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DMST 283 ECHO 2 > Pulmonary Regurgitation > Flashcards

Pulmonary Regurgitation Flashcards

1
Q

What is Pulmonary regurgitation?

A

The backflow from the PA to the RV during diastole

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2
Q

How does Pulmonary regurgitation symptoms occur?

A

Symptoms occur are due to RV volume overload and varying levels of right heart failure with severe PR

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3
Q

What are signs/ symptoms of Pulmonary regurgitation?

A
  1. Dyspnea
  2. Peripheral edema
  3. Fatigue
  4. Increased JVP
  5. Liver engorgement
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4
Q

What is the PR cycle?

A
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5
Q

What is the role of Echo in pulmonary regurgiation?

A
  1. Determine the etiology of PR
  2. Assess RV size and function
  3. Estimate severity of regurgitation
  4. Estimate PA pressures
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6
Q

What are the two major causes of PR?

A
  1. Functional Causes
  2. Organic causes
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7
Q

What are function causes?

A

Anything that causes annular dilation

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8
Q

What are examples of functional cause?

A
  1. Congenital heart disease with RV dilation
  2. Pulmonary artery dilation (Marfan syndrome)
  3. RV cardiomyopathy
  4. RV infarction
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9
Q

What are organic causes?

A

Disorders of the pulmonary valve

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10
Q

What are examples of organic causes?

A
  1. Carcinoid heart disease
  2. Congenital lesions (such as repaired tetralogy of fallott)
  3. Iatrogenic (post surgical)
  4. Rheumatic valve disease (rare)
  5. Trauma
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11
Q

What are the qualitative parameters in assessing PR?

A
  1. Jet width
  2. Flow reversal in branch pulmonary arteries
  3. PR jet width ratio
  4. Intensity of PR signals
  5. PR pressure half time
  6. PR index
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12
Q

In terms of flow reversal in branch PA: some degree of flow reversal can usually be seen where?

A

In the Main PA starting at moderate PR

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13
Q

In terms of flow reversal in the branch PA’s: Diastolic reversal in the RPA or LPA is a strong indicator of what?

A

Severe PR

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14
Q

In terms of flow reversal in the branch PA branches, generally, what does it mean if there is more distal PR?

A

More severe the PR

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15
Q

In terms of the PR jet width ratio: the Ratio of the width of the PR jet is compared to what?

A

The RVOT diameter

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16
Q

What is a pitfall of the PR jet width ratio?

A

The RVOT diameter can be difficult to obtain, and it may not be possible to see on some patients

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17
Q

What is the PR jet ratio formula?

A

(PR jet width)/(RVOTd)

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18
Q

What is the range for the PR jet width ratio?

A
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19
Q

When looking at the intensity of the PI spectral signal, what do we compare?

A

We compare the intensity of the regurgitant signal to the intensity of the antegrade signal

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20
Q

In terms of PR pressure half time, where do we measure on a spectral filter wave?

A

From peak early diastolic velocity to baseline

21
Q

What are the ranges for mild, moderate, and severe PR with Pressure half time?

A
22
Q

What does mean?

A

This is an “A dip” at the atrial contraction

23
Q

What might cause a change in pressure at the A dip?

A

Change in pressure between the RA and the PA

24
Q

When might you see the A dip in the waveform?

A

In a PI waveform with normal PA pressure

25
Q

Where might the PR A dip occur on the ECG?

A

Just after the P wave

26
Q

In terms of the PR index and PR velocity, PR velocity accounts for what two reasons?

A
  1. PA pressure falls due to forward run-off to the lungs as well as regurgitation back into the RV
  2. The RV diastolic pressure (RVEDP) rises due to the normal tricuspid inflow as well as PR volume back into the RV
27
Q

In terms of PR index and PR velocity, the PG between the RV and PA is how big?

A

Relatively small (20-30 mmHg) compared to the Aorta and LV (100mmHg)

28
Q
A

Lower

29
Q

In terms of PRI (pulmonary regurgitation index), with a large PG (mild PR) the signal continues how?

A

Throughout all of the diastole of the ratio

30
Q

In terms of PRI, what is Severe PRI?

A

Severe PRI =< 0.77

31
Q

In terms of pre-systolic forward flow, The RVEDP exceeds the PA pressure, what will occur?

A

Forward flow out the PV will result

32
Q

What does pre-systolic forward flow occur with?

A

Severe PR

33
Q

In terms of Pre-systolic forward flow, RV diastolic dysfunction is non-compliant when?

A

Where the RV is extremely stiff and non-compliant

34
Q

What are quantitative parameters to estimate severity of PR?

A

Regurgitant volume and fraction

35
Q

Is it advocated to use quantitative parameters to estimate severity of PR?

A

No

36
Q

What is the acronym for PAT?

A

Pulmonary acceleration time

37
Q

What does PAT Measure?

A

Measure of mean pulmonary artery pressure (mPAP)

38
Q

In terms of pulmonary pressure estimates, PAT is used less than what?

A

RVSP

39
Q

How do we use PAT to measure?

A

PW with sample volume placed in the RVOT

40
Q

As the mPAP rises what happens to the PAT?

A

It decreases

41
Q

What does each of these images represent?

A
  1. Normal on the left
  2. Increased pulmonary resistance on the right
42
Q

When estimating PA pressures, in the absence of RVOT obstruction it is assumed that RVSP is what?

A

the same as the PA pressure

43
Q

When estimating PA pressures, RVSP can be estimated using what?

A

TR jet pus RAP as previously described

44
Q

When estimating PA pressure, how many new pressures can be calculated when PR is present

A
  1. 2
  2. PAEDP and mPAP
45
Q

What formula do we use for PAEDP and mPAP using PR?

A

The bernoulli principle

46
Q

Label the chart

A
47
Q

In terms of Valve repair and Replacement, what is preferred more?

A

Repair is more preferred to a valve replacement

48
Q

Usually valves with severe stenosis/ regurgitation will be dealt with how?

A

Replaced or repairs

49
Q

A valve may be replaced or repaired when?

A

Before severe stage if
1. The patient meets surgical criteria for another pathology
2. There is permanent damage being done to other organs due to the stenosis or regurgitation

DMST 283 ECHO 2 (14 decks)

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