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110 Cards in this Set

  • Front
  • Back
Midsystolic click an/or late systolic murmur may indicate ______
Mid systolic click and/or murmur may indicate MITRAL VALVE PROLAPSE
Which cardiac abnormalities are frequently noted on the Echo of patients with marfan's syndrome?
MV prolapse
AoRoot dilation
Compressed LA
Rheumatica mitral stenosis might cause LA _____ and _______.
Rheumatic mitral stenosis might cause LA ENLARGEMENT and ATRIAL FIB --> thrombus
Mitral valve area from doppler is calculated by what formula...
MVA = 220/PHT

or

MVA = 759/DT
When using CW to obtain the peak pressure gradient for mitral stenosis ... How do you calculate PG?
Pressure gradient is calculated using bernolli's
The doppler jet of mitrral stenosis obtained closer to the apex is sometimes confused with ____
AI
The Doppler jet of MR is sometimes confused with the jet of ____
AR
A dense band of echoes between the posterior LV wall and the MV may represent (on PSAX)
MAC
What are the secondary echo findings in patients with MS?
Enlarged LA
Pul Htn ---> D shaped LV
Pancake Septum
Enlarged RV
Rheumatic heart disease most oftens affects what valve?
MV
What are the other causes of MS (1%)?
MAC
Myxoma
Parachute MV
Calcification
What do you look for on M-mode in patients with MS?
Thickened leaflets
Decreased D to E excursion
Anterior motion of the PMVL
Severe acute regurge might cause
Acute pulmonary edema
Which diseases cause LVH?
Hypertrophic CMP
Systemic HTN
Volume Overload
AS
Amylodosis
Coarctation of aorta
Plaimentry MV opening at _____ in PSAX during _____ to rule out ______
Planimentry MV opening at TIP OF LEAFLETS at EARLY DIASTOLE to rule out MITRAL STENOSIS
Normal MVA is
4 to 6 cm*
Mitral regurge results in _____ overload
MR results in VOLUME overload
A patient with LA myxoma may develop symptoms similar to those patients having ______
MV stenosis
The RVSP may be estimated using
The max velocity of TR (using Bernolli)
Rupture chordae might cause ....
MV Prolapse
MR
Flail leaflet ---> eccentric regurge ----> acute pul edema
Doming of any cardiac valve on 2D echo is consistent with ____
Stenosis
The valsalva maneuver and the inhalation of amylnitrite sometimes used for checking ....
Septal defects
Diastolic dysfunction
Mitral valve prolapse
HOCM ---> accentuates SAM
What are the doppler findings in a patient with Mitral stenosis
Increased E velocity
Decreased EF slope
Increased PHT
Decreased MVA
Increased mean pressure gradient
Increased Max pressure gradient
What are the secondary echo findings in chronic significant mitral regurge?
LT heart volume overload
LA enlargmenet
LV enlargement
Pul Htn ---> Rt heart failure ---> dilated CMP
2D echo findings in patients with combined mitral and aortic stenosis might show
Concentric LVH
LA Enlargement
Doming of the leaflets
thickening of the leaflets
On a biscuspid aortic valve, if one of the cusps is larger it may show ____ on a 2D echo
Raphe Line
If a patient presented with fever of unknown origin, positive blood culture and murmur. Based on the clinical information the most likely diagnosis is ____
those symptoms are the "Triad" for infective endocarditits
Left ventricle show ____ motion in patient with flail mitral valve leaflet
Flail leaflet shows HYPERDYNAMIC wall motion
What are the color and doppler findings for severe MR?
Holosystolic envelope
Large Jet (length of LA, hitting pul veins_
PISA > 0.9
Vena Contracta > 0.7
A mitral valve prolapse may be augmented by having the patient perform ____
valsalva
Amyl nitrite inhalation
To calculate stroke volume using doppler in a particular region of interest, what two parameters are needed?
CSA and VTI
cross sectional area
Velocity Time Integral
Bicuspid aortic valve occurs in approx _____ percent of the population
1-2%
which formula is used to calculate MVA by doppler?
MVA = 220/PHT
MVA = 759/DT
What is the continuity equation?
CSA (lvot) x VTI (LVOT)/VIT (mv)
What is the most common cause of aortic stenosis in old age group?
Degenerative
The EPSS may be ____ in patients with aortic regurge
EPSS may be INCREASED with AI
What are the indications of progressive mitral valve regurge?
LA enlargement
LV dilatation
Decreased systolic function
Increased EPSS
On the Mmode of a bicuspid aortic valve, the valve closure line appears
ECCENTRIC
Which equation is used for measuring peak pressure gradient of flow through a valve?
Bernolli = 4 (max velocity*)
What is parachute mitral valve?
Chordae is attached to one pap muscle only. Can be part of the 1% cause of mitral stenosis
In severe cases of aortic stenosis the aortic root may be ______
Dilated
Which equation is used to calculate aortic valve area?
Contiuity equation

