? |
Lax or 4C |
|
|
What can cause right atrial enlargement? |
TS, because of the volume and pressure overload TR can also cause RA enlargement |
|
|
Will TS effect the IVC? If so, then why? |
IVC becomes dilated due to the backup of blood and right atrial enlargement. The Normal IVC diameter is 1.2 - 2.3 cm) |
|
|
Will the E-F slope be increased or decreased if there is tricuspid stenosis? |
The "E-F" slope is decreased because the mobility of the leaflets are reduced. The right ventricle fills slower when TS is present; therefore, the valve is held open by an elevated right atrial pressure |
|
|
True or false, with TS, there will be posterior motion of the posterior TV leaflet due to tethered TV leaflet tips |
False, there will be anterior motion of the posterior TV leaflet |
|
|
How would you measure the pressure half-time of a TS waveform? |
Get the p1/2t by measuring the deceleration slope from "E" to "F" on peak TS waveform. TS results in a decreased "E-F" slope and an increased max velocity ( > 1 m/sec) of the TS waveform |
|
|
What is the equation to get the tricuspid valve area? |
TVA = 190/pressure half-time Note: MVA =220/pressure half-time |
|
|
What is the normal TV area? |
7-9 cm² |
|
|
What value showcases severe TS? |
< 2.0 cm² |
|
|
What is TR? |
An incompetent TV that permits backward systolic flow from the RV into the RA |
|
|
What type of murmur is associated with TR? |
Holosystolic murmur that increases with respiration |
|
|
Is TR common? |
Up to 93% of patients have trace-to-mild TR |
|
|
Which heart disease mainly affects the right side and especially the TV? |
Carcinoid heart disease |
|
|
Can TV prolapse cause TR? If so, what types? |
Yes: TVP can be Mid-to-late systolic or holosystolic prolapse into the right atrium of one to all three of the TV leaflets |
|
|
True or false, Incomplete closure of the TV may be due to right ventricular infarct, papillary muscle dysfunction, ruptured TV chordae, pacemaker wire, or tumor |
True |
|
|
Describe Ebstein anomaly and the TV |
Can cause TR The tricuspid valve is near the apex and RV becomes atrialized |
|
|
Which congenital disease has atrial displacement (atrialized RV) where the TV is toward the apex |
Ebstein anomaly |
|
|
What are some complications of TR? |
-Right atrial and right ventricular enlargement. This enlargement may lead to A fib. (common) -enlargement of IVC, hepatic vein, svc and neck veins -leg and abdominal swelling, liver enlargement, portal hypertension |
|
|
Which valve is larger, the tricuspid or the mitral valve? |
Tricuspid valve |
|
|
What is a complication of functional TR? |
Functional TR is primarily due to tricuspid annular dilation and right ventricular (RV) enlargement and dysfunction; it occurs most often secondary to left-sided heart disease, especially in the setting of mitral valve pathology. |
|
|
What is the difference between functional TR and organic TR? |
Organic TR = primary, effects the valve itself Ex: Ebstein anomaly, carcinoid heart disease, rheumatic disease Functional TR = secondary ex: tv annular dilatation (asymmetric), annular shape, pulmonary hypertension, LV/RV dysfunction |
|
|
What is the normal diastolic dimension of the IVC? |
1.2 - 2.3 |
|
|
What are the best views to find TV prolapse? |
Lax rvit, 4c, Subcostal |
|
|
Can TR cause paradoxical septal motion? What is it? |
Yes Paradoxical septal motion is defined as movement of the interventricular septum away from the left ventricular free wall during systole which is the opposite of its normal movement which is inward toward the left ventricle / or the left ventricular free wall during systole. |
|
|
What percentage of patients have trace-to-mild TR? |
93% |
|
|
What can be calculated from the TR peak velocity? |
An estimate of the RVSP or PAP (pulmonary artery pressure) RVSP = PAP If the IVC collapses, the RAP = 10 Therefore: RVSP = 4(TR peak velocity)² + RAP |
|
|
If the TR peak velocity = 2.2 m/sec and the IVC collapses normally during the sniff test, what is the RVSP/PAP? |
4(2.2)² + RAP 4(2.2)² + 10 19.4 +10 = 29.4 mmHg |
|
|
What can severe TR do to the hepatic vein? |
It can be dilated and have flow reversal |
|
|
Describe the severity scale of the degree of pulmonary hypertension based on the RVSP method for normal, mild, moderate and severe PHTN |
|
|
|
What is pulmonic stenosis? |
