Exam 2 Valvular Disease

Front 1

Mitral valve area using the pressure half time method

Back 1

MVA=220 ÷ PHT

Front 2

MV area using the Deceleration time method

Back 2

MVA= 759 ÷ DT

Front 3

Pressure half time from DT equation

Back 3

PHT= 0.29 × DT

Front 4

Cross sectional area equation

Back 4

CSA= (0.785)(LVOT diameter)2

Front 5

MV area using continuity equation method

Back 5

MVA cm2 = (CSA x VTI lvot) / VTI MV

Or (0.785)(LVOT diameter)2 (VTI LVOT) / VTI MV

Front 6

Stroke volume equation

Back 6

SV= CSA x VTI lvot

Front 7

Aortic valve area continuity equation

Back 7

AVA (cm)2 = (.785) (LVOT diameter)2 (LVOT VTI)/ VTI AV

Front 8

Aortic valve velocity ratio

Back 8

VR= V1/V2

Remeber V1 happens before V2

V1: LVOT velocity

V2: Max AV valve velocity

VR is the velocity ratio

Front 9

Aortic valve velocity ratio

Back 9

Normal ratio is 1. Severe stenosis is 0.25 or less. This means the valve area is 25% of normal

Front 10

early aortic valve opening

Back 10

Aortic insufficiency

Front 11

early closure of the MV

Back 11

Aortic insufficiency

Front 12

With M-mode you detect diastolic flutter of the anterior mitral valve leaflet and the aortic valve, early closure of the mitral valve, and early opening of the aortic valve. What is the diagnosis?

Back 12

Aortic insufficiency

Front 13

T or F? In cases of mild AI, the pressure difference gradually decreases creating a flatter pressure halftime waveform.

Back 13

True

Front 14

True or false? Severe AI causes the aorta's pressure to drop quickly creating a more rapid LV pressure increase and a flatter pressure halftime.

Back 14

False. Severe AI has a steeper waveform.

Front 15

Which of the following would most likely cause chronic AI?

Aortic dissection, aortic stenosis, trauma, or left atrial myxoma?

Back 15

Aortic stenosis

Front 16

T or F? AI is the result of an incompetent aortic valve that permits backward systolic flow from the aorta, through the aortic valve, into the left ventricle.

Back 16

False AI is backward diastolic flow when the valve is closed

Front 17

A low-pitched, mid-diastolic, rumble at the apex. (Austin Flint murmur) is heard in patients with what?

Back 17

Severe AI

Front 18

Patient is experiencing exertional dyspnea, syncope, and chest pain. Echo reveals LV enlargement, decreased LV function and diastolic dysfunction. What is most likely the diagnosis?

Back 18

AI

Front 19

High-pitched, blowing, diastolic decresendo murmur at the left sternal border is heard with

Back 19

AI

Front 20

What pressure halftime would you expect on a patient with mild AI?

A.) > 500 msec

B.) 350-500 msec

C.) < 200msec

D.) 16-30 mmHg

Back 20

Greater than 500 msec

Front 21

Small D shaped left ventricle, flattened IVS, and a dialated, hypertrophied right ventricle.

Back 21

MS with Pulmonary hypertension

Front 22

Possible left atrial thrombus and spontaneous echo contrast, decreased mitral valve area, and hockey stick mitral valve

Back 22

Mitral Stenosis

Front 23

Flattened E-F slope, pressure half time, Deceleration slope.

Back 23

Mitral stenosis

Front 24

Absent a wave and Mid systolic closure of Pulmonic valve creating "flying W" happens with___

Back 24

Ms with associated pulmonary hypertension

Front 25

What is the most common cause of mitral stenosis?

Back 25

Rheumatic fever

Front 26

Increased LA pressure, scarring of the MV apparatus, dilatation of the IVC and SVC are all complications of what?

