Intro to Valvular Pathology

Question 1

4 pathologies causing valvular disease

Answer 1

calcific
rheumatic
congenital
acquired

Question 2

what is calcification commonly seen in

Answer 2

elderly patients

Question 3

what is the amount of elderly patients seen with calcification

Answer 3

1 in 4

Question 4

what part of the valve does calcification affect

Answer 4

affects the underside or the annulus of the valve (not tips)

Question 5

what valves are most common to calcify

Answer 5

AV MV

Question 6

2 things calcification may cause

Answer 6

stenosis
regurgitation

Question 7

M-mode can be difficult to see the cusps with significant calcific AS T/F

Answer 7

T

Question 8

AV sclerosis (calcific changes to valve) appearance

Answer 8

cusps = thin/pliable
underside of AV = calcified

Question 9

MAC starts at _____ and progresses _____

Answer 9

annulus (usually posterior)
inward on to leaflets

Question 10

MAC is associated with (2)

Answer 10

systemic HTN
diabetes

Question 11

is MAC likely to get stenosis

Answer 11

less likely as ant cusps is normally good and valve is big to begin with

Question 12

which type of artifact with calcification cause

Answer 12

post shadowing

Question 13

rheumatic valve disease is caused by

Answer 13

scarring from rheumatic fever

Question 14

Rheumatic fever is an inflammatory condition such as (2)

Answer 14

strep throat
scarlet fever

Question 15

acute rheumatic heart disease involves

Answer 15

endocardial vasculitis (swelling leads to valve damage)

Question 16

what happens to cusp tissue with rheumatic disease

Answer 16

cusp tissue is infiltrated with fibrous tissue causing them to shorten and retract (cusps can no longer come together to coapt)

Question 17

rheumatic heart disease is most common to least common valves (percentage)

Answer 17

MV 75-85%
AV 20-25%
PV/TV 5%

Question 18

AV rheumatic heart disease usually coincides with ______ and usualyl associated with ____

Answer 18

MV stenosis + regurg
some degree of AS

Question 19

rheumatic heart disease is seen as chronic disease in the older population of ____ but may be chronic or acute ____

Answer 19

North america/europe
from other countries

Question 20

Rheumatic MV disease starts at

Answer 20

leaflet tips

Question 21

with rheumatic MV disease commisure become _____, ______, and ______. ____ or ____ of chordae tendinae

Answer 21

thickened
fibrosed
fused
matting
shortening

Question 22

T/F Rheumatic TV disease usually happens in isolation

Answer 22

F MV almost always involved

Question 23

Rheumatic TV disease causes ____ of the TV leaflets seen in 2D

Answer 23

diastolic doming

Question 24

Most TV/PV disease is _____

Answer 24

congenital

Question 25

is it common to find a congenital valve disease on a routine adult echo

Answer 25

no as they usually have already been found

Question 26

Ebstein's Anomaly

Answer 26

Abnormal apical displacement of the TV

Question 27

acquired valve disease can be caused by (2)

Answer 27

annular dilatation Carcinoid heart disease

Question 28

annular dilatation

Answer 28

valve cannot close due to annular stretch from chamber dilatation

Question 29

carcinoid heart disease

Answer 29

rare malignant tumor causing RT heart valve damage only valves = thickened, retracted, and fixed (TR/TS)

Question 30

_____ valvular disease = volume overload = dilatation

Answer 30

preload

Question 31

____ valvular disease = pressure overload = hypertrophy

Answer 31

afterload

Question 32

4 acute causes

Answer 32

viral myocarditis MI embolism trauma

Question 33

can acute ever cause hypertrophy

Answer 33

no as it takes time to build muscle

Question 34

4 chronic causes

Answer 34

ischemia, HTN, calcific disease, regurg

Question 35

how does chronic changes cause remodelling (regurg/stenosis)

Answer 35

AV regurg = dilate AV stenosis = thickening

Question 36

eccentric hypertrophy

Answer 36

dilation with little change in LV thickness

Question 37

organic regurg aka

Answer 37

primary

Question 38

organic regurg is what

Answer 38

regurgitation due to abnormality of the cusps (structural abnormality of the valve)

Question 39

3 examples or organic regurg

Answer 39

valvular prolapse calific disease masses on the valve

Question 40

functional regurg aka

Answer 40

secondary

Question 41

functional regurg is what

Answer 41

regurg due to annular dilation, which leads to poor cusp coaptation in an otherwise normal valve

Question 42

2 examples of functional regurg

Answer 42

HTN (AV) MI (poor LV function leads to LV dilatation)

Question 43

one or both valve leaflets bow behind the valve annulus causing the valve to leak

Answer 43

valvular prolapse

Question 44

if only one leaflet prolapses, regurg will be ____ rather than ___

Answer 44

eccentric concentric

Question 45

valvular disease if often leaked to ____

Answer 45

connective tissue disorders

Question 46

valvular prolapse is most common on

Answer 46

MV

Question 47

T/F proplase can occur to any valve

Answer 47

T