Valves Flashcards by Kaitlyn Yeager

Which of the following valves is most likely affected in patients with rheumatic heart disease?

A. Tricuspid
B. Mitral
C. Aortic
D. Pulmonic

Mitral

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Given a tricuspid gradient of 3 m/sec and a right atrial pressure of 15 mmHg, what is the RVSP?

A. 21 mmHg
B. 27 mmHg
C. 70 mmHg
D. 51 mmHg

51 mmHg

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All of the following are physical findings in patients with aortic regurgitation EXCEPT:

A. Wide pulse pressures
B. Diastolic “blowing” murmur
C. Systolic “blowing” murmur
D. Bounding, bifid arterial pulses

Systolic “blowing” murmur

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All of the following are etiologies for tricuspid regurgitation EXCEPT:

A. Pulmonary hypertension
B. Ebstein’s anomaly
C. Systemic hypertension
D. Seen in normals

Systemic hypertension

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Atrial fibrillation is most commonly associated with which valvular disease?

A. Calcifies aortic stenosis
B. Bicuspid aortic valve
C. Rheumatic mitral stenosis
D. Mitral valve prolapse

Rheumatic mitral stenosis

Left atrium often dilates enough to cause a fib

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Longstanding mitral stenosis leads to all of the following EXCEPT:

A. Pulmonary hypertension
B. Left atrial dilatation
C. Left ventricular dilatation
D. Congestive heart failure

Left ventricular dilatation

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The development of angina, dyspnea, and syncope might be signs of advanced:

A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Mitral regurgitation

Aortic stenosis

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All of the following syndromes significantly raise the patient’s risk of aortic dissection EXCEPT:

A. Turner’s syndrome
B. Marfan syndrome
C. Down syndrome
D. Ehlers-Danlos syndrome

Down syndrome

(At risk for AVSDs)

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A common cause for right ventricular volume overload is?

A. Tricuspid regurgitation
B. Patent ductus
C. Pulmonic stenosis
D. Tetralogy of Fallot

Tricuspid regurgitation

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All of the following are etiologies for pulmonic regurgitation EXCEPT:

A. Pulmonic stenosis
B. Pulmonary hypertension
C. Systemic hypertension
D. Carcinoid heart disease

Systemic hypertension

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Which of the following syndromes fits with aortic regurgitation, aortic dilatation, aortic dissections, and aortic aneurysms?

A. Barlow
B. Dressler’s
C. Noonans
D. Marfan

Marfan

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All of the following are causes of acute mitral regurgitation EXCEPT:

A. Mitral valve prolapse
B. Ruptured chordae
C. Papillary muscle dysfunction
D. Endocarditis

Mitral valve prolapse

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Systolic flow reversal in the pulmonary veins indicates:

A. Mild mitral regurgitation
B. Acute mitral regurgitation
C. Severe mitral regurgitation
D. Moderate mitral regurgitation

Severe mitral regurgitation

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When is the Doppler pressure half-time calculation for mitral area NOT accurate?

A. With associated moderate AI
B. With associated mild AI
C. Post balloon valvuloplasty
D. With associated moderate MR
E, with associated mild MR

Following post balloon valvuloplasty

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Severe mitral regurgitation can often result in all of the following EXCEPT:

A. Pulmonary hypertension
B. Left ventricular dilatation
C. Systemic hypertension
D. Left ventricular volume overload

Systemic hypertension

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Which valve lesion typically has the highest Doppler peak velocity?

A. Aortic regurgitation
B. Tricuspid regurgitation
C. Mitral regurgitation
D. Pulmonic regurgitation

Mitral regurgitation

(Usually a 100mmHg gradient between the LV and LA so that the MR velocity is 4-5 m/sec)

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Patients with a parachute mitral valve usually have which echo finding?

