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139 Cards in this Set
- Front
- Back
what is the max diameter of the asc AO?
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4cm
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What is the most common AO valve etiology under 70years, and over 70 years/
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under 70=Bicuspid AoV
>70=degenerative |
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What cusps are Raphe's between?
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Rt & Lt coronary cusps
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look at presure curves in notes/
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and understand them
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What is the pressure like with mild chronic AI compared to acute AI?
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Chronic=long PHT
Acute=short PHT |
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What is the best view to analyze the vena contracta? What is the size of the vena contracta with mild, mod and severe AS or regurg?
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PSLA=best place
Mild=<3mm Mod<3-6mm Severe=>6mm these numbers can be used for both stenosis and regurge . |
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What would cause post stenotic dialation?
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-cystc medial nechrosis
-jet hitting the wall |
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What is the best score for WMSI? what would the index have to be for a perfusion defect to be considered?
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best=1
>20% perfusion defect=>1.7 |
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What changes occur on ECG with infarct, injury, and ishemia?
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infarct-prominent Q wave
Injury=elevated ST Ishemia=inverted t-wave |
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what happens to the ECG on the opposite side of the heart to an infarct?
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opposite of what happens with ishemia
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name and explain the classifications of MI?
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subendocardial-only inner layer of myocardium
subepicardial-both inner, and middle layer transdural-through all the layers of the myocardium |
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what are the complications of MI?
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-pap muscle dysfucntion resulting in MR
-chordae or pap muscle rupture resulting in flail MV & severe MR -Thrombus -WM abnormalities -PE(dressler's syndrome) -VSD-more common in hypertensive females -rupture of free wall w/ acute pericardial effusion |
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Look in notes at pressure curves for diastolic dysfunction and compare them?
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do it
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What happens to LA pressure with pseudonormalization?
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mean LA pressure is increased
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What type of distolic dysfunction would most likely be happening when LVH is seen? What about if a dialated LA is seen?
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LVH-probably impared relaxation
Dialated LA-resitrictive |
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What phase of diastolic dysfunction would you see a b-bump on m-mode?
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restrictive due to increased LVEDP
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HOw do you tell when there is diastolic dysfunction with color m-mode?
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look at the slope of the color.
normal=steep/no slope abnormal=more horizontal angle |
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what will the spectral waveform of severe acute MR look like?
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v-wave
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what are the components of the bernouli equation?
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convection acceleration
flow acceleration viscous friction |
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what are the diseases associated w/ MAC?
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high BP(common)
renal disease AO stenosis hypertrophic cardiomyopathy |
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What does the 3rd heart sound represent? What is it associated with?
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ventricular gallop associated with :
-high cardiac output-anemia or hyperthyroidism -increased LV filling during early diastole(MR) -CHF |
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what does the 4th heart sound represent?
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atrial gallop
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What ejection fraction is considered good conditions for clot formation?
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<35%
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What is pulmonic stenosis in adults usually the result of?
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congenital disease
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when a wall motion abnormality lasts 24-72 hours, but has not had irreversible damage, it is referred to as what/
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stunned tissue
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What is the most common cause of Mitral stenosis?
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rhumatic fever
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What are the categories of pericardidtis?
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-infectious
-inflammatory -intracardiac-pericardial communications |
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T/F PVC's may cause the aortic valve opening to be increased in amplitude?
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false
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T/F patients w/ bicuspid valves always have abnormal Eccentricity indices?
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false
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T/F siphilis is a common cause of AO root dialation in the united states?
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false
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Up to 10% of all cardiac disease is a result of endomyocardial fibrosis in which country?
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africa
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immobility of the AO root is due to what?
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reduced LA emptying and filling
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When tissue is abnormal at rest but functional with reprofusion through exercise or medication, what kind of tissue is it refered to?
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hibernation tissue
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the term "second obstruction" of mitral stenosis refers to what/
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-pulmonary hypertension
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What is one of the most well known cardiac complications in patients with lupus erythatosis?
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Libman-Sack's endocarditis(smal; vegges)
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What are some mediastinal substances which may cause cardiac tamponade?
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Compression mass
air due to barotraumas |
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When there is a flail MV, what may happen to the LV function?
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It may become hyperkinetic
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What does the gret cardiac vein anastamose with?
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oblique vein of marshal
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An aneurysm of the IAS is considered when the septal bulging is greater than how many cm's?
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>1,5cm
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Symptoms of which cardiomyopathy may only be experienced during exercise?
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hypertrophic cardiomyopathy
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A MV prolapse may be augmented by having the pt. do what/
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valsalva maneuver
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What gender do unicuspid AO vavles more commonly occur?
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males
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What is the most common cause of AO dissection?
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chronic hypertension
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T/F ebsteins is not a possible cause of Tricuspid stenosis?
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true
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T/F when mitral and aortic stenossi are present together, the trans aortic pressure gradient may be increased due to increased volume?
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false
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The part of the heart most often affected in patients with scleroderma is what?
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myocardium
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What are osler nodes?
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lesions seen in patients with acute bacterial endocaridits which are small, raised, red and tender areas on the finger and toe pads.
