Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MIDS 247 > Ch 2 MV Stenosis > Flashcards

Ch 2 MV Stenosis Flashcards

1
Q

What is the cause/etiology of MV stenosis?

A

-M/c due to rheumatic disease!!!
-May result from congenital (very rare) + acquired conditions

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

List 3 conditions that may cause congenital MV stenosis?

A

-Cor triatriatum
-Supravalvular MV ring
-Parachute MV

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

List 4 non-rheumatic acquired causes of MV stenosis?

A

-Lupus erythematosus
-Carcinoid
-Rheumatoid arthritis
-Age related degenerative MV annular calcifications (m/c)

(all rare except the last point)

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

What is becoming the leading cause of acquired MV stenosis in developed countries?

A

Age related degenerative MV annular calcifications

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

What is MAC?

A

Mitral annular calcification (m/c affects posterior annulus)

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

MAC often occurs in pt’s with what?

A

-Fibroelastic deficiency of MV
-Systemic hypertension
-Metabolic diseases (diabetes, renal dialysis, hypercalcemia)

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

List what mild, moderate + severe is with MAC?

A

Mild: < 1/3
Moderate: up to 2/3
Severe: > 2/3

(assessed in PSAX MV)

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

Rheumatic MV stenosis is characterized by what 2 features on a 2D echo?

A

-Commissural fusion
-Bowing/doming of MV leaflets in diastole

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

List other features of rheumatic MV stenosis?

A

-Base + mid sections of leaflets move towards the ventricular apex
-Restriction in motion of leaflet tips (fusion of the ant + post leaflets along the med + lat commissures)

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

Clinical manifestations of rheumatic MV stenosis are due to what?

A

-Progressive decrease in MV area
-This causes a high risk for pt’s to develop a-fib + clot formation in the LA + LAA (systemic thromboembolism)

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

List pathologic changes due to the narrowing of the MV orifice?

A

-Increased LAP
-Pulmonary edema
-Pulmonary hypertension
-Right ventricular hypertrophy + dilation
-Secondary TV regurg
-Right heart failure

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

List 4 symptoms of MV stenosis?

A

-Dyspnea (at rest or on exertion, due to pulmonary congestion from elevated LAP)

-Fatigue (decreased CO, aggravated by a-fib)

-Right heart failure (secondary due to pulmonary hypertension)

-Palpitations (from a-fib)

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

What is the role of echo with MV stenosis?

A

-Determine cause of lesion (rheumatic, congenital, other causes of LV inflow obstruction)

-Score MV (to determine suitability for balloon valvuloplasty)

-Assess LA (size, presence/absence of thrombus)

-Estimate severity of stenosis (mild, moderate, severe)

-Assessment of RVSP

-Check for associated valve lesions

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

List key findings in 2D with rheumatic MV stenosis?

A

-Doming of the anterior MV leaflet due to commissural fusion (hockey stick appearance!)
-Chordal thickening + fusion
-LA enlargement

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

The planimetry measurement is done in what view to determine MV orifice area?

A

PSAX MV level (zoomed in)

(must scan from base to apex to identify the smallest opening/orifice)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the classic appearance of the anterior MV leaflet with MV stenosis?

A

Hockey stick

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

The flatter the E-F slope on a MV m-mode tracing, the more or less severe the MV stenosis?

A

More severe

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

A full echo evaluation of MV stenosis includes what 3 parameters?

A

-Mean diastolic transmitral pressure gradient
-MVA
-Secondary changes including measurements of relevant chamber sizes + estimation of right heart pressures

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

Pressure gradients can be calculated using what equation?

A

Simplified bernoulli equation

20
Q

How can we obtain the mean MV gradient?

A

By tracing the spectral doppler diastolic transmitral velocity envelope (meaning we trace the MS jet)

21
Q

List the MV stenosis pressure gradient ranges for mild, moderate + severe?

A

Mild: <5 mmHg
Moderate: 5-10 mmHg
Severe: > 10 mmHg

22
Q

What is pressure half-time?

A

-The time interval b/w the max early diastolic transmitral pressure gradient + the time point at which the pressure gradient is half the max value

-The smaller the orifice (MVA), the slower the rate of pressure decline b/w the LA + LV, increasing the PHT

23
Q

Is the PHT short or long in pt’s w/o significant MV stenosis? Why?

A

It is short b/c the transmitral (LA to LV) diastolic pressure gradient declines rapidly as the pressures in these 2 chambers quickly equalize

24
Q

Is the PHT short or long in pt’s with severe MV stenosis? Why?

