Pathophysiology I

Front 1

A 3 leaflet structure anatomically similar to the Aortic Valve, is called?

Back 1

Pulmonic Valve

Front 2

What lies inside the Pulmonary Artery Annulus?

Back 2

Pulmonic Valve

Front 3

What lies between the RVOT and the Pulmonary Artery?

Back 3

Pulmonic Valve

Front 4

How many leaflets of the Pulmonic Valve are typically seen simultaneously in 2D echo?

Back 4

1-2

Front 5

Optimal VIEWS of the Pulmonary Artery are? (3)

Back 5

PSAX (Ao level)

PLAX (RVOT)

Sub SAX (Ao level) *w/ anterior angulation RVOT and PV leaflets are seen

Front 6

RV inflow can be recorded from which VIEWS? (2)

Back 6

Apical

ParaSternal RVOT

Front 7

What is the normal RVIT velocity?

Back 7

0.3 - 0.7 m/s

Front 8

Pulmonic Stenosis is a _______________, __________________ and/or _________________ of the Pulmonic Valve.

Back 8

Narrowing

Thickening

Obstruction

Front 9

Heart condition that impedes Systolic blood flow traveling from the RV through the Pulmonary Valve into the Pulmonary Artery, is called?

Back 9

Pulmonic Stenosis

Front 10

Pulmonic Stenosis impedes ______________ blood flow from the _____________ into the _______________________.

Back 10

Systolic

RV

Pulmonary Artery

Front 11

Pulmonary Stenosis Murmur is a _____________, ________________, _________________ murmur.

Back 11

Harsh

Systolic

Ejection

Front 12

A Pulmonary Stenosis Murmur is heard best in the?

Back 12

2nd Left Intercostal space

Front 13

What may be present during a Pulmonary Stenosis Murmur?

Back 13

Thrill

Front 14

What is a normal Pulmonic Valve area?

Back 14

3 - 5 cm sqd.

Front 15

What is the most common cause of Pulmonary Stenosis?

Back 15

Congenital

Front 16

What is the most uncommon cause of Pulmonary Stenosis?

Back 16

Rheumatic Heart Disease

Front 17

A Sinus of Valsalva Aneurysm is a cause of what?

Back 17

Pulmonary Stenosis

Front 18

When a Sinus of Valsalva Aneurysm protrudes into the RVOT obstructing the flow, this is a form of?

Back 18

SubValvular Pulmonary Stenosis

Front 19

Pulmonary Stenosis may occur in conjunction with other congenital abnormalities, such as?

Back 19

TGA

Tetralogy of Fallot

Front 20

What are the 3 different areas of the PV that Pulmonary Stenosis can occur?

Back 20

Valvular

SubValvular (Infundibular)(below the valve)

SupraValvular (above the valve)

Front 21

Carcinoid Heart Disease is involved in causing which Heart conditions?

Back 21

Pulmonary Stenosis

Pulmonary Regurgitation

Front 22

What are 3 complications of Pulmonary Stenosis?

Back 22

Dyspnea on exertion

Jugular Venous Distention

RVH

Front 23

RVH, flattening of the IVS, and a 'D' shaped LV are due to?

Back 23

RV Pressure Overload

Front 24

What are the visual characteristics of Pulmonary Stenosis in 2D echo?

Back 24

Thickened PV leaflets

Systolic Doming

Front 25

RV Pressure Overload can cause? (3)

Back 25

RVH

Flattening of the IVS

'D' Shaped LV

Front 26

Post-Stenotic Dilitation of the Main Pulmonary Artery is due to?

Back 26

High velocity Pulmonic Stenosis Jet

Front 27

What can happen in the later stages of Pulmonary Stenosis?

Back 27

RV failure

Front 28

What is the normal 'A' wave dip for the Pulmonic Valve?

Back 28

2-3 mm

Front 29

What is the 'A' wave depth for Severe Pulmonic Stenosis?

Back 29

> 8 mm

Front 30

When using M-Mode to evaluate the Pulmonic Valve, place the line through the?

Back 30

Posterior (right) PV Cusp

Front 31

Pulmonic Stenosis creates ___________________ Systolic flow that travels from the ______________ into the _____________________.

Back 31

Turbulent

RV

Pulmonary Artery

Front 32

When there is no 'A' wave present, this is a sign of?

