Know It Pt.3! Flashcards
What is the most common cause of pulmonic stenosis?
Congenital
What is the most rare and unlikely cause of pulmonic stenosis?
Rheumatic fever
Is carcinoid heart disease, a cause for pulmonic stenosis
Yes
What is carcinoid heart disease?
A tumor that is secreting high levels of serotonin.
This can cause congestive heart failure, affect the valves and cause right sided failure
What other things can cause pulmonic stenosis?
-Pulmonic stenosis of Peripheral junction of the right and left pulmonary arteries
-Infundibular(Subvalvular)
-Prosthetic valve dysfunction
Infundibular just means?
Subvalvular
What is Noonan syndrome?
A cardio facial genetic syndrome that causes heart problems, short facial features, and other issues
What disease is classified as a genetic cardio facial syndrome?
Noonan syndrome
Noonan syndrome is classified with what three cardiac things?
Pulmonic stenosis
HCM
ASD (30%)
What percentage of patients with Noonan -syndrome have an ASD
30 %
With pulmonic stenosis, what secondary issues occur
Systolic pressure overload leads to RVH
Regional hypertrophy may lead to?
Infundibular stenosis
With Pulmonic stenosis the ___ chamber usually remains normal and it’s the ____ chamber that will enlarge
RV ; RA
What is a big physical symptom of pulmonic stenosis?
Dyspnea on exertion
What is the murmur for pulmonic stenosis?
Systolic ejection murmur -left upper sternal border
With pulmonic stenosis m-mode may show an increase in what?
Increase in the a dip
What is pulmonic stenosis What occurs on m mode with the a dip?
A dip increases
If the a- dip on m mode of a pulmonic valve increases more than 7 mm. What do we consider this?
Severe PS
Describe the pulmonic valve differences on m mode between pulmonic stenosis and pulmonary hypertension
PS = increased a dip (>7mm is severe PS)
PHTN= flying “w” a dip decreases
In which direction do the pulmonic valve tether with pulmonic stenosis?
Systolic doming or tethering for PS
Pulmonic stenosis can cause post stenotic ____ of the pulmonary artery
Dilation
With infundibular pulmonic stenosis, what is narrowed
RVOT
Pulmonic stenosis does ___ cause PHTN
NOT
Pulmonic stenosis causes ___ and right side ___ it does not cause ____
CHF; dilation ;PHTN
With pulmonic stenosis what should you use to locate the level of obstruction?
Pulse wave and color
When trying to locate the level of obstruction, why would you not use continuous wave?
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
With pulmonic stenosis measure ___ & ___ gradients
Peak ; mean
What two views are best for measuring gradients for pulmonic stenosis
-RVOT PLAX
-RVOT PSAX
What is the normal normal pulmonary artery velocity?
1 m/sec
A patient has a pulmonic stenosis velocity of 5 m/s. How would you calculate getting the gradient?
You take the velocity and put it into the Berniollui equation.
Answer is 100mmhg
If you cannot obtain a pulmonic stenosis gradient from your parasternal, window, where else can you go?
Subcostal short axis
What’s is the mild, mid & severe velocity for PS?
Mild = <3
Mod= 3-4
Severe = >4
What is the mild, mid & severe PS gradients ?
Mild= <36mmhg
Mod= 36-64mmhg
Severe = > 64mmhg
True or false- phonic stenosis gradients will not vary with respiration
False
With pulmonic stenosis Doppler what other technique should you use when Dopplering?
Respirometer because pulmonic stenosis can vary with respirations
What is the most common cause of TS?
Rhuematic fever
What are two rare or unlikely causes of tricuspid stenosis?
-Congenital
-Carcinoid heart disease
Carcinoid heart disease causes what characteristic to the leaflets?
Fixed body
Rheumatic heart disease causes what characteristic to the leaflets?
Tethered (doming) leaflets tips
With tricuspid stenosis, what chamber has increased pressure and causes dilation)
RA
Rheumatic tricuspid stenosis is almost always associated with?
Mitral rheumatic stenosis
Carcinoid heart disease results from an increase in ____ production this increase in _____production causes ____ of the right heart endocardium, causing right side stenosis.
Serotonin; serotonin; fibrosis
What disease causes induced fibrosis of the right heart endocardium, causing stenosis?
Carcinoid heart disease
What organ filters out serotonin?
Lungs
Signed and symptoms of tricuspid stenosis may be masked by?
MS
What is the murmur for tricuspid stenosis?
Opening snap diastolic murmur
Does tricuspid stenosis and it’s murmur vary with respiration
Yes
Tricuspid stenosis can end of causing what three secondary issues/symptomd
RH failure
Ascites
Pulmonary edema
If a patient has tricuspid stenosis, what will the M mode of TAPSE show?
Decreased E-F slope
Reduced E because of the stenotic valves, the LV cannot fill
Why would the E wave on TAPSE be decreased with tricuspid stenosis?
because of the stenotic valves, the LV cannot fill resulting in decreased E
Incarcerate disease, the tricuspid of leaflets are thickened and may appear?
Fixed
What is the mean gradient for severe tricuspid stenosis?
> or equal to 5mmhg
What is the VTI for severe tricuspid stenosis?
> 60cm
What is the tricuspid valve area that indicates severe tricuspid stenosis?
<1cm
What is the most common cause of mitral stenosis?
Rheumatic heart disease- commissarul fusion
What congenital disease can cause mitral stenosis and is it common?
A congenital parachute mitral valve can cause a mitral stenosis, but it is a rare etiology
What is acquired mitral stenosis?
MAC
Mitral annus calcification is a ___ form of mitral stenosis
Acquired
With mitral stenosis, you have leaflet ____, ____ & chordae ____ & fusion
Thickening ; scarring ; shortening
With MS which chamber has increased pressure and dilation
LA
Long-standing mitral stenosis obstruction leads to what process?
Pulmonary hypertension
Pulmonary hypertension due to long-standing mitral stenosis obstruction causes what two chambers to enlarge?
RV & RA
True or false- mitral stenosis has an increase in cardiac output
False
Acute rheumatic fever is caused by what?
Beta hemolytic, strep
___% of people that they get acute rheumatic fever end up developing mitral stenosis
45
Acute rheumatic fever caused by ____ causes what symptoms
Beta hemolytic strep;
Polyarthritis, fever, subcutaneous nodules, carditis & rash
What is the murmur for mitral stenosis?
Low frequency, opening snap diastolic rumble
What is common with the left atrium regarding mitral stenosis?
A fib
What is hemoptysis?
Bloody sputum
What are some symptoms of CHF?
Fatigue
Orthopnea
Dyspena
Peripheral edema
Hemoptysis
What is orthopena?
Shortness of breath when lying flat
What is the famous presentation of mitral stenosis on Echo ?
Hockey stick appearance
Are the leaflet tips of the mitral valve tethered or fixed with mitral stenosis?
Tethered
With MS what is the best plan to determine severity of mitral stenosis?
PSAX with planimetry
Which cardiac valve is the second most common to be affected by rheumatic heart disease?
Aortic valve
What does the m-mode of a mitral stenosis valve look like?
It looks blocky
M-mode of mitral stenosis has a decreased?
E-F slope
Mitral stenosis patients become very symptomatic with what secondary disease process
A-fib
Mitral stenosis patients may lose up to ___% of ____ ____ since they are very dependent on ___ contraction
50% ; diastolic filling; atrial
What is the mild, mid & severe mean gradient for MS?
Mild = <5mmhg
Mod= 5-10mmhg
Severe = >10mmhg
What is the mild,mid & severe PAP for MS?
Mild = <30mmhg
Mod= 30-50mmhg
Severe = >50mmhg
Why would we measure pulmonary artery pressure for mitral stenosis? What does that tell us?
pulmonary artery pressure tells us what the LA pressure is
So this is another measurement that helps support this severity of mitral stenosis
Why would we use pressure halftime for a mitral valve Doppler in CW and/or PW?
Pleasure halftime would tell us the severity of MV area
What is the formula for pressure halftime?
220/PHT
What is the normal mitral valve area?
4-6cm
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
C)
How do you determine the maximum velocity (VMAX) for MVA with MV pressure halftime?
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
How do you calculate the MVA with the of MV pressure halftime?
You take 220 divided by your MV PHT that you got by measuring the E wave slope
A patient has a mitral valve pressure halftime of 400 m/s what is the area?
- 220÷400 (220/PHT)
Answer is 0.5cm
What is the difference in measuring MV pressure halftime versus MV Decel time
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
With MV decel time we’re measuring from?
The E wave down to the baseline
With mitral valve pressure halftime, we are measuring from?
Just the E wave (DO NOT GO ALL THE WAY DOWN TO THE BASELINE)
What mitral valve measurement measures only the peak early diastolic slope?
MV PHT
Which mitral valve measurement measures from the peak early diastolic flow all the way to the baseline?
MV DECEL TIME
If you are measuring mitral valve decel time, what is the calculation for using that to calculate mitral valve area?
759/decel time
How do you convert mitral valve deceleration time to pressure halftime?
Decel time X 0.29
A patient has a mitral valve deceleration time of 400 ms. Please calculate the pressure halftime.
The calculation to convert MV decel time to pressure halftime is: DECEL TIME X 0.29
Answer= 116
If LA pressure is higher than LV pressure in diastoleon a tracing. What does this represent?
MS