A narrowing, thickening, and/or obstruction of the pulmonic valve that impedes systolic blood flow traveling from the RV into the pulmonary artery |
|
|
What are the 3 classifications of pulmonic stenosis based on location? |
1. Subvalvular (infundibular) PS ---obstruction of RVOT (below the valve) 2. Valvular PS --obstruction of PV cusps 3. Supravalvular PS --obstruction in the pulmonary artery (above the valve) |
|
|
If there is pulmonic stenosis of the infundibulum, where would the stenosis be? |
Subvalvular - obstruction of RVOT (below the valve) |
|
|
What type of murmur does pulmonic stenosis have? |
A harsh systolic ejection murmur heard at the left upper sternal border; a thrill may also be present |
|
|
What is the most common cause of pulmonic stenosis? |
Congenital PS |
|
|
What can cause PS? |
1. Congenital PS (most common) 2. Carcinoid heart disease involvement 3. Rheumatic heart disease (uncommon) 4. Sinus of Valsalva aneurysm (if the aneurysm protrudes into the RVOT, it can obstruct the flow through RVOT. This is a form of subvalvular (infundibular) PS |
|
|
What are some complications of pulmonic stenosis? |
1. Dyspnea on exertion (DOE) 2. Jugular venous distention (JVD) 3. RV hypertrophy 4. Rule out associated congenital anomalies |
|
|
How would pulmonic stenosis appear on an echo? |
1. Thickened PV leaflets with systolic doming 2. RV hypertrophy due to increased afterload (pressure) 3. LV takes on "D" shape (RV pressure) 4. RA enlargement (volume and pressure overload) 5. May develop into RV failure 6. Post-stenotic dilatation of MPA due to velocity of PS jet striking pulmonary artery wall |
|
|
What can M-Mode detect if there is pulmonic stenosis? |
The "A" wave dip would be increased Greater than or equal to 8mm versus a normal dip @ 2-3 mm |
|
|
What is the primary method of evaluating pulmonic stenosis? |
Getting the peak gradient by tracing the waveform that will give us the max PG, mean PG and peak velocity. |
|
|
What equation will give us a pressure gradient? |
PG = 4(V)² Bernoulli's equation |
|
|
How would you calculate the pulmonic valve area to determine the severity of the pulmonic stenosis? |
|
|
|
What are the severity scale values of mild, moderate and severe PS? |
|
|
|
What is pulmonic insufficiency? |
An incompetent PV that permits backward diastolic flow from pulmonic artery into the RV |
|
|
What type of murmur does PI make? |
Low-pitched diastolic murmur that may increase with respiration |
|
|
If pulmonary hypertension causes PI, how would the murmur change? What is the name of it? |
It becomes high-pitched blowing diastolic murmur. This is called a Graham-Steele Murmur |
|
|
What is a Graham-Steele Murmur? |
A high-pitched blowing diastolic murmur that occurs when pulmonary hypertension is present which causes severe PI |
|
|
What can cause PI? |
1. Pulmonary hypertension (causes pulmonary artery and PV annulus dilatation resulting in the incomplete closure of the PV cusps 2. Infective endocarditis 3. Rheumatic heart disease 4. Congenital anomalies (tetralogy of fallot, vsd, valvular pulmonic stenosis) 5. Carcinoid heart disease |
|
|
In what order does rheumatic heart disease attack the valves? |
Mitral valve is attacked first, then the aortic valve and then evolves the pulmonic valve |
|
|
What are some complications of PI? |
1. PI is usually well tolerated for years 2. Increased risk for endocarditis 3. Dyspnea 4. Severe PI may lead to right heart failure |
|
|
Is PI common? |
Yes, up to 87% of patients have this |
|
|
Can PI cause paradoxical septal motion? |
Yes |
|
|
What happens to the tricuspid valve if the PI jet is directed at it? |
Diastolic flutter of the tricuspid valve |
|
|
Describe what happens if there is severe, acute PI |
There will be a premature opening of the PV because the PI increases the right ventricular end diastolic pressure (RVEDP). The RVEDP prematurely elevates above the pulmonary artery pressure due to volume overload which forces the PV open |
|
|
When are prosthetic valves implanted? |
When patient has hemodynamically significant valvular disease. Hemodynamically means when changes occur that cause more issues |
|
|
Which valve usually requires valvular rings? |
Mitral valve |
|
|
What are common brand names of valvular rings? |
Carpenter rings and Duran rings |
|
|
What criteria would be needed to use a bioprosthetic valve? |
-elderly patients where long-term durability is less important - patients that can't be put on anticoagulation medicine -patients that have an increased risk for thromboembolism |
|
|
What criteria would be needed to get a mechanical prosthesis valve? |
-children and young adults -Patients with renal failure, small valve annulus, high re-operative risk, or if a patient already requires anticoagulation medication (like if they were already a-fib) -if a patient requires an aortic root replacement (aortic dissection with severe AI) |
|
|
Name the three types of bioprosthetic valves |
1. Autograft (self to self) 2. Homograft (allograft) human-to-human 3. Heterograft (xenograft) animal-to-humam |
|
|
If a patient needs a bioprosthetic valve and is used from their own body. What type of valve is it? |
Autograft |
|
|
What is the procedure that the individual's valve annulus and trunk are excised and relocated to the aortic valve position. The coronary arteries are then repositioned. |
Ross procedure |
|
|
Which part of the body can be used to recreate an autograft bioprosthetic valve |
The fascia lata (thigh muscle covering) can be reconstructed into a valve |
|
|
If a patient requires a bioprosthetic valve from another human, what kind of valve is it? |
Homograft aka allograft |
|
|
What is an allograft? |
The same as a homograft bioprosthetic valve |
|
|
Which bioprosthetic valve appears very similar to a native valve? |
Homograft |
|
|
In a homograft bioprosthetic valve, what can be used to create a valve? |
-the aortic valve or dura mater (brain covering) |
|
|
How is a homograft bioprosthetic valve mounted? |
Can be mounted with or without stents |
|
|
Does a stentless or stented valve offer improved hemodynamics with a decreased pressure gradient? |
Stentless |
|
|
What type of bioprosthetic valve transfers from an animal to a human? |
Heterograft aka xenograft |
|
|
What is a xenograft valve? |
Heterograft valve from an animal |
|
|
What animals do a heterograft valve come from? |
Porcine (pig) or bovine (cow) |
|
|
What is a pig valve called? |
Porcine heterograft valve |
|
|
What is a cow valve called? |
Bovine heterograft valve |
|
|
Which valve is used from a porcine heterograft? |
Their trileaflet aortic valve |
|
|
True or false, a porcine heterograft valve can only be stented when mounted |
False, it can be stented or stentless |
|
|
In a bovine heterograft, which part of the cow is used to create a valve? |
Cow's pericardium |
|
|
How is a bovine heterograft valve mounted? |
With stents and a sewing ring |
|
|
Carpentier-Edwards, Medtronics, Hancock, Ionescu-Shiley, Edwards Prima Plus and Toronto SPV are examples of what? |
Brand names of heterograft valves (from animals) |
|
|
How many struts are used in a bioprosthetic valve? How many can you see? |
3 struts are used but should only see 2 |
|
|
What are complications with bioprosthetic valves? |
1. Calcification and/or degeneration 2. Inherently stenotic 3. Thrombus trapped on leaflets or stents 4. Prosthetic valve endocarditis 5. Abnormal amount of regurgitation 6. Perivalvular leak (around valve) 7. Dehiscence (sutures become loose or break and the valve is unstable) 8. Abnormalities of valve annulus (ring abscess) |
|
|
What must the sonographer measure on every study of patients with prosthetic valves? What is done with that info collected? |
Prosthesis valve area and pressure gradient must be obtained and compared to the manufacturer's statistics and previous echos |
|
|
How can a prosthetic valve cause endocarditis? |
Areas of turbulent flow create a perfect environment for bacteria to latch on and fester |
|
|
True or false A single, small, central jet is considered abnormal with a bioprosthetic valve |
False, it's considered normal. |
|
|
What is dehiscence? |
The sutures in the sewing ring become loose and/or break and the prosthesis is no longer stable. This then causes a perivalvular leak. |
|
|
Name the different types of mechanical valves |
1. Ball and Cage 2. Tilting disc 3. Bileaflet tilting disc |
|
|
Which mechanical valves is similar to a native valve? |
Ball and Cage |
|
|
How does a Ball and Cage mechanical valve work? |
Pressure pushes the ball up and down in order to open and close the valve |
|
|
What brand name is associated with a Ball and Cage mechanical valve? |
Starr-Edwards (think of a baseball star in a batting) |
|
|
How many openings are there in a tilting disc mechanical valve? What are they called? |
2 openings |
|
|
These brand names are example of what kind of valve: Medtronic Hall, Omnicarbon, Monostrut and Bjork-Shiley |
Tilting Disc mechanical valve |
|
|
How many openings does a Bileaflet Tilting Disc valve have? |
3 openings |
|
|
Which mechanical valve is the least stenotic mechanical prosthetic valve? |
Bileaflet Tilting Disc valve |
|
|
Which mechanical prosthetic valve has central flow? |
Bileaflet Tilting Disc |
|
|
St. Jude, CarboMedics, ATS Open Pivot, On-X, and Conform-X are all brand names of what kind of valve? |
Bileaflet Tilting Disc valve |
|
|
What are some complications of mechanical valve replacements? |
1. Inherently stenotic 2. Thrombus 3. Pannus (fibrous ingrowth of tissue) 4. Regurgitation 5. Perivalvular leak 6. Dehiscence (makes valve rock) 7. Abnormalities of valve annulus 8. Prosthetic valve endocarditis 9. Mechanical failure 10. Hemolysis - red blood cell damage |
|
|
What term is a fibrous ingrowth of tissue. This leads to regurgitation and/or stenosis because the prosthesis is unable to open and/or close properly? What is it a complication of? |
Pannus, complication of a mechanical valve |
|
|
How would you analyze a bioprosthetic valve on echo? |
1. Evaluate leaflet mobility and thickness 2. Rule out calcification, degeneration, stenosis, thrombus, infective endocarditis, regurgitation, perivalvular leak, dehiscence, annulus abnormalities 3. TEE to rule out vegs or thrombi |
|
|
How would you analyze a mechanical valve on echo? |
-TTE can evaluate parts of the heart, but artifacts block certain anatomy -evaluate disc motion -rule out thrombus, pannus ingrowth, stenosis, infective endocarditis, regurgitation, dehiscence, mechanical failure, annulus abnormalities |
|
|
Why is a TEE useful with mitral valve mechanical prosthesis evaluation? |
Because of its posterior location |
|
What is this a diagram of? |
Bioprosthetic valve: stented/trileaflet |
|
|
Which prosthetic valve has flow as a central jet through a trileaflet valve, and is similar to a native valve |
Bioprosthetic valve |
|
What is this a diagram of? |
Ball and Cage |
|
|
Which prosthetic valve has flow that occurs as turbulent, high velocity, peripheral circumferential jets. There is no flow through the center. |
Ball and Cage mechanical valve |
|
What is this a diagram of? |
Tilting Disc mechanical valve |
|
|
Which prosthetic valve has flow that occurs as two different flow patterns due to a major and minor orifice on each side |
Tilting Disc |
|
What is this a diagram of? |
Bileaflet Tilting Disc mechanical valve |
|
|
Which prosthetic valve has flow that occurs as three different flow patterns due to three different orifices and is the least stenotic? |
Bileaflet Tilting Disc mechanical valve |
|
|
The tip of a _______ points toward the roof of the LA in systole. |
Flail leaflet |
|
|
The tip of a _________ is curved so that the tip points toward the LV apex. |
Prolapsing |
|
|
___________ = chordal-mitral connection of leaflet to papillary muscle intact = tips point toward LV |
Prolapsing |
|
|
Cordial rupture, which causes ___________ and the tips point toward the roof of the LA |
Flail leaflet |
|
|
What is the term that is the narrow neck between the proximal acceleration on the ventricular side of the valve and jet expansion in the LA |
Vena contracta |
|
|
Which view is the vena contracta best measured? |
PLAX on TTE |
|
|
Vena contracta is measured as the (largest or smallest) width of the jet |
Smallest |
|
|
A vena contracta width less than _______ Indicates mild regurgitation; a vena contracta width of __________ indicates severe regurgitation. |
0.3 cm, 0.7 cm |
|
|
What is functional MV regurgitation a disease of? |
Considered a disease of the LV, NOT of the MV |
|
|
__________ mitral regurgitation often results in an eccentric posteriorly directed jet |
Ischemic |
|
|
Mitral valve prolapse often has an __________ regurgitant jet |
Eccentric |
|
|
What two things can occur of the normal pattern of pulmonary venous inflow into the LA in systole in patients with severe mitral regurgitation |
Reversal or blunting |
|
|
Regurgitant volume can be calculated by subtracting the ________ from the __________ |
Regurgitant volume can be calculated by subtracting the stroke volume across a competent valve (forward SV) from the antegrade volume flow rate across the regurgitant valve (total SV) |
|
|
To calculate PISA, how should you optimize the image? |
Dropping the baseline/lower aliasing velocity to 30 - 40 cm/s |
|
What is this part of PISA called? |
Flow convergence |
|
What is this area called? |
Vena contracta |
|
What is this area called? |
Jet area |
|
What is this area called? |
Jet length |
|
|
What does carcinoid disease affect? |
The right side of heart. Leaflets become "fixed" aka stationary |
|
If the MR is early peaking and triangular, how severe is it? |
More severe |
|
|
What is patient prosthesis mismatch? |
Valve area inadequate for body size |
|
|
What happens during acute MR? |
-result of flail leaflet, torn papillary or an acute myocardial infarction -the LV and LA aren't prepared for rapid onset of volume overload |
|
|
What happens during chronic MR? |
-the heart attempts to compensate for the regurgitation and fix the pathology -at first, the LV becomes hypertrophic, but will eventually will become dilatated if it persists. The LV stroke volume will also decrease now that the LV is enlarged. The LAP will also will also increase if the volume overload continues and pulmonary hypertension may develop |
|
|
D, 4(2)² +10 = 26 |
|
|
B |
|
|
A |
|
|
A |
|
|
A |
|
|
C |
|
|
A |
|
|
B |
|
|
B |
|
|
A |
|
|
A |
|
|
B |
|
|
A |
|
|
A |
|
|
B |
|
|
A |
|
|
B |
|
|
B, PLAX is best |
|
|
B; holosystolic prolapse of the AMVL and/or PMVL greater than or equal to 3mm below the C-D points |
|
|
A |
|
|
B, MR happens during systole |
|
|
D |
|
|
B |
|
|
A |
|
|
C |
|
|
A |
|
|
B |
|
|
C |
|
|
Mitral stenosis severity scales are based on the following techniques: pulsed wave Doppler mapping technique, color flow regurgitant jet area/left atrial area, continuous wave Doppler spectral strength and shape of the waveform. A. True B. False |
B, the techniques listed are for MR. |
|
|
During the pulmonary vein Doppler exam, we detect a reversed "S" wave and increased "D" wave. This is known as pulmonary venous systolic flow reversal and indicates _________. A. Normal pulmonary vein flow B. Mild mitral regurgitation C. Moderate mitral regurgitation D. Severe mitral regurgitation |
D |
|
|
D |
|
|
In most cases, if the posterior mitral valve leaflet prolapses there is a posterior directed jet of mitral regurgitation and if the anterior mitral valve leaflet prolapses, there is an anterior directed jet of mitral regurgitation. A. True B. False |
B; prolapsed posterior MV leaflet will have an anterior directed jet and if the anterior mitral valve leaflet prolapses, there is a posterior directed jet of mitral regurgitation |
|
|
D |
|
|
A, |
|
|
A |
|
|
B; it increases with respiration |
|
|
A |
|
|
B |
|
|
A |
|
|
A |
|
|
A |
|
|
C; 4(4)² + 15 = 79 The RAP is 15 because the IVC doesn't collapse |
|
|
B, PS makes a harsh systolic ejection murmur, a thrill may also be present |
|
St. Jude bileaflet Tilting Disc |
D |
|
Flow occurs as a central jet through a trileaflet valve |
A |
|
Ball and Cage mechanical valve |
C |
|
Used in patients where long-term durability is not required |
A |
|
No flow through the center of the valve, only to the sides |
C |
|
Bileaflet mechanical valve |
D |
|
Starr-Edwards |
C |
|
Least stenotic of all the mechanical prosthetic valves |
D |
|
Tilting Disc mechanical valve |
B |
|
Flow occurs as two different flow patterns due to a major and minor orifice on either side of the disc |
B |
|
Stented, trileaflet bioprosthetic valve |
A |
|
Porcine valve |
A |
|
Flow occurs as three different flow patterns through three different orifices that promotes central flow |
D |
|
Medtronic Hall tilting disc |
B |
|
Flow occurs as turbulent, high velocity, peripheral circumferential jets |
C |
|
|
A |
|
|
D |
|
|
C |
|
|
A |
|
|
A |
|
|
B, uses cow's pericardium |
|
|
D |
|
|
A |
|
|
A |
|
|
D, all can cause stenosis |
|
|
A |
|
|
D |
|
|
A |
|
|
D |
|
|
A |
|
|
A |
|
|
A |
|
|
B |
|
|
A |
|
|
D |
|
|
A |
|
|
B, because of the TEE probe's posterior location to the valve |
|
|
B |
|
|
A |
|
|
A |
|
|
What does EROA stand for? |
Effective regurgitant orifice area |
|
|
Would TS results in a (decreased or increased) "E-F" slope and an increased max velocity ( > 1 m/sec) of the TS waveform |
Decreased |
|
|
What is Barlow Syndrome? |
Mitral valve prolapse |