Back 32

Pulmonary Hypertension

Front 33

Which 2 methods are most helpful in defining the site of PS flow disturbance and site of obstruction?

Back 33

Color Flow

PW Doppler

Front 34

Which views are utilized to differentiate which area of the Pulmonic Valve is Stenotic (ie. subvalvular)?

Back 34

RVOT

PSAX (Ao level)

Front 35

Which transducer has a better Doppler signal-to-noise ratio?

Back 35

Non-Imaging (Pedoff)

Front 36

True/False:

A smaller transducer can be angled to be more parallel with a jet.

Back 36

TRUE

Front 37

In the Peak Pressure Gradient Severity Scale:

Mild PS

Moderate PS

Severe PS

Back 37

Pressure Gradient:

Mild: 5 -30 mmHg

Mod: 30 - 64 mmHg

Sev: > 64 mmHg

Front 38

The Pulmonic Valve Area is calculated using which equation?

Back 38

Continuity Equation

Front 39

Measurements from which 2 areas are used in the Continuity Equation to find the Pulmonic Valve Area?

Back 39

RVOT

PV

Front 40

Measurement for Mild Pulmonic Stenosis is?

Back 40

> 2.0 cm sqd.

Front 41

Measurement for Moderate Pulmonic Stenosis is?

Back 41

1 -2 cm sqd.

Front 42

Measurement for Severe Pulmonic Stenosis is?

Back 42

< 1.0 cm sqd

Front 43

The Retrograde (backward) flow through the Pulmonic Valve into the RV during __________________, may be ____________ or ___________________.

Back 43

Diastole

Acute

Chronic

Front 44

What percentage of patients with otherwise normal hearts, appear to have Pulmonary Regurgitation?

Back 44

87%

Front 45

Significant Chronic Pulmonary Regurgitation is a?

Back 45

Right Ventricular Volume Overload

Front 46

A Pulmonary Regurge Murmur is a _______________ pitched, _________________ murmur.

Back 46

Low pitched

Diastolic

Front 47

A Pulmonary Regurge Murmur may ________________ with inspiration.

Back 47

Increase

Front 48

Where is a Pulmonary Regurge Murmur heard best?

Back 48

along 3rd or 4th intercostal space adjacent to the left sternal border

Front 49

Which Murmur is heard best along the 3rd or 4th intercostal space adjacent to the left sternal border?

Back 49

Pulmonary Regurge Murmur

Front 50

When Pulmonary Hypertension is present, a ____________ pitched, blowing, _______________ decrescendo Murmur may be heard.

Back 50

High pitched

Diastolic

Front 51

A patient with Pulmonary Hypertension and a high pitched, blowing, diastolic decrescendo sound in their chest, has a Murmur called?

Back 51

Graham Steele Murmur

Front 52

A Graham Steele Murmur is a ____________ pitched, ______________, _________________ decrescendo murmur.

Back 52

High pitched

Blowing

Diastolic

Front 53

What is the most common cause of Pulmonic Regurge?

Back 53

Pulmonary Hypertension

Front 54

True/False:

Pulmonary Hypertension causes insufficiency secondary to dilatation of the valve ring.

Back 54

TRUE

Front 55

What are some causes of Pulmonary Regurge? (6)

Back 55

1. Pulmonary Hypertension
2. Pulmonary Valve repair
   
3. Infective Endocarditis
4. Rheumatic Heart Disease
5. Congenital abnormalities (ie. VSD)
   
6. Carcinoid Heart Diseas

Front 56

What are 4 complications related to Pulmonary Regurge?

Back 56

1. Well tolerated for years
2. increased risk for Endocarditis
3. Dyspnea
4. Right Heart failure (severe PR)
   

Front 57

True/False:

In 2D, Pulmonic Regurge may be present with Infective Endocarditis or Valvular Pulmonic Stenosis.

Back 57

TRUE

Front 58

In 2D, what are an RVD or RV Volume Overload pattern indicative of?

Back 58

Pulmonary Regurge

Front 59

In M-Mode, RV enlargement or RV Volume Overload pattern are an indication of?

Back 59

Pulmonary Regurge

Front 60

In M-Mode, fine diastolic flutter of the Tricuspid Valve is an indication of?