A

It is long b/c the pressure gradient declines very slowly, which results in a long PHT

25
What is planimetry?
-Tracing done in PSAX MV level to determine where the MV orifice is smallest -Acquired on mid diastolic frame -Trace the inner edge of the black/white interface of the MV
26
3D planimetry allows for a more reliable measure of what?
MVA (mitral valve area), it is the most accurate non-invasive way to determine MVA b/c it does not rely on flow dynamics
27
List the MV area measurements for mild, moderate + severe?
Mild: > 1.5 cm^2 Moderate: 1-1.5 cm^2 Severe: < 1 cm^2
28
MS may lead to chronic LAP overload which results in what 4 things?
-LAE -Pulmonary hypertension -Right heart dilation -Functional TV regurg
29
List pitfalls in the evaluation of MS severity regarding pressure gradient?
-The intercept angle b/w MS jet + u/s beam -Beat to beat variability with a-fib -Dependence on transvalvular volume flow rate (such as exercise + co-existing MV regurg)
30
List pitfalls in the evaluation of MS severity regarding 2D/3D valve area?
-Image orientation -Tomographic plane -2D gain settings -Intraobserver + interobserver variability in planimetry of orifice -Poor acoustic access -Deformed valve anatomy after commissurotomy
31
List pitfalls in the evaluation of MS severity regarding valve area?
-Definition of Vmax + early diastolic slope -Nonlinear early diastolic velocity slope -Sinus rhythm with A-wave superimposed on early diastolic slope -Influence of coexisting AoV regurg -Changing LV + LA compliances immediately after commissurotomy
32
When should we NOT use PHT?
When there is severe aortic regurg
33
How is PHT + co-existing aortic regurg associated?
-LV filling occurs both antegrade across the MV + retrograde across the AoV -This results in a faster rise in LV diastolic pressure + causes a shorted half-time measurement -PHT method remains useful with only mild to moderate aortic regurg
34
How does MS affect the LV?
-Causes small LV with normal wall thickness + normal systolic function -Causes diastolic function to become impaired due to restriction of flow across MV -Causes dilation of LV due to co-existing AoV regurg, MV regurg or myocardial dysfunction
35
Why does MS result in LA enlargement + thrombus formation?
-Causes chronic pressure overload + leads to gradual enlargement of the LA -Causes low flow volume rate + results in stasis of blood flow + thrombus formation -LAA is a common spot for thrombus formation in the LA
36
Why does MS result in pulmonary hypertension?
-Increased LA pressure causes pulmonary venous hypertension + consequent pulmonary hypertension -Pulmonary pressures can be measured from the TR jet
37
Why does MS result in mitral regurg?
-Significant MR is a contraindication to surgical or percutaneous commissurotomy -Co existing MR elevates transmitral flow volume rates + the transmitral pressure gradient
38
List 6 consequences of MS on other cardiac chambers + structures?
-LV changes -LAE + thrombus formation -Pulmonary hypertension -MV regurg -AoV changes -TV regurg
39
Why does MS result in AoV changes?
-Stenosis + regurg will affect the AoV -Difficult to optimize CD b/c of the merging of 2 diastolic flow disturbances -Image AoV in short axis + use doppler techniques to accurately assess this valve
40
Why does MS result in TV regurg?
-Doppler patterns are similar to the MV, same quantitative methods for evaluation can be applied -Significant TV regurg is common due to pulmonary hypertension + annular dilation
41
What is a percutaneous balloon mitral commissurotomy?
-Procedure of choice for pt's with symptomatic severe MS -A catheter goes through the femoral vein + travels across the septum (transseptal puncture), guided by CT or TEE -The balloon inflates + deflates several times to widen the valve opening -The balloon deflates + is removed once the opening of the valve has been widened enough
42
How can we treat valve stenosis?
-With medications if symptoms are mild -With a balloon valvotomy or surgical valve repair/replacement when medications don't work
43
Differentiate the MV morphology in grade 1 (mild) + grade 4 (very severe)?
Grade 1: -Highly mobile valve with only leaflet tips restricted -Leaflets near normal thickness (4-5mm) -Single area of increased echo brightness -Minimal thickening just below leaflets Grade 4: -No or minimal forward movement of leaflets in diastole -Thickening of all leaflet tissue (> 8-10mm) -Extensive brightness throughout much of leaflet tissue -Extensive thickening + shortening of all chordal structures extending down to pap muscles
44
What are 2 contraindications from percutaneous MV commissurotomy?
-Must have moderate to severe MV regurg -Must have presence of LA thrombi
45
What are 2 complications from percutaneous MV commissurotomy?
-Increase in the severity of MV regurg -ASD at transseptal catheter puncture site
46
MS results in what 4 things?
-Low CO -Increased LA size -Atrial arrhythmia's -Systolic embolic events
47
With chronic MS, what 2 conditions may develop leading to RV enlargement/failure + TV regurg?
Pulmonary edema + pulmonary hypertension

MIDS 247 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions