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127 Cards in this Set

  • Front
  • Back

Describe Auto-graft

A valve self-transplant

Describe Homograft


& AKA

AKA Allograft




Transfer from one human to another

Describe Heterograft


& AKA

Xenograft




Transfer from animal to human

Describe Porcine bioprosthetic valve

Pig's AoV used for MV replacement

Describe Bovine bioprosthetic valve

Cow's Parietal Pericardium for AoV replacement

MC Autograft bioprosthetic valve procedure performed

Ross procedure

Describe the Ross Procedure

Patient's own PV used for AoV

Complications of Bioprosthetic valves

Calcs/degeneration


Dehiscence


Regurg/leaks


Stenosis


Infective Endocarditis

S/P cardiac surgery septal motion should be _____

Paradoxical

First type of mechanical valve used

Ball & cage


**Starr-Edwards

90% of mech valves used today are _____

Bileaflet Tilting Disc




**St. Jude leading manufac

MC dysfunction of mechanical valves

Thrombus Formation

Mechanical Valve Malfunctions

Thrombus/Abscess Formation


Structural changes- variance


Endocarditis- Incr risk b/c foreign


Regurg/perivalv leak


Dehiscence



Doppler of Prosthetic Valves

Mildly stenotic by nature




Peak Vel > 2.5 m/sec is ABNORM

Prosthetic valve MVA Abnormal when


PHT is _____


MVA is ____

PHT > 180 msec




MVA < 1.8 cm2

Auscultation of "Honking" murmur

Post TAVR

Valve transplant from one human to another:


A) Autograft


B) Allograft


C) Xenograft


D) Heterograft

B) Allograft




*ALL the same

The Ross Procedure is an example of


A) Autograft


B) Allograft


C) Xenograft


D) Heterograft

A) Autograft




PV to AoV

T/F: Bioprosthetic valves are subject to calcification and degeneration

True

T/F: Mechanical valves are subject to calcification and degeneration

False

T/F: Bioprosthetic valves are subject to dehiscence

True

T/F: Mechanical valves are subject to dehiscence

True

T/F: Bioprosthetic valves are subject to variance

False




*Dont change Shape

T/F: Mechanical valves are subject to variance

True

MC type of mechanical valve used today

Bi-leaflet tilting disc




St Jude

Endocarditis can be defined as an invasion of :


A) Micro-organism


B) Vegetation


C) Abscess

A) Micro-organism

IV drug abusers w/ endocarditis will most likely present w/


A) IVS abscess


B) Ant MV leaflet abcess


C) MV veg


D) TV veg

D) TV Veg


*RT heart valve d/t venous flow

Chamber enlargement d/t sig regurg indicates


A) acute veg


B) chronic veg

B) chronic veg

T/F: Vegs w/ the worst prognosis (d/t embolization) are those < 1cm

False

MC method to treat Endocarditis

Antibiotics

The ___ is continuous w/ the endocardium at the base of the great vessels


A) Tunica Adventitia


B) Tunica Media


C) Tunica intima


D) all above


E) None

C) Tunica Intima (Endothelium)

Which carries GREATEST risk of endocarditis?


A) Mechanical heart valve


B) Bioprosthetic heart valve


C) CAD


D) Syphilis

A) Mechanical heart valve

Which is best method to diagnose endocarditis?



Blood test

Clinical S&S's of Endocarditis

FUO


+ blood cultures


New/worsening heart murmur


January Lesions & Osler's Nodes

Describe Moderator Band

A thick bundle of muscle of the RV

Describes the 'coumadin/warfarin ridge'

Tissue separating the LAA & LUPV

Describe the epicardial fat pad




List DDx & differentiate the 2

Located anteriorly- btw Epi & Myocardium


appears anechoic




DDx Loculated Effusion: btwn Epi & Parietal pericardium!