Back 60

Pulmonary Regurge

Front 61

In M-Mode, premature opening of the Pulmonic Valve opening on/before the QRS complex is due to?

Back 61

Severe Acute Pulmonary Insufficiency (PR)

Front 62

How do you differentiate between true and physiologic Pulmonary Insufficiency?

Back 62

Calculate the length and duration of the PR jet

Front 63

A Pulmonary Insufficiency Jet is < ____ cm in length and not ___________________ in duration.

Back 63

< 1 cm

HoloDiastolic

Front 64

Which technique is used to measure the severity of Pulmonary Insufficiency?

Back 64

Mapping Technique

(PW at the RVOT)

Front 65

What is the Mapping Technique?

Back 65

Pulse Wave the RVOT

Front 66

In CW, intensity and shape of a signal (wave) provides an indication of?

Back 66

Pulmonary Insufficiency Severity

Front 67

How do you document a Pulmonary Insufficiency Jet?

Back 67

CW Doppler

Front 68

The Pulmonary Insufficiency waveform is seen ____________ the baseline, while the normal Pulmonary Valve waveform is seen _____________ the baseline.

Back 68

Above

Below

Front 69

What do you use to determine the Pulmonary Artery End-Diastolic Pressure (PAEDP)?

Back 69

CW Doppler

Front 70

Color Doppler Flow determines the ______________ and ______________ of the Pulmonary Insufficiency Jet from multiple windows, providing an estimate of the ________________ of the Pulmonary Insufficiency.

Back 70

Length

Width

Severity

Front 71

What is the normal Pulmonary Artery End-Diastolic Pressure (PAEDP)?

Back 71

4-12 mmHg

Front 72

What is the equation used to calculate the Pulmonary Artery End-Diastolic Pressure (PAEDP)?

Back 72

4 x (PR end diastolic velocity) sqd. + RAP

*PAEDP = LA mean pressure

Front 73

What is the normal Systolic Pulmonary Artery Pressure (SPAP)?

Back 73

15 -30 mmHg

Front 74

In the absence of RVOT obstruction, what is the Systolic Pulmonary Artery Pressure (SPAP) equal to?

Back 74

RVSP

*SPAP = RVSP

Front 75

In the presence of RVOT obstruction, which equation is used to calculate the Systolic Pulmonary Artery Pressure?

Back 75

SPAP = RVSP - PV transvalvular peak PG

Front 76

What is the normal Mean Pulmonary Artery Pressure (MPAP)?

Back 76

9-18 mmHg

Front 77

What is the equation used to calculate the Mean Pulmonary Artery Pressure (MPAP)?

Back 77

4 x (PR peak velocity) sqd.

Front 78

If Pulmonary Insufficiency is considered physiologic, the waveform will be _________ cm in length and not _______________ in duration.

Back 78

< 1 cm

not HoloDiastolic

Front 79

If Pulmonary Insufficiency is considered borderline, the waveform will be ________ cm in length and _________________ in duration.

Back 79

1 -2 cm

HoloDiastolic

Front 80

If Pulmonary Insufficiency is found clinically significant, the waveform will be _________ cm in length with a peak velocity of _____________ m/s and ______________________ in duration.

Back 80

> 2 cm

>1.5 m/s

HoloDiastolic

Front 81

Mild Jet width/RVOT width is?

Back 81

< 40%

Front 82

Severe Jet width/RVOT width is?

Back 82

> 70%

Front 83

True/False:

A thicker Jet indicates more severe Pulmonary Insufficiency.

Back 83

TRUE

Front 84

A Jet size by Color Flow Doppler has a narrow origin and is < 10 mm in length and has a soft/slow deceleration time, describes what level of Pulmonary Regurge?

Back 84

Mild PR

(according to ASE)

Front 85

A Jet size by Color Flow Doppler has intermediate values (not well validated), describes which level of Pulmonary Regurge?

Back 85

Moderate PR

(according to ASE)

Front 86

A Jet size by Color Flow Doppler is usually large with a wide origin, may be brief in duration, and has a dense CW envelope w/ a steep deceleration slope, describes which level of Pulmonary Regurge?

Back 86

Severe PR

(according to ASE)

Front 87

If the Pulmonary Valve is abnormal and the RV is dilated, which level of Pulmonary Regurge is this?

Back 87

Severe PR

(according to ASE)