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113 Cards in this Set

  • Front
  • Back
What AS etiology is most common and starts as a bicuspid valve?
What AS etiology is associated with mitral stenosis?
What AS etiology affects only 1-2% of the population and is often simply a membrane?
What are two AS etiologies unrelated to the native AV itself?
Valvular Obstruction (Sub/Supra)
Prosthetic Valve Dysfunction
A secondary finding in AS is?

Why does AS lead to LVH?
Systolic Pressure Overload (Increase in Afterload)
An increase in LVEDP leads to an increase in what?
LA Pressure
Does ventricular dysfunction develop early or late in the course of AS?
Ventricular Dysfunction develops LATE
AS puts a patient at increased risk for what disease?
How does aortic sclerosis differ from AS?
Valvular thickening without a pressure gradient
Name three physical signs of AS.
What kind of murmur is characteristic of AS? Located where?
1) Harsh Systolic Ejection Murmur
2) Crescendo-Decrescendo
3) Right Upper Sternal Border
When auscultating an AS patient, what will usually be missing?
A2 (lack of valve movement)
Name four physical signs of AS on 2D echocardiograms.
1) Thickened AV leaflets
2) Decreased valve opening
3) Aortic dilatation
4) LVH
Name the ranges for mild, moderate, and severe Aortic Jet Velocity (m/s)
Aortic Jet Velocity
MILD: < 2.9 m/s
MOD: < 4.0 m/s
SEV: > 4.0 m/s
Name the ranges for mild, moderate, and severe Aortic Mean Gradient (mmHg)
Aortic Mean Gradient
MILD: < 20 mmHg
MOD: < 40 mmHg
SEV: > 40 mmHg
Name the ranges for mild, moderate, and severe AVA (cm^2)
MILD: > 1.5 cm^2
MOD: <= 1.5 cm^2
SEV: < 1.0 cm^2
Name an M-Mode finding which would indicate a bicuspid AV.
Eccentric Closure (diastolic closure line shifted anteriorly)

(NOTE: can be created artificially by being too low)
How will bicuspid AV leaflets appear on M-mode?
Thickened (may be mild)
In the PLAX view, how may an AS patient with a bicuspid AV present?
Systolic Doming (aka Tethering)
In the PSAX view, how will an AS patient with a bicuspid AV present?
Football-shaped oriface
If an AS patient is found to have a bicuspid AV, what else must be checked for?
Aortic Coarctation
The best view to diagnose a bicuspid AV is:

A) PSAX diastole
B) PSAX systole
C) PLAX diastole
D) PLAX systole
B) PSAX systole
What is the normal velocity of the descending AO?
1 m/s
For a patient with AO coarctation, what pattern will be seen in the spectral doppler display (CW)?
Diastolic Flow (aka Run-Off)

(right side of systolic U pattern will trail up to the next systolic U, since the flow takes time to pass through the narrowing)
Which view is best for detecting subvalvular membranes?
Apical 5
In what anatomical location are most subvalvular membranes seen?
LVOT, beneath the AV
A subvalvular membrane can cause what two findings in 2D echo?
1) LVH
2) Early systolic closure of AV leaflets
Which is more common: subvalvular or supravalvular membranes?
Subvalvular is more common
(Supravalvular is very rare)
What is Takayasu's arteritis?
Fibrosis of the aortic arch & descending aorta (supravalvular). In advanced cases, multiple coarctations may occur.
- > young Asian & African women
- aka Aortic Arch Syndrome
Increased velocity and turbulance will occur where in relation to an obstruction?

A) Above
B) At the level of
C) Below
B) At the level of
Anytime an obstruction is discovered or suspected, a VTI should be performed in order to provide what two pieces of information?
Peak Gradient
Mean Gradient
LVOT velocity is 5 m/sec
BP = 110/84
What is this patient's peak LV pressure?
210 mmHg

(Bernouli + sys BP)
The theory behind the continuity equation is that the ___ & ___ of the LVOT will always equal that of the AV.
Area & Flow Velocity
Describe the Continuity Equation (using LVOT diameter & peak velocities).
AVA = (A1 x Vlvot) / Vav

where A1 = (LVOT dia / 2)^2 x pi
If peak LVOT velocity (PW) is 1 m/sec, LVOT diameter is 2 cm, and peak AV velocity (CW) is 3.5 m/sec, what is the AVA?
0.9 cm^2
Using the continuity equation, when would the severity of AS be underestimated?