Back 26

Mitral stenosis

Front 27

Mitral regurgitation associated with mitral stenosis is most likely due to

Back 27

Left atrial enlargement

Front 28

True of false? Diastolic doming of the anterior mitral valve leaflet creates a hockey stick appearance when MR is present.

Back 28

False. This happens with MS

Front 29

Dyspnea hemoptysis and fatigue are all symptoms of what?

Back 29

Mitral stenosis

Front 30

___ of the valve leaflets is caused by pressure pushing on the under surface of the leaflets along with comissural fusion.

Back 30

Doming

Front 31

Increased E-F slope, increased A wave, and decreased leaflet excursion (D-E) may present on M-mode when mitral stenosis is present.

Back 31

False. A decreased E-F slope and decreased or absent A wave with a decreased excursion is seen with MS

Front 32

Mitral stenosis creates a volume and pressure overload pattern, which may result in

Back 32

RV hypertrophy, RV enlargement, and a small D shaped LV

Front 33

T or F?

RV hypertrophy, RV dialtion, flattening of the IVS, paradoxical wall motion, and a small D shaped LV are the result of pulmonary hypertension.

Back 33

True

Front 34

Absent A wave combined with mid systolic closure of the pulmonic valve creates a flying W in the presence of what?

Back 34

Pulmonary hypertension

Front 35

If the MV pressure half time is 230 msec, what is present?

Back 35

Severe mitral stenosis

Front 36

Mitral Comissurotomoy, catheter balloon Valvuloplasty, and mitral repair or replacement are all treatments for what?

Back 36

Mitral stenosis

Front 37

T or F?

In the presence of MS, we see increased LA pressure, enlargement of the LA and echo contrast or a thrombus

Back 37

True

Front 38

What is the most common method of calculating the mitral valve area?

Back 38

Pressure halftime method

MVA = 220÷PHT

Front 39

Which one represents the MV area?

PHT/220

220/PHT

Peak gradient/ 220

4(v)2 where V= peak velocity

Back 39

220 ÷ pressure half time

Front 40

Normal mitral valve area equals

Back 40

4-6 cm squared

Front 41

Low pitched, diastolic rumble with an opening snap is the murmur associated with

Back 41

Mitral stenosis

Front 42

T or F?

Regurgitation increases preload. Stenosis increases afterload.

Back 42

True

Front 43

Left ventricular hypertrophy and post stenotic dilatation of the aorta

Back 43

Degenerative aortic stenosis

Front 44

Football shaped opening and raphe

Back 44

Bicuspid aortic stenosis

Front 45

Peak velocity of 4.5 m/sec, max and mean pressure gradient

Back 45

AS waveform

Front 46

Eccentric closure line (25% have a normal closure by m-mode)

Back 46

Bicuspid Aortic valve

Front 47

Systolic crescendo decresendo murmur is associated with what?

Back 47

Aortic stenosis

Front 48

During echo on a 74 year old patient, we detect LV hypertrophy, LV enlargement, decreased LV systolic function, and post stenotic dilatation of the aortic root. What is most likely present?

Back 48

Degenerative aortic stenosis

Front 49

T or F?

According to ICAEL the AS systolic velocity must be evaluated from multiple transducer positions with a dedicated non-imaging CW transducer.

Back 49

True

Front 50

What type of AS originates at the sinuses of valsalva and extends medially to the cusps?

Back 50

Degenerative

Front 51

According to the continuity equation the AVA = (.785)(LVOT diameter)2 (V1)÷ (V2)

Back 51

True

Front 52

T or F In the presence of AS, aortic valve replacement is performed if the patient develops symptoms and or progressive LV hypertrophy

Back 52

True, AOV area is also important in determining replacement.

Front 53

What type of stenosis originates at the AV cusps and moves toward the commissures?

Back 53

Rheumatic

Front 54

When is a raphe typically seen?

Back 54

Bicuspid aortic valve

Front 55

T or F? The continuity equation assumes that flow through a tube is constant. Flow is equal to velocity multiplied by area. Therefore if the area decreases, the velocity must also decrease.

Back 55

False, if the area decreases, the velocity must increase.

Front 56

The LVOT diameter is aquired from LAX in cases of what?

Back 56

Aortic stenosis to calculate the AVA

Front 57

T or F?

Causes of AS are myxomatous degeneration, hereditary factor, connective tissue disorders, or skeletal abnormalities.

Back 57

False

Front 58

During an echo if you detect thickened aortic valve with a peak velocity greater than 2 m/sec the patient has aortic

Back 58

Stenosis

Front 59

If the patient has a thickened AOV with a peak velocity less than 2 m/sec they have aortic

Back 59

Sclerosis

Front 60

2 year old patient has valvular congenital AS. What most likely caused it?

Back 60

Bicuspid aortic valve

Front 61

AS patient usually gets serial echos to track changes in the

Back 61

Degree of AS, systolic and diastolic dysfunction, chamber and wall size

Front 62

Patient has decreased cardiac output, chest pain, syncope, and possible cerebral infarct. What is the likely diagnosis?

Back 62

Aortic stenosis

Front 63

What would you expect to see on m mode of an 11 year old with bicuspid AS

Back 63

Eccentric closure

Front 64

T or F?

AS can decrease aortic valve systolic flutter.

Back 64

True

Front 65

All of these windows should be used for the aortic valve doppler waveform

Back 65

Apical, suprasternal, and parasternal

Front 66

T or F?

Doppler echo is the method of choice for diagnosis of aortic stenosis

Back 66

True

Front 67

If LVOT diameter is 1.7, V1 is 1, and V2 is 4 what is the AVA?

Back 67

.57 cm squared

Front 68

T or F?

The aortic valve doppler waveform always appears below the baseline.

Back 68

False

Front 69

PHT from DT

Back 69

.29 × DT

Front 70

MVA using DT

Back 70

759÷DT

Front 71

MVA using PHT

Back 71

220÷PHT

Front 72

MS impedes ___ bloodflow traveling from the LA into the LV

Systolic or Diastolic?

Back 72

Diastolic. when the valve is open

Front 73

Which murmur is a low pitched DIASTOLIC rumble with an opening snap

Back 73

Mitral Stenosis

Front 74

What can be caused by severe mitral annular calcification? MAC

Back 74

Mitral stenosis

Front 75

MV artesia (absence of normal opening) or parachute MV (only one papillary muscle attached to MV) are both causes of what?

Back 75

Congenital MV stenosis

Front 76

Left atrial mass, tumor or vegetation due to infective endocarditis or anything that obstructs MV flow are examples of what?

Back 76

Secondary Mitral stenosis

Front 77

With mitral stenosis, LA enlargement and scarring of the MV apparatus that shortens and thickens the leaflets and chords can cause

Back 77

Associated mitral regurgitation.

Front 78

LA thrombus (particuarly in the left atrial appendage) and systemic embolization, increased LA size and pressure, spontaneous echo smoke, infective endocarditis, and decreased cardiac output can be seen with ___

Back 78

Mitral stenosis

Front 79

classic finding of MS

Back 79

Hockey stick appearance of the Anterior mitral valve leaflet

Front 80

A large RV and a small D shaped LV are seen with

Back 80

Mitral stenosis

Front 81

What part of the cycle should you do planimetry of the MV for MVA?

Back 81

Early diastole, during maximal opening

Front 82

M-mode of MS

Back 82

1. Decreased EF slope (0-30mm/sec), reduced amplitude of E wave, and absent A wave

2. Decreased DE excursion (amplitude)

3. Thick MV leaflets

4. Anterior motion of the PMVL

Front 83

Normal MV m-mode

Back 83

Front 84

D to E to FO represents ___. This accounts for 70 to 75% of filling

FO to first upward of A is what? ___

Back 84

Early and rapid filling.

