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Fall '23 Echo > Final Exam Lecture Fall '23 > Flashcards

Final Exam Lecture Fall '23 Flashcards

1
Q

What differentiates MAC from rheumatic heart dz?

A

the leaflet tips in MAC are still thin and mobile
***if you think about it MAC really affects only the annulus, can extend to base of annulus

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2
Q

Associated complications of MAC

A

left atrial enlargement
left ventricular enlargement
mitral regurg
mitral stenosis

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3
Q

(predisposing factors for MAC) diseases that can cause stress on the annulus by either…

A
  1. elevating LV systolic pressure (HTN, Hypertrophic cardiomyopathy, aortic stenosis)
  2. Causing abnormal mitral motion (MVP, MVR, MR)
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4
Q

2 possible causes of MAC stroke

A
  1. MAC can cause LAE, leaders to A-fib, leads to embolic event
  2. Calcific emboli from MAC lesion
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5
Q

Can MAC extend into membranous portion of IVS? true or false

A

TRUE!
can cause AV block, intraventricular block , and a-fib

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6
Q

what is a microbial infection of the membrane lining the heart

A

infective endocarditis

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7
Q

causes of infective endocarditis

A

bacterial (strep or staph)
yeast infection
fungal infection

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8
Q

perivalvular abscess as what dz advances

A

infective endocarditis…
forms along mitral and aortic rings as extensions of dz
may cause fistula

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9
Q

infective endocarditis classified as (2)

A

acute (high grade fever, heart murmur may develop in little as a week)
subacute (AKA SBE subacute bacterial endocarditis) - low-grade fever, fatigue, weight loss, cough, weakness
both are bacterial, both destroy the valve

for acute* - think… “whats acute??? well babies are a-cute. and what sound do babies make???? not “mama” but mur-mur” LOL

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10
Q

Valve destruction of veggies usually result in

A

valve regurg

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11
Q

Veggies are more common on what side of heart…

A

LEFT side
affect MV more than AoV

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12
Q

Although not as common, right-sided veggies are seen more with

A

IV drug use, indwelling catheters, pacer wires

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13
Q

Veggies can exist on all valves… true or false?
They tend to form on what side of affected valves?

A

TRUE
tend to form on low pressure side
MV and TV on atrial side
AV and PV on ventricular side

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14
Q

“healed veggies” are called such if there is no

A

no active infection
usu smaller/more echogenic (fibrosis/calcium)

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15
Q

These veggies are the largest

A

fungal

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16
Q

These veggies have NO positive blood cultures

A

fungal

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17
Q

what is the predominant clinical sign of acute infective endocarditis

A

high fever

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18
Q

Subacute Bacterial Endocarditis (aka SBE) is only accurate if

A

banter is the source of the infection

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19
Q

These will make blood cultures unreliable or impossible

A

antibiotic therapy

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20
Q

echo appearance of veggie

A

irregular shape
Can look like a diffuse focal thickening along surface of valve
Can also be pedunculate masses that are highly mobile

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21
Q

Larger veggies more at risk for embolization?

A

Yes! More likely to break off if bigger

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22
Q

Left sided heart lesions can demonstrate what (4)

A
  1. petechiae skin lesions
  2. purpuric skin lesions
  3. transient ischemic events
  4. stroke
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23
Q

right sided heart lesions can display what symptoms

A

pneumonia like symptoms

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24
Q

valve _______ from veggies usu result in valvular __________.

A

destruction, regurgitation

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25
Q

NBTE is what… it is in response to what?

A

refers to formation of platelet and fibrin thrombi on cardiac valves and adjacent endocardium in response to TRAUMA, circulating immune complexes, vasculitis, or a hypercoagulable state

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26
Q

NBTE is caused by infection… true or false?

A

FALSE!
Caused by trauma!!!!! (physical trauma ie catheter)

Can become the origin for infection

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27
Q

NBTE can become infective endocarditis? True or false

A

TRUE
can also cause emboli and impair valve function

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28
Q

Systemic Lupus or other circulating immune complexes may result in friable platelet and fibrin veggies along a valve leaflet closure aka

A

Libman Sacks lesions or endocarditis

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29
Q

Large thrombotic veggies may form on valves and produce significant emboli to the brain, kidneys, spleen, mesentery, extremities, and coronary arteries. A product of _________. These veggies tend to form on congenitally abnormal cardiac valves or those damaged by

A

Marantic Endocarditis, rheumatic fever

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30
Q

Negative blood cultures and valvular vegetations suggest what diagnosis

A

NBTE (nonbacterial thrombotic endocarditis)

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31
Q

In noninfective endocarditis, what is often needed but will have the opposite effect in infective endocarditis?

A

anticoagulant

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32
Q

Definition of mitral valve prolapse

A

protruding or buckling of one or both MV leaflets into the LA in SYSTOLE in varying degrees
extend ABOVE plane of MV annulus (>or equal to 2mm)

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33
Q

I’m a floppy valve… what am I? I also am histologically identical to what syndrome?

A

Mitral valve prolapse, identical to Marfan’s syndrome

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34
Q

What are some different names for MVP

A
  1. Degenerative MV disease
  2. Myxomatous MV disease
  3. Fibroelastic deficiency (mildest form of MVP) - older patients, loss of mechanical integrity, decreased CT production
  4. Barlow disease (most severe form of MVP) - younger patients, excess leaflet tissue
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35
Q

I’m an anorexic, thin, young, female ballet dancer. I also have Marfan’s syndrome. How’s my mitral valve?

A

probably has mitral valve prolapse!!!!!!!
*also, Ehler Danlos syndrome (hyperelastic skin/joint mobility)

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36
Q

Most common cause of MR in developed countries

A

MVP

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37
Q

Varying degree of MR can cause

A

CHF
Pulmonary HTN
Acute pulmonary edema
Bacterial endocarditis from thick leaflets
Flail MV
Ruptured chordae
Sudden death (arrhythmias)

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38
Q

Do NOT use this view for MVP

A

apical!!! MVP OVERDIAGNOSED if view is off axis
use PLAX (2D and m-mode)

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39
Q

What’s the cure for MVP

A

none… so reassure the patient!
there are treatments though…

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40
Q

I am the mitral valve. One of my chordae has ruptured. I most likely have

A

mitral valve FLAIL (instead of prolapse)

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41
Q

I affect the MV. I am uncommon, am usu associated with endocarditis, and a more common on anterior leaflet… I am

A

MV aneurysm

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42
Q

MS consists of a pressure overload of what

A

the LA, RV, and pulmonary vasculature tree

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43
Q

Most common cause of mitral stenosis worldwide?

A

rheumatic heart disease

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44
Q

3 congenital causes of mitral stenosis

A

cor triatriatum
supravalvular mitral ring
parachute mitral valve

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45
Q

these are becoming the leading cause of non rheumatic heart disease (acquired MS)

A

age related degenerative MACS

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46
Q

one can acquire mitral stenosis (non rheumatic) in many ways (6)

A

vegetations, thrombus, myxoma (other tumors)
lupus
carcinoid heart disease
rheumatoid arthritis
radiation valvulitis
MACS

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47
Q

what is parachute mitral valve (1 of 5 rare causes of what)

A

rare causes of MS
it is a congenital abnormality
only one papillary muscle or two very close together in LV and chordae of both leaflets attach to single muscle

48
Q

what is cor triatriatum

A

congenital
membrane (fibromuscular) divides LA into 2 chambers
may or may not cause obstruction

49
Q

rheumatic mitral stenosis, define. may develop after what?

A

rheumatic fever is systemic inflammatory disease (affects heart, brain, joints, skin, subcutaneous tissue)
may develop after strep

50
Q

echo hallmarks of rheumatic ms

A

affects both leaflets
leaflet thickening
leaflet calcifications
decreased leaflet mobility
commissural fusions
from tips to base (thickening)

51
Q

chronic elevation of LA pressure

A

right heart pumps harder
can go into failure over time
TR results
Rt heart failure

52
Q

M-mode of MV

A

D point: MV opens, beginning of diastole
E point: maximum excursion of valve
F point: lowest point after passive filling phase
A point: atrial contraction
C point: valve closure, systole begins

53
Q

Acute vs Chronic MR

A

Acute MR - no changes in LA or LV size/function
Chronic MR - increase in LV and LA volume (LV function can become impaired due to volume overload)

54
Q

!isolated rheumatic TV stenosis almost never occurs TRUE OR FALSE

A

TRUE! occurs only if there is rheumatic MV disease

55
Q

Carcinoid heart disease defined

A

results from presence of carcinoid tumors found mostly in GI tract
(50% of patients with carcinoid syndrome have cardiac involvement)

56
Q

what are some symptoms of carcinoid heart dz

A

facial flushing, abdominal pain, diarrhea, renal failure, hepatic failure, hepatomegaly, elevated venous pressure, systolic/diastolic murmur

57
Q

Caval index measures what

A

right atrial pressures

58
Q

congenital stenosis occurs at the _______level. what 2 kinds.

A

valvular; both below are congenital
bicuspid valve: doming of valve, fusion of raphe, balloon valvuloplasty to correct
dysplastic pulmonary valve: associated with Noonan’s syndrome, immobile cusps from thickened tissue, thickened valve tissue

59
Q

3 types of PV stenosis

A

valvular
subvalvular
supravalvular

60
Q

Pulmonary HTN is

A

an increase in pulmonary arterial pressure >30mmHg systolic

61
Q

How does the RV respond FIRST with pulmonary HTN?

A

RV responds first with hypertrophy followed by RVE, TR, PI, and RAE

62
Q

Secondary pulmonary HTN can occur due to other abnormalities or pathology taking place elsewhere, such as

A

mitral stenosis
heart failure with elevated LV end diastolic pressures
cor pulmonale (rt heart failure due to pulmonary dz)
thrombotic emoli to lungs
congenital heart dz with a lt-rt-shunt

63
Q

Pulmonary HTN M-mode appearance (right heart)

A

“Flying W”
Midsystolic closure of pulmonic valve

64
Q

Grading severity of pulmonary hypertension (right heart) method:

A

AcT/RVET ratio
place sample volume just proximal to PV in center of RVOT
measure AcT (acceleration time)
mesure RVET (right ventricular ejection time)
AcT divided by RVET

normal ratio is 0.45

65
Q

what is acceleration time a measurement of

A

measured from onset of systolic flow to peak of velocity

66
Q

Normal acceleration time for pulmonary arterial pressure in detecting pulmonary HTN is

A

greater than or equal to 120 msec

67
Q

With increasing pulmonary pressure the time required for what increases, which delays what?

A

the time required for RV pressure to exceed PA pressure increases, which delays the opening of the PV

68
Q

RVH occurs with

A

PV stenosis at subvalvular or supravalvular level
tetralogy of Fallot
chronic pulmonary HTN
mitral stenosis
Pulmonary emboli
Eisenmenger’s physiology

69
Q

Normal free wall measurement is

A

1.9 to 2.9mm

70
Q

RVVO can result from

A

INCREASED VOLUME OF BLOOD FROM EITHER WAY!!!
you either have blood increasing from to RV from RA or back flow of blood from the pulmonary system which obstructs RV blood flow from leaving

71
Q

The tunica _______ composes 80% of aortic wall

A

tunica media

72
Q

Elasticity of the AO wall does two things

A

dampening of force in systole
expulsion of stored energy in diastole

73
Q

Average diameter for the abdominal aorta is

A

2cm

74
Q

What part of the descending thoracic ao is vulnerable to traumatic injury\?

A

aortic isthmus
ao is fixed to thorax at this point

75
Q

“obstructive lesion (structural abnormality)” Ao stenosis is VERY RARE

A

supravalvular ao stenosis
it’s congenital
its a narrowing of asc ao just distal to coronary arteries

76
Q

supravalvular ao stenosis does have 3 types

A
  1. hour glass (most common) above sinuses, may be thicker cusps, assoc. w/williams syndrome, elfin faces, mental retardation, peripheral pulmonic stenosis
  2. fibrous membrane with narrow opening (aka discrete) - near sinotubular junction
  3. diffuse narrowing (hypoplasia) of descending ao aka “strand” - often involves origin of brachiocephalic arteries
77
Q

coarctation (of ao) is

A

narrowing of desc aorta near origin of ductus arteriosus; associated with other heart defects (bicuspid ao valve, MV malformations)

78
Q

2 types of subvalvular obstruction

A
  1. discrete form (barrier w/in LVOT just below AoV)
  2. tunnel type of sub aortic obstruction
79
Q

the MOST COMMON aortic abnormality is

A

aortic dilation

80
Q

asc ao dilation usu due to (4)

A

HTN
Atherosclerosis
Cystic medial necrosis
Post stenotic dilation
Marfan’s
Rheumatoid arthritis
Systemic lupus
Reiter Syndrome (type of arthritis)

81
Q

Dilation actually becomes an aneurysm when…

A

when dilation is severe, 50% bigger than it should be

82
Q

aortic aneurysm criteria (measurements):

A

is an aneurysm if:

more than 5 cm in ascending aorta
more than 4 cm in descending aorta
6 cm or higher presents higher risk for rupture

83
Q

aneurysms can be caused by (etiology)

A

atherosclerosis
Syphilis
trauma
aortic stenosis
Congenital (ao coarctation)
PDA
Aortitis

84
Q

Types of aneurysms (3)

A

dissecting
saccular (think “sack-like”)
fusiform (entire circumference, uniform dilation, think fusilli pasta)

85
Q

aneurysms can have 3 shapes

A
  1. annuloaortic: ao root, annulus, sinus of vasalva (SOV)
  2. annulus, SOV, and part of asc ao
  3. beginning at sinotubular junction, skipping the annulus and SOV
86
Q

Aortic sizes measure from a PLAX at what part of cardiac cycle?

A

end diastole

87
Q

Most common aneurysm is

A

atherosclerotic aneurysm
25% are thoracic
rest are abdominal aneurysms

88
Q

symptoms of aneurysms

A

wheezing
cough
dyspnea
hemoptysis (esophagus compression)
hoarseness (laryngeal nerve compression)
dysphagia

89
Q

the gold standard in diagnosing aneurysm is

A

angiography… but even they can STILL MISS if aneurysm is layered with thrombus

90
Q

complications of
LSOVA
NCSOVA
RSOVA

A

THE MOST COMPLICATIONS OCCUR IN the RIGHT!!!!

LSOVA
1. LA/RA rupture
2. cause LA compression

NCSOVA
1. may rupture into LA, RA, LV, or ventricular septum

RSOVA
1. may rupture into RA, RV, or adjacent main pulmonary artery
2. can cause RVOT obstruction
3. May result in RCA dissection or compression and acute MI
4. May compress conduction system and cause heart block
5. may rupture into pericardium and cause tamponade

91
Q

What is aortitis

A

general term that refers to a broad group of conditions which causes inflammation of aortic wall

infectious or not
radiation induced
idiopathic

92
Q

acute aortic syndrome

A

several life threatening entities overlap

93
Q

aortic dissection what is

A

catastrophic event initiated by a sudden tear of intimacy and resulting cleaving of media
column of blood enters aortic wall and destroys the media while stripping the intimate from adventitia
classified by location

94
Q

Ao Dissection classified by location…. two names… what are they… describe the locations

A

Standford classification:
Type A: asc aorta (tamponade most common cause of death)
Type B: all as long asc ao not included

Debakey classification
Type 1: ascending, transverse, descending ao involved (70%)
Type 2: ascending ao, stops proximal to brachiocephalic
Type 3: descending ao and may extend into abd ao

95
Q

Ao dissection causes

A

HTN
atherosclerosis
Marfan’s
aging
pregnancy
trauma
iatrogenic injury
inflammatory dz
cocaine use
renal dz
strenuous physical exercise

96
Q

patient symptoms of ao dissection

A

excrutiating pain
severe at onset
radiate in path of dissection
clammy (acute)
shock
hypertensive or hypotensive

97
Q

In dissection, contrast agents opacify the _______ lumen FIRST.

A

TRUE

98
Q

trauma normally occurs with

A

high speed deceleration injuries from MVA

99
Q

bioprosthetic valve is

A

heterograft, xenograft, stented, scentless, homograft, autograft
*as long as it comes from live tissue

100
Q

valve of choice for TV and PV is

A

bioprosthetic valve

101
Q

porcine valve comes from what animal

A

“P” for pig

102
Q

Ross procedure is

A

pulmonary AUTOGRAFT

103
Q

Valved conduit is used to repair

A

congenital heart disease (done in kids/young adults, GROWS WITH PATIENT!)

104
Q

least stenotic mechanical prosthetic valve

A

St Jude
3 orifices
(think, st Jude… 3… the trinity…) 3 peaks, 3 orifices

105
Q

Most common ball and cage valve is

A

Starr Edwards

106
Q

Classic type of mitral ring and tricuspid ring is

A

CARPENTIER EDWARDS

107
Q

Most common tilting disc valve is

A

Bjork Shiley and Medtronic Hall
2 orifices

108
Q

the higher the pressure in the pulmonary artery, the higher the

A

RVSP
elevated pressure in the pulmonary artery can lead to pulmonary artery HTN, so it must be monitored

109
Q

RVSP is a good estimate of

A

pulmonary artery pressure

110
Q

RVSP equation is

A

4(Vsquared) + RAP
RAP obtained from caval index

TR is the max velocity jet or (V) in the equation

111
Q

RAP or right atrial pressure is determined by

A

caval index

112
Q

in the absence of RVOT obstruction, RSVP actually =

A

SPAP

113
Q

Cutoff for a normal RVSP is

A

35 mmHg

40-50 mild
>50 moderate
>60 severe

114
Q

Both deep vein thrombosis (DVT) and pulmonary embolism fall under what category of dz

A

thromboembolic dz

115
Q

When putting information in The Bernoulli equation, you need to look and see if the value of the Pressure gradient needs to be adjusted value-wise… for example

A

change 291 cm/s to m/s… so it would be 2.91 m/s instead for Vmax… THEN plug into Bernoulli equation

116
Q

Flattening of the EF slope and/or decreased/absent A wave indicates

A

Mitral stenosis

Fall '23 Echo (19 decks)

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