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Flashcards in Valvular Deck (137):
0

A secondary finding in aortic stenosis is?

LVH left ventricular hypertrophy

1

In aortic stenosis is pulse pressure wide or narrow?

Narrow ( pulse pressure is the difference between systolic and diastolic pressure it is wide in AI (regurg) and narrow in AS

2

What are some echo valvular findings in aortic stenosis?

Thickened ao leaflets, decreased valve opening, LVH, post stenotic dilatation of the ao

3

What are some physical signs/complaints for aortic stenosis?

Angina, dyspnea and syncope/ sudden death, harsh systolic ejection murmur r upper eternal border, decreased or absent a2, decreased and delayed carotid upstroke with bruit thrill transmitted from aov

4

What are some etiology associated w ao stenosis?

Calcific/degenerative (50 percent start as bicuspid)
Rheumatic(associated w mitral stenosis)
Congenital (bicuspid memnbrane(1-2 percent of population)
Supra and sub valvular obstructions
Prosthetic valve dysfunction

5

Aortic jet velocities?

Mild 2.6-2.9
Mod3.0-4.0
Severe >4.0

6

Ava?

Mild >1.5
Mod 1.0-1.5
Severe <1.0

7

Echo findings for bicuspid AoV?

Possible eccentric closure of mmode (one flap more anterior not in midline - 25 percent will have normal midline closure)
Thickened ao leaflets (may be mild)
Systolic doming in lax view
Bicuspid orifice in sax view (football)
Check for coexist coarctation of ao

8

The best view to diagnose a bicuspid AoV is the parasternal?

Short axis systole (sax) football money shot

9

Normal desc ao velocity?

1m/sec

10

Echo findings for ao coarctation?

Congenital membrane or ridge in lvot beneath AoV
Early systolic closure of ao leaflets
Lvh

11

What view is best for detecting su valvular membranes?

Apical 5ch (approx 15 percent will grow back post surgical removal)

12

What is takayasu arteritis?

Also called aortic arch syndrome this disease occurs more in young women from Asia. There is fibrosis of the arch and descending ao of unknown etiology. In advanced states multiple coarctations may occur (look for supra valvular as)

13

Patients bp is 110/84. Aortic velocity is 5m/sec. Peak LV pressure in this patient is?

210 mmhg (add the ao gradient) 100mmhg if the velocity is 5m/sec(to the systolic BP)

14

The normal Ava is?

3-4cm2

15

What is a severe Ava?

<1.0cm2

16

Using the continuity equation when would the severity of as be underestimated?

Lvot measured too large

17

Which pressure is obtained during Doppler?

Peak or peak instantaneous (for as it's the highest gradient anytime during systole)

18

Know that echo gradients are usually higher than cath gradients

Peak instantaneous versus peak to peak

19

How to determine severe aortic stenosis?

First look at the valve area (must be below 1.0)
Second look at the max gradient (if valve areas are equal)
Third look at the wall thickness (evidence of lvh)

20

A pt Marfan syndrome might have which of the following cardiac abnormalities?

MVP & aortic dissection

21

Rheumatic mitral stenosis creates a volume and pressure overload pattern which may result in all the following except?

LV enlargement

22

Long-standing mitral stenosis leads to all of the following except?

Left ventricular dilatation

23

Which of the following syndromes fits with aortic regurgitation, aortic dilitation, aortic dissection and aortic aneurysm?

Marfan syndrome. Marfan's syndrome is a connective tissue disease that can lead to all of these problems with aortic valve and aorta

24

Using saline contrast, systolic appearance of bubbles in the inferior vena cava would indicate?

Tricuspid regurgitation

25

One advantage of using the parasternal long asked you to diagnose mitral valve prolapse is?

Falls prolapse caused by the anulus shape is avoided. Due to the curvature of the mitral annulus even normal valves appear like the leaflets prolapse in Apical four chamber view

26

Afib is most commonly associated with which valvular disease?

Rheumatic mitral stenosis. In rheumatic mitral stenosis the la often dilates enough to cause a fib

27

What pressure half time by continuous wave Doppler would you expect on the patient with severe aortic insufficiency?

<200 msec. This would indicate that the aortic insufficiency is severe as the pressure halftime slope of the spectral trace is very steep. This means that the pressure between the aorta and left ventricle is almost equal by the end of diastole

28

When the heart has compensate for increased afterload the ventricle responds by?

Hypertrophy. Yes increasing the afterload will increase the force that the ventricle had to overcome with each contraction. Over time this will lead to LVH

29

What best describes a sinus of valsalva aneurysm?

Saccular type of dilatation. A sinus of valsalva aneurysm appears as a thin sack pushing away from the proximal aortic root of one of the sinuses.

30

With a fib and mitral stenosis the Doppler velocity is best performed?

Averaged over 3-5 beats

31

Complications of rheumatic mitral stenosis include all of the following except?

Dilated LV. Yes the LV does not dilate due to mitral stenosis in pts w Rheunatic valvular disease

32

Longstanding ms may lead to which of the following?

Pulmonary HTN. As la pressure increases in longstanding ms pilmoanry HTN may result

33

Which of the following occurs first in the setting of severe mitral regurgitation due to a flailed leaflet

Dilated right ventricle

34

Systolic flow reversal in the pulmonary veins indicates:?

Severe mural regurg.

35

Which valve lesion typically has the lowest Doppler peak velocity?

Pulmonic regurgitation

36

Some etiology for pulmonic stenosis?

Congenital (most common)
Rheumatic (rare)
Carcinoid
Infundibular

37

Some Pathophysiology for ps?

Systolic pressure overload leads to RVH.
Regional hypertrophy may lead to infundinular stenosis.
Commonly associated w other congenital malformations (vsd, asd, tetralogy of fallot)

38

Some physical signs of ps?

Dyspnea on exertion.
Systolic ejection murmur left upper sternal border.

39

Some echo findings for ps?

M-mode may show may show an increase in the pulmonic a-dip of more than 7mm (useful for severe ps only).
Valvular thickening and systolic doming (2-d).
RVH
Ps protects the lungs.

40

Ps does not cause?

Pulmonary HTN

41

Doppler findings in ps?

Increased velocity and turbulence at level of obstruction (valvular, sub valvular, or supravalvular.
Measure peak and mean gradients (psax and rvot long)

42

Normal pulmonary velocity?

1m/sec.
Ex: 4m/sec (64 mmhg)

43

If unable to obtain ps gradient from the parasternal window were else can you go?

Subcostal short axis

44

Ps severity?

Mild:Below 3.0m/s or 36mmhg
Mod:3.0-4.0 or 36-64 mmhg
Severe: above 4.0m/s or 64mmhg.

45

Ps gradients vary w what?

Respiration

46

Etiology for ms?

Rheumatic (commissarial fusion) most common.
Congenital (rare).
Acquired Mac
Prosthetic valve dysfunction

47

The insertion of mitral chordae tendineae into a single pap muscle is?

Parachute mitral valve (tunnel stenosis)

48

Some Pathophysiology for ms?

Diffuse leaflet thickening scarring contraction commisural fusion and chordae shortening and fusion.
Associated mr may be present.
Increased la pressure causes la dilation
Long standing obstruction leads to pul HTN (RV and RA enlargement)

49

Physical signs of ms?

Diastolic murmur (rumble) with opening snap.
A fib is common.

50

Me murmur =

low frequency "diastolic rumble" with an opening snap.

51

What is the hockey stick appearance associated w?

Rheumatic ms

52

Which cardiac valve is the second most common to be affected by rheumatic heart disease?

Aortic (most common mitral 97%)

53

Pts w ms often develop?

A fib (most common)

54

Echo findings for ms?

Thickened MV leaflets with decreased mobility.
Tethered MV leaflet tips (hockey stick appearance).
LA enlargement.
Signs of pul HTN in advanced disease.

55

Ms pts become very symptomatic with ?

A fib. Might lose 50% of diastolic filling since they are very dependent on atrial contraction.

56

Doppler findings for ms?

Increased Doppler and turbulence across the MV.
Use PHT for valve area.
Mitral regurg might b present.
Measure mean trans valvular gradient.

57

Normal MVA?

4-5cm2

58

With a fib ms velocity calculations are best performed?

Averaged over 5-10 beats

59

Given a mitral PHT of 400m/sec what would the area be?

.5cm2

60

Equation for MVA?

220➗PHT

61

Given a mitral deceleration time of 400msec calculate the MV PHT?

