Know It Pt.4! Flashcards
What are primary cusp diseases that cause aortic regurg?
-stenosis
-subacute bacterial endocarditis
-ankylosing spondylitis
What is ankylosing spondylitis? And what can it cause?
Chronic joint inflammation the primarily affects the spine. This can cause aortic regurgitation.
A ___ aortic root can cause AR
Dilated
What are some reasons the aortic root may become dilated and end up causing aortic regur?
-marfans syndrome
-HTN
- Aortitits
- aneurysm
Loss of _____ caused by ____, ____, or a _____ can cause AR
Commissural support; trauma ; dissection ; or perimembrabous VSD
Which disease goes with aortic dissection?
A) Turner syndrome
B) Marfan syndrome
C) Down syndrome
D) PHTN
B
What kind of VSD can cause aortic regur?
Perimembrabous VSD
A Perimembrabous VSD causes loss of ____ which results in AR
Commissure support
What is the famous sign you will see on short axis of a sinus of Valsalva aneurysm?
Windsock appearance ( it looks like the sinus of Valsalva is bulging out)
Aortic regurgitation first causes LV ____ and then leads to LV ___
Volume overload; dilation
Is there a increased or decreased ejection fraction with long-standing aortic regurgitation?
Decreased.
What kind of arterial pulse would you hear with someone that has aortic regurgitation ?
Bounding, bisferious (bifid) pulse
What murmur is associated with aortic regurgitation?
High pitched, diastolic BLOWING murmur
left sternal border
What are some symptoms of aortic regurgitation the patient might feel?
- DOE
-Angina
-syncope
-CHF
How do you calculate pulse pressure?
Systolic BP - Diastolic BP
Aortic regurgitation has a ____pulse pressure
Wide
What does a wide pulse pressure versus a narrow pulse pressure indicate?
Wide PP = wide difference between blood pressure numbers
Narrow PP= narrow difference between blood pressure numbers
What kind of murmur would you hear in a patient with a rupture of a sinus of Valsalva aneurysm?
A) harsh systolic
B) crescendo decrescendo
C) diastolic rumble
D) continuous
D
What murmur is associated with severe aortic regurgitation??
Austin flint murmur
The Austin Flint murmur is what kind of murmur?
Rumbling diastolic murmur
The Austin Flint murmur is best heard where?
Apex
A diastolic rumbling murmur heard at the Apex most likely indicates what pathology?
Severe AR
Although a Austin Flint murmur is a good indication of severe aortic regurgitation. What can it often sound like?
Mitral stenosis murmur
With aortic regurg m-mode of the mitral valve may show ____ of the AMVL due to the ____ hitting it.
Diastolic fluttering ; AR jet
On m mode of the mitral valve in a patient that has aortic regurgitation what might you see with the anterior mitral valve leaflet
Diastolic fluttering of AMVL because AI jet is hitting AMVL
______ closure of the MV on m-mode may occurs with AI because of increased _____
Pre systolic ; Elevated LVEDP
When does a normal mitral valve close in accordance with the Ekg ?
And Where would a mitral valve close with aortic regurgitation on M mode?
Right in the middle of the QRS
MV would close early or before the QRS with AR
What two things happen with the mitral valve on m-mode in a patient with aortic regurgitation
- Diastolic fluttering of the anterior mitral valve leaflet due to AI jet hitting that leaflet.
- Pre closure of the mitral valve due to increased LVEDP closing it shut
What does M mode of premature mitral valve closure look like?
Occurs before the QRS and a wave is gone
What three things may occur with the aortic valve on m mode due to aortic regurgitation?
-diastolic fluttering of the aortic valve
-Lack of closure of the aortic valve
-pre-systolic opening of the aortic valve
Why may diastolic fluttering of the aortic valve occur with aortic regur?
Because of increase the volume and pressure of the regurgitating jet at the aortic valve
Why may the aortic valve have a lack of closure with aortic regurgitation?
Elevated LVEDP causes the AV to stay open
Why may the aortic valve pre-OPEN insistently with aortic regur?
Because of the elevated LVEDP which does not allow the aortic valve to relax and close. That LV pressure instead continues to have the AV pop open and open early
Chronic aortic regurgitation patients need serial echoes to track what?
LV changes
True or false- aortic valve or aortic root abnormalities may be present with aortic regurg
True
With aortic regurgitation, the left ventricular contractility may be ___ or ___ depending on if the regurg is acute or chronic
Hyperdyanmic ; of hypodyanmic
What modality is best for diagnosing aortic dissections?
A) chest x-ray
B)TTE
C)TEE
D) Angiogram
C) TEE
Hyper dynamic LV contractility is indicative of ___ AR
Acute
Hypo dynamic LV contractility is indicative of ___ AR
Chronic
With AR there is ____ turbulence in the LVOT
Diastolic
With AR. What might our with the blood flow within the descending aorta?
Diastolic flow reversal
Map the Regurgitant area of AR with what 2 things?
PW & color
How do you estimate LVEDP?
You get the end diastolic gradient with CW Doppler
Diastolic BP - End diastolic gradient
The formula :
Diastolic BP - End diastolic gradient
is for what?
