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57 Cards in this Set

  • Front
  • Back

What are the leaflets of the tricuspid valve called?

- anterior 
- septal *(also called medial)* 
- posterior (you can see when angling medially and inferiorly

- anterior


- septal *(also called medial)*


- posterior (you can see when angling medially and inferiorly

What happens with tricuspid stenosis (TS)?

RAE (right atrium enlargement)


- volume overload


- pressure overload


- dilated IVC (>2.3cm)



NOTE: 3 chamber view for TV will have to be modified, over-rotated

What is RAP?

right atrial pressure

What is the doppler constant for MVA?

220/PHT

What is the doppler constant for the TVA?

190/PHT

What is the measurement for normal TVA?

7-9cm squared

What is the area measurement for severe TS?

<2cm squared

What type of murmur does TS have?

diastolic "rumble" with respiratory variations and an opening snap



creates a turbulent, mosaic, high velocity jet from the RA through the TV to the RV during DIASTOLE

What are the causes of TS?

- *MOST COMMON* rheumatic fever (RHDz) - most likely started in the MV


- congenital: ebstein's anomaly


- carcinoid heart disease


- prosthetic valve dysfunction




Is TS an isolated vavlular pathology?

NO, always evaluate other valves for abnormalities

What is tricuspid regurgitation (TR)?

back flow of blood from the RV into the RA during SYSTOLE

What happens with TR?

- right atrial enlargement (RAE): dilated TV annulus, IVC, hepatic veins


- right ventricular volume overload (RVVO)

What is the percentage of TVP being associated with MVP?

10-15%

What are the optimal views for TVP?

- PSLA/RV inflow tract


- AP4


- subcostal

What is the measurement for RVE?

> 3-4cm

What is the percentage of patients that have trace-mild TR?

93%

What is the normal RVSP/RVDP?

25/5

What is the normal PAP?

25/10



*RVSP=PAP*

What type of murmur does TR have?

- holosystolic and can increase with respiration


- creates a turbulent, mosaic SYSTOLIC flow in a backward direction from the RV into the RA

What are the causes of TR?

PHTN



Incomplete closure of the TV


- RV infarct


- papillary muscle dysfx


- ruptured TV chordae


- pacemaker wire


- tumor


What are the complications of TR?

RAE/RVE may lead to a-fib



dilatation peripheral veins


- IVC/hepatics


- SVC/neck veins


- portal HTN: liver enlargement, pedal edema

What do you see in doppler in a patient with TS?

- increased velocity


- CW doppler >1m/sec


- decreased E-F slope

What happens with RV pressure during PS?

RV pressure overload causes D shaped septum in diastole



*D shaped septum in diastole and systole is due to PHTN. RV overload rounds in systole.*

What is the normal measurement of the "a" wave dip?

2-3 mm

What is the measurement of the "a" wave during PS?

> or = 8mm

What is the normal PV velocity?

< 1.7 m/sec

What is pressure for mild PS?

5-30mmHg

What is the pressure for severe PS?

>64mmHg

What needs to be obtained for PS and PI during doppler?

substitute RVOT diameter and PV data in place of the LVOT and Aov data

What type of murmur occurs during PS?

- harsh systolic ejection murmur, "thrill"


- creates a turbulent, mosaic, high velocity flow during SYSTOLE from the RV, RVOT through the PV into the MPA

What are the causes of PS?

- MOST COMMON: congenital


- carcinoid heart dz


- RHDz: uncommon


- sinus valsalva aneurysm (AOV)

What is the difference between subvalvular and supravalvular stenosis?

- SUBvalvular stenosis is an obstruction in the RVOT (BELOW the valve)



- SUPRAvavlular stenosis is an obstruction in the PA (ABOVE the valve)

What are the complications of PS?

- DOE (dyspnea on exertion)


- jugular vein distention


- *RVH*


- R/O associated anomalies

What is the percentage of normal patients that have PI?

87%

What type of murmur does PI have?

- low-pitched diastolic murmur: may increase with inspiration



- Graham steele murmur: PHTN & PI, high-pitched blowing diastolic murmur

What part of the heart does infective endocarditis effect?

- affects the endothelial layer of the heart


- valves = MOST COMMON

What are the types of infective endocarditis?

- bacteremia = most common


- fungemia = less common


- vegetation (VEG)

What is the primary site of infective endocarditis (SBE - subacute bacterial endocarditis)?

flow side of the valve

Who is at high risk for infective endocarditis?

- prosthetic valves


- AOV Dz


- coarctation of the AO


- MR


- PDA's


- VSD's


- ** IV drug users **


- Marfan's syndrome

What are the signs and symptoms of infective endocarditis?

- FUO (fever of unknown origin)


- night sweats/joint pain (arthralgia)


- weight loss/anemia


- new murmur


- tachycardia

What are the complications of infective endocarditis?

embolization


- increased incidence with vegetations that are >5mm, mobile, and pedunculated (attached by a stalk)

What is the size of veg?

>2-3 mm visible by TTE

What are the two ways to measure a veg?

- using calipers


- planimetry


- use zoom

What does vegetative obstruction result in?

valvular stenosis



- perform appropriate calculations


- PHT & MVA for MV


- continuity equation for AOV

What is the measurement of the "a" wave for PHTN?

THERE IS NO "a" WAVE IN PHTN

What are the two types of prosthetic valves?

- bioprosthetic (tissue)


- mechanical

What are the three types of bioprothetic valves?

- auto-graft (self to self, PV used in AOV position)


- homograft (allograft) transfer from one human to another


- heterograft (xenograft) animal to human

Prosthetic valves are inherently ________.

Prosthetic valves are inherently stenotic

________ leaks are abnormal, small leaks are normal

Perivalvular leaks are abnormal, small leaks are normal.

Who are the candidates for mechanical valves?

- children/young adults, excluding women of child-bearing years


- for patients with renal failure, small valve annulus, high re-operative risk, and A-fib



(lasts up to 20 yrs without complications) but require lifelong anticoagulation therapy

Who are the candidates for bioprosthetic valves?

- elderly patients where long term durability is less important



(lasts up to 10-12 yrs, do not require anticoagulation)

Why do we replace native valves with prosthetic valves?

- stenosis


- SBE (bacterial infection)


- severe regurgitation


- aortic dissection with severe regurge


- valves rings to repair valves

* this will be a true or false question and the answer will be TRUE*


infective endocarditis secondary regurge is probable

What is carcinoid heart disease?

rare, but interesting and important cause of intrinsic tricuspid and pulmonary valve disease leading to significant morbidity and mortality caused by right heart failure

How do pathogens get introduced into the circulatory system?

- oral cavity e.g. dental procedures


- upper respiratory tract


- GI tract


- female reproductive tract


- skin

What are the examples of heterograft (xenograft) animal to human prosthetic valves?

- porcine (pig)


- bovine (cow)


- carpentier-edwards

What are the causes of MS?

- rheumatic fever (most common)


- mitral annular calcification


- congenital


- prosthetic valve dysfx


- LA mass, tumor, vegetation (SBE)