A. Left ventricular dilatation
B. Right ventricular dilatation
C. Left atrial thrombus
D. Three papillary muscles
E. Single papillary muscle

Single papillary muscle

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The most common cause of mitral regurgitation in elderly patients is:

A. Calcified mitral annulus
B. Rheumatic heart disease
C. Atrial fibrillation
D. Papillary muscle dysfunction

Calcified mitral annulus

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A secondary finding in aortic stenosis is:

A. Left ventricular hypertrophy
B. Aortic regurgitation
C. Left ventricular enlargement
D. Left atrial enlargement

Left ventricular hypertrophy

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Patients with mitral valve prolapse and mitral regurgitation have an increased risk for:

A. Endocarditis
B. Developing WPW
C. Pulmonary hypertension
D. Systemic hypertension

Endocarditis

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Severe aortic regurgitation can often result in all of the following EXCEPT:

A. Left ventricular dilatation
B. Pulmonary hypertension
C. Mitral valve preclosure
D. Left ventricular volume overload

Pulmonary hypertension

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In patients with moderate aortic stenosis the:

A. Left atrial systolic pressure exceeds that of the left ventricle
B. Left ventricular systolic pressure exceeds that of the aorta
C. Aortic systolic pressure exceeds that of the left ventricle
D. Left ventricular diastolic pressure exceeds that of the aorta

Left ventricular systolic pressure exceeds that of the aorta

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Which of the following is an etiology of valvular aortic stenosis?

A. IHSS
B. Coarctation of the aorta
C. Rheumatic fever
D. Systemic hypertension

Rheumatic fever

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Rheumatic mitral stenosis creates a volume and pressure overload pattern which may result in all of the following EXCEPT:

A. Left ventricular enlargement
B. Left atrial enlargement
C. Small “D” shaped left ventricle
D. Right ventricular enlargement

Left ventricular enlargement

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Complications of rheumatic mitral stenosis include all of the following EXCEPT: A. Possible pulmonary hypertension B. Scarring of the mitral valve apparatus C. Increased left atrial pressure D. Dilated left ventricle

Dilated left ventricle

What is the most common echocardiographic method for calculating the mitral valve area? A. Doppler pressure half-time B. Doppler continuity equation C. Mitral valve planimetry D. PISA (proximal isovelocity surface area)

Doppler pressure half-time

Which of the following is an etiology of valvular pulmonic stenosis? A. Infundibular stenosis B. Ventricular septal defects C. Carcinoid heart disease D. Marfan disease

Carcinoid heart disease

Patients with rheumatic mitral stenosis might receive all of the following treatments EXCEPT: A. Septal myectomy B. Catheter balloon valvuloplasty C. Mitral valve repair D. Mitral commissurotomy

Septal myectomy (Morrow Procedure) is for reducing the amount of septal muscle in patients with HOCM and IHSS

An underestimation of the severity of aortic stenosis by continuous wave Doppler may occur with: A. Angle cosine theta of 40º B. Severe AR C. High cardiac output D. High Doppler gain settings

Angle cosine theta of 40º (Should be less than 20º)

Which of the following is the most common etiology for tricuspid stenosis? A. Ebstein’s anomaly B. Prosthetic valve dysfunction C. Rheumatic fever D. Congenital malformation E. Acquired stenosis

Rheumatic fever

What is the aortic valve area cutoff for severe stenosis? A. < 1 cm2 B. 2.5-3.5 cm2 C. 6-8 cm2 D. 3-5 cm2

< 1 cm2 (Same for severe mitral stenosis)

If you measure the LVOT too big, how will this affect your measurement for aortic area? A. Area is too large B. Area cannot be measured in dilated hearts C. Area is too small D. Area does not change

Aortic area will be too large

Marfan syndrome is best described as: A. A connective tissue disorder B. Causing mitral stenosis C. A type of cancer D. Seen in short people

A connective tissue disorder

What is the normal mitral valve area? A. 6-8 cm2 B. 4-6 cm2 C. < 1 cm2 D. 3-4 cm2

4-6 cm2

All of the following are etiologies for pulmonic stenosis EXCEPT: A. Congenital malformations B. Rheumatic heart disease C. Carcinoid heart disease D. Endocarditis

Endocarditis

A patient with Marfan Syndrome might have which of the following cardiac abnormalities? A. Bicuspid aortic valve and aortic coarctation B. Mitral valve prolapse and aortic dissection C. Atrial septal defect and mitral stenosis D. Ventricular septal defect and pulmonic stenosis

Mitral valve prolapse and aortic dissection

With atrial fibrillation and mitral stenosis the Doppler velocity is best performed: A. Averaged over 2 beats B. Unable to measure in A-fib C. Averaged over 3-5 beats D. Averaged over 20 beats

Averaged over 3-5 beats

In echocardiographic the use of the continuity equation in patients with aortic stenosis is based on the premise that: A. The worse the stenosis, the higher the V1 B. The higher the cardiac output, the lower the V2 C. The worse the stenosis, the lower the V1 D. Flow below the valve is equal to flow above the valve

Flow below the valve is equal to flow above the valve. (According to the Law of Conservation, flow below an obstruction equals flow above. As it passes through a narrow orifice the flow must accelerate to maintain the same volume)

Which term below best describes the type of aortic stenosis that originates at the sinuses of Valsalva and extends medially to the aortic valve cusps? A. Congenital B. Prosthesis C. Rheumatic D. Degenerative

Degenerative (Commonly starts at the outer edges of the leaflets and progresses inward)

Acquired valvular heart disease may be due to all of the following EXCEPT: A. Rheumatic fever B. Down syndrome C. Age D. Endocarditis

Down syndrome (This is a congenital problem)

Which of the following is the most common etiology for aortic stenosis? A. Rheumatic fever B. Calficic/degenerative C. Congenital membranes D. Prosthetic valve dysfunction E. Supra valvular obstructions

Calcific/degenerative

What causes mitral valve pre systolic closure? A. Elevated LVEDP B. Low LVEDP C. Moderate AR D. Pulmonary hypertension

Elevated LVEDP

Which of the following best describes a sinus of Valsalva aneurysm? A. Commonly seen in the left coronary sinus B. Often accompanied by sub valvular aortic stenosis C. Saccular type of dilatation D. Often involves more than one sinus

Saccular type of dilatation (Appears as a thin sack pushing away from the proximal aortic root of one of the sinuses)

Echocardiographically, where do most aortic aneurysms occur? A. Aortic arch B. Abdominal aorta C. Aortic isthmus D. Aortic root

Abdominal aorta

Systolic flow reversal in the pulmonary veins can also be described as: A. Normal B. No reflow C. Retrograde D. Antegrade

Retrograde

Inhalation of amyl nitrite might be used to demonstrate which of the following? A. Mitral insufficiency B. Mitral valve prolapse C. Valvular mitral stenosis D. Valvular aortic stenosis

Mitral valve prolapse (Amyl nitrite is a vasodilator - there is less blood returning to the heart and this might accentuate mitral valve prolapse)

Patients with Marfan syndrome are following by echo to check: A. Changes in aortic root dimensions B. Mitral valve prolapse C. Aortic regurgitation D. Mitral regurgitation

Changes in aortic root dimensions

What is the primary effect of long standing aortic regurgitation? A. Dilated left ventricle B. Dilated right ventricle C. Mitral valve preclosure D. Decreased ejection fraction

Decreased ejection fraction

All of the following are etiologies for mitral regurgitation EXCEPT: A. Ebstein’s anomaly B. Cleft mitral valve C. Ruptured mitral chordae D. Mitral endocarditis

Ebstein’s anomaly

One advantage of using the parasternal long axis view to diagnose mitral valve prolapse is: A. The relative position of the mitral and tricuspid valves is better visualized B. There is less motion of the mitral annulus C. False prolapse caused by the annulus shape is avoided D. The ultrasonic beam is perpendicular to the leaflets in systole

False prolapse caused by the annulus shape is avoided

What is the mitral valve area cutoff for severe stenosis? A. 4-6 cm2 B. 6-8 cm2 C. 3-4 cm2 D. < 1 cm2

< 1 cm2

What pressure half time by continuous wave Doppler would you expect on a patient with mild aortic insufficiency? A. 350-500 msec B. <200 msec C. >500 msec D. 16-36 msec

>500 msec (Slope of the spectral trace is relatively flat)

Why follow patients with chronic aortic regurgitation? A. Look for mitral valve preclosure B. Check the left atrial size C. Check the left ventricular size D. Check for pulmonary hypertension

Check the left ventricular size

Which valve lesion typically has the lowest Doppler peak velocity? A. AR B. TR C. PR D. MR

Pulmonic regurgitation (During diastole there is usually a low gradient between the pulmonary artery and right ventricle. The PR velocity is 1-2 m/sec in normals)

All of the following are etiologies for aortic regurgitation EXCEPT: A. Marfan syndrome B. Aortic type 1 dissection C. Systemic hypertension D. Pulmonary hypertension

Pulmonary hypertension

What is the normal aortic valve area? A. <1 cm2 B. 6-8 cm2 C. 3-5 cm2 D. 2.5-3.5 cm2

2.5-3.5 cm2 (Or 3-4)

Severe pulmonic regurgitation can often result in all of the following EXCEPT: A. Right ventricular volume overload B. Systemic hypertension C. Diastolic murmur D. Right ventricular failure

Systemic hypertension

Given the mitral pressure half time of 200 msec what would the area be? A. 0.9 cm2 B. 2 cm2 C. 1 cm2 D. 1.1 cm2

1.1 cm2 (Dividing the half time of 200 msec into the constant 220) 220 / 200 =1.1

Which of the following occurs first in the setting of severe mitral regurgitation due to a flail leaflet? A. Dilated left atrium B. Dilated right ventricle C. Dilated left ventricle D. Dilated right atrium

Dilated right ventricle (In the setting of severe acute mitral regurgitation the left atrium does not have time to dilate an it acts as a conduit passing high pressures to the lungs, in turn the right ventricle responds to this pressure by dilating)

How do you position a patient with aortic stenosis for using a PEDOF probe along the right sternal border? A. Left lateral decubitus B. Right lateral decubitus C. Fowlers D. Trendelenburg

Right lateral decubitus

Which of the following would most likely cause chronic aortic insufficiency? A. Trauma B. Mitral stenosis C. Aortic stenosis D. Aortic dissection

Aortic stenosis

In echo, when is a raphe typically seen? A. Bicuspid aortic valve B. Rheumatic aortic stenosis C. Cleft aortic valve D. Degenerative aortic stenosis

Bicuspid aortic valve (A raphe is the fused commissure line between 2 of the 3 aortic leaflets in a typical bicuspid valve. Usually 86% between the right and left aortic leaflets)

Which of the following valves is least likely affected in patients with rheumatic heart disease? A. Mitral B. Pulmonic C. Aortic D. Tricuspid

Pulmonic

Using the continuity equation, when would the severity of aortic stenosis be overestimated? A. LVOT measured too small B. Mean aortic velocity too low C. Peak aortic velocity too low D. LVOT measured too large

LVOT measured too small

High frequency systolic vibrations of the aortic valve on M-mode most likely reflects: A. A normal finding B. Aortic valve regurgitation C. Low cardiac output D. Mitral insufficiency

A normal finding (However, diastolic fluttering usually indicates aortic regurgitation)

Given a tricuspid regurgitant gradient and right atrial pressure what can you calculate? A. Left ventricular systolic pressure B. Right ventricular systolic pressure C. Left ventricular end diastolic pressure D. Right atrial pressure

Right ventricular systolic pressure

From the left parasternal position, which of the following are you most likely to get accurate velocity measurements? A. Mitral regurgitation B. Left ventricular outflow tract C. Pulmonary artery D. Aortic stenosis

Pulmonary artery

Dynamic LVOT obstruction causes the aortic valve to: A. Close in late systole B. Flutter in systole C. Close in mid systole D. Flutter in diastole

Close in mid systole (IHSS is an example)

Which of the following are common secondary findings in mitral stenosis? A. Right atrial enlargement and mitral regurgitation B. Left ventricular and left atrial dilation C. Left ventricular hypertrophy and dilation D. Left atrial enlargement and signs of pulmonary hypertension

Left atrial enlargement and signs of pulmonary hypertension

What percent of patients with bicuspid aortic valve will NOT have eccentric closure on M-mode? A. 25% B. 15% C. 50% D. 40%

25%

What pressure half time by continuous wave Doppler would you expect on a patient with severe aortic insufficiency? A. > 500 msec B. 16-36 msec C. 350-500 msec D. < 200 msec

< 200 msec (This would indicate that the aortic insufficiency is severe since the pressure half time slope of the spectral trace is very steep. The pressure between the aorta and left ventricle is almost equal by the end of diastole)

Patients with Marfan syndrome typically die from which of the following? A. Mitral valve prolapse B. Stroke C. Aortic dissection D. Syncope

Aortic dissection

All of the following are etiologies of valvular aortic stenosis EXCEPT: A. Congenital B. Calcific C. Rheumatic D. IHSS

IHSS (Subvalvular not valvular)

Given a tricuspid gradient of 4 m/sec and a right atrial pressure of 20 mmHg what is the RVSP? A. 36 mmHg B. 84 mmHg C. 27 mmHg D. 51 mmHg