Diastolic filling.

Front 85

MS associated with PHTN. Flattened IVS is from the increased___ in the RV

With ___ overload the IVS will round some in systole

Back 85

Pressure.

Volume.

Front 86

M-mode

Back 86

MS w/ PHTN

Front 87

Most common method to access MS is

Back 87

Pressure half time

Front 88

With MS, the ___ waveform and the __ the pressure half-time, the more severe the stenosis.

Back 88

Flatter, longer (higher number)

Front 89

With AI, the ___ the waveform, and

the ___ pressure half-time = more severe

Back 89

Steeper,

Shorter (lower number)

Front 90

Normal MV area?

Back 90

4-6 cm2

Front 91

MVA w/ mild MS?

Back 91

>1.5 cm2

Front 92

1 to 1.5 cm2 MVA is what degree of stenosis?

Back 92

Moderate

Front 93

MVA w/ severe MS

Back 93

< 1 cm2

Front 94

MVA with MS

Back 94

Normal: 4-6

Mild: 1.5-4

Moderate: 1-1.5

Severe: <1

Front 95

A thickened AOV that does open well with a peak velocity <2 m/s is

Back 95

Aortic sclerosis

Front 96

A thickened AOV that doesn't open well with a peak velocity >2 is

Back 96

Aortic stenosis

Front 97

___ to the stenotic aortic valve flow is laminar

Back 97

Proximal

Front 98

___ to stenotic AOV flow is turbulent

Back 98

Distal

Front 99

Doppler echo measures ___ pg, while the cath lab provides the peak to peak PG

Back 99

Instantaneous ( measures velocity and converts it to PG using Bernoulli equation)

Front 100

Subvalvular congenital AS may be due to a ___

Back 100

Membrane across the LVOT

Front 101

Valvular congenital AS is due to

Back 101

Bicuspid or unicuspid AOV

Front 102

Supravalvular congenital AS is due to an aortic ___

Back 102

Coarctation

Front 103

If someone has a bicuspid AOV, the sonographer should always look for___

Back 103

Coarctation ( color flow and spectral doppler in suprasternal)

Front 104

When should you look for bicuspid aortic valve *what part of the cycle

Back 104

Systole with the valve open

Front 105

With rheumatic MS, 30% of patients will have ___ as well.

Back 105

AS

Front 106

Mini thoracotomy (robotically assisted w/ small incision between ribs) and TAVR (balloon catheter w/ a stent-mounted valve crimped on its tip) are both methods of ____ replacement

Back 106

AOV

Front 107

Any turbulent flow (MS, AS, AI) can cause ___

Back 107

Infective endocarditis

Front 108

With quad AOV (4 cusps), the cusps usually open well (no AS) but most cases have associated __

Back 108

AI

Front 109

AS increases___. Therefore,the LV must work harder to pump blood, causing LV hypertrophy.

Back 109

Afterload (resistance the heart must pump against)

Front 110

Post stenotic dilatation of AO root and ascending aorta due to high velocity jet striking the aortic root wall can be seen in patients with ___

Back 110

AS

Front 111

Planimetry from SAX of the AOV should be done at what part of the cycle?

Back 111

Early systole

Front 112

As vs normal AOV m-mode

Back 112

Front 113

AS waveform from suprasternal or right parasternal, flow traveling toward the transducer

Back 113

Front 114

AS doppler waveform from the apex with flow traveling away from transducer

Back 114

Front 115

What measurements are needed to get the aortic valve area?

Back 115

LVOT diameter, peak LVOT velocity, peak AOV Velocity. (VTI of both if there is AS)

Front 116

AS severity scale

Back 116

Front 117

Flow reversal above the baseline in the descending aorta (SSN) is an indication of ___

Back 117

Severe AI

Front 118

AI PHT of 350-500 is

Back 118

Moderate

Front 119

Greater than AI 500 PHT is

Back 119

Mild