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Extra Stuff CCI Review > Know It Pt.3! > Flashcards

Know It Pt.3! Flashcards

1
Q

What is the most common cause of pulmonic stenosis?

A

Congenital

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2
Q

What is the most rare and unlikely cause of pulmonic stenosis?

A

Rheumatic fever

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3
Q

Is carcinoid heart disease, a cause for pulmonic stenosis

A

Yes

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4
Q

What is carcinoid heart disease?

A

A tumor that is secreting high levels of serotonin.

This can cause congestive heart failure, affect the valves and cause right sided failure

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5
Q

What other things can cause pulmonic stenosis?

A

-Pulmonic stenosis of Peripheral junction of the right and left pulmonary arteries

-Infundibular(Subvalvular)

-Prosthetic valve dysfunction

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6
Q

Infundibular just means?

A

Subvalvular

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7
Q

What is Noonan syndrome?

A

A cardio facial genetic syndrome that causes heart problems, short facial features, and other issues

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8
Q

What disease is classified as a genetic cardio facial syndrome?

A

Noonan syndrome

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9
Q

Noonan syndrome is classified with what three cardiac things?

A

Pulmonic stenosis
HCM
ASD (30%)

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10
Q

What percentage of patients with Noonan -syndrome have an ASD

A

30 %

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11
Q

With pulmonic stenosis, what secondary issues occur

A

Systolic pressure overload leads to RVH

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12
Q

Regional hypertrophy may lead to?

A

Infundibular stenosis

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13
Q

With Pulmonic stenosis the ___ chamber usually remains normal and it’s the ____ chamber that will enlarge

A

RV ; RA

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14
Q

What is a big physical symptom of pulmonic stenosis?

A

Dyspnea on exertion

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15
Q

What is the murmur for pulmonic stenosis?

A

Systolic ejection murmur -left upper sternal border

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16
Q

With pulmonic stenosis m-mode may show an increase in what?

A

Increase in the a dip

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17
Q

What is pulmonic stenosis What occurs on m mode with the a dip?

A

A dip increases

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18
Q

If the a- dip on m mode of a pulmonic valve increases more than 7 mm. What do we consider this?

A

Severe PS

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19
Q

Describe the pulmonic valve differences on m mode between pulmonic stenosis and pulmonary hypertension

A

PS = increased a dip (>7mm is severe PS)

PHTN= flying “w” a dip decreases

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20
Q

In which direction do the pulmonic valve tether with pulmonic stenosis?

A

Systolic doming or tethering for PS

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21
Q

Pulmonic stenosis can cause post stenotic ____ of the pulmonary artery

A

Dilation

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22
Q

With infundibular pulmonic stenosis, what is narrowed

A

RVOT

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23
Q

Pulmonic stenosis does ___ cause PHTN

A

NOT

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24
Q

Pulmonic stenosis causes ___ and right side ___ it does not cause ____

A

CHF; dilation ;PHTN

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25
Q

With pulmonic stenosis what should you use to locate the level of obstruction?

A

Pulse wave and color

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26
Q

When trying to locate the level of obstruction, why would you not use continuous wave?

A

Because continuous waves is going to pick up all velocities and we are looking for a very specific area, which is why we use pulse wave

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27
Q

With pulmonic stenosis measure ___ & ___ gradients

A

Peak ; mean

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28
Q

What two views are best for measuring gradients for pulmonic stenosis

A

-RVOT PLAX

-RVOT PSAX

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29
Q

What is the normal normal pulmonary artery velocity?

A

1 m/sec

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30
Q

A patient has a pulmonic stenosis velocity of 5 m/s. How would you calculate getting the gradient?

A

You take the velocity and put it into the Berniollui equation.

Answer is 100mmhg

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31
Q

If you cannot obtain a pulmonic stenosis gradient from your parasternal, window, where else can you go?

A

Subcostal short axis

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32
Q

What’s is the mild, mid & severe velocity for PS?