116 (equation is deceleration time x .29)
400x.29=116

62

Given decel time how do you calculate MVA?

759➗decel time

63

What is decel time in ms?

Is from peak flow to where the slope hits the baseline.

64

Etiology of TS?

Rheumatic (most common)
Congenital (rare)
Carcinoid (rare)
Prosthetic valve dysfunction

65

Carcinoid vs Rheumatic?

Carcinoid=fixed body of the leaflets. Rheumatic =tethered leaflet tips

66

Pathophysiology of TS?

Increased RA pressure causes RA dilation.
Rheumatic TS almost always associated w ms.
Carcinoid heart disease results from increased serotonin production.

67

Physical signs of TS?

Signs and symptoms may be masked by ms.
Diastolic murmur (varies w respiration) and an opening snap.
Symptoms of R heart failure (ascities peripheral edema

68

Echo findings in TS?

Mmode shows decreased e-f slope, reduced E wave
Thickened tv leaflets w decreased mobility.
RA and IVC enlargement.
Tethered tv leaflets (doming).

69

TS severity?

Mean gradient more or equal to 5
Inflow tvi more than 60cm
TVA by continuity less than 1

70

Etiology of AI?

Primary cusp disease (stenosis, endocarditis, ankylosing (contractility) spondylitis.)
Dilated aortic annulus and root (Marfan, HTN, aneurym).
Loss of commisural support.

71

Which anomaly goes w aortic dissection?

Marfan syndrome

72

If you have a uniformly dilated aortic root which term best describes this?

Fusiform

73

What kind of murmur would you hear in a pt w a rupture of a sinus of valsalva aneurysm?

Continuous

74

Which is the most common chamber for a sinus of valsalva aneurysm to rupture into?

RA

75

What is the classic aortic regurg murmur?

Diastolic "blow"

76

Echo findings of AI?

Mmode may show diastolic fluttering of the mitral valve leaflets (mostly anterior) or ivs.
Mitral valve pre closure w severe acute AI
Pre systolic opening of the aortic leaflets

77

What can cause MV fluttering on mmode?

AI

78

What causes MV preclosure?

An elevated LVEDP

79

Where is normal MV closure on ECG?

In the middle to the end of the QRS complex.

80

Doppler findings of AI?

Diastolic turbulence in the LVOT.
Diastolic flow reversal in the descending aorta (mod to sev AI)
Obtain the end diastolic gradient from cw Doppler to estimate the LVEDP (diastolic BP - end diastolic gradient)

81

Ao PHT?

Mild. More than 500msec
Mod. 500-200 msec
Sev. Less than 200 msec (fast)

82

Another term for descending aorta diastolic flow reversal?

Retrograde

83

Mild aortic regurg is seen as what in Doppler?

As an incomplete spectral trace.

84

Etiology for PI?

Primary valve disease
Pul HTN
Carcinoid

85

Some physical signs of PI?

Low pitched diastolic murmur may increase w inspiration.
W pul HTN a high pitched blowing diastolic murmur (graham Steele) may be heard.

86

A pt comes to the echo lab w decreased co, cp, syncope, and a possible cerebral infarct. What is the most likely diagnosis?

AS

87

MV prolapse is seen best in which view?

PlAX

88

What would you typically expect to see on mmode of an 14 y/o w a bicuspid ao valve?

Eccentric closure. On mmode you can usually see eccentric closure of the aortic leaflets where they are not on the middle of the aorta.

89

Pts w Marfan syndrome typically die from what?

AO dissection. These pts develop dilated aortic roots and commonly for from AO dissection

90

MR in pts w rheumatic MS is most likely due to?

LA enlargement. In pts w rheumatic ms as the LA dilates they can get increasing amounts of mr as the annulus stretches.

91

Inhalation of amyl nitrate might be used to demonstrate which of the following?

Mitral valve prolapse. Since amyl is a vasodilator there is less blood returning to the heart and this might accentuate mitral valve prolapse.

92

Doppler findings in PI?

Severe PI spectral trace is not holodiastolic. (Early diastolic and nothing else)

93

How would you calculate pulmonary artery and end diastolic pressure?

Pulmonic insufficiency velocity.

94

How to calculate PAEDP?

