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110 Cards in this Set
- Front
- Back
Midsystolic click an/or late systolic murmur may indicate ______
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Mid systolic click and/or murmur may indicate MITRAL VALVE PROLAPSE
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Which cardiac abnormalities are frequently noted on the Echo of patients with marfan's syndrome?
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MV prolapse
AoRoot dilation Compressed LA |
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Rheumatica mitral stenosis might cause LA _____ and _______.
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Rheumatic mitral stenosis might cause LA ENLARGEMENT and ATRIAL FIB --> thrombus
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Mitral valve area from doppler is calculated by what formula...
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MVA = 220/PHT
or MVA = 759/DT |
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When using CW to obtain the peak pressure gradient for mitral stenosis ... How do you calculate PG?
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Pressure gradient is calculated using bernolli's
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The doppler jet of mitrral stenosis obtained closer to the apex is sometimes confused with ____
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AI
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The Doppler jet of MR is sometimes confused with the jet of ____
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AR
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A dense band of echoes between the posterior LV wall and the MV may represent (on PSAX)
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MAC
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What are the secondary echo findings in patients with MS?
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Enlarged LA
Pul Htn ---> D shaped LV Pancake Septum Enlarged RV |
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Rheumatic heart disease most oftens affects what valve?
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MV
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What are the other causes of MS (1%)?
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MAC
Myxoma Parachute MV Calcification |
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What do you look for on M-mode in patients with MS?
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Thickened leaflets
Decreased D to E excursion Anterior motion of the PMVL |
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Severe acute regurge might cause
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Acute pulmonary edema
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Which diseases cause LVH?
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Hypertrophic CMP
Systemic HTN Volume Overload AS Amylodosis Coarctation of aorta |
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Plaimentry MV opening at _____ in PSAX during _____ to rule out ______
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Planimentry MV opening at TIP OF LEAFLETS at EARLY DIASTOLE to rule out MITRAL STENOSIS
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Normal MVA is
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4 to 6 cm*
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Mitral regurge results in _____ overload
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MR results in VOLUME overload
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A patient with LA myxoma may develop symptoms similar to those patients having ______
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MV stenosis
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The RVSP may be estimated using
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The max velocity of TR (using Bernolli)
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Rupture chordae might cause ....
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MV Prolapse
MR Flail leaflet ---> eccentric regurge ----> acute pul edema |
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Doming of any cardiac valve on 2D echo is consistent with ____
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Stenosis
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The valsalva maneuver and the inhalation of amylnitrite sometimes used for checking ....
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Septal defects
Diastolic dysfunction Mitral valve prolapse HOCM ---> accentuates SAM |
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What are the doppler findings in a patient with Mitral stenosis
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Increased E velocity
Decreased EF slope Increased PHT Decreased MVA Increased mean pressure gradient Increased Max pressure gradient |
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What are the secondary echo findings in chronic significant mitral regurge?
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LT heart volume overload
LA enlargmenet LV enlargement Pul Htn ---> Rt heart failure ---> dilated CMP |
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2D echo findings in patients with combined mitral and aortic stenosis might show
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Concentric LVH
LA Enlargement Doming of the leaflets thickening of the leaflets |
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On a biscuspid aortic valve, if one of the cusps is larger it may show ____ on a 2D echo
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Raphe Line
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If a patient presented with fever of unknown origin, positive blood culture and murmur. Based on the clinical information the most likely diagnosis is ____
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those symptoms are the "Triad" for infective endocarditits
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Left ventricle show ____ motion in patient with flail mitral valve leaflet
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Flail leaflet shows HYPERDYNAMIC wall motion
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What are the color and doppler findings for severe MR?
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Holosystolic envelope
Large Jet (length of LA, hitting pul veins_ PISA > 0.9 Vena Contracta > 0.7 |
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A mitral valve prolapse may be augmented by having the patient perform ____
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valsalva
Amyl nitrite inhalation |
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To calculate stroke volume using doppler in a particular region of interest, what two parameters are needed?
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CSA and VTI
cross sectional area Velocity Time Integral |
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Bicuspid aortic valve occurs in approx _____ percent of the population
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1-2%
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which formula is used to calculate MVA by doppler?
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MVA = 220/PHT
MVA = 759/DT |
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What is the continuity equation?
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CSA (lvot) x VTI (LVOT)/VIT (mv)
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What is the most common cause of aortic stenosis in old age group?
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Degenerative
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The EPSS may be ____ in patients with aortic regurge
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EPSS may be INCREASED with AI
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What are the indications of progressive mitral valve regurge?
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LA enlargement
LV dilatation Decreased systolic function Increased EPSS |
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On the Mmode of a bicuspid aortic valve, the valve closure line appears
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ECCENTRIC
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Which equation is used for measuring peak pressure gradient of flow through a valve?
