Brainscape's Knowledge GenomeTM

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


See full index

Valvular Heart Disease > Comprehensive Assessment of Primary Mitral Valve Disease > Flashcards

Comprehensive Assessment of Primary Mitral Valve Disease Flashcards

1
Q

What does primary mitral valve disease encompass?

A

Entities where disease of the valve itself causes pathophysiology leading to clinical impairment.

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

What are the two main types of primary mitral valve disease?

A

Mitral regurgitation (MR) and mitral stenosis (MS).

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

What has significantly improved the diagnosis of mitral valve pathology?

A

Advances in echocardiography, particularly 3D echocardiography.

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

Does medical therapy currently improve the natural history of primary MR?

A

No, there is currently no medical therapy that improves the natural history of primary MR.

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

What has improved in the surgical management of primary MR?

A

Better repair techniques have decreased operative mortality and improved durability.

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

What is a common cause of acute mitral regurgitation?

A

Disruption of the mitral apparatus, such as a perforated leaflet or torn chord.

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

What are the typical symptoms of acute MR?

A

Pulmonary edema, respiratory distress, hypotension, and shock.

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

What auscultation finding is key to diagnosing all valvular disease?

A

A typical murmur on physical examination.

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

What murmur is often associated with myxomatous degeneration of the mitral valve?

A

A mid-systolic click followed by a late systolic murmur.

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

How does chronic primary MR typically progress?

A

Slowly over many years, with symptoms developing insidiously.

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

What is the most common cause of symptomatic mitral stenosis?

A

Rheumatic carditis.

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

What is Ortners syndrome?

A

Hoarseness caused by extreme left atrial enlargement impinging on the left recurrent laryngeal nerve.

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

What is the typical auscultatory finding in mitral stenosis?

A

A soft diastolic rumble heard best in the left lateral decubitus position.

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

What does Stage A in the classification of primary MR indicate?

A

Patients at risk of MR.

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

What distinguishes primary MR from secondary MR?

A

Primary MR is a disease of the valve itself, whereas secondary MR is due to left ventricular disease.

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

What is the Carpentier classification used for?

A

To classify types of mitral valve pathologies.

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

What characterizes Type II in the Carpentier classification?

A

Leaflet prolapse.

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

What is a common imaging test for evaluating mitral regurgitation?

A

Two-Dimensional Transthoracic Echocardiography (TTE).

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

What is the definition of Stage D in the classification of primary MR?

A

Symptomatic severe MR.

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

What are the hemodynamic consequences of severe mitral regurgitation?

A

Moderate or severe left atrial enlargement, left ventricular enlargement, and pulmonary hypertension.

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

Fill in the blank: The typical murmur of mitral stenosis is a _______.

A

soft diastolic rumble.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

True or False: Secondary MR can be cured by treating the mitral regurgitation alone.

A

False.

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

What physiological states can precipitate or worsen symptoms in mitral stenosis?

A

Exercise, pregnancy, fever, hyperthyroidism, atrial arrhythmia.

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

What is the significance of the interval history between S2 and OS in mitral stenosis?

A

It is a good guide to MS severity.

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

What is degenerative/myxomatous mitral valve disease?

A

A condition characterized by degeneration of the mitral valve leading to regurgitation.

26
Q

What is the Carpentier classification of mitral valve regurgitation?

A

A classification system that includes three types:
* Type I: Normal leaflet motion with annular dilation or leaflet perforation
* Type II: Leaflet prolapse
* Type III: Leaflet restriction, further divided into IIIa (restricted opening) and IIIb (restricted closing).

27
Q

How is primary mitral regurgitation diagnosed using transthoracic echocardiography (TTE)?

A

Diagnosis is made when mitral leaflets are displaced >2 mm into the left atrium during systole in the parasternal long view.

28
Q

What does TTE assess in mitral regurgitation?

A

TTE assesses:
* Scallop anatomy
* Leaflet tethering
* Extent of mitral annular calcification
* Left atrial and left ventricular size
* Left ventricular function
* Pulmonary artery pressures.

29
Q

What is the role of 2D transesophageal echocardiography (TEE) in evaluating mitral valve pathology?

A

2D TEE provides important anatomical information and helps visualize the mitral valve apparatus.

30
Q

In what view are the A2 and P2 scallops visualized using 2D TEE?

A

In the midesophageal four chamber view at 0°.

31
Q

What are the advantages of three-dimensional (3D) echocardiography over 2D echocardiography?

A

3D echocardiography offers:
* Better characterization of leaflet pathology
* Improved communication of valve anatomy
* Excellent spatial and temporal resolution.

32
Q

What is a limitation of 3D echocardiography?

A

It requires familiarity with image acquisition and manipulation; errors can lead to misinterpretation.

33
Q

What complementary roles do computed tomography (CT) and magnetic resonance imaging (MRI) play in assessing mitral regurgitation?

A

CT and MRI can help assess:
* Mitral valve anatomy
* Coronary anatomy
* Left ventricular function
* Left atrial appendage thrombus.

