Know It Pt5! Flashcards
What are 3 primary valve diseases that cause MR?
-MVP
-Rheumatic Stenosis
-endocarditis
Papillary muscle dysfunction can be due to _____ MR
Ischemic
A ____chordae tendineae can cause ____
Ruptured ; MR
Congenital valve abnormalities can cause ____
MR
Annulus ____ or ___ can cause MR
Dilation or calcification
With MR the first thing to occur is ____ in the LA then that leads to ___ of the LA
Volume overload; dilation
With MR what 2 chambers become dilated due to volume overload?
LA & LV
MR is what kind of murmur?
Holosystolic murmur that radiates to the axilla
Long standing MR leads to symptoms of ____ & ____ complicated by LV dysfunction
CHF & PHTN
_____ prolapse causes MR
MVP
What are some mitral valve abnormalities that you may see on echo with MR?
- MVP
-MAC
-Rheumatic stenosis - Myxomatous leaflets
What are - Myxomatous leaflets?
A valve disease associated with other diseases.
Causes thick MV leaflets and chorade creating a loss of mechanical leaflet integrity
____ dilation & ____ may be present with MR
LV; hyper contractility
What is the MV scallop view from the sonographers prospective?
A3,A2,A1 on top AMVL
P3, P2, P1 on bottom PMVL
What is the MV scallop view from the surgeon prospective?
A1,A2,A3 on top AMVL
P1,P2,P3 on bottom PMVL
A vena contracta of a MR jet may be seen with which cardiomyopathy?
A) Restrictive
B) infiltrative
C) Dilated
D)HOCM
C
What are the 4 parts of a MR jet?
- Flow of convergence ( dome of flow)
- Vena contracta
- Jet size
- Down stream affect of pulm veins
If the vena contracts of a MR jet is > or equal to ____ cm it’s severe MR
> or equal to 0.7cm
What is meant by the downstream affect of the MR Jet?
How it affects the pulmonary veins & if there’s pulmonary vein flow reversal
What does PISA stand for?
Proximal isovelocity surface area
What is PISA used to estimate?
EROA ( effective regur office area)
PISA assumes the radius (r) of the ____ occurs at the same time as the peak regurgitant MRvelocity.
Flow of convergence dome
PISA method is able to provide us with what 3 valves?
-EROA
-Regurgitant flow
-Regurgitant volume
What are the l steps of PISA?
- Zoom in on MR
- Take images with and without color
- LOWER baseline aliasing velocity to -30 to -40cm/s
- Measure r - radius of vena contracta
- Take CW Doppler of MR and VTI trace it
With PISA what should do with your baseline aliasing velocity?
Lower it to -30 to -40
To calculate PISA & EROA what 3 things did you need to measure?
- CW VTI of MR jet ( VTI)
- Peak revue velocity (V-max) given when you do VTI anyway
- R-radius of vena contracta
What does r mean in the PISA math?
Radius of vena contracta
What does Va in the PISA math mean?
Aliasing velocity ( baseline / VTI)
What does PkVreg in the PISA math mean?
Regurgitant amount of volume ( VMAX)
What is the regurgitation volume formula?
EROA X VTI of MR
What is the mild, mod & severe vena contracta for MR?
Mild= <0.3cm
Mod=0.3-0.69 cm
Severe= > or equal to 0.7cm
What is the mild, mod & severe EROA?
Mild = <0.2cm
Mod = 0.2-0.39cm
Severe = > or equal to 0.4cm
What is the mild, mod & severe Regurgitation volume ?
Mild= <30ml
Mod= 30-59ml
Severe= > of equal to 60ml
What is the Conda effect?
When regur jets hug the walls and causes us to underestimate the jet size
What’s another name for the Conda effect?
Eccentric jets
If you suspect severe MR where else should you take a look?
Pulmonary veins
What does JA/LAA ratio stand for?
Jet area / left atrial area
You obtain the JA/LAA in what 2 views?
AP4 & AP2
What is the mild, mod & severe JA/LAA ratio?
Mild= <20%
Mod= 20-39%
Severe= > or equal to 40%
Pulmonary vein ____ reversal indicates severe MR
Systolic reversal or decreased S wave in pulm veins
The greatest source of error in measuring in PISA with?
A) length of regur jet
B) vena contracts measurement
C)radius of flow convergence
D) peak velocity measurement
C)
What is dp/dt a measurement of?
LV myocardial directional contractility
Which is a measurement of LV myocardial directional contractility ?
A) EDV-ESV
B) P=4v2
C) EROA x VTI
D) DP/dt
D
Dp/dt describes the rate in ___rise in the LV during ____
Pressure ; systole
In a patient with normal LV systolic function the Dp/dt there’s ___ raise in ____ pressure in systole
Rapid ; systolic
In a pt. That has impaired LV systolic function the rate in squeezing systolic pressure is _____ therefore dp/dt starts to ___
Lower ; falll
Dp/dt is measured in which?
A) mmhg
B) Cm
C) %
D) mm
A
Dp/dt is ____ to measure even in the cath lab
Difficult
In the echo lab where is our dp/dt measurement taken from?
CW MR Doppler jet
What is a normal LV dp/dt?
> 1200mmhg/sec
What is the formula for dp/dt?
32 / MR jet going from 1-3m/sec
When measuring the dp/dt MR jet ensure your sweep speed is?
High as possible to “spread out the trace”
How do you measure the dp/dt?
32/ MR get from 1-3m/sec
Measure slope of MR from 1-3msec
Dp/dt is not reliable if the MR is ___ or if there is significant increased _____
Acute ; afterload
A systolic MR velocity of ____ to ____ m/sec indicates high gradient between LA & LA in systole
4.5 to 5 m/sec
Left atrial pressure can be calculated from the ____ peak velocity
MR
What is the formula for LAP calculation with MR?
Systolic BP - MR gradient
Calculate LAP from a MR Doppler
SBP = 120mmhg
MR= 5m/sec
- Convert the 5m/sec with the bernloui equation
- Then you have your MR and put into the equation
Answer = 20mmhg
