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DMST 283 ECHO 2 > Mitral Regurtitation > Flashcards

Mitral Regurtitation Flashcards

1
Q

Which is false regarding the pathophysiology of AI?

  1. Chronic AI may have normal LV pressures
  2. Chronic AI may lead to angina
  3. Acute severe AI may have normal LV pressures
  4. AI may be caused by dilated AV annulus, leading to reduced coapt action.
A

Acute severe AI may have normal LV pressures

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2
Q

Why might AI cause early MV closure?

A

The pressures in the LV increase very quickly, and the LV pressure overcomes the LA pressure earlier

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3
Q

Grade the AI using the eyeball method

A

Mild

The Jet height looks to be about 1/3.

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4
Q

Which of the following is true regarding infective endocarditis?

  1. Common cause of acute severe AI
  2. Appears first as a bright, thickened LV lining (endocardium)
  3. Appears as a fixed mass on the LV side of the AV
  4. Causes AI by making the AV cusps fibrotic and rigid
A

Common cause of acute severe AI

IE is an inflammation/infection of the endocardium and valves. It presents on echo as mobile mass. The main mechanism for injury here is that the infection destroys the cusps. The vegetation itself may also prolapse through the valve to cause AI

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5
Q

Leaflets need to be perfectly aligned in order to do what?

A

Stop any regurgitation

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6
Q

What are reasons that would cause the mitral leaflets to not allow good coaptation?

A
  1. Malformation
  2. Torn
  3. Degenerated
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7
Q

What kind of pressures would cause some degree of mitral leaflet abnormalities?

A

> 100 mmHg PG between the LV and LA

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8
Q

What might cause some chordae tendonae abnormalities?

A

Chords may be elongated, maldeveloped or ruptured

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9
Q

What are some examples of chordae tendonae abnormalities?

A
  1. Inflammation
  2. Calcification
  3. Endocarditis
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10
Q

What are some MR ethologies?

A
  1. MVP
  2. Cleft MV
  3. Chordal rupture
  4. Flail MV
  5. MAC
  6. LV dilation
  7. Massess
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11
Q

Mitral valve prolapse is a systolic bowing of what?

A

The belly of the MV leaflets in systole into the LA >2mm

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12
Q

Label these 2D features of the MVP From left to right

A
  1. Closing
  2. Closed
  3. Prolapsed
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13
Q

What are some genetic association for Mitral valve prolapse?

A

Genetic association such as
1. Marian or Euler-danlos sydrome
2. Connective tissue disorders

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14
Q

Mitral valve prolapse are prone to what signs and symptoms?

A
  1. Chordal rupture
  2. Bacterial endocarditis
  3. Arrhythmias
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15
Q

What is the prevalence of the MVP? (How many people have it)

A

2-5% of general population

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16
Q

What is the demographic of individual that will get mitral valve prolapse ?

A
  1. Tall, slender build
  2. Pet us excavatum
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17
Q

What is Pectus excavatum?

A

Congenital deformity of the chest that causes several ribs and the sternum to grow inwardly

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18
Q

What does individual with Pectus Excavatum have?

A
  1. Difficult echoes
  2. Association with Marfan syndrome
  3. Varying degrees of deformity
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19
Q

What is MV prolapse?

A
  1. Type of myxomatosis valve disease (thickening)
  2. Leaflet(s) displaced into the LA during systole
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20
Q

Between men and women who is more affected by MV prolapse?

A

3:1 for females

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21
Q

What are some clinical features of MV prolapse? (What do we see?)

A
  1. Ranges in severity
  2. Mid-late systolic murmur
  3. Systolic “click” murmur
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22
Q

Which window should we use to measure MVP?

A

PLAX zoom, A4C gives false +

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23
Q

How do we measure MVP?

A
  1. Annulus to annulus
  2. Distance from the line to back of leaflet

always measure in PLAX zoom

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24
Q

What do these two images demonstrate?

A

Posterior displacement of the prolapsing leaflets in systole (near end of T wave of ECG)
left = Normal, right = MVP

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25
Q

How will the MVP MR jet look if only one MV leaflet prolapses?

A

The MR jet will be angled in the opposite direction

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26
Q

What is a cleft mitral valve?

A

Slit like defect in one of the MV leaflets

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27
Q

How common is cleft mitral valve?

A

Rare

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28
Q

What leaflet is usually affected by the Cleft mitral valve?

A

Usually AMVL

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29
Q

What signs is cleft mitral associated with?

A
  1. Congenital defects
  2. MV thickening
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30
Q

What is a chordal rupture?

A

1 or several of the chordae can break

PML MVP with rupture chord

The leaflet does even touch or coapt

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31
Q

What is a MV flail?

A

When the Leaflet edge has free motion or a hinged appearance

Looks like air moving in and out

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32
Q

What does LV dilatation present like/with?

A

Tented MV

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33
Q

What disease is LV dilatation usually associated to?

A

IHD ischemic heart disease

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34
Q

The tented MV has an increase in what?

A

Coaptation depth: depth from the MV leaflet tips to the MV annulus

35
Q

Is LV dilatation usually measured?

A

Not commonly measured

36
Q

What is LV dilatation usually caused by what movements?

A

Pap muscles being pulled away from the MV as the LV expands

37
Q

The length of the Red arrows indicates what?

A

How far the MV leaflet tips are from the MV annulus.

38
Q

During a Tented MV with Dilated LV as the LV expands when it fails, what happens to the MV?

A

It becomes tented

39
Q

How do papillary muscle abnormalities present? Aka how does it normally present?

A

Normally, contraction of the LV also contracts the pap muscles. But sometimes Paps become misaligned with changes in LV geometry

40
Q

What causes Ischemic MR?

