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Echo Spring Midterm > Midterm 2019 > Flashcards

Midterm 2019 Flashcards

1
Q

Most common cause of Mitral Stenosis?

A

Rheumatic Fever

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2
Q

Classic finding associated with MS?

A

Diastolic doming of the AMVL

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3
Q

The color flow Doppler jet of MS can be described as what?

A

Narrow “flame shaped” turbulent jet at the MV leaflet tips which extends into the LV in diastole

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4
Q

When evaluation MS what kind of Doppler should be used

A

Mean pressure gradient
by planimetry of
CW Doppler ASE level 1 recommendation

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5
Q

MC method for MVA

A

P1/2t

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6
Q

Equation for MV p1/2t

A

220/ P1/2t

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7
Q

The _____ the waveform the _____the MS

A

flatter, more severe

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8
Q

What maybe a result of long standing MS

A

Pulmonary HTN

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9
Q

When does MS occur (systole or diastole) and is it pressure or volume overload?

A

Diastole

Pressure

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10
Q

What cardiomyopathy is commonly associated with MR

A

Annulus dilatation - possibly caused by cardiomyopathy or CAD displace the papilary muscles and chordae tendineae

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11
Q

MR is a volume overload process that leads to enlargement of the LA. LA enlargement leads to what arrhythmia?

A

A. Fib

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12
Q

M-mode of the ao valve in the presence of MR can show what?

A

Ao valve notching (partial mid-systolic closure) due to sudden decrease in the amount of volume leaving the LV.

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13
Q

What is the most popular method used to evaluate MR?

A

Color Doppler

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14
Q

When evaluating MR with color what 3 areas used to determine the severity of the MR jet

A

jet width, depths and duration

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15
Q

When performing PISA to evaluate MR what views are used and what is your color baseline range?

A

Optimize the color Doppler image of MR (A4 and A3)

Shift the color Doppler baseline downward to an aliasing velocity between 20-40 cm/sec

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16
Q

What are common causes of acute MR

A

rupture of the chordae due to MVP,
acute ischemia
acute infarction
infective endocarditis

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17
Q

What are the two types of mitral valve prolapse?

A

Mid to late systolic

Holosystolic (pansystolic)

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18
Q

What is the difference between Ao stenosis and scleroisis

A

AO stenosis - thickened, does not open well, >2 m/sec

AO sclerosis - thickened, opens well, <2 m/s may or may not become stenotic in the future

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19
Q

3 types of AO stenosis

A

Degenerative AS (sclerosis of a previously normal valve)

Rheumatic AS

Congential AS

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20
Q

3 types of congenital stenosis

A

Subvalvular - congenital AS may be due to a congenital membrane across the LVOT

Supravalvular- congenital AS due to an aortic coarctation

Valvular - congenital AS may be due to a bicuspid AOV (1-2% of population)

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21
Q

What is a raphe?

When should the valve be evaluated?

A

underdeveloped ao cusp

systole

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22
Q

Ao stenosis is pressure or volume overload and what happens to the LV?

A

Pressure

LV function is preserved by development of concentric LVH

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23
Q

Pts with AS have routine echo to evaluate what 5 areas

A 
AS
LVH
Systolic function
Diastolic function 
Chamber size
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24
Q

On M- mode a bicuspid ao valve will show what?

A

eccentric closure line. located off center due to difference in size of two cusps

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25
Q

What happens to the AO in the presence of aortic stenosis?

A

Post stenotic dilatation of AO root and or ascending ao due to high velocity jet striking the ao root wall

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26
Q

What 3 measurements are needed to perform the continuity equation of the AVA

A 
LVOT diameter
LVOT velocity (VTI)
AOV velocity (VTI)
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27
Q

What are 3 causes of acute AI

A

infective endocarditis

dissection of ascending ao

trauma cause loss of commissural support

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28
Q

Severe AI causes what kind of murmur?

A

Austin Flint

low-pitched
mid-diastolic
“rumble” at apex

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29
Q

AI is a pressue or volume overload? What happens to the LV?

A

volume

overtime will lead to LV dilatation

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30
Q

What two measurements can be taken from PLAX to help evaluate the AI

A

The AI jet width/LVOT width ratio - helps determine severity

Vena contracta

31
Q

Most common measurements used to evaluate AI

A

P 1/2 t

peak velocity

32
Q

Most common cause of TS

A

Rheumatic heart disease (90%)

Ts rarely occurs alone

33
Q

What views can be used to evaluate TV

A

LAX, SAX, A4, A3 with angulation, and subcostal

34
Q

What is used to obtain the TVA

A

P 1/2t is obtained by measureing the decel slope from “E” to “F” on the peak TS waveform

35
Q

What is the equation for P 1/2t for TV

A

190/ Pressure half time

36
Q

What percentage of people have trace to mild TR?

A

93%

37
Q

In pts with carcinoid heart disease the TV becomes what?