To Determine LVEDP
What do you need for the JH/LVOT ratio work?
LVOT measurement in PLAX
&
AI JET width in PLAX (vena contracta of AI)
JH/LVOT calculation is comparable to ___ like we use for the MV
PISA
What is the JH/LVOT mild, mid & severe valves?
Mild= <25%
Mod= 25-65%
Severe =>65%
What’s the mild, mod & severe of Vena contracta AI jet?
Mild= <3mm
Mod= 3-6mm
Severe= >6mm
In what 2 views can you measure the JH/LVOT?
PLAX & PSAX
What is the formula for that will help the sonographer determine the AI jet width?
JH/LVOT
What a mild, mid & severe PHT for AR?
Mild= >500msec
Mod= 500-200msec
Severe= <200msec
A mild AR jet will will have a ____ trace of Doppler
Incomplete
The steeper the aortic regurgitate jet is, the faster the ______ which means the more ____ the AI
PHT; severe
You originally measure your LVEDP from your continuous wave. However, what is another wayyou can estimate it?
Aortic regurgitate, Doppler traces
Example of measuring LVED:
Pt. Has BP of 120/50 and end diastolic velocity is 2m/sc
How do you calculate LVEDP?
Put the velocity of 2 into the brenoulli equation
Then you subtract that diastolic BP from answer to Bernoulli equation
What 2 primary valve diseases cause pulmonary regurgitation?
Stenosis and endocarditis
What 3 things cause pulmonary regurgitation?
-PHTN
-carcinoid heart disease
-Stenosis,endocarditis
True or false-trivial to mild pulmonary regurgitation is normal
True
Pulmonary regurgitation May 1st lead to RV _____ and then it will lead to RV _____
Volume overload; dilation
Severe pulmonary regurgitation may cause overall?
Right heart failure
True or false- Even moderate pulmonary regurgitation can not be well tolerated for years
False! It can very much be well tolerated for years
What is the murmur for pulmonary regurgitation?
Low pitched diastolic murmur LSB
What is the murmur for pulmonary hypertension and what’s it called?
High-pitched blowing diastolic murmur LSB
GRAHAM STEELE
Freebie
What does a Graham Steele murmur sound like?
What pathology is it a sign of?
High-pitched blowing diastolic murmur
It is a sign of pulmonary hypertension
True or false-it is very common for pulmonary regurgitation to cause tricuspid valve fluttering due to volume overload in the RV
False. It’s rare
With pulmonary regurgitation RV dilation is with a displacement of the LV septum. _____
Posteriorly
There is usually ____ turbulence within the RVOT with pulmonary regur
Diastolic
How do you calculate pulmonary artery end diastolic pressure?
A) tricuspid, peak velocity
B) pulmonic regurgitation velocity
C) tricuspid regurgitation velocity
D) pulmonic peak velocity
B
How do you calculate pulmonary artery end diastolic pressure when they give you a right atrial pressure and a EDV?
Ex: patient has a RAP of 8 mmHg
and a EDV of 2.7m/sec
What’s the PAEDP?
1st. Convert the EDV to mmhg by using the modified Bernoulli (29.16)
- Then put add the RAP to what you go in the modified Bernoulli (8 + 29.16) RAP + EDV
- You add & get ur PAEDP ( 37mmhg)
What is the formula for calculating PAEDP with a RAP?
RAP + EDV
What are some pulmonary valve abnormalities that caused tricuspid regurgitation?
-rheumatic stenosis
-prolapse
-endocarditis
-Carcinoid heart disease
With the tricuspid regurgitation, there is an elevated _____ pressure
Pulmonary
Annulus ____ or ____ can cause tricuspid regurgitation
Dilation or calcification
What congenital valve abnormality may cause tricuspid regurgitation?
Epstein’s
Tricuspid Regurgitation first leads to RA ____ then leads to RA ____
Volume overload ; Dilation
What murmur is associated with tricuspid regur?
Holosystolic murmur that may increase with inspiration
______ _____ distention occurs with TR
Jugular vein
_______ of IVC may be seen with TR
Dilation
What is the most common valvular problem associated with carcinoid syndrome?
A) tricuspid stenosis
B) mitral stenosis
C) tricuspid regurgitation
D) mitral regurgitation
C) TR
What’s is CVP?
Central Venous pressure
CVP refers to ____ pressure close to the ____
IVC ; RA
What refers to the IVC pressure close to the right atrium?
CVP
What are the 3 values we can give for RAP and describe them
3mmhg -normal IVC and collapses with sniff
8mmhg - moderate. Dilated IVC collapses <20%
15mmhg- Severe- dialated IVC >2.1cm & doesn’t collapse %50
With Tricuspid regurgitation there is _____ turbulence in the RA
Systolic
What’s the formula for measuring RVSP?
TR gradient + RA pressure estimation
_____ of flow in ___ veins may be seen with severe TR
Reversal; hepatic
When severe TR you should Doppler the ____ veins with a _____
Hepatic ; respirometer
What spectral Doppler regur shape is seen with severe TR?
Triangle shape with severe TR Doppler
If there is no Pulmonic stenosis the RVSP should equal the?
PAP
