Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Echo 2 > C8: Mitral Stenosis > Flashcards

C8: Mitral Stenosis Flashcards

1
Q

define MS

A

incomplete opening of the MV during diastole w/ thickened MV leaflets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

which valve does rheumatic fever effect first

A

MV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 layers of the MV leaflets

describe them

A

from ventricle side to atrial side:

fibrosa: provides structural support and stiffness when valve is closed
spongiosa: provides flexibility, contains less dense tissue
atrialis: smooth layer composed of endocardial cells that line the whole atria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which MV leaflet is more complex

how

A

AML, one layer extends mediallu towards the AV to form the aorto-mitral curtain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

do both MV leaflets cover the same area of the valve orifice

A

yes, approx…. AML is longer and occupies up 1/3 of the MV annulus, PML is shorter and occupies 2/3 of MV annulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how are the MV scallops labeled

A

lateral to medial, 1-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

which MV leaflet is more susceptible to MAC

A

PML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

3 functions of chordae tendinae

how many are there

A

anchoring the valve
maintain ventricular geometry
prevent prolapse during systole

120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

main function of pap muscles

A

contract during systole to hold the valve closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

describe the position and structure of the PM pap muscle

A

on the inferior wall of the LV (seen from PSAX adjacent to the septum)

has 2 bodies that trifurcate into 3 heads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

blood supply for PM pap muscle

A

posterior descending A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

describe the position and structure of the AL pap muscle

A

on the anterolateral wall of the LV (seen from PSAX near LV free wall)

had 1 body that bifurcated into 2 heads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

blood supply for AL pap muscle

A

left anterior descending A and circumflex A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

which pap muscle is more susceptible to complications from ischemia or infarction

A

PM pap muscle because it only has 1 artery supplying it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

4 etiologies on MS

A
  1. rheumatic fever
  2. degenerative (MAC)
  3. congenital
  4. masses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

describe how rheumatic fever causes MS

A

inflammation causes swelling and then scarring of the leaflets, starts at the leaflet tips… will eventually lead to calcifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how are the commissures effected w/ rheumatic MS

chordae?

A
  • theyre thickened and fibrosed

- matted and shortened (think rheu’matted’ fever)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

characteristic appearance of MV w/ rheumatic MS

A

fish mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

describe how degeneration (MAC) causes MS

A

calcification of the MV annulus that usually starts at the posterior basal annulus and progresses inwards to the leaflets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

which area of the MV is usually spared w/ MAC

A

leaflet tips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MAC is associated w/ which conditions

A 
HTN
diabetes
hypercalcemia
age
Marfan's syndrome
renal dialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

describe the congenital causes of MS

A

usually involves subvalvular apparatus like a single pap muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

term for a single pap muscle

A

parachute MV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what types of masses may cause MS

A

large MV vegetation from bacterial endocarditis

large LA myxoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

describe the pathophysiology of MS in the heart

A

reduce opening of MV leads to increased LA pressure, this increases PV, lung and PA pressure and evetually increases RVSP and RA press which leads to TR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

describe the pathophysiology of MS in body

A

increase RH press leads to increase venous press w/ hepatomegaly, pedal edema, sometimes distended JVs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

which arrhythmia is common w/ severe MS

A

A fib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

symptoms of MS are similar to which other condition

A

backwards HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

w/ MS, does LV and LA pressure equalize during diastasis

why

A

no, you’ll lose diastasis and will see forward flow into the LV instead

theres a smaller opening for blood to pass through so press takes longer to drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what kind of murmur is heard w/ MS

A

diastolic rumble at apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

3 symptoms of MS

A

dyspnea
reduced execise capacity (SOBOE)
fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what factors can make the symptoms of MS worse

A 
any increase in HR or CO:
fever
anemia
preg
hyperthyroidism
rapid arrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

complications of MS

A 
a fib
atrial enlargement
blood clots and thromboembolism
hempotysis
endocarditis
34
Q

what is hempotysis

A

frothy, bloody sputum in the lungs

35
Q

w/ MS would you measure the thickness of the valve leaflets

how do you do this

A

yes

zoom on the MV, scroll until valve is at maximal opening and well seen, measure both leaflets

36
Q

4 important doppler parameters to grade MS severity

A

mean trans-mitral press gradient (important) - trace VTI
MV area - measure PHT
pulmonary artery pressures
MR

also do continuity equation

37
Q

rheumatic MS 2D appearance

A

commissural fusion: leads to doming of the AML and restricts the movement of the PML

restricted motion

38
Q

whats the characteristic MV appearance of rheumatic MS

A

hockey stick

39
Q

w/ the MV have the double bump w/ MS

A

no

40
Q

norm value for MV leaflet thickness

A

1-2 mm

41
Q

characteristic of severe MAC

A

posterior shadowing in and behind the LA

42
Q

can the chordae be effected by MAC

A

yes

43
Q

another term for MAC

A

mitral sclerosis

44
Q

what is a cor triatriatum sinister

A

a perforate LA membrane that impedes flow of blood from LA to LV and causes a gradient b/w the LA and LV

45
Q

are there any symptoms unique to cor triatriatum sinister

A

no, same as other types of MS

46
Q

is the MV usually norm w/ cor triatriatum sinister

A

yes

47
Q

what does the severity of the cor triatriatum sinister depend on

A

the size of the perforation(s) in the membrane, eg. how easily blood can get through

48
Q

describe a LA myxoma

A

most common primary tumor in the heart, most are benign… often attached to the fossa ovalis w/ a peduncle/foot

49
Q

US appearance of a LA myxoma

A

globular, fine speckld appearance

50
Q

what can happen if a LA myxoma is large

A

prolapse into the MV during diastole and cause functional MS

51
Q

what is a parachute MV

associated w/ which syndrome

A

a single pap muscle that often placed too far superior in the LV

shone’s syndrome

52
Q

5 anomalies of shone’s syndrome

A 
supravalvular ring
parachute MV
subAO stenosis
bucuspid AV
Ao coarctation
53
Q

how do you do MV planimetry

is it accurate

A

zoom on the MV in PSAX and trace around the blood tissue interface

can be the most accurate method to quantify MS if done properly

54
Q

what does the accurate on MV planimetry depend on

A

ability to clearly see the orifice
tracing orifice directly at leaflet tips
gain settings
operator skill

55
Q

if you transect the MV above the leaflet tips, how will that effect MV planimetry

A

will underestimate its severity

56
Q

MS on M-mode

A

reduced excursion on MV, loss of double bump and diastasis, tracing will be brighter

57
Q

when is the only time we do colour on the MV in PSAX

A

if theres MR

58
Q

is you have MS, would your MV inflow PW be accurate for assessing diastolic dysfunction

what should you do

A

no, MS will cause the flow to be high velocity

reply on TDI tracing instead

59
Q

PW will alias over what velocity

A

2m/s

60
Q

how do we get MV mean press gradient

how does the machine calculate it

A

use CW through the MV inflow and trace the waveform…

machine will give you the mean PG by applying 4(v^2) to each point on the trace and avg the values… this is done b/w the waveform is not parabolic and the PG varies throughout diastole

61
Q

how can HR effect the MV mean press gradient value

what about preload

A

Lower HR will result in a smaller waveform for mean PG is underestimated

can be over or underestimated w/ changes in preload

62
Q

MV mean press gradient value for mild MS

severe

A

mild: < 5 mmHg
severe: >10 mmHg

63
Q

how does MS effect PHT

A

the rate of atrial emptying in slowed due to a narrowed orifice which prolongs the decline on early diastolic PG b/w the LA and LV… PHT will be prolonged

64
Q

how are MV area and PHT related

A

inversely… press fall slower w/ a more stenotic valve b/c the PG is maintained for longer

65
Q

formula for MV area

A

MV Area = 220 / PHT

66
Q

how is DT effected w/ MS

A

prolonged, press fall slower w/ a more stenotic valve b/c the PG is maintained for longer

67
Q

as MS gets more severe, how can the MV inflow A wave change

A

gets merged w/ the e wave

68
Q

how do we measure MV area w/ the continuity method

A

calculate SV through the AV/a control valve using the LVOT and LVOT VTI, then we can measure the VTI of the MV inflow and extrapolate and MV area from that

69
Q

can you use to continuity method to measure MS if you have mod-severe MR or AR

A

no, use PHT instead, or PISA, or use a different valve for the control valve

70
Q

continuity equation formula for MV area

A

MVA = (pie (r^2) x VTI) of LVOT / VTI of MV

you need LVOT diameter
LVOT PW trace
MV CW trace

71
Q

2 sources of error when calculating MV area w/ continuity equation

A

incorrect measurement of LVOT area

incorrect doppler angle

72
Q

continuity equation to measure MV area is less accurate in which conditions

when would you not use this meathod

A

significant MR, AR

ASD or other intracardiac shunt

73
Q

which method for measuring MV area is the quickest

A

PHT

74
Q

does TTE or TEE have better sensitivity for blood clots

A

TEE. TTE has high specificity but low sensitivity

75
Q

why is it important to measure RVSP w/ MS

A

it tells you how the heart in handling the MS

76
Q

can MS cause pulmonary hypertension

is it reversible

A

yes

at first, longstanding PHT causes irreversible increases and wont resolve even w/ MV surgery

77
Q

what does timing of MV surgery depend on

A

LV/LA and Rv function

78
Q

pharmacologic treatment for MS

A

beta blockers
diuretics
anticoagulation
anti-arrhythmics

you would try these before surgery

79
Q

surgical treatment for MS

A

valve repair - cant be done if the cause is calcific
balloon valvuloplasty
commissurotomy (causes regurg)

valve replacement
bioprosthetic
mechanical
percutaneous

80
Q

norm MV area

A

4-6 cm^2

81
Q

MV area for mild MS

severe

A

mild: >1.5 cm^2
severe: < 1 cm^2

same as mild/severe AS

Echo 2 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions