Unit 3

Question 1

What is the first 3 indications of mitral regurgitation?

Answer 1

LA dilated, LV dilated, and LVVO pattern

Question 2

How thick are the mitral valve leaflets?

Answer 2

1 mm

Question 3

Which leaflet of the MV is longer?

Answer 3

Anterior. Larger from the base to the center. About 2.0 cm

Question 4

Which leaflet of the MV is shorter?

Answer 4

Posterior. Takes up about 1/3 of the base but is only 1.2 cm in width

Question 5

About how many chordae tendonae arise from each papillary muscle?

Answer 5

12 Primary chordae

Question 6

What else should you always look for with MR?

Answer 6

blood pressure

Question 7

You should evaluate the MV and the _________ for the cause of MR.

Answer 7

left ventricle

Question 8

What is primary MR?

Answer 8

Something is structurally wrong with the valve.

Question 9

What is secondary MR?

Answer 9

Due to enlarged LV or other cause

Question 10

Where is the jet with primary MR?

Answer 10

eccentric, aka the edges of the valve

Question 11

Where is the jet with secondary MR?

Answer 11

central jet

Question 12

Ischemic MR is caused by?

Answer 12

LV remodeling. Coronary artery disease

Question 13

Non-ischemic MR is caused by?

Answer 13

chronic cardiomyopathies

Question 14

What is symmetric tethering?

Answer 14

both leaflets tethered causing global LV systolic dysfunction and remodeling

Question 15

What type of MR jet is common with symmetric tethering?

Answer 15

centrally located jet

Question 16

What is asymmetric tethering?

Answer 16

one leaflet tethers due to localized remodeling and dysfunction of posterior wall

Question 17

What type of MR jet is common with asymmetric tethering?

Answer 17

eccentrically posterior directed MR jet

Question 18

What two things can cause tenting of the MV?

Answer 18

inferior MI and non-ischemic cardiomyopathy

Question 19

Mitral stenosis has a ________ gradient for a stronger severity.

Answer 19

higher. (5-10mmHg is moderate for MS)

Question 20

Mitral regurgitation has a __________ for a stronger severity

Answer 20

lower. (EX on powerpoint was 4.5 m/s is severe MR)

Question 21

LA dilation is one of the first symptoms of MR. Which direction can the LA be dilated?

Answer 21

vertically or horizontally. Sometimes PLAX isn’t accurate because it only measures inferior to superior.

Question 22

Vena Contracta represents the effective flow area with MR. What is mild and what is severe?

Answer 22

Mild = less than or equal to 0.3 cm
Severe = greater than or equal to 0.7 cm

Question 23

We use color flow to subjectively determine MR severity. What is mild MR?

Answer 23

Jet is just beyond the MV leaflets

Question 24

We use color flow to subjectively determine MR severity. What is moderate MR?

Answer 24

Jet is 1/3 way into left atrium

Question 25

We use color flow to subjectively determine MR severity. What is severe MR?

Answer 25

Jet mid to back wall of left atrium. Goes back towards the pulmonary veins.

Question 26

MR happens in what cardiac cycle?

Answer 26

systole

Question 27

What type of murmur is heard with MR?

Answer 27

holosystolic that radiates to the armpit. Blowing or high-pitched murmur

Question 28

What side of the baseline is MR seen on with Doppler?

Answer 28

below the baseline

Question 29

What type of murmur is heard with AR?

Answer 29

high-pitched, blowing, diastolic decrescendo murmur at the left sternal boarder. Severe AR creates a low-pitched, mid-diastolic, rumble at the apex (Austin-Flint murmur)

Question 30

What cardiac phase does AI occur in?

Answer 30

Diastole

Question 31

What are the first three cardiac sequelae for AR?

Answer 31

LVVO, dilated LV, and increased LV end-diastolic pressure (lean patient forward)

Question 32

What cardiac phase is a bicuspid aortic valve best seen in?

Answer 32

systole

Question 33

What does Phen-fen do to the valves?

Answer 33

Adds a gristle-like material

Question 34

What characteristics are seen with Marfan's syndrome?

Answer 34

dilated aortic root with associated MVP connective disease

Question 35

When is surgery indicated for severe AI?

Answer 35

Early closure of the MV and early opening of the AOV

Question 36

What is the pressure half time for mild AI?

Answer 36

Greater than 400 milliseconds

Question 37

What is the pressure half time for moderate AI?

Answer 37

400 - 200 miliseconds

Question 38

What is the pressure half time for severe AI?

Answer 38

Less than 200 milliseconds

Question 39

How can you tell the difference in chronic and acute AI in regards to the Doppler velocities?

Answer 39

Chronic is wider and flatter. Acute has more of an angle for pressure halftime

Question 40

How can you tell the difference in MS and AI?

Answer 40

MS does not reach high velocities like AI. AI occurs in the isovolumic phases. AI has a greater end diastolic velocity

Question 41

The ___________ the jet, the more severe the AI.

Answer 41

Wider. Not about distance, it’s about width of jet. Unlike MR.

Question 42

If the eccentric jet of AR hits the AMVL, what does this cause?

Answer 42

A smiley sign. Diastolic doming. Reverse doming.