SV (lvot) / VTI (aov)
What is Marfan's syndrome?
Autosomal disease causing dilatation, aneurysm formation, rupture of peripheral arteries, redundant AMVL, dilation and dissection of Aorta
What is aortic valve stenosis area severity scale?
Normal 3 to 5 cm*
Mild 1.1 to 1.9 cm*
Severe < 0.75 cm*
What are the causes of left ventricular thrombus?
Slow moving blood caused by Aortic Stenosis, decreased LV systolic function, aneurysm
What is the aortic valve stenosis peak pressure gradient severity scale?
Normal < 16 mmHg
Severe > 64 mmHg
What is the effect of aortic stenosis on LV?
Pressure overload/increased afterload
Concentric LVH
What is the effect of chronic aortic regurge on LV?
LV dilated (sphere shape)
What is the most common symptom of aortic stenosis?
Dyspnea on exertion


also: syncope, chest pain
What is mitral valve stenosis severity scale?
Normal 4 - 6 cm*
Severe < 1 cm*
The possible associated congenital anomaly with bicuspid aortic valve is _____
Aortic coarctation (75%)
What are the causes of left atrial thrombus?
Mitral stenosis
slow moving blood
atrial Fib
What are the echo diagnostic criteria for severe aortic insufficency?
< 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
What is the normal P1/2T of the Mitral Valve and severe?
PHT > 220 m/sec severe MS
normal 30-60 m/sec
When evaluating regurge, what determines acute vs chronic and what determines the severity?
Acute vs Chronic depends on slope

Severity depends on the intensity or brightness of the envelope
What are common echo Mitral Stenosis?
Commissure effusion
Thickened leaflets
Diastolic doming "hockey stick"
LA enlargement
What are the common causes of mitral stenosis?
99% rheumatic heart disease
1% parachute MV, MVP, MAC, Myxoma
With mitral stenosis, which chamber is NOT affected?
LV
What are doppler findings for Mitral stenosis?
Increased DT
Increased PHT
Decreased MVA
Spectral broadening
What are M-mode findings with mitral stenosis?
Anterior motion of the PMVL
Decreased D to E excursion
Thickened leaflets
Decreased EF slope
What are color findings for mitral stenosis?
Candle flame/turbulent flow post stenosis
What are the indications of severe MS?
velocity > 1.3
MVA < 1 cm*
MPG > 10 mmHg
P1/2T > 220 m/sec
What are 2 causes of increased EPSS that are not due to decreased EF?
Aortic Regurge
Mitral stenosis
What are the indications of severe mitral regurge?
Jet size vs LA > 40%
Jet hitting pul veins
PISA > 0.9
Vena contract > 0.7
What does PISA stand for?
Proximal isovelocity service area
What is the couda effect?
The regurge jet hits the chamber walls and bounces so you cannot determine severity of jet
What are the causes of Aortic stenosis < 70 years old? > 70 years old
< 70 years = bicuspid Aov
> 70 years = degenerative
What causes eccentric regurge?
Bicuspid AoV
Aortic valve prolapse
How many ways can you detect Aortic stenosis?
VTI
MPG
AVA

** increased velocity indicates increased stenosis ONLY in AoV
How to do perform continuity equation?
LVOT diameter in PLAX -->PW LVOT and trace ---> CW AoV trace
What else causes concentric LVH and symptoms similar to Aortic Stenosis?
Sub-aortic membrane
Aortic regurge causes ....
Volume overload and dilation
MV flutter, increased EPSS, reverse doming of MV in diastole
Aortic stenosis causes ....
Pressure overload and Concentric LVH
How many ways are there to determine AR severity
Area of jet in PSAX
Area of color in AP5
CW ----Velocity
P1/2t (slope)
What are the 3 causes of acute severe Aortic Regurge
1) trauma
2) Aortic dissection
3) Infective endocarditis

leads to ----> acute Pul Edema
Define mitral valve prolapse
Posterior displacement of any portion of the MV leaflets beyond the mitral annular plane during sytole
What is Classic MVP
Primary or myxomatous valve prolapse
What is secondary MVP
Hemodynamic MV prolapse/functional MV prolapse