A

Mild = <3
Mod= 3-4
Severe = >4

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33
Q

What is the mild, mid & severe PS gradients ?

A

Mild= <36mmhg
Mod= 36-64mmhg
Severe = > 64mmhg

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34
Q

True or false- phonic stenosis gradients will not vary with respiration

A

False

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35
Q

With pulmonic stenosis Doppler what other technique should you use when Dopplering?

A

Respirometer because pulmonic stenosis can vary with respirations

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36
Q

What is the most common cause of TS?

A

Rhuematic fever

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37
Q

What are two rare or unlikely causes of tricuspid stenosis?

A

-Congenital
-Carcinoid heart disease

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38
Q

Carcinoid heart disease causes what characteristic to the leaflets?

A

Fixed body

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39
Q

Rheumatic heart disease causes what characteristic to the leaflets?

A

Tethered (doming) leaflets tips

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40
Q

With tricuspid stenosis, what chamber has increased pressure and causes dilation)

A

RA

41
Q

Rheumatic tricuspid stenosis is almost always associated with?

A

Mitral rheumatic stenosis

42
Q

Carcinoid heart disease results from an increase in ____ production this increase in _____production causes ____ of the right heart endocardium, causing right side stenosis.

A

Serotonin; serotonin; fibrosis

43
Q

What disease causes induced fibrosis of the right heart endocardium, causing stenosis?

A

Carcinoid heart disease

44
Q

What organ filters out serotonin?

A

Lungs

45
Q

Signed and symptoms of tricuspid stenosis may be masked by?

A

MS

46
Q

What is the murmur for tricuspid stenosis?

A

Opening snap diastolic murmur

47
Q

Does tricuspid stenosis and it’s murmur vary with respiration

A

Yes

48
Q

Tricuspid stenosis can end of causing what three secondary issues/symptomd

A

RH failure
Ascites
Pulmonary edema

49
Q

If a patient has tricuspid stenosis, what will the M mode of TAPSE show?

A

Decreased E-F slope

Reduced E because of the stenotic valves, the LV cannot fill

50
Q

Why would the E wave on TAPSE be decreased with tricuspid stenosis?

A

because of the stenotic valves, the LV cannot fill resulting in decreased E

51
Q

Incarcerate disease, the tricuspid of leaflets are thickened and may appear?

A

Fixed

52
Q

What is the mean gradient for severe tricuspid stenosis?

A

> or equal to 5mmhg

53
Q

What is the VTI for severe tricuspid stenosis?

A

> 60cm

54
Q

What is the tricuspid valve area that indicates severe tricuspid stenosis?

A

<1cm

55
Q

What is the most common cause of mitral stenosis?

A

Rheumatic heart disease- commissarul fusion

56
Q

What congenital disease can cause mitral stenosis and is it common?

A

A congenital parachute mitral valve can cause a mitral stenosis, but it is a rare etiology

57
Q

What is acquired mitral stenosis?

A

MAC

58
Q

Mitral annus calcification is a ___ form of mitral stenosis

A

Acquired

59
Q

With mitral stenosis, you have leaflet ____, ____ & chordae ____ & fusion

A

Thickening ; scarring ; shortening

60
Q

With MS which chamber has increased pressure and dilation

A

LA

61
Q

Long-standing mitral stenosis obstruction leads to what process?

A

Pulmonary hypertension

62
Q

Pulmonary hypertension due to long-standing mitral stenosis obstruction causes what two chambers to enlarge?

A

RV & RA

63
Q

True or false- mitral stenosis has an increase in cardiac output

A

False

64
Q

Acute rheumatic fever is caused by what?

A

Beta hemolytic, strep

65
Q

___% of people that they get acute rheumatic fever end up developing mitral stenosis

A

45

66
Q

Acute rheumatic fever caused by ____ causes what symptoms

A

Beta hemolytic strep;

Polyarthritis, fever, subcutaneous nodules, carditis & rash

67
Q

What is the murmur for mitral stenosis?

A

Low frequency, opening snap diastolic rumble

68
Q

What is common with the left atrium regarding mitral stenosis?

