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DMST 283 ECHO 2 > Tricuspid Stenosis > Flashcards

Tricuspid Stenosis Flashcards

1
Q

What is Tricuspid Stenosis?

A

Obstruction of blood flow from the RA across the tricuspid valve into the RV

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2
Q

Etiology of the TV may have what two origins?

A
  1. Congenital
  2. Acquired
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3
Q

What is the frequency of Tricuspid stenosis?

A
  1. Rare
  2. Usually associated with other congenital cardiac defects
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4
Q

What are four examples of congenital TS?

A
  1. Mal- developed leaflets
  2. Shortened Chordae tendiae
  3. Annular hypoplasia
  4. Abnormalities of the papillary muscles
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5
Q

Rheumatic TS is usually concurrent with what?

A

MS

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6
Q

What does rheumatic TS usually lead to?

A

Dyspnea

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7
Q

What is the pathophysiology of TS?

A

1.TV area decrease
2. RA pressure increases
3. RAE
4. Increased pressure works its way backward into the system

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8
Q

What are some clinical signs of TS?

A

Rt and Lt CHF

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9
Q

What are some RT CHF symptoms?

A
  1. Systemic venous congestion
  2. Jugular venous distension (elevated jugular venous pressure)
  3. Ascites
  4. Peripheral edema
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10
Q

What are some LT CHF signs?

A

Happens with MS/ Rheumatic MS

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11
Q

What are some symptoms of TS?

A
  1. Fatigue
  2. Abdominal discomfort and swelling
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12
Q

What is the role of echo for TS?

A
  1. Determine Etiology
  2. Assess RA size
  3. Assess RV size and function
  4. Estimate severity of stenosis
  5. Estimate RVSP
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13
Q

What are some acquired TS causes?

A
  1. Rheumatic valve disease
  2. Carcinoid Heart disease
  3. Cor Triatriatum
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14
Q

Anatomic changes in rheumatic TS resemble what?

A

Those of MS

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15
Q

What are some things we see with rheumatic valve disease?

A

When the leaflets are

  1. Thickened
  2. Fibrotic
  3. Fused
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16
Q

What is the sonographic appearance of Rheumatic heart disease?

A
  1. Diastolic doming
  2. Aliasing in the RV during diastole
17
Q

What is Carcinoid heart disease caused by?

A

A rare, malignant neuroendocrine tumor

18
Q

How does the carcinoid heart tumor affect the TV?

A

It secretes the hormone serotonin which damages both tricuspid and pulmonary valves

19
Q

What is the echogenic appearance of carcinoid heart disease?

A

Echogenic deposits on the endocardial surfaces and the myocardium

20
Q

What does the valves look like with carcinoid heart disease?

A

Plaque causes the valves and chordae to become rigid, thickened, and retracted

21
Q

What are some key differences between carcinoid and rheumatic?

A

Rheumatic always involves the MV and Carcinoid may involve the PV but never the MV

22
Q

What do we use to assess for TS severity?

A

We look at
1. Mean TV pressure gradient
2. Tricuspid inflow velocity time integral (VTI)
3. TV Pressure half time
4. Tricuspid valve area (TVA)

23
Q

TS will alias how in the Right sided heart?

A

TS will alias during diastole in the RV

24
Q

How do we get a VTI measurement?

A

Trace the entire TV inflow waveform in CW doppler

25
Q

What does tracing the CW doppler image of the TV do?

A

Gives us both the mean pressure gradient and the VTI measurement

26
Q

What is the most important value we get from CW TV inflow?

A

Mean PG

27
Q

What is the mean PG for TV?

A

Average over several beats to account for changes in venous return with respiration

28
Q

What is the limitation of P1/2T?

A

Tachycardia

29
Q

Why is tachycardia a limitation of P1/2T?

A

E and A waves fuse

30
Q

What is the normal TVA?

A

6-7

31
Q

What are limitations of using the continuity formula for TVA?

A
  1. Suboptimal alignment to the jet direction
  2. Improper LVOT diameter or VTI measurement
  3. When significant TR coexists with TS, the SV is altered, and TVA cannot be calculated.
32
Q

What are some treatments for TS?

A

Medications and Surgical

33
Q

How do we use medications to treat TS?

A

Diuretics/ nitrates to relieve venous congestion

34
Q

What are some surgical ways to treat TS?

A
  1. Surgical de-bulking of tumor or vegetation
  2. Transvenous balloon valvuloplasty is improving
35
Q

Fill out the chart

A

DMST 283 ECHO 2 (14 decks)

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