Describe eustachian valve

A flap of membranous, endocardial tissue


located at opening of the IVC & RA


*More stiff than Chiari

Describe Thebesian valve

Flap of endocardial tissue which guards the opening of the Coronary Sinus into the RA

Describe the Chiari Network

A freely mobile, lace-like membrane


Located in RA near orifice of coronary sinus

Describe Primary Tumors

75% are benign

Describe Secondary Tumors

More Common than primary tumors

MC benign tumor of adult pop

Myxoma

MC benign tumor found in children

Rhabdomyoma

MC location of Myxoma

LA

MC location of attachment of Myxoma

By a stalk to the IAS near the fossa ovalis

Auscultation of Myxoma

Tumor "plop"

M-mode findings of Myxoma

blunted E-point MV


Reduced E-F slope

MC tumor of cardiac valves & valve apparatus

Papilloma/papillary fibroelastoma

Describe Papilloma

small, pedunculated benign tumor

Describe Lipoma

Neoplasm of mature fat cells



MC location for Lipoma

IAS

Describe Lipoma appearance

"Dumbell" shaped IAS


Thickening of IAS w/ sparing of fossa ovalis

Fibroma MC arises from :

LV free wall or IVS

Describe Fibroma

Does not invade the pericardium


Isolated


Slow growing


Echogenic

Describe Rhabdomyoma

Multiple tumors


Assoc w/ tuberous sclerosis


Found in RV walls

Describe Hemangioma

Vascular tumors

MC primary malignant tumor of the heart

Angiosarcoma

MC location of Angiosacroma

RA

Describe Metastatic/ Secondary Tumors

MC than primary


Pericardial > myocardial

The Eustachian Valve in utero will direct bl into the ___

PFO

Chiari network will more likely be ___ as compared to the Eustachian valve

Mobile or free floating

The Eustachian valve & chiari network are found in the

RA

MC cardiac tumors are


a) Primary & benign


b) Primary & malignant


c) Secondary & malignant


d) Secondary & benign

c) secondary & malignant

Myxoma is an example of a ___ tumor

Primary & bengin

A myxoma will most often arise from the ___

Fossa Ovalis

The 2nd MC location of a myxoma to arise from is

Pulm V

If a myxoma mimics MS, the MC presenting S&S will be :

DOE

Akas for Mural Thrombi

Layered, Laminated, sessile

MC location for Thrombi

Apex

Aka for Mobile Thrombi

Pedunculated

Describe the 2 layers of Pericardium

Parietal- thick outer layer




Visceral/Serous/Epicardium- inner layer

Normal amount of Pericardial fluid

20 cc's

Define Acute Pericarditis

Inflammation of pericardium


Usually results in pericardial effusion

Complications of Acute Pericarditis

Constrictive pericarditis


Cardiac Tamponade


Dressler's Syndrome

Describe Dressler's Syndrome

Pericardial Effusion s/p MI


surfaces 1 week - 3 months later

MC S&S of Acute Pericarditis

Positional CP


worse when pt is supine or swallows

Auscultation of Acute Pericarditis

Pericardial friction rub


Distant muffled heart sounds

EKG findings of Acute Pericarditis

Low voltage QRS - loose electricity in fluid around heart

Describe best way to meas fluid in pericardial effusion

PLAX - in Systole

Pericardial Effusion Severity Scale


Norm:


Physiologic:


Mild:


Mod:


Sev:



Norm: 15-50cc (20)



Physiologic: Only seen in systole <50cc




Mild: Seen Post in Syst &Dyst, <1cm, <100cc




Mod: Ant & Post in Syst &Dyst, <1cm, 100-500cc




Sev: Ant & Post in Syst&Dyst, > 1cm, >500cc

References to help determine Pericardial vs Pleural effusion

Desc Ao in PLAX


Coronary sinus in A2C

Define Constrictive Pericarditis

A fibrotic thickened & adherent pericardium


-restricts diastolic filling of vents

MC Etiology of Constrictive Pericarditis in underdeveloped countries

TB

MC Etiology in US

Idiopathic

Auscultation of Constrictive Pericarditis

Diastolic "knock"

