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17 Cards in this Set
- Front
- Back
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Define Mitral Regurgitation
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The backward flow of blood into LA in systole
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List six (6) causes of MR.
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MV leaflets: MVP, flail leaflet
IE: infective endocarditis leads to leaflet destruction, perforation, deformation RHD = commissural fusion & thickened leaflet tips due to Rheumatic heart diseas Marfan’s Syndrome: dilated AO root and/or MV annulus is warped in some way Papillary muscle rupture Mitral annulus: dilation, calcification MAC: mitral annular calcification – area of echogenicity on LV side of PMVL Cardiomyopathy, prosthetic MV dysfunction, Trauma |
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List the symptoms of MR.
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Fatiuge is the earliest symptom
Dyspnea on exertion (DOE) is most common Orthopnea |
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Describe the murmur of MR.
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High pitched holosystolic “blowing” heard at apex, often radiates to L axilla or back
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Chronic MR
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Etiology: Myxomatous valve disease
Annular dilation |
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Acute MR Etiology
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Endocarditis
Papillary Muscle Rupture Chordal Rupture |
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List some 2D findings of MR.
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LVA, LAE in mod-severe MR
LV function: hypercontractile (acute), progresses to hypocontractility as the ventricle wears out |
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M-mode findings
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May see cause of MR (vegetations MVP MAC)
Use to assess LV/LA dilation Hypercontractile LV pattern due to LV volume overload |
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Be able to describe each method for assessing MR severity. Know the normal and abnormal values (and units) of each.
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Spectral wave form intensity
Color flow extent into LA = RJA, RJA/LA area, PISA Vena Contracta, Regurge volume, Regurge Fraction, Effective Regurge orifice (ERO) |
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Look at Jet
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Small Jet: Mild
Med Jet: Mod Large Jet: Severe |
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) Planimeter Jet Area
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Mild MR: < 4 cm2
Mod MR: 4 – 8 cm2 Severe MR: > 8 cm2 |
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Planimeter Jet area and divide by LA Area (RJ cm2/LA cm2)
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Mild MR: <20%
Mod MR: 20 -40% Severe MR: > 40% |
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PISA: Proximal Isovelocity Surface Area
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Measures the volume of blood entering the reguritant orifice
Based on continuity of flow Blood flow converging on the reguritant flow can be seen as isovelocity |
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Quantitating MR
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*Best used when central regurg jet is present.
Radius 0 will have to adjust settings Aliasing velocity ( color baseline box setting to 30 or 40 ) MR Peak Velocity (CW) MR Severity (trace CW) |
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2D findings indicative of
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Pulmonary Hypertension.
Mid-systolic closure or notching “W” of the pulmonary valve RAE, RVE Flattened IVS “D” Shaped |
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M-mode Findings
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Diminished or absent A wave of the pulmonary valve
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Method for determining the presence of Pulmonary Hypertension using doppler.
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Estimation of RV or PA pressures: RVSP=PASP so;
RVSP/PAP (mmHg) = 4(VTR)2 + est RAP To estimate RAP: visually assess IVC in subcostal view. If upon inspiration analysis shows: Full Collapse, then RAP = 5mmHg >50% Collapse, then RAP = 10mmHg <50% Collapse, then RAP = 15mmHg No Collapse, then RAP = 20mmHg Need to look at velocity of TR in CW: 4(VTR)2 + est RAP = RVSP/PAP |