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Bernolli = 4 (max velocity*)
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What is parachute mitral valve?
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Chordae is attached to one pap muscle only. Can be part of the 1% cause of mitral stenosis
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In severe cases of aortic stenosis the aortic root may be ______
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Dilated
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Which equation is used to calculate aortic valve area?
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Contiuity equation
SV (lvot) / VTI (aov) |
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What is Marfan's syndrome?
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Autosomal disease causing dilatation, aneurysm formation, rupture of peripheral arteries, redundant AMVL, dilation and dissection of Aorta
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What is aortic valve stenosis area severity scale?
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Normal 3 to 5 cm*
Mild 1.1 to 1.9 cm* Severe < 0.75 cm* |
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What are the causes of left ventricular thrombus?
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Slow moving blood caused by Aortic Stenosis, decreased LV systolic function, aneurysm
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What is the aortic valve stenosis peak pressure gradient severity scale?
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Normal < 16 mmHg
Severe > 64 mmHg |
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What is the effect of aortic stenosis on LV?
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Pressure overload/increased afterload
Concentric LVH |
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What is the effect of chronic aortic regurge on LV?
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LV dilated (sphere shape)
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What is the most common symptom of aortic stenosis?
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Dyspnea on exertion
also: syncope, chest pain |
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What is mitral valve stenosis severity scale?
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Normal 4 - 6 cm*
Severe < 1 cm* |
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The possible associated congenital anomaly with bicuspid aortic valve is _____
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Aortic coarctation (75%)
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What are the causes of left atrial thrombus?
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Mitral stenosis
slow moving blood atrial Fib |
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What are the echo diagnostic criteria for severe aortic insufficency?
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< 0.75 AVA
M-mode = early closure of MV and early opening of AoV Color Doppler = Vena contracta > 6 mm LVOT/AR jet ratio > 65% AR jet area/LVOT area > 60% PHT < 220 msec Backflow in DTA or ascending aorta |
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What is the normal P1/2T of the Mitral Valve and severe?
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PHT > 220 m/sec severe MS
normal 30-60 m/sec |
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When evaluating regurge, what determines acute vs chronic and what determines the severity?
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Acute vs Chronic depends on slope
Severity depends on the intensity or brightness of the envelope |
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What are common echo Mitral Stenosis?
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Commissure effusion
Thickened leaflets Diastolic doming "hockey stick" LA enlargement |
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What are the common causes of mitral stenosis?
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99% rheumatic heart disease
1% parachute MV, MVP, MAC, Myxoma |
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With mitral stenosis, which chamber is NOT affected?
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LV
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What are doppler findings for Mitral stenosis?
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Increased DT
Increased PHT Decreased MVA Spectral broadening |
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What are M-mode findings with mitral stenosis?
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Anterior motion of the PMVL
Decreased D to E excursion Thickened leaflets Decreased EF slope |
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What are color findings for mitral stenosis?
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Candle flame/turbulent flow post stenosis
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What are the indications of severe MS?
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velocity > 1.3
MVA < 1 cm* MPG > 10 mmHg P1/2T > 220 m/sec |
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What are 2 causes of increased EPSS that are not due to decreased EF?
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Aortic Regurge
Mitral stenosis |
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What are the indications of severe mitral regurge?
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Jet size vs LA > 40%
Jet hitting pul veins PISA > 0.9 Vena contract > 0.7 |
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What does PISA stand for?
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Proximal isovelocity service area
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What is the couda effect?
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The regurge jet hits the chamber walls and bounces so you cannot determine severity of jet
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What are the causes of Aortic stenosis < 70 years old? > 70 years old
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< 70 years = bicuspid Aov
> 70 years = degenerative |
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What causes eccentric regurge?
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Bicuspid AoV
Aortic valve prolapse |
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How many ways can you detect Aortic stenosis?
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VTI
MPG AVA ** increased velocity indicates increased stenosis ONLY in AoV |
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How to do perform continuity equation?
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LVOT diameter in PLAX -->PW LVOT and trace ---> CW AoV trace
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What else causes concentric LVH and symptoms similar to Aortic Stenosis?
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Sub-aortic membrane
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Aortic regurge causes ....
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Volume overload and dilation
MV flutter, increased EPSS, reverse doming of MV in diastole |
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Aortic stenosis causes ....
