Reading...
Play button
Play button
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;
28 Cards in this Set
- Front
- Back
|
Define Mitral Stenosis.
|
A narrowing of the MV orifice impeding the diastolic flow of blood from the LA to the LV
|
|
|
Name at least 4 causes of MS
|
Rheumatic Fever (most common)
Severe Mitral Annular Calcification (MAC) Congenital (parachute MV, double orifice MV) Infective Endocarditis or LA tumor may mimic MS |
|
|
Name at least 4 signs/symptoms of MS
|
Heart Failure
DOE (dyspnea/orthopnea on exertion – (most common, 80%) Hemoptysis (coughing blood) 30% Right Heart Failure (jugular vein distention, hepatomegaly, peripheral edema) LA volume overload – pulmonary congestion - RHF Chest pain (15%) Syncope |
|
|
Common arrhythmia associated with MS?
|
A-fib
|
|
|
What heart sound is heard with MS? Murmur of MS occurs in what time of the cardiac cycle?
|
Low-pitched diastolic murmur with pre-systolic accentuation
Loud S1, OS after S2 Time from S2 to OS indicates severity (short interval = high LA pressure) |
|
|
How would a tumor or a vegetation seen on the MV affect the blood flow?
|
Atrial tumor obstructing LV inflow
|
|
|
List 3 m-mode findings of MS.
|
Thickened MV leaflets with decreased EF slope / DE excursion
LAE, anterior motion of the posterior leaflets |
|
|
List at least 6 2D findings of MS.
|
PLA – Diastolic doming of AMVL “hockey stick”
Anterior motion of posterior leaflet Thickened MV leaflets, calcified PSA – commissural fusion, LAE, possible LA thrombus, decreased orifice (planimeter) Flattened septum & RVE if pulmonary hypertension is present |
|
|
In a patient with severe MS, where might spontaneous contrast be seen?
|
In the LA
|
|
|
What causes the spontaneous contrast?
|
Low velocity blood flow
|
|
|
What further complications can result due to the spontaneous contrast?
|
Thrombus formation
|
|
|
Color flow: Describe the MV diastolic appearance in a patient with MS.
|
Aliasing color flow rather than normal “red” flow toward apex; Mosaic
Narrow “flame shaped” mosaic jet tips extending into LV in diasole MR |
|
|
CW/PW
|
Increased MV E-velocity at MV leaflet tips (>1.3m/sec)
Decreased EF slope of MV inflow = increased decal time + increased P ½ time Increased Mean Pressure Gradient (Mean PG) |
|
|
Describe and draw the normal MV spectral waveform
|
Normal MV flow is laminar and biphasic.
MV flow peaks early in diastole. Rises again with “atrial kick” in late diastole |
|
|
How does the narrowed orifice of MS affect blood flow velocities?
|
Blood flow velocity increases through the orifice as a high velocity jet
|
|
|
Describe and draw the spectral waveform of MS.
|
Increased MV E-velocity at MV leaflet tips (>1.3m/sec)
Decreased EF slope of MV inflow = increased decal time + increased P ½ time Increased Mean Pressure Gradient (Mean PG) |
|
|
Define Pressure ½ time
|
The time it takes for the pressure gradient to drop to half of its original value
|
|
|
What is the normal P ½ time of the Mitral Valve?
|
30-60msec
|
|
|
What is the P ½ time in severe MS?
|
>220msec
|
|
|
What is the value for a normal MVA?
|
>2.4 or 4-6 cm2
|
|
|
Explain 2D Planimetry of the MV to obtain MVA
|
PSA-MV (scan superior then inferior)
Find the smalles valve orifice in diastole Reduce gains and freeze image Planimeter (trace) inner border of tissue |
|
|
Formula for MVA by P ½ method?
|
220/ P ½T
|
|
|
Name and write the equation that is used to calculate maximum pressure gradients
|
Modified Bernoulli Equation 4(max velocity)2
|
|
|
MV Mean PG correlates best with Cath data. What are the values for MV Mean PG for mild, moderate, and severe MS?
|
mild – <5mmHG
moderate – 6-10mmHG severe – >10 |
|
|
Mitral Stenosis is what type of overload and to what chamber?
|
Pressure overload in LA
|
|
|
Over time the chronic condition of MS can cause what secondary complication of the right heart?
|
pulmonary hypertension RHF, , RAE, RVE, pulmonary congestion
|
|
|
Chronic MS 2D findings of this condition are:
|
Diminished or absent a-wave of the pulmonary valve
Midsystolic closure or notching of the pulmonary valve “w” of pulmonic valve during systole Enlarged RAE, RVE Flattened ins (d-shape) and paradoxical movement of the septum during systole Dilated IVC LAE |
|
|
How can doppler be used to diagnose the presence of this complication?
|
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 peak velocity of TR in CW: 4(VTR)2 + est RAP = RVSP/PAP |