A

Abnormality at the LV myocardial level

41
Q

What is impacted/ affected by Ischemic MR?

A

LV wall + pap muscle both affected by blocked artery

42
Q

During Ischemic MR the Pap muscle moves away and does what?

A

Moves away from the Valve plane as the LV dilates. This tethers the chordae

43
Q

What does MR cause the LA to do?

A

Dilate

44
Q

How can we assess for LA size?

A
  1. PLAX LA dimension
  2. LAVI
45
Q

The amount of MR can be put into context by doing what?

A

Relating the jet area to the LA size

46
Q

Small la + Large MR = what ?

A

More severe (Acute MR)

47
Q

What does a large LA and Large MR mean?

A

Less severe (chronic MR)

48
Q

How do we measure LV size and function?

A
  1. LV PLAX Mets
  2. Dp/DT
49
Q

What is the formula for Dp/Dt?

A

Dp/dt = 32/change in time

50
Q

How do we assess RVSP (pulmonary pressures)?

A
  1. TR max vel/PG
  2. IVC diameter and collapsibility
  3. PAT (add if you cannot calculate RVSP)
  4. MPAP and PAEDP
51
Q

How would we use colour doppler to estimate MR?

A
  1. Qualitative (Distance to LA)
  2. Semi- quantitative (VC and PISA)
52
Q

How would we use spectral doppler to measure MR severity?

A
  1. Qualitative: (brightness and shape)
  2. Quantitative (PISA)
53
Q

What gives us a qualitative/ Indirect measurement of MR severity?

A

Colour doppler

54
Q

What variables act on the colour doppler jet?

A
  1. Preload
  2. Jet direction
  3. Number of jets
  4. Jet length
  5. Jet area
55
Q

What questions do we need to ask when using the eyeball approach to MR assessment with colour doppler?

A
  1. How much of the LA does the jet take up?
  2. Does the MR reach the back of the LA
  3. Is the jet eccentric
56
Q

What are some ASE methods of indirect grading of MR?

A
  1. Vena contracta
  2. PISA radius
57
Q

What is entrainment?

A

Blood already sitting in the LA gets displaced by the incoming MR jet

58
Q

What is entrainment frequent with?

A

Central jets

59
Q

What is entrainment represented by?

A

Non-aliased colours usually darker blue

60
Q

Entrainment leads to overestimation of what?

A

MR severity

61
Q

What is the mild, mod, and severe values for PISA radius?

A
  1. Mild: <0.4 cm
  2. Mod variable
  3. Severe: >0.9 cm
62
Q

What are some things we look for during a qualitative MR spectral assessment?

A
  1. Trans-mitral flow velocity
  2. Pulmonary venous flow PW
  3. Intensity of MR signal CW
  4. Contour of MR jet CW
63
Q

What does trans-mitral flow velocity lead to?

A

Increased preload due to more MR which means a higher E wave

64
Q

MV inflow is also dependent on what

A

LV relaxation and filling pressures

65
Q

For trans-mitral flow velocity, what Quantitive valvular is considered severe MR?

A

> 1.2 m/s

66
Q

In terms of trans-mitral flow dominant A-wave pattern excludes what?

A

Severe MR

67
Q

With pulmonary vein systolic flow reversal, with severe MR, we start so see what?

A

Backward flow into the PVs during systole

68
Q

Systolic flow reversal in >1 pulmonary vein means what?

A

Severe MR

69
Q

Eccentric mild/mod MR angled directly into a PV may alter what?

A

The flow pattern of that one PV

70
Q

To see MR CW jet intensity we need to compare what?

A

MR signal antegrade MV inflow signal.

71
Q

In terms of MR CW jet intensity, the brighter the CW signal of CW, means what?

A

The more significant the leak

72
Q

Label the MR jet intensity

A
  1. Mild MR
  2. Moderate MR
  3. Severe MR
73
Q

In terms of CW of MR jet from MVP, when is MR usually seen?

A

Mid to late systole only

74
Q

Regular MR jet is what?

A

Holosystolic

75
Q

In terms of CW MR jet contour, The CW MR jet reflects what?

A

The systolic PG between LV and LA during systole

76
Q

Why is severe MR more triangular than a parabolic shape

A
  1. Volume of blood leaking back into the LA increased the LA pressure
  2. Decrease in PG between LV/LA
77
Q

How do we get quantitative PISA?

A
  1. Turn on Colour
  2. Zoom MV
  3. Shift down colour baseline to 20-40 cm/sec to produce aliasing
  4. Select PISA radians in MV calculation package
  5. Measure radius
  6. Enter Nyquist limit into calc package
78
Q

What are some limitations of PISA?

A
  1. Multiple jets
  2. Eccentric jets
79
Q

What are spectral parameters we are not using to quantify MR on their own?

A
  1. MR peak velocity
  2. MR peak PG
80
Q

What are the three main methods for assessing MR quantitatively

A
  1. Regurgitation volume
  2. Regurgitation fraction
  3. Effective regurgitation orifice area
81
Q

Which of the following is not a sign of chronic decompensated MR?

  1. Increased LVEDP
  2. Increased stroke volume
  3. Increased LAP
  4. Pulmonary congestion
A

Increased stroke volume

With decompressed MR, the LV can no longer keep up and the stroke volume is decreased. With compensated MR, the SV increases due to the increased EDV (starling)

82
Q

MVP is defined as having one or both MV leaflets extending behind the MV annulus in the ______ window by >______mm.

A

PLAX; 2

83
Q

Which disease presents with a MVL having a hinge like appearance?

A

Flail MV

84
Q

Prolapse of which leaflet is causing this MR jet and why?

A

PMVL. The jet streams away from the affected side

(The left is the anterior wall and the right is the posterior wall)

DMST 283 ECHO 2 (14 decks)

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