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66 Cards in this Set
- Front
- Back
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What are the two abnormalities
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stenosis
regurgitation |
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Stenosis is less blood going through the valve why?
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doesn't open all the way
sticky |
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Where is the pressure highest if the valve is stenotic?
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right before the valve
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What would create the narrowing of the valve orifice that produces an obstruction
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pressure increase before valve
decrease after the valve |
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The more severe the stenosis the
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greater the pressure and the greater the velocity through the valve
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What does stenosis mean for the proximal chamber ?
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CH will dilate
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What happens first with stenosis
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pressure overload
hypertrophy = atrial don't hypertrophy it will DILATE |
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what happens with stenosis
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1. increase velocity through the valve (1st sign)
2. the pressure increase in the CH proximal to the valve |
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Stenosis produces =
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pressure overload and it is followed by volume overload
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Regurgitation
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volume increases FIRST and when CH are dilated than pressure builds up
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Isolated valvar disease
one valve is stenotic clinical symptom |
valve area is reduced 75% of its normal diameter
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*Atria response to stenosis =
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dilate
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ventricle response to stenosis
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hypertrophy
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2D stenotic valve
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restricted opening
calcifcation thickened leaflet |
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(6) evaluate patient with valuar disease
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1. look 2D health and underlying cause of stenosis
2. 2D measurement of the valve = planimetry 3. use doppler to quantify the severity of the stenosis 4. Evaluate those patients with any coexisting lesions 5. assess LV systolic function (EF) 6. document response to chronic pressure overload |
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With stenosis what do we have
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pressure overload on the heart
increase pressure gradient through the stenotic valve increase velocity through the valve |
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2 Equations for valuvar stenosis
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Continuity eq (AS)
PHT (MS) |
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What does aortic valve look like
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3 cusps
systole normal aortic valve area 3-4cm2 2cm leaflet cusp separation |
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Pt with AS can give HX of what kind of symptoms
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SOB
DOE CHF dyspnea, orthopena, proxizmal nocturnal dyspnea angina pectoris |
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What type of murmur would you hear with AS
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harst systolic ejection murmur
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Most common form of AS
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caused by degerative calcifcation
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what causes AS
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degenerative
congenital rheumatic heart disease bicuspid aortic valve |
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2D evaluate AS
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1.how many cusps
2. degree of valuvar calcification 3. size of aortic annulus, supravalvar area and ao root 4. 2ndary subvalvar obstruction 5. LVH, LT atrail enlargement, ventricular function |
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AS LVH why?
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bc pressre overload in the left ventricle
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Continuity eq
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AVA= cSA of lvot (plax) X velocity of the LVOT (apical 5 pW) / velocity of the AO (apical 5 CW)
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Most important if pt has AS
look for (doppler) |
maxminal peak velocity through CW
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Severity of stenosis AO
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1. peak Ao velocity is Greater Than 4,/s
2. mean pressure gradient is greater than or equal to 50mmhg 3. AVA is less than = to .75cms 4. Ration will help assess patients with low or high CO RATIO OF LVOT/AO VALVE VTI |
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if you have a patient with increase CO
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increase velocity
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if Aortic jet is less than 3 m/s
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no need for valve replacement
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Asymptomatic
aortic jet velocity mean pressure gradient valve area |
Aortic jet velocity will increase .3 m/s per year
mean pressure gradient will increase 7mmhg per year valve area will decrease .12cm2 per year |
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Severe AS
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LVH
lt atrail enlargement |
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MS
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narow mitral valve orfice
impede diastole flow from LA -LV |
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PRIMARY cause of MS
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rheumatic heart disease
causes commissures to fuse, sticky |
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on ECho MS
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thickened
calcified subvalvar apparatus |
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ON M-Mode MS
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you will see a decrease E-F slope
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Biggest problem wth MS
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LA dilatation
Atrail wall hypertrophy= increase pressure build up |
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MS pt at risk for
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Pulmonary HTN
LA thrombus- stasis of BLOOD |
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the best way to assess As is thorugh
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the velocity = Continuity eq
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Velocity is NOT a good indicator in the severity of
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MS
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measuring mitral valve
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1. Plemetry (PSAX)
2. Continuity Eq 3. pressure 1/2 time 4. PISA |
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PHT formula MVA
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MVA= 220/PHT
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what is PHT
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time it takes for pressure MV to go down 1/2 original value
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PHT exceptions
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AI
MR valvotomy |
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PHT
doppler? view? |
want to get maximal velocity of MV use CW doppler
from apical view |
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PHT corresponds valve area of
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1cm2
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Normal PHT
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30-60ms
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decel time - DT
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PHT = .29 X DT
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Continuity eq MVA=
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lvot diameter X .785 X VTI LVOT (PW) / VTI MV (CW)
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normal MV
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annuls 4-6cm2
mild stenosis 1.6-2cm2 moderate 1.1-1.5cm2 severe= less than 1cm2 |
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MS i severe when mean pressure gradient
MVA PHT |
mean pressure gradient greater than equla 10mmhg
MVA less than or equal to 1cm2 PHT greater than 220ms |
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the key to determine MS
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plemetry (PSAX) directly
PISA continuity PHT (indirectly) |
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What is MS and what does it do to the heart
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MS produces pressure overload - will cause LA dilate
Aitral dilate it will back up to the PULMONARY VASCULAR BED can develop: PHTN |
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MS can back up to rit side of heart cause ?
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RA dilated
RVH stasis of Blood |
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PT that have severe MS and have enlarged LA
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stasis of blood
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Consequence of MS
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LA enlargment
LA thrombus LA appendage thrombus] stasis of blood MR PHTN ] long standing MS |
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what would pulmonic valve look like with pulmonary HTN on M-mode
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flying -W
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if there is PHTN what else are you gonna see
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RVH
RV enlargement Paradoxical motion TR 2ndary to annulus stretch |
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RT sided stenosis - much less common
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pediatric occurance
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Tricuspid stenosis
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due to rhematic disease
associated with MS |
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Other causes for tricuspid stenosis
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CARCINOID heart disease
attacks the rt side of the heart you will see regurgitation/stenosis |
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Normal tricuspid flow velocity
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.3-.5 m/s
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Normal pressure gradient should be less than
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2mmhg
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Formula for TS
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tricuspid = 190m/s / PHT
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TS SEVERE
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pressure gradient is greater than 7mmhg
PHT is greater than 190ms |
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Pulmonic stenosis
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usually congential heart disease
can be acquired if caused by CA or vegitation mass compress the RVOT subvalvuar stenosis (below the pulmonic valve ) TOF Hypertropic COM |
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when would you see pulmonic stenosis happen
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systole
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