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T/F amyl nitrate may be used to enhance the obstruction in a hypertrophic obstroctive cardiomyopathy?
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true, you can also do the valsalva
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What is the most common cause of a bioprosthetic valve dysfunction?
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tissue degeneration
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What is the most common cause of adult aortic stenosis?
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calcified aortic stenosis
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HOw does aortic stenosis affect the atrial pressure curve?
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a-wave is elevated w/ aortic stenosis
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HOw does MR affect the atrial pressure cuve?
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v-wave becomes more prominent because the v-wave represents the systolic filling, and there is more systolic filling with MR
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There is a small dicrotic notch in the AO pressure curve. What does this represent?
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closure of the aortic valve
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cor pulmonale
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lung disease
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What will m-mode of the PV look like with PHTN?
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absent a-dip
mid-systolic notching |
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What is the difference in the flattening of the septum with RVVO compared to RVPO?
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with RVVO, septal flattening occurs only in diastole wheras flatteing with RVPO occurs throughout the cycle
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What is the systolic, diastolic, and mean pressure associated with PHTN?
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systolic>35mmHg
diastolic>25mmHg mean>25mmHg |
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How does the MV inflow help you with PHTN?
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Helps you differentiate btw PHTN caused by cor pulmonale(lung disease), or increased Lt sided pressures.
-if the mitral inflow shows a restrictive pattern, this probably indicates elevated LV pressures causeing PHTN -if the mitral inflow is normal to impared relaxation, this indicates PHTN caused by lung problems |
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Where is the transverse sinus located?
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-pericardial fold behind great vessels
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HOw is the tissue doppler different btw restrictive cardiomyopathy, and constrictuve pericardidis?
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restrictive cardiomyopathy=lower amplitude tissue doppler
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Why would there be mid-systolic notching of the aortic valve with IHSS?
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because half way through systole the AMVL is sucked up(ventrui effect), and obstructs the aortic ouflow breifly. This is what causes the notch
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What type of diastolic function would likely be present w/ hypertrophic cardiomyopathy?
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impared relaxation due to
LVH |
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There is a small dicrotic notch in the AO pressure curve. What does this represent?
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closure of the aortic valve
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cor pulmonale
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lung disease
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What will m-mode of the PV look like with PHTN?
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absent a-dip
mid-systolic notching |
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What is the difference in the flattening of the septum with RVVO compared to RVPO?
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with RVVO, septal flattening occurs only in diastole wheras flatteing with RVPO occurs throughout the cycle
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What is the systolic, diastolic, and mean pressure associated with PHTN?
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systolic>35mmHg
diastolic>25mmHg mean>25mmHg |
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How does the MV inflow help you with PHTN?
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Helps you differentiate btw PHTN caused by cor pulmonale(lung disease), or increased Lt sided pressures.
-if the mitral inflow shows a restrictive pattern, this probably indicates elevated LV pressures causeing PHTN -if the mitral inflow is normal to impared relaxation, this indicates PHTN caused by lung problems |
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Where is the transverse sinus located?
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-pericardial fold behind great vessels
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HOw is the tissue doppler different btw restrictive cardiomyopathy, and constrictuve pericardidis?
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restrictive cardiomyopathy=lower amplitude tissue doppler
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Why would there be mid-systolic notching of the aortic valve with IHSS?
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because half way through systole the AMVL is sucked up(ventrui effect), and obstructs the aortic ouflow breifly. This is what causes the notch
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What type of diastolic function would likely be present w/ hypertrophic cardiomyopathy?
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impared relaxation due to concentric LVH
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HOw is the regurgitant jet directed with an anterior flail MV leaflet vs. a posterior flail MV leaflet.
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with an anterior flail leaflet, reguge jet is directed posteriorly and visa versa
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When can you not use the pisa parameter?
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when there is an accentric jet(ie. flail MV)
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what is the area where the coronary sulcus meets the interventricular septum?
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coronary sinus
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with which type of transducer is there increased side love intensity?
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phased array
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What is another name for MVP? (syndrome)
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barlow's syndrome
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At what rate does m-mode sample?
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1800frames per second
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Supraventricular aortic stenosis is asssociated with what syndrome?
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william's syndrome
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what valve is most often affected by papillary fibroelastomas?
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mitral valve
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Which type of mitral deformity occurs where there is only one papillary muscle into which both cordae inser?
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parachute mitral valve
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What are the two ways in which muscular dystrophy cause heart failure?
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muscle weakness
thoracic deformity |
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IVC plethora
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<50% reduction in diameter of the IVC wth inspiration
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what type of endocarditis is non-bacterial and results in an accumulation of debris in the endocarduium?
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atypical verrucous
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What auscultory finding may be heard with constrictive pericarditis?
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pericardial knock
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What should the mean pressure gradient be to consider MV stenosis?
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>10mmHg
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Which type of hypertrophic cardiomyopathy involves only the anterior interventricular septum?
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type 1
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When a tricuspid repair is done in conjuction with a mitral valve replacement, what kind of annuloplasty may it be?
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Devega
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Where is the eustachian valve?
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in the IVC
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What is the water balloon appearance associated with?
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marfan's syndrome
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What is the most common form of cyanotic heart disease?
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TOF
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Which of the following is not a common occurance with a parachute MV:
-subaortic stenosis -pulmonic stenosis -suprvalvular ring of the left atrium -coarctation of the aorta |
pulmonic stenosis
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What type of infarct may cause a dialation of the mitral valve annulus with subsequent MR?
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anterior wall MI
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How do PVC's affect the M-mode tracing of the MV?
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loss of the a-wave
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tortus aorticus is found where
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right atrium
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what should the aortic peak pressure gradient be for a severe stenosis be considered?
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>70mmHg
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what tumor occurs on the AV node?
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mesotheliomas
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T/F decreased LV systolic function is a common finding in chronic hypertensio?
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false
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A small fibroelastic protrusion seen on the aortic valve in older patients may represent what
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lamble's excressence
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T/F patients with mitral snetosis may have a momentary anterior displacement of the IVS during diastole?
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true
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HOw might the mitral inflow waveform be affected if the patient has tachycardia?
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have a single e/a velocity
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What is the rudimentry valve which guards the coronary sinus?
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thesbian valve
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HOw does LV systolic function affect the pre-ejection period?
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the pre-ejection period would be longer with LV systolic function
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where do most metastatic tumors of the heart come from?
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lung and breast
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T/F you will probably have normal distaolic function with restrictive cardiomyopathy?
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false-usually impared relaxation
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What are the support structures at the end of the aortic valve cusp called?
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arantius nodules
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What does VTI calculate?
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mean pressure gradient
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which type of ASD may be associated with abnormal drainage of the right pulmonary vein?
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sinus venosus
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where does the moderator band extend?
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from the lower interventricular septum to the anterior wall where it joins the papillary muscle.
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spontaneous cordal rupture more often occurs on which leaflet of the MV?
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posterior
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what is the largest TV leaflet?
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anterior
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what is another name for the RVOT?
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infundibulum
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what will the a-wave be on a person with sever pulmonic stenosis
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>7mm
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T/F LA enlargement is not a possible finding with constrictive pericarditis?
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false
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which valve is least commonly affected by endocarditis
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pulmonary valve
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when mitral valve leaflets are flail, which chamber do they point towards?
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LA
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carvallo's sign
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An auscultory finding in tricuspid stenosis of an increased intensity of the diastolic murmur
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When would you hear an austin flint murmer?
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heard along the left sternal border
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Frand starlings law
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the increase degree of streatch=hyperdynamic ventrical (ie. the more recoil)
-associated with severe AI |
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When you see a b-bump on the mitral valve, what does the probably mean the LT atrium is starting to look like?
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starting to dialate because of increased LVEDP translating to the atria
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With severe AI, how can this sometimes affect fow in the desc. aorta?
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You can sometimes have reversed diastolic flow in the desc. ao.
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w/ AI, are the more concerned with the width or length of the regurgitant jet?
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length
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What is the formula for regurge fraction? explain it
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SV(av)-SV(mv)/SV(av)
Done if there is a normal MV and regitant AoV to quantify the severity of the regurge. You can do the same with the MV if the MV has regurge, and the AO doesn't. |
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What is normal PV a duration and A-velociey?
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A-duration=<30 normally
A velocity=<150ms normally |
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HOw does an m-mode tracing of the aortic valve change with Dialated cardiomyopathy, or low CO?
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"sloping aorta" due to low cardiac output, and the valve starts to close early
-don't have the nice box appearance |
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HOw does the MV inflow change with dialated cardiomyopathy?
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decreased MV inflow due to increased LV pressure with dialated cardiomyopathy.
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HOw can dialated cardiomyopathy give a false impression of stenosis? What should be done in this situiation?
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May underestimate the severity of stenosis.
-This is because the heart is dialated thus separating the valves decreasing the severity of the stenosis. -there is also lower cardiac output, so blood my give a normal velocity through what would normally be a stenotic valve. -This patient should get a stres echo done to ring out the true AO v area. |
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Arrythmogenic RV cardiomypoathy
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fatty infiltrative disease
-typical features=young male w/ right sided heart disease. |
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What should you automatically think of when a patient has a hx of rhumatic fever?
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Ms or Aos
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Why is there no E-A peak on an m-ode of Mitral stenosis
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because leaflets move together
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What MVA is considered severe stenosis?
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<2
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Which chambers are ort affected w/ MS?
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LV because blood is backing up into right side
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Formula for PHT
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DT x 0.29
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Whta would caus underestimation of MV stenosis?
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AI becuase pressures in the ventrical are equalizing faster, so the PHT wouldn't be as long as it normally would
-An ASD can also cause the same affect |
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What conditions can mimic Mitral stenosis?
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vegetation
LA myxoma |
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What is the most common form of congenital MV stenosis?
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parachute MV
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What should you think if a mid-systolic click is heard?
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MV prolapse
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What is normal LAA velocity
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46cm/s
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what is the best window to assess MVP?
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PSLA
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