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Extra Stuff CCI Review > Know It Pt.4! > Flashcards

Know It Pt.4! Flashcards

1
Q

What are primary cusp diseases that cause aortic regurg?

A

-stenosis
-subacute bacterial endocarditis
-ankylosing spondylitis

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2
Q

What is ankylosing spondylitis? And what can it cause?

A

Chronic joint inflammation the primarily affects the spine. This can cause aortic regurgitation.

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3
Q

A ___ aortic root can cause AR

A

Dilated

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4
Q

What are some reasons the aortic root may become dilated and end up causing aortic regur?

A

-marfans syndrome
-HTN
- Aortitits
- aneurysm

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5
Q

Loss of _____ caused by ____, ____, or a _____ can cause AR

A

Commissural support; trauma ; dissection ; or perimembrabous VSD

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6
Q

Which disease goes with aortic dissection?

A) Turner syndrome
B) Marfan syndrome
C) Down syndrome
D) PHTN

A

B

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7
Q

What kind of VSD can cause aortic regur?

A

Perimembrabous VSD

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8
Q

A Perimembrabous VSD causes loss of ____ which results in AR

A

Commissure support

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9
Q

What is the famous sign you will see on short axis of a sinus of Valsalva aneurysm?

A

Windsock appearance ( it looks like the sinus of Valsalva is bulging out)

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10
Q

Aortic regurgitation first causes LV ____ and then leads to LV ___

A

Volume overload; dilation

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11
Q

Is there a increased or decreased ejection fraction with long-standing aortic regurgitation?

A

Decreased.

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12
Q

What kind of arterial pulse would you hear with someone that has aortic regurgitation ?

A

Bounding, bisferious (bifid) pulse

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13
Q

What murmur is associated with aortic regurgitation?

A

High pitched, diastolic BLOWING murmur

left sternal border

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14
Q

What are some symptoms of aortic regurgitation the patient might feel?

A
  • DOE
    -Angina
    -syncope
    -CHF
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15
Q

How do you calculate pulse pressure?

A

Systolic BP - Diastolic BP

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16
Q

Aortic regurgitation has a ____pulse pressure

A

Wide

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17
Q

What does a wide pulse pressure versus a narrow pulse pressure indicate?

A

Wide PP = wide difference between blood pressure numbers

Narrow PP= narrow difference between blood pressure numbers

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18
Q

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

A

D

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19
Q

What murmur is associated with severe aortic regurgitation??

A

Austin flint murmur

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20
Q

The Austin Flint murmur is what kind of murmur?

A

Rumbling diastolic murmur

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21
Q

The Austin Flint murmur is best heard where?

A

Apex

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22
Q

A diastolic rumbling murmur heard at the Apex most likely indicates what pathology?

A

Severe AR

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23
Q

Although a Austin Flint murmur is a good indication of severe aortic regurgitation. What can it often sound like?

A

Mitral stenosis murmur

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24
Q

With aortic regurg m-mode of the mitral valve may show ____ of the AMVL due to the ____ hitting it.

A

Diastolic fluttering ; AR jet

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25
Q

On m mode of the mitral valve in a patient that has aortic regurgitation what might you see with the anterior mitral valve leaflet

A

Diastolic fluttering of AMVL because AI jet is hitting AMVL

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26
Q

______ closure of the MV on m-mode may occurs with AI because of increased _____

A

Pre systolic ; Elevated LVEDP

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27
Q

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?

A

Right in the middle of the QRS

MV would close early or before the QRS with AR

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28
Q

What two things happen with the mitral valve on m-mode in a patient with aortic regurgitation

A
  1. Diastolic fluttering of the anterior mitral valve leaflet due to AI jet hitting that leaflet.
  2. Pre closure of the mitral valve due to increased LVEDP closing it shut
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29
Q

What does M mode of premature mitral valve closure look like?

A

Occurs before the QRS and a wave is gone

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30
Q

What three things may occur with the aortic valve on m mode due to aortic regurgitation?

A

-diastolic fluttering of the aortic valve
-Lack of closure of the aortic valve
-pre-systolic opening of the aortic valve

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31
Q

Why may diastolic fluttering of the aortic valve occur with aortic regur?

A

Because of increase the volume and pressure of the regurgitating jet at the aortic valve

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32
Q

Why may the aortic valve have a lack of closure with aortic regurgitation?

A

Elevated LVEDP causes the AV to stay open

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33
Q

Why may the aortic valve pre-OPEN insistently with aortic regur?

A

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

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34
Q

Chronic aortic regurgitation patients need serial echoes to track what?

A

LV changes

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35
Q

True or false- aortic valve or aortic root abnormalities may be present with aortic regurg

A

True

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36
Q

With aortic regurgitation, the left ventricular contractility may be ___ or ___ depending on if the regurg is acute or chronic

A

Hyperdyanmic ; of hypodyanmic

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37
Q

What modality is best for diagnosing aortic dissections?

A) chest x-ray
B)TTE
C)TEE
D) Angiogram

A

C) TEE

38
Q

Hyper dynamic LV contractility is indicative of ___ AR

A

Acute

39
Q

Hypo dynamic LV contractility is indicative of ___ AR

A

Chronic

40
Q

With AR there is ____ turbulence in the LVOT

A

Diastolic

41
Q

With AR. What might our with the blood flow within the descending aorta?

A

Diastolic flow reversal

42
Q

Map the Regurgitant area of AR with what 2 things?

A

PW & color

43
Q

How do you estimate LVEDP?

A

You get the end diastolic gradient with CW Doppler

Diastolic BP - End diastolic gradient

44
Q

The formula :

Diastolic BP - End diastolic gradient

is for what?