A

A fib

69
Q

What is hemoptysis?

A

Bloody sputum

70
Q

What are some symptoms of CHF?

A

Fatigue
Orthopnea
Dyspena
Peripheral edema
Hemoptysis

71
Q

What is orthopena?

A

Shortness of breath when lying flat

72
Q

What is the famous presentation of mitral stenosis on Echo ?

A

Hockey stick appearance

73
Q

Are the leaflet tips of the mitral valve tethered or fixed with mitral stenosis?

A

Tethered

74
Q

With MS what is the best plan to determine severity of mitral stenosis?

A

PSAX with planimetry

75
Q

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

A

Aortic valve

76
Q

What does the m-mode of a mitral stenosis valve look like?

A

It looks blocky

77
Q

M-mode of mitral stenosis has a decreased?

A

E-F slope

78
Q

Mitral stenosis patients become very symptomatic with what secondary disease process

A

A-fib

79
Q

Mitral stenosis patients may lose up to ___% of ____ ____ since they are very dependent on ___ contraction

A

50% ; diastolic filling; atrial

80
Q

What is the mild, mid & severe mean gradient for MS?

A

Mild = <5mmhg
Mod= 5-10mmhg
Severe = >10mmhg

81
Q

What is the mild,mid & severe PAP for MS?

A

Mild = <30mmhg
Mod= 30-50mmhg
Severe = >50mmhg

82
Q

Why would we measure pulmonary artery pressure for mitral stenosis? What does that tell us?

A

pulmonary artery pressure tells us what the LA pressure is

So this is another measurement that helps support this severity of mitral stenosis

83
Q

Why would we use pressure halftime for a mitral valve Doppler in CW and/or PW?

A

Pleasure halftime would tell us the severity of MV area

84
Q

What is the formula for pressure halftime?

A

220/PHT

85
Q

What is the normal mitral valve area?

A

4-6cm

86
Q

With atrial fibrillation mitral stenosis velocity calculations are best performed?

A) unable to measure in a fib
B) averaged over 20 beats
C) averaged over 5 to 10 beats
D) averaged over two beats

A

C)

87
Q

How do you determine the maximum velocity (VMAX) for MVA with MV pressure halftime?

A

Draw a line at the end diastolic slope ignoring the a wave and any valve clicks

This slope at the E wave tells us pressure halftime and from this we can get the MVA

88
Q

How do you calculate the MVA with the of MV pressure halftime?

A

You take 220 divided by your MV PHT that you got by measuring the E wave slope

89
Q

A patient has a mitral valve pressure halftime of 400 m/s what is the area?

A
  1. 220÷400 (220/PHT)

Answer is 0.5cm

90
Q

What is the difference in measuring MV pressure halftime versus MV Decel time

A

With MV PHT - we are measuring just the E wave and are NOT going all the way down to the baseline

With MV Decel time - we measured at the end all the way down to the baseline

91
Q

With MV decel time we’re measuring from?

A

The E wave down to the baseline

92
Q

With mitral valve pressure halftime, we are measuring from?

A

Just the E wave (DO NOT GO ALL THE WAY DOWN TO THE BASELINE)

93
Q

What mitral valve measurement measures only the peak early diastolic slope?

A

MV PHT

94
Q

Which mitral valve measurement measures from the peak early diastolic flow all the way to the baseline?

A

MV DECEL TIME

95
Q

If you are measuring mitral valve decel time, what is the calculation for using that to calculate mitral valve area?

A

759/decel time

96
Q

How do you convert mitral valve deceleration time to pressure halftime?

A

Decel time X 0.29

97
Q

A patient has a mitral valve deceleration time of 400 ms. Please calculate the pressure halftime.

A

The calculation to convert MV decel time to pressure halftime is: DECEL TIME X 0.29

Answer= 116

98
Q

If LA pressure is higher than LV pressure in diastoleon a tracing. What does this represent?

A

MS

Extra Stuff CCI Review (18 decks)

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