PAEDP=RAP+EDP (4v2)
PAEDP=10+4(1.5)squared

95

Mitral regurgitation in PT's with rheumatic mitral stenosis is most likely due to:?

Left atrial enlargement

96

Which term below describes the type of aortic stenosis that originates at the sinus of valsalva and extends medially to aortic valve cusps?

Degenerative, AS starts outer edges moving inward.

97

Which of the following is the most common etiology for pulmonic stenosis?

Congenital malformations

98

All of the following physical findings on PT's with aortic regurgitation Except:?

Systolic blowing murmur

99

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

Rheumatic fever

100

All of the following are m-mode findings in rheumatic mitral stenosis Except:?

Increased E-F slope

101

Which of the following syndromes fit with aortic regurg, Ao dilatation, Ao dissection & AO aneurysms?

Marfans, a connective tissue disorder

102

Severe TR can often result in all Except:?

Pulmonary hypertension, TR does not cause pulmonary hypertension

103

All of the following are etiologies of valvular aortic stenosis Except:?

IHSS, this is hypertrophic involment

104

A common cause for right ventricular volume overload is?

Tricuspid regurgitation

105

Severe MR can often result in all of the following Except:?

Systematic hypertension

106

The development of angina, dyspnea & syncope may be advanced stages of:?

Aortic stenosis

107

Which of the following is the most common etiology for mitral stenosis?

Thematic fever

108

Which of the following are common secondary findings for mitral stenosis?

Left atrial enlargement and signs of PHTN.

109

All of the following are etiologies for aortic regurg Except:?

Pulmonary hypertension

110

When the heart has to compensate for increased afterload the ventricle responds by:?

Hypertrophy

111

Marfan syndrome is best described as:?

Connective tissue disorder

112

All of the following syndromes significantly raise the PT's risk for aortic dissection Except:?

Down syndrome

113

What is the best way to determine if severe mitral regurg is present?

Pulmonary venous flow

114

PT's with Marfan syndrome are follies by echo to check?

Changes in aortic root dimensions

115

In echo the use of the continuity equation in PT's with aortic stenosis is based on the premise that:?

Flow below the valve is equal to flow above the valve

116

With a mitral pressure 1/2 time of 230m/sec, what will present?

Severe MS

117

Etiology of valvular aortic stenosis?

Rheumatic fever

118

In PT's with moderate aortic stenosis the:?

Left ventricle systolic pressure exceeds that of the aorta

119

All of the following are physical findings in PT with aortic regurg Except:?

Systolic blowing murmur

120

Longstanding mitral stenosis may lead to which of the following?

Pulmonary hypertension

121

Myxoma's commonly are attached to which of the following?

Interatrial septum

122

Prolapse is defined as what ?

A systolic movement of one or both mitral leaflets in the LA

123

What is Marfan disease?

Congenital connective tissue disease causing aortic dilatation and MVP

124

In Marfan syndrome why does aortic dissection and mvp occur?

Decreased fibrillin

125

What is ehlers danlos disease?

Another connective tissue disease, like Marfan pts you look for mvp and dilated ao dissection

126

Severe aortic aneurysms are greater than?

5.0 cm

127

Physical sign for MVP?

Mid systolic click with or without a systolic murmur, usually a symptomatic may have fatigue dyspnea or anxiety

128

Do not diagnose prolapse from the AP4CH view!!!

Do not diagnose prolapse in the presence of large pericardial effusion!!! Pe can cause pseudo

129

With MVP what are the jet directions of the MR?

Posterior leaflet prolapse results in an anteriorly directed jet and anterior leaflet prolapse in a posteriorly directed jet

130

Etiology of PI?

Due to a primary valve disease such as stenosis and endocarditis, PHTN, carcinoid heart disease

131

What is the most common valvular abnormality associated w carcinoid syndrome?

TR

132

What is CVP?

Central venous pressure - refers to the IVC pressure close to the RA

133

What type of valve is a st. Jude?

Bi-disk

134

Thickened tricuspid leaflets which are fixed in the open position might mean that the patient has which of the following problems?

Carcinoid heart disease

135

A patient with marfans syndrome might have which of the following common cardiac abnormalities?

Mitral valve prolapse and aortic dissection, these are common findings

136

A patient has a blood pressure of 130/80 and a VSD jet of 5 m/s. What is their right ventricular systolic pressure?

30 mmhg