A

To Determine LVEDP

45
Q

What do you need for the JH/LVOT ratio work?

A

LVOT measurement in PLAX
&
AI JET width in PLAX (vena contracta of AI)

46
Q

JH/LVOT calculation is comparable to ___ like we use for the MV

A

PISA

47
Q

What is the JH/LVOT mild, mid & severe valves?

A

Mild= <25%
Mod= 25-65%
Severe =>65%

48
Q

What’s the mild, mod & severe of Vena contracta AI jet?

A

Mild= <3mm
Mod= 3-6mm
Severe= >6mm

49
Q

In what 2 views can you measure the JH/LVOT?

A

PLAX & PSAX

50
Q

What is the formula for that will help the sonographer determine the AI jet width?

A

JH/LVOT

51
Q

What a mild, mid & severe PHT for AR?

A

Mild= >500msec
Mod= 500-200msec
Severe= <200msec

52
Q

A mild AR jet will will have a ____ trace of Doppler

A

Incomplete

53
Q

The steeper the aortic regurgitate jet is, the faster the ______ which means the more ____ the AI

A

PHT; severe

54
Q

You originally measure your LVEDP from your continuous wave. However, what is another wayyou can estimate it?

A

Aortic regurgitate, Doppler traces

55
Q

Example of measuring LVED:

Pt. Has BP of 120/50 and end diastolic velocity is 2m/sc

How do you calculate LVEDP?

A

Put the velocity of 2 into the brenoulli equation

Then you subtract that diastolic BP from answer to Bernoulli equation

56
Q

What 2 primary valve diseases cause pulmonary regurgitation?

A

Stenosis and endocarditis

57
Q

What 3 things cause pulmonary regurgitation?

A

-PHTN
-carcinoid heart disease
-Stenosis,endocarditis

58
Q

True or false-trivial to mild pulmonary regurgitation is normal

A

True

59
Q

Pulmonary regurgitation May 1st lead to RV _____ and then it will lead to RV _____

A

Volume overload; dilation

60
Q

Severe pulmonary regurgitation may cause overall?

A

Right heart failure

61
Q

True or false- Even moderate pulmonary regurgitation can not be well tolerated for years

A

False! It can very much be well tolerated for years

62
Q

What is the murmur for pulmonary regurgitation?

A

Low pitched diastolic murmur LSB

63
Q

What is the murmur for pulmonary hypertension and what’s it called?

A

High-pitched blowing diastolic murmur LSB

GRAHAM STEELE

64
Q

Freebie

A
65
Q

What does a Graham Steele murmur sound like?

What pathology is it a sign of?

A

High-pitched blowing diastolic murmur

It is a sign of pulmonary hypertension

66
Q

True or false-it is very common for pulmonary regurgitation to cause tricuspid valve fluttering due to volume overload in the RV

A

False. It’s rare

67
Q

With pulmonary regurgitation RV dilation is with a displacement of the LV septum. _____

A

Posteriorly

68
Q

There is usually ____ turbulence within the RVOT with pulmonary regur

A

Diastolic

69
Q

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

A

B

70
Q

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?

A

1st. Convert the EDV to mmhg by using the modified Bernoulli (29.16)

  1. Then put add the RAP to what you go in the modified Bernoulli (8 + 29.16) RAP + EDV
  2. You add & get ur PAEDP ( 37mmhg)
71
Q

What is the formula for calculating PAEDP with a RAP?

A

RAP + EDV

72
Q

What are some pulmonary valve abnormalities that caused tricuspid regurgitation?

A

-rheumatic stenosis
-prolapse
-endocarditis
-Carcinoid heart disease

73
Q

With the tricuspid regurgitation, there is an elevated _____ pressure

A

Pulmonary

74
Q

Annulus ____ or ____ can cause tricuspid regurgitation

A

Dilation or calcification

75
Q

What congenital valve abnormality may cause tricuspid regurgitation?

A

Epstein’s

76
Q

Tricuspid Regurgitation first leads to RA ____ then leads to RA ____

A

Volume overload ; Dilation

77
Q

What murmur is associated with tricuspid regur?

A

Holosystolic murmur that may increase with inspiration

78
Q

______ _____ distention occurs with TR

A

Jugular vein

79
Q

_______ of IVC may be seen with TR

A

Dilation

80
Q

What is the most common valvular problem associated with carcinoid syndrome?

A) tricuspid stenosis
B) mitral stenosis
C) tricuspid regurgitation
D) mitral regurgitation

A

C) TR

81
Q

What’s is CVP?

A

Central Venous pressure

82
Q

CVP refers to ____ pressure close to the ____

A

IVC ; RA

83
Q

What refers to the IVC pressure close to the right atrium?

A

CVP

84
Q

What are the 3 values we can give for RAP and describe them

A

3mmhg -normal IVC and collapses with sniff

8mmhg - moderate. Dilated IVC collapses <20%

15mmhg- Severe- dialated IVC >2.1cm & doesn’t collapse %50

85
Q

With Tricuspid regurgitation there is _____ turbulence in the RA

A

Systolic

86
Q

What’s the formula for measuring RVSP?

A

TR gradient + RA pressure estimation

87
Q

_____ of flow in ___ veins may be seen with severe TR

A

Reversal; hepatic

88
Q

When severe TR you should Doppler the ____ veins with a _____

A

Hepatic ; respirometer

89
Q

What spectral Doppler regur shape is seen with severe TR?

A

Triangle shape with severe TR Doppler

90
Q

If there is no Pulmonic stenosis the RVSP should equal the?

A

PAP

Extra Stuff CCI Review (18 decks)

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