A) LVOT measured too large
B) LVOT measured too small
C) Peak aortic velocity too high
D) Mean aortic velocity too high
A) LVOT measured too large
Describe the Continuity Equation (using LVOT diameter & VTI).

LVOT CSA = (LVOT Dia^2) * 0.785
If LVOT VTI is 24, LVT diameter is 2 cm, and AV VTI is 50, what is the AVA?
1.51 cm^2
If a patient has poor LV function or when mod/sev AI is present, which continuity equation works best:

A) Continuity Equation using peak velocities
B) Continuity Equation using VTI
B) Continuity Equation using VTI
Should LVOT diameter be measured in systole or diastole?
What anatomical locations should be used in measuring LVOT diameter?
AV leaflet insertion points
Which of the following correlate better?

A) Mean Gradient vs Cath Gradient
B) Peak vs Peak-to-Peak
A) Mean Gradient vs Cath Gradient
Which pressure is obtained during TTE/TEE doppler?
(aka Peak Instantaneous)
In a cath lab pressure tracing, what does it mean if the LV pressures & AO pressures track together (in unison)?
No AS is present (unless LV/AO pressures are out of sync)
When evaluating for AS, what is the first thing to look for?
Decreased AVA
(AVA < 2.5 cm^2)
When evaluating for AS, what is the second thing to look for (if valve areas are the same)?
Increasing Peak Gradient (LVOT/AV)
When evaluating for AS, what is the third thing to look for (if valve areas & peak gradients are the same)?
Wall Thinkness (for LVH)
What PS etiology is most common?
What PS etiology is rare?
Name four etiologies of PS, besides the most & least common (congenital & rheumatic, respectively)
1) Carcinoid
2) Peripheral (Jxn of RPA/LPA)
3) Subvalvular (Infundibular)
4) Prosthetic Valve Dysfunction
Which syndrome is classified as a cardiofacial syndrome with PS, HCM, and ASD (30%)?
Noonan Syndrome
PS will cause systolic (pressure or volume) overload which will lead to what?
Pressure Overload
What is often the cause of infundibular (subvalvular) PS?
Regional Hypertrophy
Name three congenital abnormalities that PS is commonly associated with.
1) VSD
2) ASD
3) Tetralogy of Fallot
How will PS typically affect RV and RA chamber sizes?
RA will enlarge
RV will remain normal
PS puts a patient at increased risk for what?
What are two common physical symptoms experienced by patients with PS?
1) Dyspnea upon exertion
2) Jugular Venous Pulsation (JVP)
What is commonly found during ascultation in patients with PS?
Systolic Ejection Murmer
(Left Upper Sternal Border)
What is a common M-mode finding in patients with PS?
Increased A wave
In patients with severe PS, M-mode may show an increase in what of > 7mm?
A dip
Name three common 2D echo findings for patients with PS.
1) Valvular thickening and systolic doming
2) RVH
3) Post-stenotic dilatation of the PA
Name one 2D echo finding in patients with subvalvular (infundibular) PS.
Narrowing of RVOT
In the M-mode of the PV, what is the a-dip caused by?
Atrial Contraction
What happens to the a-dip (m-mode) with PS?
A-dip becomes larger and exaggerated
What happens to the a-dip (m-mode with pulmonary hypertension (PHTN)?
A-dip disappears
When using doppler in a stenotic area, will increased velocity & turbulance occur before, at, or after the obstruction?
Increased velocity & turbulance will occur AT the obstruction
Anytime PS is suspected, what measurements should be obtained? How & where?
- Peak & Mean Gradients
- Tracing the doppler envelope
What is the normal pulmonary velocity?
1 m/sec
Does PS cause PHTN?
If unable to obtain PS gradient from the parasternal window, where else can you go?
Subcostal SAX
Name the peak velocity ranges (m/s) for mild, moderate, and severe PS
PS: Peak Velocity (m/s)
MILD: < 3.0
MOD: < 4.0
SEV: > 4.0
Name the peak gradient ranges (mmHg) for mild, moderate, and severe PS
PS: Peak Gradient (mmHg)
MILD: < 36
MOD: < 64
SEV: > 64
What is the most common etiology of MS?
(commissarial fusion)
What is the rarest etiology of MS?
(parachute MV)
What are two MS etiologies that are neither rare or common?
Aquired MAC
Prosthetic Valve Dysfunction
What is the cause of a parachute MV?
Single Papillary Muscle (congenital)
MS causes increased pressure and dilatation where?
What effect can chronic MS have on the right side of the heart?
PHTN (RV & RA enlargement)
What effect does MS have on cardiac output?
Decreased Cardiac Output
Longstanding MS leads to all the following except:

C) LV dilatation
D) LA dilatation
C) LV dilatation
45% of patients with this disease develop MS.
Acute Rheumatic Fever
What arrhythmia is common in patients with MS?
Atrial Fibrillation
What kind of murmur is present in patients with MS?
Diastolic rumble with opening snap
What are common physical symptoms of MS?
CHF (dyspnea, fatigue, orthopnea, peripheral edema)
Hemoptysis (bloody sputum)
Name four ways in which MV M-mode can identify MS.
1) decreased E-F slope
2) anterior motion of posterior leaflet
3) reduced E wave amplitude
4) multiple echos
Which of the following valves is least likely to be affected in rheumatic heart disease?

A) mitral
B) aortic
C) tricuspid
D) pulmonic
D) pulmonic
A "hockey-stick" presentation of the MV leaflet tips indicates what?
(associated w/ rheumatic MS)
Thickened leaflets with decreased mobility describe what MV condition?
Why can atrial fibrillation result from MS?
LA dilatation causes stretched conduction tracts, which can trigger ectopic PMs
Are MS patients with AFIB symptomatic? Why or why not?
Symptomatic. MS patients are dependant on atrial contraction for their cardiac output, and AFIB will reduce diastolic filling by 50%
To determine MS, name the ranges for mild, moderate, and severe MVA (cm^2)
MS: MVA (cm^2)
MILD: > 1.5
MOD: < 1.5
SEV: < 1.0
To support MS diagnosis, name the ranges for mild, moderate and severe Mean Gradient (mmHg)
MS: Mean Gradient (mmHg)
MILD: < 5
MOD: < 10
SEV: > 10
To support MS diagnosis, name the ranges for mild, moderate, and severe PA pressure (mmHg)
MS: PA Pressure (mmHg)
MILD: < 30
MOD: < 50
SEV: > 50
Name two additional measurements that should be taken when MS is suspected.
1) Pressure Half Time
2) Mean Gradient
With atrial fibrillation, MS velocity calculations are best performed:

A) averaged over 2 beats
B) averaged over 5-10 beats
C) averaged over 20 beats
D) unabled to measure in AFIB
B) averaged over 5-10 beats
Name two methods of calculating MVA in MS patients.
1) Pressure Half-Time
2) Planimetry in PSAX
What is pressure half-time?
For MS, which flow pattern is used to calculate it?
- The time it takes for the pressure gradient to decrease by half.
- For MS, it is calculated from the diastolic mitral inflow deceleration slope
How do you calculate MVA using pressure half-time?
MVA (cm^2) = 220 / pressure half-time (msec)
How do you calculate MVA using deceleration time?
P1/2t = dt x 0.29
MVA (cm^2) = 220 / pressure half-time (msec)


MVA (cm^2) = 759 / dt
Given a mitral P1/2t of 400 msec, what would the area be?

A) 0.5 cm^2
B) 1.0 cm^2
C) 1.8 cm^2
D) 2.0 cm^2
A) 0.5 cm^2
Given a mitral deceleration time of 400 msec, what would the P1/2t be?

A) 50 ms
B) 116 ms
C) 220 ms
D) 600 ms
B) 116 ms
In a cath lab pressure tracing, what does it mean if the LA pressure tracks higher than the LV pressure in diastole?
In a cath lab pressure tracing, what does it mean if the LV pressure tracks higher than the AO pressure in systole?
What is the most common etiology of TS?
What are the two rarest etiologies of TS?
What is another etiology of TS which is neither rare or common?
Prosthetic Valve Dysfunction
On 2D echo, how can you identify carcinoid vs rheumatic TS?
Carcinoid = fixed leaflet bodies
Rheumatic = tethered leaflet tips
Increased RA pressure causes what RA effect?
RA dilatation
Rheumatic TS is almost always associated with what?
Increased serotonin production from a carcinoid tumor (intestinal tract or pancreas) can result in what?
Carcinoid Heart Disease
Serotonin deposits on the right heart endocardium causing TS/TR/PS/PR is called what?
Carcinoid Heart Disease
TS causes increased risk of what?