Cath Lab findings of Constrictive Pericarditis

"square root" sign


Early diastolic dip: rapid filling


Plateau: mid to late diastole where little vent vol expansion

2D findings of Constrictive Pericarditis

No fluid


"bound down" appearance of free walls


Negative sniff test

T/F: A pt with acute pericarditis will always present on echo with fluid accumulation

False

All of the following are referring to the serous pericardium EXCEPT:


A. Epicardium


B. Endocardium


C. Visceral


D. Inner Layer

B. Endocardium

All of the following etiologies for Pericardial Effusions, EXCEPT:


A. Pregnancy


B. Hypertension


C. Tuberculosis


D. Trauma


E. Aortic Dissection

B. HTN (Causes LVH!)

All of the following can be used to differentiate a pericardial from a pleural effusion, EXCEPT:


A. Descending aorta


B. Coronary Sinus


C. Parietal pericardium


D. Visceral pericardium

D. Visceral pericardium

Signs & symptoms of Acute Pericarditis include all of the following EXCEPT:


A. Chest pain


B. Fever & Chills


C. Dyspnea


D. Pericardial friction rub


E. Hepatomegaly and peripheral edema

E. Hepatomegaly and peripheral edema




**Chronic S&S!

A mild Pericardial Effusion would be estimated at _____ ml:


A. 20-50


B. <100


C. 300


D. >500

B. <100

A mild Pericardial Effusion will be seen as a :




A. Ant & Post anechoic area seen in syst & diast


B. Post anechoic area seen in syst, not diast


C. Post anechoic area seen in syst & diast

C. Post anechoic area seen in syst & diast

Heart sounds will be ___ in the presence of a large pericardial effusion.


A. Diminished


B. Intensified


C. Unchanged

A. Diminished

If a pt has constrictive pericarditis, the majority of ventricular filling will occur in:


A. Early diastole


B. Mid diastole


C. Late diastole




*The above will be noted on the ____ via the 'square root sign'

A. Early diastole



*Cardiac cath

Definition of cardiac tamponade

Accumulation of pericardial fluid, usually RAPIDLY, which leads to increased intra-pericardial pressure

Increased intra-pericardial pressure causes:

- Diastolic compression/collapse


- Impaired diastolic filling


- Incr resistance to venous return to heart


- Decreased cardiac output (no bl to pump)


- Decreased systemic BP


- Changes w/ respiration

Describe what changes with respiration occur with cardiac tamponade

- Transvalvular and venous flow velocities: IVRT


- Pulsus Paradoxus


- Ventricular cavity volume change

Common Etiologies of Caridac Tamponade

MC: Malignant metastatic disease




ideopathic or iatriogenic


metabolic


infectious


inflammatory


TB



Cardiac Tamponade S&S's

Positional CP


Beck's Triad !


dyspnea/ tachypnea


cough/ hoarseness


JVD/ hepatomegaly


peripheral cyanosis/ cold extremities


tachycardia

Describe Beck's Triad

Hypotension


Quiet heart sounds


Increased venous pressure

* Rule of Thumb with Cardiac Tamponade! *

Lt heart "decreases" with inspiration


Rt heart "increases" with inspiration




Lt heart "increases" with expiration


Rt heart "decreases" with expiration

Cardiac Tamponade S&S's (con'd) :



Name & describe




*Apply Rule of Thumb for Left heart

Pulsus Paradoxus - decrease of >10mmHg in syst BP w/ inspiration




Total Paradoxus - complete absence of pulse w/ inspiration




(Systemic BP = Left heart!)

