EchoBoards Flashcards
(42 cards)
What are the pitfalls of using pressure half time in rheumatic mitral stenosis?
- Marked tachycardia
- Aortic regurgitation
- High LA pressure
- Post valvuloplasty (acute change to LA compliance)
- AV block/arrhythmias
- Do not use in calcific mitral stenosis
These factors can lead to inaccurate assessments of mitral stenosis severity.
When is stress echocardiography recommended for patients with degenerative mitral stenosis?
Class 1 recommendation if discrepancy between echo findings and symptoms (for example, an asymptomatic patient)
This recommendation is based on the need to assess functional significance in the presence of conflicting clinical information.
What are the criteria for severe mitral stenosis during stress echocardiography?
- Mean gradient >15mmHg with exercise
- Mean gradient >18mmHg with dobutamine
- RVSP >60mmHg with exercise (not dobutamine)
These thresholds help determine the severity of mitral stenosis under stress conditions.
What is the optimal heart rate for assessing mitral valve stenosis?
60-80 bpm
This range is preferred as it allows for better visualization of diastolic flow and accurate measurement of gradients.
Why is a slower heart rate beneficial in assessing mitral stenosis?
It prolongs diastole, allowing better visualization of the mitral inflow gradient and pressure half-time
Diastolic filling time is primarily affected by mitral stenosis, making this aspect critical for assessment.
What happens to the mean gradient at higher heart rates?
It can artificially increase, leading to overestimation of severity
Conditions such as tachycardia or atrial fibrillation with rapid ventricular response can exacerbate this issue.
What are the characteristics of rheumatic mitral stenosis?
- Affects leaflet tips
- Causes commissural fusion
- Affects chordae tendineae
- Mobility is affected at the leaflet tips
These features are significant in understanding the pathology of rheumatic mitral stenosis.
What are the characteristics of calcific mitral stenosis?
- Affects leaflet base
- Affects annulus
- No commissural fusion
- Mobility affects base, the tips are mobile
These characteristics distinguish calcific mitral stenosis from rheumatic mitral stenosis.
What are the stages of mitral stenosis?
A (at risk), B (progressive), C (asymptomatic severe), and D (symptomatic severe).
What is the Carpentier classification for mitral regurgitation?
A classification system that categorizes mitral regurgitation into three types based on leaflet motion.
What characterizes Type 1 in the Carpentier classification?
Normal leaflet motion
Potentially repairable; Examples: Leaflet perforation (Primary MR), Atrial MR or non ischemic cardiomyopathy (Secondary MR)
What characterizes Type 2 in the Carpentier classification?
Increased leaflet mobility
Highly repairable; Example: Mitral valve prolapse
What characterizes Type 3 in the Carpentier classification?
Decreased leaflet mobility
What distinguishes Type 3A from Type 3B in the Carpentier classification?
3A affects both systolic AND diastolic; 3B affects systolic only
What is the treatment approach for Type 3A mitral regurgitation? Also, what are examples of Type 3A?
Not repairable, requires replacement
Examples: Rheumatic mitral valve, Mitral annular calcification, Drug induced MR
What is the treatment approach for Type 3B mitral regurgitation? Also, what is an example of Type 3B?
Medical therapy first, repair/replacement is second line
Example: Ischemic cardiomyopathy
What are the indications for mitral valve surgery in patients with mitral regurgitation?
Symptoms
Asymptomatic
* LVEF <60%
* LVESD > 40mm
* New AF
* PASP >50mmHg
LVEF: Left Ventricular Ejection Fraction; LVESD: Left Ventricular End-Systolic Diameter; AF: Atrial Fibrillation; PASP: Pulmonary Artery Systolic Pressure.
What are the characteristics of chronic severe mitral regurgitation?
- Dilated ventricle
- LV enlargement
- LA enlargement
LV: Left Ventricle; LA: Left Atrium.
What are the 2D findings associated with mitral regurgitation?
- Flail leaflet
- Left ventricular enlargement
- Left atrial enlargement
Normal LV size is a specific finding for non-severe MR.
What does a vena contracta measurement greater than 0.7 indicate?
Severe mitral regurgitation
Vena contracta is a method used to assess the severity of MR.
What is a specific sign for mitral regurgitation observed in PV Doppler?
Systolic reversals
Systolic reversals in pulmonary venous flow indicate significant backward flow due to MR.
As mitral regurgitation increases, what happens to the V wave and E wave in mitral diastolic inflow?
Bigger V wave and increase in E wave
E wave > 1.2m/s suggests severe MR or restrictive filling.