A reduction or alteration in LV size/shape may cause leaflets to move past the annular plane
What are 2 echo types of mitral valve prolapse
Mid - to - late systolic
holosystolic
What are the signs and symptoms in patients with MVP
Asymptomatic
family history of cardiac disease
palpitations
chest pain
Dyspnea
fatique
syncope
heart failure
What are the complications of Mitral valve prolapse
Progressive MR
infective endocarditis
embolic events
ruptured chordae
What are the most imporant cardiac auscultation findings in patients with MVP
Mid to late systolic click
S1 is accentuated
What are the most important ECG findings in patients with MVP
Normal in asymptomatic
Flat inverted biphasic T wave
nonspecific ST segment changes
Arrythmias
LA enlargement
What are the most important medical and surgical treatments for MVP
None
treat the cause
Holter monitor
exercise stress test
What are the most important M mode findings in patients with MVP
Mid to late systolic sagging back of the anterior, posterior or both leaflets

holosystolic sagging
What are the most important 2D findings in patients with MVP
Protruding leaflets
elongated chordae
LA dilation
LV volume overload
What are the most important doppler findings in patients with MVP
MR @ late systole
Holosystolic MR
What is aortic stenosis?
Narrowing of the AoV orrifice during systole
What are the most common etiologies of Aortic Stenosis?
Degenerative (old age)
Congenital (bicuspid AoV)
Rheumatic fever
What are the signs and symptoms in patients with Aortic stenosis?
Left heart failure
Angina pectoris
syncope
dizziness
decreased CO
Decreased systolic blood pressure
What are the complications of aortic stenosis?
LV Volume overload
LVH
Increased LV end diastolic pressure
Increased LA pressure
LV systolic dysfunction
Pul HTN
What are the most importatn cardiac ausculatation findings in patients with aortic stenosis
Harsh systolic ejection murmur

Gallivardin's phenomenon
What are the most important EKG findings of aortic stenosis?
LVH with ST segment depression & T wave inversion
LA enlargement
Conduction defects
Atrial Fib
What are the most important medical and surgical treatments in patients with aortic stenosis?
Rheumatic fever prophylaxis
Cholesterol lowering drugs

Surgical ---> AoV replacement
Ross procedure
Aortic balloon valvuloplasty
What is bicuspid AoV?
A congenital abnormality with 2 cusps. Creates a raphe line where 2 cusps have fused together
What are the most important M mode findings in patients with bicuspid AoV
Eccentric diastolic closure of AoV leaflets with normal openings of AoV
What are the most important 2D findings in patients with bicuspid AoV
Thickened leaflets
elliptical football shaped opening
Systolic doming
diastolic doming
post stenotic dilation of aorta
LV dilation
LA dilation
Concentric LVH
What are the most important M mode/2D findings in patients with degenerative/rheumatic AS?
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
What are the most important doppler findings iin patients with AS?
increased velocity (>4 = severe)
MPG > 50 = severe
PIPG > 64 = severe
AVA < 0.75 = severe
Define aortic regurge
Backflow of blood through AoV during diastole
What are the most common etiologies of AR?
Genetic --- Marfan or mucopolysaccaridosis

Inflammatory

Stress -- renal failure, Systemic HTN, AS,

Structural
What are the signs and symptoms in patients with AR
Asymptomatic
Left Heart failure ---> RT heart failure
Pul Edema
Volume overload
pressure overload
What are the most important ausculation findings in patients with aortic regurge
High pitched "blowings" decresendo diastolic murmur @ LT sternal border
What are the most important EKG findings in AR
ST segment elevation with peaked T waves
What are the complications of AR
Volume overload
pressure overlaoad
Coronary ischemia
angina
What are the most important medical and surgical treatments for AR
Beta blockers
valve repair/replacement
What are the most important M mode findings in patients with AR?
Fine diastolic flutter of AMVL
Premature closure of MV
premature opening of AoV
What are the most important 2D findings in patients with AR?
Chamber dilation
LV hyperkinesis
(long term) hypo kinesis
What are the most important PW doppler fidnings in patients with AR
Holodiastolic flow reversal in the DTA, Abdominal aorta, Subclavian

increased LVOT velocity
Increased LV VTI
Decreased DT
Diastolic MR
What are the most important CW doppler findings in patients with Ar
Decreased DT
Bright waveform
Vena Contracta