34
Q

How is left ventriculography used to assess mitral regurgitation severity?

A

It qualitatively classifies severity from mild (1+) to severe (4+) based on contrast opacification of the left atrium.

35
Q

What is the vena contracta method in Doppler quantitation of mitral regurgitation?

A

It assesses the size of the narrowest portion of the regurgitant jet, reflecting MR severity.

36
Q

Fill in the blank: The effective regurgitant orifice area (EROA) can be calculated using the formula EROA = ( 2 Πr² * Va ) / PkVreg, where r is the _______.

A

[radius of the hemisphere].

37
Q

What is the significance of using the proximal isovelocity surface area (PISA) method?

A

PISA helps in the quantitative assessment of MR severity based on blood flow dynamics near the regurgitant orifice.

38
Q

True or False: In patients with severe MR, the E wave velocity is usually less than 1.2 m/s.

A

False.

39
Q

What is the impact of measurement errors in the PISA radius on the EROA calculation?

A

Any error in measurement of the PISA radius will lead to a substantial error in the EROA calculation because the radius is squared in the flow convergence equation.

40
Q

What E wave velocity indicates severe mitral regurgitation (MR)?

A

E wave velocity is usually greater than 1.2 m/s in patients with severe MR.

41
Q

What mitral inflow pattern virtually excludes the presence of severe MR?

A

The presence of an A wave dominant mitral inflow pattern virtually excludes the presence of severe MR.

42
Q

How can pulsed wave Doppler be used in assessing MR?

A

It can be used to calculate the MR regurgitant volume and fraction using the continuity equation.

43
Q

What happens to forward systolic pulmonary vein flow in patients with severe MR?

A

Forward systolic pulmonary vein flow can be reversed or blunted.

44
Q

True or False: Elevated LA pressure and atrial fibrillation can cause blunted systolic flow in the pulmonary vein.

A

True

45
Q

What are common pitfalls in the echocardiographic assessment of MR severity?

A
  • Relying on color Doppler with a low Nyquist limit
  • Inadequate assessment with highly eccentric jets
  • Limitations with eccentric jet or multiple jets
  • Underestimating MR severity in TEE due to anesthesia
  • Misinterpretation of EROA
  • Failure to recognize imaging artifacts
  • Variability of mitral gradients depending on heart rate
  • Limitations of 2D TEE in diagnosing mitral clefts
  • Deceptive color Doppler assessments in acute severe MR
46
Q

What is the difference between calcific and rheumatic mitral stenosis (MS)?

A

Calcific MS involves annular calcification and is seen in elderly patients, while rheumatic MS shows commissural fusion and calcification predominating at leaflet tips.

47
Q

What is the role of continuous wave Doppler (CWD) in assessing mitral stenosis?

A

CWD should be used to assess peak and mean mitral gradients.

48
Q

What does the pressure half-time (T1/2) measure in mitral valve assessment?

A

It measures the time required for the maximum pressure gradient to decrease by half of its original value.

49
Q

Fill in the blank: The formula to calculate mitral valve area is MVA = 220 / _______.

A

T1/2

50
Q

What factors can affect the pressure half-time in mitral stenosis assessment?

A
  • Changes in LV compliance
  • Moderate or severe aortic regurgitation
51
Q

What is the purpose of transesophageal echocardiography (TEE) before balloon valvuloplasty?

A

To confirm the absence of an LA appendage thrombus and assess the degree of concomitant mitral regurgitation.

52
Q

What scoring system is used to predict outcomes of percutaneous balloon mitral valvuloplasty?

A

Wilkins score

53
Q

What is the significance of a Wilkins score of 8 or less?

A

It predicts a suitable percutaneous valvuloplasty.

54
Q

What is the primary use of invasive hemodynamics in valvular heart disease?

A

To clarify the clinical significance of mitral valve pathology when noninvasive assessments don’t correlate.

55
Q

How does severe mitral stenosis affect LA/LV diastolic gradients?

A

It produces an LA/LV diastolic gradient without diastasis.

56
Q

What is a common surrogate for left atrial pressure in invasive hemodynamic assessment?

A

Pulmonary capillary wedge pressure (PCWP)

57
Q

What can cause inaccuracies in gradient assessment using PCWP?

A

PCWP waveforms are delayed by 40–120 ms relative to the LA waveforms.

58
Q

List the strengths of 2D TTE in assessing mitral regurgitation.

A
  • Quantify MR
  • Differentiate between primary and secondary MR
  • Assess LA and LV size for MR severity
59
Q

What are the limitations of 2D TEE in assessing mitral stenosis?

A
  • Detailed assessment of scallop/leaflet anatomy may not be feasible
  • Requires an experienced echocardiographer
  • Unreliable if 2D image quality is poor
60
Q

What is the role of 3D TEE in mitral valve assessment?

A

It provides an integrated view of valve pathology and is more accurate for planimetry.

Valvular Heart Disease (13 decks)

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