A

The TV leaflets are thick and rigid with no change in position from diastole and systole

38
Q

In pts with long standing TR the LV with take what shape due to RV vol overload

A

D-shaped LV during ventricular diastole indicating RV diastolic volume oveload

39
Q

Formula for RVSP

A

RVSP/PAP = 4(TR Peak Velocity) squared +RA pressure

40
Q

Most common etiology for TR

A

Pulm HTN due to LT heart pathology

41
Q

Why is the TR jet commonly baffled toward the IAS

A

the anterior leaflet is the longest

42
Q

What is TVP commonly associated with

A

MVP (19-50%) isolated TVP is rare

43
Q

What are the two best views for TVP

A 
A4 (anterior and septal leaflets)
parasternal RVIT (anterior and posterior leaflets)
44
Q

MC etiology for pulmonic stenosis

A

congenital PS is most common cause

45
Q

What is the primary method for evaluating pulmonic stenosis

A

via Peak pressure gradient.

Peak tracing provides max pressure gradient, mean pressure gradient and peak velocity

46
Q

Regurg of what valve causes a fine diastolic flutter of the TV?

A

PI

47
Q

what percentage of pts will have PI

A

up to 87%

48
Q

Define dehiscence

A

dehiscence occurs if the sutures in the sewing ring loosen or break and the prosthesis is no longer stable. This causes the valve to rock and may lead to a perivalvular leak

49
Q

Pannus

A

fibrous ingrowth of tissue

50
Q

All mechanical valves have

A

sewing ring, moving component and a cage, strut or frame.

51
Q

MC brand name for a ball and cage mech valve

A

Starr-Edwards

52
Q

MC brand name for tilting disc?

Which is discontinued?

A

Metronic- Hall- MC

Bjork-Shiley (discontinued)

53
Q

MC bileaflet tilting disc brand name

A

St. Jude valve

54
Q

Most common abnormality leading to malfunction of mech valves

A

thrombus. They result from particles that become trapped and proliferate on the stents or discs. This may totally obstruct the valve leaflets creating stenosis

55
Q

Prosthetic endocarditis is typically a result in what abnormality

A

ring abscess which can lead to dehiscence, perivalvular leaks and or stenosis.

56
Q

Which imaging modality is helpful when evaluating a mitral mechanical valve

A

TEE

57
Q

Which valve is prone to sudden failure

A

Bovine pericardial valve due to a tear in one of the leaflets

58
Q

Which type of valve has larger regurg volume

A

mech valves

59
Q

What are the two categories of heart failure

A

reduced LV ejection fraction

Perserved LV ejection fraction. Normal EF is 55% or higher

60
Q

Typically LT heart failure is a result of what?

What does it result in?

A

damage to LV myocaridum

results in pulm congestion and increased pulm pressure

61
Q

Typically Rt heart failure is a result of what?

what does it result in?

A

follows LT HF due to increase pulm pressure

Results in systemic congestion

62
Q

4 main causes of heart failure

A

Decreased myocardial contractility
Increased myocardial workload
Filling disorders
Dysrhythmias

63
Q

4 main areas to evaluate HF on echo

A

Decrease Lt and Rt vent function
Increased Lt and Rt vent size
Grade and diastolic function
Determine the underlying cause.

64
Q

3 causes for ischemic heart dz

A

Atherosclerosis- changes in intimal lining of arts. Begins as fatty streak, builds fibrous plaque, becomes complicated lesion that can completely block off an artery

Coronary artery spasm - causes temp obstruction to cor art bf - cocaine

Coronary artery thrombosis- typically the result of sudden formation of clot or piece of plaque that breaks off and blocks a cor art.

65
Q

2 causes of MI

A

Ischemic MR - due to LV dilatation, arrythmias, or papillary muscle ischemia/ infarct/ rupture

Ischemic VSD - results when an area of the IVS becomes weakened and ruptures. Not as common as ischemic MR

66
Q

Gold standard for determining the presence and severity of CAD

A

Cardiac Cath - presence location and severity of CAD

67
Q

Pericardial Effusion is a common acute react to MI how soon after

A

Common acute - 2-4 days

Response to acute MI 30-40%

68
Q

Where is the most common location for a true aneurysm?

A

Apex (85-95%)

69
Q

What is used to determine true vs pseudoaneurysm?

A

The neck diameter/ true diameter ratio (<0.5 suggest pseudo)

Neck will be narrow vs true aneurysm

70
Q

Where are LV thrombus commonly located?

A

Apex

diagnosis based on echodense mass, visible in at least 2 views & distinguishable from other cardiac structures & artifacts

71
Q

Papillary muscle dysfunction is associated with what wall MI

A

inferior MI and results in MR

72
Q

RV infarc are rare occur with what wall MI

A

Isolated RV infarction is rare (3-5%)

Inferior wall MI

73
Q

The opposing wall to an infarcted wall becomes how in motion

A

hyperkinetic

74
Q

What are the two branches off the left main coronary?

A

LAD - supplies- anterior, septum and apical wall of LV

Lt CX - posterior and lateral wall of LV

Echo Spring Midterm (1 decks)

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