Cardiac Iii

Front 1

Describe the mitral stenosis?

Back 1

narrowing of the mitral vale orifice

Front 2

Most common etiology is Mitral stenosis

Back 2

Rheumatic heart disease

Front 3

etiologies affecting the mitral valve orifice b/c of Mitral stenosis

Back 3

Rheumatic heart disease
o Calcification of the mitral annulus (may extend to base of leaflets)
o Obstruction due to thrombus, tumor (myxomas), vegetations
o Congenital MS
 Parachute mitral valve where only one papillary muscle is attached to the MV

Front 4

what is parachute mitral valve? and is the eitology of what disease?

Back 4

only one papillary muscle is attach to the mitral valve
and is one eitology of mitral stenosis

Front 5

Describe RHD

Back 5

Leaflets become scarred and contracted. Adhesions fuse the commissures and restrict motion of both leaflets. The leaflets become tethered (confined) in a downward position, creating a funnel-shaped structure. The narrowed orifice inhibits flow from the LA to the LV and thus becomes a barrier to normal flow. This results in increased diastolic left atrial flow.

Front 6

Describe the heodynamics of MS

Back 6

•  in MVA causes a diastolic pressure gradient (pressure difference) between the LA and LV
 Valve area of 2 cm2 or more = minimal transvalvular pressure gradient and patient is usually asymptomatic
 Valve area < 2 cm2 = significant pressure gradient. This leads to pressure overload of the LA, pulmonary vascular bed, and RV
•  in LA pressure may lead to LA enlargement
 occurs with at least moderate MS
• LA enlargement/pressure may cause atrial fibrillation
• Chronic increase in LA pressure causes an increase in pulmonary resistance, leading to reduced lung compliance and difficulty breathing. The right heart has to work harder to pump blood into the lungs. Tricuspid regurgitation usually develops when the right heart is affected.
•

Front 7

Other complications of MS include:

Back 7

Thrombus formation Due to LA enlargement, loss of function, and stasis of blood flow. LAA common site for thrombus
 LA enlargement causes stretching of the annulus and MR
 Pulmonary hypertension occurs because of the increased resistance to pulmonary venous flow.

Front 8

What is the common site for thombus when mitral stenosis occur?

Back 8

Left atria area

Front 9

What is the sign/ and symptoms for M/s

Back 9

1. Dyspnea upon exertion
• Dyspnea and pulmonary edema occur because of the changes in the pulmonary vasculature, which reduce lung compliance
2. Hemoptysis
• Increased pulmonary pressure results in the rupture of pulmonary capillaries, leading to bleeding or hemoptsis
3. CP
• Pulmonary HTN can contribute to CP
4. Palpitations
• A-Fib
5. Orthopnea
6. Paroroxysmal nocturnal dyspnea
7. Fatigue
8. Syncope
9. Hoarseness
• Impingement upon the laryngeal nerve due to LA enlargement can lead to hoarseness
10. Stroke
11. EKG indicates A-Fib, LAE, LVH
12. Auscultation characterized by diastolic, low-pitched, rumbling murmur

Front 10

Dyspnea and pulmonary edema occur because of the changes in the pulmonary is what disease and describe what pathology of the heart

Back 10

dyspnea upon exertion and describe MS

Front 11

What can contribute to chest pain during MS?

Back 11

pulmonary HTN

Front 12

increased pulomanry pressure results in the ruptrue of pulmonary capillaries, leading to bleeding called?

Back 12

hemoptysis in mitral stenosis

Front 13

impingement upon the laryngel nerve due to LA enlargement can lead to what?

Back 13

hoarseness (eitology of Ms)

Front 14

EKG in MS indicate what?

Back 14

A-fib,, LAE, LVH

Front 15

diastolic, low-pitched, rumbling murmur is called?

Back 15

ausculation (eitology of MS)

Front 16

What are the four treatment for ms

Back 16

1. Prophylactic antibiotic therapy
2. Commissurotomy
3. Percutaneous ballon mitral valvuloplasty
4. Mitral valve replacement

Front 17

2-D of MS

Back 17

1. Thickened MVLs (increased echogenicity)
2. Restricted valve motion
3. Diastolic doming of the anterior mitral leaflet (PLAX)
• Hockey stick appearance
o Due to the high pressure overload in the LA and also fusion between the tissues of the leaflets
• Usually seen with at least moderate MS
4. Commissural fusion (PSAX)
5. Anterior motion of the posterior MVL
♠ Due to tethering
6. Decreased mitral valve orifice
• Significant = 1 cm2
7. Fibrosis and shortening of chordae tendineae
8. Small LV (isolated MS)
9. LAE
• Spontaneous contrast (smoke)
• Thrombus formation
10. Pulmonary Hypertension (P HTN)
11. RVH and dilatation

Front 18

What is the appearance of the AMVL in diastolic of MS?

Back 18

hockey stick b/c hgih pressure in LA and fusion b/w the tissues of the leaflets

Front 19

Describe M-mode of MS

Back 19

1. Thickened mitral leaflets (increased echogenicity)
2. Decreased E-F slope (0 – 30 mm/s indicates significant MS)
3. Anterior motion of the posterior mitral leaflet
4. Decreased A wave of the MVL
5. Reduced D-E excursion (< 15 mm)
6. LAE
7. Pulmonary HTN
8. RV hypertrophy and dilatation
• Flattened or paradoxical IVS
• Due to volume overload/pressure
9. Early diastolic dip of IVS
• Due unrestricted flow into the RV

Front 20

indicate significant of MS in E-F slop

Back 20

decrase EF slop (0-30)mm/s

Front 21

reduced d-e excursion in MS to what?

Back 21

less than or equal to 15mm

Front 22

describe in 2D of MVA planimetry of MS

Back 22

1. Taken in the PSAX at the MV level
2. The very tips of the MVLs should be centered in the middle of the image
3. The measurement is performed at the beginning of diastole when the MV is at its widest excursion
4. The valve area is traced along the inside border of the mitral orifice

Front 23

What is the normal CSA for MS

Back 23

4-6cm2

Front 24

What is the severe CSA for MS

Back 24

< 1.0 cm2

Front 25

What is mild CSA of MS
What is moderlate CSa of MS

Back 25

mild-1.5-2.5
moderate-1-1.5

Front 26

Pitfalls of 2-D Planimetry

Back 26

1. Improper imaging plane
2. Inappropriate gain settings
3. Poor lateral resolution – echo dropout; borders are not visualized well
4. Shadowing from calcification – can’t delineate borders
5. Mitral Commissurotomy (surgical procedure to increase mitral orifice size)

Front 27

Doppler Features of MS

Back 27

1. Spectral broadening of diastolic flow (turbulent)
2. Increased diastolic velocities (>1.3 m/s)
3. Decreased E-F slope (diastole): Flattened slope
• Increased pressure half-time
4. Increased A wave
5. Pulmonary venous flow pattern
• Decreased systolic flow, prolonged duration
• Increased pressure half-time of diastolic flow
6. Pulmonary Hypertension
• SPAP (systolic pulmoanry artery pressure)
• Use tricuspid regurgitation to calculate RV systolic pressure
• RV systolic pressure = 4 x (Vmax TR2) + RAP
• Substitute 10 mmHG for RAP (right atria pressure)

Front 28

In MS describe A wave related to doppler and M mode?

Back 28

Doppler-increased A wave
M mode-deceased awave

Front 29

doppler MV calculation determine what

Back 29

mean pressure gradient
peak pressure gradient
MVA

Front 30

Describe pressure half time

Back 30

 rate of pressure decline across the stenotic mitral orifice is determined by the cross-sectional area of the orifice: the smaller the orifice, the slower is the rate of pressure decline.
 Defined as the time interval (milliseconds) between the maximum early diastolic transmitral pressure gradient and the time point where the pressure gradient is half the maximum value.

MVA = 220
P1/2


1. The Doppler signal is obtained demonstrating the highest velocity
2. The velocity representing ½ the original pressure gradient is determined by dividing the peak velocity by the square root of 2 (1.414) or multiplying the peak velocity by 0.71
3. A line is drawn along the slope until it intercepts the half value
4. Vertical lines are drawn from the peak velocity to the baseline and from the half value to the baseline
5. The distance between these two lines represents time on the horizontal axis and is equal to the pressure half-time.
6. This number is divided into 220 to obtain the MV area.

Front 31

what happen to the pressure half time if the smaller the orifice

Back 31

increase pressure 1/2 time b/c take longer to run through

Front 32

What is pressure half time serenity values

Back 32

Severe
> 220 msec

Front 33

What is normal value of pressure half time of MS?

Back 33

30-60 msec

Front 34

What is the normal and severe value of MVA of MV (MS)

Back 34

normal 4-6cm2
sev-<1cm2

Front 35

What is the mild and severe value of mean pressure gradient

Back 35

< or equal 5 -mild
>12 severe

Front 36

describe color flow doppler of MS

Back 36

• Increased velocities results in aliasing
• Turbulent flow results in mosaic color
• MS demonstrates a “candle flame” in the LV

Front 37

Pitfalls of pressure half time of MS

Back 37

• Decreased pressure half time/increased mitral valve area
♠ Significant aortic insufficiency
♠ Decreased LV compliance
♠ Sudden change in LA compliance (e.g. tachycardia, acute MR)
• Increased pressure half time/decreased mitral valve area
♠ Decreased rate of LV relaxation
♠ Immediate post mitral valve balloon valvuloplasty

Front 38

Complication of MS

Back 38

♠ MR
♠ Pulmonary hypertension
♠ A-fibrillation
♠ LA thrombus and embolization
♠ Increased risk of endocarditis
♠ Decreased cardiac output
♠ Mitral annular calcification (MAC)

Front 39

why is it MR during MS

Back 39

• Due to shortened and thickened chordae tendineae
• LAE interferes with coaptation of the leaflets
.

Front 40

MAC can mimic what?

Back 40

pericardial effusion, masses ,or mitral stenosis

Front 41

Describe mac (mitral annular calcification)

Back 41

• May interfere with leaflet motion if calcification involves MVLs and/or AVLs
• Complications associated with MAC include MR, LAE, and MS