Cardiac Tamponade S&S's (con'd) :



Name & describe




*Apply Rule of Thumb for Right heart

Kussmaul's Sign - paradoxical rise in venous press w/ JVD upon inspiration




*Suggests impaired filling of RV, incr blood backs up into venous system




(normally JVD would fall with insp. to allow RV to expand in diastole)



EKG findings of Cardiac Tamponade

Low Voltage: fluid absorbs electricity




Electrical alternans: variation in QRS beat to beat

Auscultation of Cardiac Tamponade

Diminished/ muffled heart sounds




Pericardial friction rub

CXR of Cardiac Tamponade

"Water bottle" shaped heart

2D Findings of Cardiac Tamponade

- Pericardial Effusion


- Swinging heart motion


- RV early diastolic collapse


- RA dimpling sign of pre-tamponade


- Dilated IVC & HV's (Failed SNIFF test)

M-mode Findings of Cardiac Tamponade

RV diastolic collapse - RVIDd = 7mm




RV/LV volume changes w/ resp


(Rule thumb- L decr w/ insp)




Decreased MV E-F slope w/ insp


(Rule thumb)

Treatment for Cardiac Tamponade

MC = Pericariocentesis - needle aspiration




Pericardial window


Pericardiectomy

*Respiration Review*




Inspiration

Inspiration: Rule of Thumb!




- Decreased intrathoracic pressure


- Decreased pulm vasc impedance (dump into LA)


- Decreased flow from lung into Lt heart


- Increased venous return to Rt heart

*Respiration Review*




Expiration

Expiration: Rule of Thumb!




- Increased intrathoracic pressure


- Increased flow from lung into Lt heart


- Decreased venous return to Rt heart

Doppler of Tamponade & CONSTRICTIVE PERICARDITIS!!

PW Doppler used




Sweep speed of 25 mm/sec


-respiratory variations in transvalvular flow!




*Rule of thumb


Lt heart: MV, AoV, Pulm Vs decrease w/ insp


Rt heart:TV, PV, Systemic Vs increase w/ insp

IVRT w/ Cardiac Tamponade & CONSTRICTIVE PERICARDITIS

IVRT




Prolonged w/ inspiration




Shortened w/ expiration

Constrictive Peri Card vs RCM




E/E' :


Ausc:


Velocity Variations:


Diastolic ____:

Constrictive Peri Card vs RCM




E/E': CPC norm, RCM stage 3 DD




Ausc: CPC pericardial knock


RCM S3 present in early diast




Velocity Variation only in CPC not RCM




CPC diastolic reversal in HV's!!


RCM diastolic MR/TR

All of the following may result from cardiac Tamponade EXCEPT:




A. Decreased cardiac output


B. Increased cardiac output


C. Impaired diastolic filling


D. Pulsus paradoxus

B. Increased cardiac output

The MC cause of cardiac tamponade is:


A. Metabolic


B. Infectious


C. Congenital


D. Malignant metastatic disease

D. Malignant metastatic disease

T/F: Acute pericarditis may cause cardiac tamponade

True

Iatrogenic means


A. No known cause


B. Created surgically or accidentally, but we know what caused it


C. Born in the atria

B. Created surgically or accidentally, but we know what caused it

Dysphagia means:


A. Difficulty swallowing


B. Difficulty eating


C. Leaning forward to breath easy


D. Hoaresness

A. Difficulty swallowing

'Alteration in QRS voltage from beat to beat' describes:


A. Pulsus Paradoxus


B. Kussmaul's sign


C. Beck's Triad


D. Electric alternans

D. Electric alternans

A patient with cardiac tamponade will most likely ___ the sniff test


A. Pass


B. Fail

B. Fail

The transvalvular velocity of the MV will ____ with inspiration when the pt has cardiac tamponade


A. Decrease


B. Increase


C. Remain constant

A. Decrease
The transvalvular velocity of the MV will ____ with inspiration when the pt has RCM

A. Decrease


B. Increase


C. Remain constant

C. Remain constant

Diastolic reversal seen in the hepatic Vs is indicative for:


A. RCM


B. Constrictive pericarditis/cardiac tamponade

B. Constrictive pericarditis/cardiac tamponade