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39 Cards in this Set
- Front
- Back
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which pap muscle is inervated by the RCA
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postertomedial
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which pap muscle is inervated by two different coronary arteries
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anterolateral
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how many chordae tendenae come off of each papillary muscle
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several
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MITRAL STENOSIS: defined
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narrowing of mitral valve orifice impeding diastolic flow from LA to LV
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Which etiology is most common for MS
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rheumatic
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what is characteristic of Rheumatic Valve damage and what do the valves look like then
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commissural fusion
cordae tendineae fusion Doming or bowing in diastole. the leaflet tips are restricted due to the commissures being fused |
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Rheumatic leaflet tips: thick or normal?
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thickened
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Rheumatic affects the ________ region with __________, _____________, ___________ and ______________- of the mitral chordae
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subvalvular
fusion, shortening, fibrosis and calcificaiton |
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MAC: common in what age
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elderly
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where is Mild MAC found?
and where if more severe? |
on the LV side of the posterior annulus, near base of posterior leaflet
the entire posterior annulus |
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what area is rarely involved with damage with MAC
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the are between the anterior MV leaflet and aortic root
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MAC may result in mild to moderate ____ due to increased _______ of the annulus
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MR
rigidity |
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MAC can finally move into the _________ and cause MS
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MV leaflets
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how do you distinguish from rheumatic MS and MAC
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MAC has the presence of MOBILE leaflet tips without commissural fusion
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CONGENITAL MV issues looks like:
2 things |
parachute MV
double orifice MV |
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what is an etiology for MS that is an left atrial tumor
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myxoma
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Left Atrial b____- v_____ t______? etiology for MS
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Ball-valve thrombus
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what is it called when it was a procedure that caused the MS
2 things |
Iatrogenic: prosthetic MV or MV annuloplasty:
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Some other etiologies for MS
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inefective endocarditis, malignant cardinoid, systemic lupus erythematosis, rheumatoid arthritis, mucpoloysaccharidosis, Farbry's disease, Whipple disease, medication toxicity, Radiation
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Rheumatic Heart Disease:
M-Mode findings: thickened ________, decreased ____(____mm/s severe), anterior motion of the ________ |
leaflets, E-F slope (0-30 mm/s is severe)
posterior leaflet (gets sucked up) |
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Rheumatic Heart Disease:
2D findings: Thickened ______ (>___mm), diastolic _______ of ______ leaflet looking like a ______, shortening and _____ of the _______, Commissural _________ |
leaflets (>3mm), doming, anterior, hockey stick, fibrosis, chordae , fusion
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Rheumatic Heart Disease:
2D findings: LA _______, and small ______, ________ hypertension and RA________ |
dilation, LV , pulmonary , dilation
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Rheumatic Heart Disease:
2D findings: PSAX: when you planimetry the valvue what does it look like? |
elliptical orifice that is relatively constant during diastole.
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Rheumatic Heart Disease:
PW and CW Doppler findings; increased ________ (> _____ m/s) velosity at leaflet tips decreased ________ (increased _______ and________) decreased systolic __________ with prolonged duration and __________of diastolic flow |
E wave 1.3 m/s
E-F Slope, deceleration time and pressure half time pulmonary venous flow, pressure half time |
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CONGENITAL:
What does it look like? where to chordae come from |
parachute
one single papillary muscle |
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CONGENITAL: 2D findings
increased/decreased echogenicity? _______ leaflet motion HOW TO SEE THE DIFF? what view and what see? |
increased
reduced PSAX: double orifice |
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What to measure for all MS
7 things |
Pressure Half time
MVA by Pressure Half Time MVA by continuity Equation MVA indexed MV mean transvalvular gradient MV end diastolic pressure gradient Evaluate MR |
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MVA mean tansvalvular gradient:
_____ gradient is the relavent hemodynamic finding and not the _______ gradient. it is from the peak mitral velocity and influenced by the ________ compliance and _____ diastolic function |
MEAN
Maximal LA LV |
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stats for other valves and MS: %s
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50% MV alone
30% MV and AV 20% AV alone 2-3% trivalvular |
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what you see with CF doppler
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narrow flame shaped
vena contracta |
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NOrmal MV measurements
E velocity A velocity E/A ration MV decel time A duration IVRT |
7-1.2 m/s
.4-.7 m/s 1-2 150-240 msec <20 msec 50-100 msec |
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when do you planimetry the MV for MS?
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at beginning of diastole
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MVA continuity Equation
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MVA (cm2) = CSA lvot (cm2) x VTI(PW)lvot
-------------------------------------- VTI(CW) MV csa: .785 x lvot (diameter)2 |
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Pressure Half Time Method PHT for MVA
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CW wave of the MV velocity
trace the gradient Max e wave/1.4 to get where the half time is located |
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Echo score index: ____ - ______
______is more favorable for balloon valvuloplasty CATAGORIES 4 of them |
4-16
< 8 CATAGORIES Leaflet mobility leaflet thickening subvalvular thickening Leaflet calcification |
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Pitfalls to MS: Pressure Gradient things
_________ angle between the ______ and the US_____ _____ to ______ variablity dependance on ______________volume flow rate |
intercept , MS jet, beam
beat beat transvalvular |
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Pitfalls to MS: 2D valve area
_______ orientation _________ plane 2D _____ settings Intra/interobserver variability in ________ orifice poor__________ access _________ valve anatomy |
image
tomographic gain planemetry acoustic deformed |
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Pitfalls to MS: T1/2 Valve area
Definition of _____ and _____ slope ________ early diastolic __________ slope _________ with a wave superimposed on _________ slope influence of coexisting ________________ changing ____ and ____ compliances immediately after commissurotomy |
vmax early diastole
nonlinear velocity sinus rhythm early diastole aortic regurg LV LA |
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Pitfalls to MS: continuity equation
accurate measurement of ___________ stroke volume |
transmital
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