84 mmHg

A patient has an RVSP of 60 mmHg. One year later the RVSP is 30 mmHg. What happened to this patient? A. Right ventricular infarction B. Left ventricular infarction C. Hypertrophic cardiomyopathy D. Pulmonary hypertension

Right ventricular infarction (Suffered a right ventricular infarction causing the right ventricle to be unable to generate sufficient pressure)

Using saline contrast, systolic appearance of bubbles in the inferior vena cava would indicate: A. A normal finding B. Tricuspid regurgitation C. Cardiac tamponade D. High right atrial pressures

Tricuspid regurgitation

What is a typical Doppler velocity range for aortic stenosis? A. 1.6-2.0 m/sec B. 0.1-1.6 m/sec C. 2.0-3.0 m/sec D. 3.0-5.0 m/sec

3.0-5.0 m/sec (This would result in a gradient range between 36-100 mmHg)

Mitral valve prolapse is best seen in which echo view? A. Subcostal 4 chamber B. Apical 4 chamber C. Parasternal long D. Parasternal short

Parasternal long axis

With a mitral pressure half time of 230 msec, what is present? A. Mild mitral stenosis B. Severe mitral stenosis C. Moderate mitral stenosis D. Normal mitral valve

Severe mitral stenosis (This would calculate to a mitral valve area below 1 cm2 which is the cutoff for severe mitral stenosis)

Longstanding mitral stenosis may lead to which of the following? A. Aortic regurgitation B. Tricuspid stenosis C. Left ventricular dilation D. Pulmonary hypertension

Pulmonary hypertension

Severe tricuspid regurgitation can often result in all of the following EXCEPT: A. Systolic murmur B. Pulmonary hypertension C. Right ventricular volume overload D. Dilated IVC

Pulmonary hypertension (TR is seen in patients WITH pulmonary hypertension, but it does not cause it)

The classic manifestations of acute rheumatic fever includes all the following EXCEPT: A. Arthritis B. Subcutaneous nodules C. Abdominal aortic aneurysms D. Carditis

Abdominal aortic aneurysms

Which of the following is the most common etiology for mitral stenosis? A. Congenital malformation B. Acquired stenosis C. Rheumatic fever D. Parachute mitral valve E. Prosthetic valve dysfunction

Rheumatic fever

For patients with the combination of aortic stenosis and atrial fibrillation, peak systolic aortic velocity will be: A. Unaffected by R-R intervals B. Higher following short R-R intervals C. Lower following long R-R intervals D. Higher following long R-R intervals

Higher following long R-R intervals (Long R-R intervals will result in more diastolic filling (volume) which according to the Frank - Starling Law, will result in a greater force of contraction)

What would you typically expect to see on the M-mode of a 14 year old with a bicuspid aortic valve? A. Eccentric closure B. Diastolic doming C. Football shaped opening D. Presence of a raphe

Eccentric closure

A patient comes to the echo lab with decreased cardiac output, chest pain, syncope, and a possible cerebral infarct. What is the most likely diagnosis? A. Pulmonary insufficiency B. Tricuspid stenosis C. Mitral valve prolapse D. Aortic stenosis

Aortic stenosis

Mitral regurgitation in patients with rheumatic mitral stenosis is most likely due to: A. Scarring of the interventricular septum B. Left atrial enlargement C. Left ventricular enlargement D. Aortic valve notching

Left atrial enlargement

When the heart has to compensate for increased afterload the ventricle responds by: A. Dilating B. Atrophy C. Hypertrophy D. Dyskinesis

Hypertrophy (Increasing the afterload will increase the force that the ventricle has to overcome with each contraction)

All of the following are M-mode findings in rheumatic mitral stenosis EXCEPT: A. Decreased E-F slope B. Multiple reverberations C. Posterior leaflet moves anterior D. Increased E-F slope

Increased E-F slope

What is the best way to determine if severe mitral regurgitation is present? A. MV inflow velocity B. Size of vena contracta C. Pulmonary venous flow D. Size of color Doppler jet

Pulmonary venous flow reversal during systole

Which of the following is the most common etiology for pulmonic stenosis? A. Congenital malformations B. Rheumatic C. Carcinoid heart disease D. Prosthetic valve dysfunction

Congenital malformations