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Pressure overload and Concentric LVH
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How many ways are there to determine AR severity
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Area of jet in PSAX
Area of color in AP5 CW ----Velocity P1/2t (slope) |
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What are the 3 causes of acute severe Aortic Regurge
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1) trauma
2) Aortic dissection 3) Infective endocarditis leads to ----> acute Pul Edema |
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Define mitral valve prolapse
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Posterior displacement of any portion of the MV leaflets beyond the mitral annular plane during sytole
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What is Classic MVP
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Primary or myxomatous valve prolapse
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What is secondary MVP
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Hemodynamic MV prolapse/functional MV prolapse
A reduction or alteration in LV size/shape may cause leaflets to move past the annular plane |
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What are 2 echo types of mitral valve prolapse
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Mid - to - late systolic
holosystolic |
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What are the signs and symptoms in patients with MVP
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Asymptomatic
family history of cardiac disease palpitations chest pain Dyspnea fatique syncope heart failure |
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What are the complications of Mitral valve prolapse
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Progressive MR
infective endocarditis embolic events ruptured chordae |
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What are the most imporant cardiac auscultation findings in patients with MVP
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Mid to late systolic click
S1 is accentuated |
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What are the most important ECG findings in patients with MVP
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Normal in asymptomatic
Flat inverted biphasic T wave nonspecific ST segment changes Arrythmias LA enlargement |
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What are the most important medical and surgical treatments for MVP
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None
treat the cause Holter monitor exercise stress test |
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What are the most important M mode findings in patients with MVP
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Mid to late systolic sagging back of the anterior, posterior or both leaflets
holosystolic sagging |
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What are the most important 2D findings in patients with MVP
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Protruding leaflets
elongated chordae LA dilation LV volume overload |
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What are the most important doppler findings in patients with MVP
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MR @ late systole
Holosystolic MR |
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What is aortic stenosis?
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Narrowing of the AoV orrifice during systole
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What are the most common etiologies of Aortic Stenosis?
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Degenerative (old age)
Congenital (bicuspid AoV) Rheumatic fever |
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What are the signs and symptoms in patients with Aortic stenosis?
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Left heart failure
Angina pectoris syncope dizziness decreased CO Decreased systolic blood pressure |
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What are the complications of aortic stenosis?
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LV Volume overload
LVH Increased LV end diastolic pressure Increased LA pressure LV systolic dysfunction Pul HTN |
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What are the most importatn cardiac ausculatation findings in patients with aortic stenosis
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Harsh systolic ejection murmur
Gallivardin's phenomenon |
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What are the most important EKG findings of aortic stenosis?
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LVH with ST segment depression & T wave inversion
LA enlargement Conduction defects Atrial Fib |
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What are the most important medical and surgical treatments in patients with aortic stenosis?
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Rheumatic fever prophylaxis
Cholesterol lowering drugs Surgical ---> AoV replacement Ross procedure Aortic balloon valvuloplasty |
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What is bicuspid AoV?
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A congenital abnormality with 2 cusps. Creates a raphe line where 2 cusps have fused together
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What are the most important M mode findings in patients with bicuspid AoV
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Eccentric diastolic closure of AoV leaflets with normal openings of AoV
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What are the most important 2D findings in patients with bicuspid AoV
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Thickened leaflets
elliptical football shaped opening Systolic doming diastolic doming post stenotic dilation of aorta LV dilation LA dilation Concentric LVH |
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What are the most important M mode/2D findings in patients with degenerative/rheumatic AS?
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Increased leaflet thickness with Decreased systolic excursion
Decreased systolic maximal cusp seperation leaflet edge thickeniing, commissural fusion, systolic doming post stenotic dilation LVH Increased LV mass index Decreased LV systolic function |
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What are the most important doppler findings iin patients with AS?
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increased velocity (>4 = severe)
MPG > 50 = severe PIPG > 64 = severe AVA < 0.75 = severe |
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Define aortic regurge
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Backflow of blood through AoV during diastole
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What are the most common etiologies of AR?
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Genetic --- Marfan or mucopolysaccaridosis
Inflammatory Stress -- renal failure, Systemic HTN, AS, Structural |
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What are the signs and symptoms in patients with AR
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Asymptomatic
Left Heart failure ---> RT heart failure Pul Edema Volume overload pressure overload |
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What are the most important ausculation findings in patients with aortic regurge
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High pitched "blowings" decresendo diastolic murmur @ LT sternal border
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What are the most important EKG findings in AR
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ST segment elevation with peaked T waves
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What are the complications of AR
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Volume overload
pressure overlaoad Coronary ischemia angina |
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What are the most important medical and surgical treatments for AR
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Beta blockers
valve repair/replacement |
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What are the most important M mode findings in patients with AR?
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Fine diastolic flutter of AMVL
Premature closure of MV premature opening of AoV |
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What are the most important 2D findings in patients with AR?
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Chamber dilation
LV hyperkinesis (long term) hypo kinesis |
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What are the most important PW doppler fidnings in patients with AR
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Holodiastolic flow reversal in the DTA, Abdominal aorta, Subclavian
increased LVOT velocity Increased LV VTI Decreased DT Diastolic MR |
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What are the most important CW doppler findings in patients with Ar
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Decreased DT
Bright waveform Vena Contracta |