Lecture: Echo Assessment Mitral Valve Exam #1 Flashcards

1
Q

increased stress on the MV apparatus causes disease. diseases fall under either one of these 2 categories:

A

the disease will either be:
1. condition that elevates LV systolic pressure

  1. condition that causes abnormal mitral motion
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2
Q

thromboembolic event also known as a

A

stroke

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3
Q

a patient’s heart rhythm goes into a fib, putting her at risk for an embolic event… the patient has an enlarged left atrium, which puts her at at risk for a blood clot (embolus and stroke to follow if not taken care of). The left atrial enlargement could have been caused by what?

A

Mitral Annular Calcification (MAC)

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4
Q

Calcific emboli from a MAC lesion can cause what

A

a thromboembolic event (stroke)

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5
Q

In SAX, MAC may be focal, extensive, or BOTH?

A

BOTH

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6
Q

symptoms:

MAC extended to base of leaflets
Motion of leaflets impaired
Narrowed diastolic flow area
Leaflet tips are thin and mobile

This is either rheumatic heart disease or Calcific Mitral Stenosis. What info from above allows you to correctly determine what disease it most likely is

A

Both diseases are similar, but the fact that the leaflets are THIN AND MOBILE still, point out that this is CALCIFIC MITRAL STENOSIS.

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7
Q

What disease can mimic other diseases (from this powerpoint)

A

MAC can mimic

mitral stenosis
pericardial effusion
masses

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8
Q

what are some examples of hemodynamic changes

A

regurgitation (acute or chronic)
stenosis
shunts (intracardiac)

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9
Q

regurgitation can lead to

A

congestive heart failure

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10
Q

A subacute (vs acute) is only an accurate diagnosis if the SOURCE of the infection (infective endocarditis) is…

A

BACTERIA

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11
Q

Patient is complaining of:

low grade fever
fatigue
weight loss
cough
weakness

could be….

A

SUBACUTE infective endocarditis!

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12
Q

This type of infection usually has a negative blood culture

A

Fungal infection

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13
Q

define “idiopathic”

A

relating to or denoting any disease or condition which arises spontaneously or for which the cause is unknown.

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14
Q

which disease process is idiopathic

A

MAC
Mitral Annular Calcification

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15
Q

arterial hypertension means the same thing as SYSTEMIC hypertension true or false

A

TRUE

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16
Q

2 causes of embolism can be caused by MAC

A
  1. MAC can cause LAE - that leads to atrial fibrillation - that leads to embolic event
  2. MAC lesion can form calcific emboli
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17
Q

patient has a high fever and a heart murmur has suddenly developed in a week - what might this be

A

ACUTE infective endocarditis

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18
Q

symptoms SUBACUTE endocarditis

A

low-grade fever, fatigue, cough, weight loss, weakness

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19
Q

what percentage of the time are blood cultures accurate?

A

95%

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20
Q

what will make blood cultures unreliable?

A

antibiotics

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21
Q

true or false patients WITH an infection and WITHOUT an infection can BOTH have vegetations?

A

TRUE

a vegetation in a patient without infection is called a “healed vegetation”

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22
Q

healed OR infected veggies are smaller and more echogenic

A

healed (more calcium, fibrosis)

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23
Q

a larger veggie or a smaller veggie has a greater chance of embolization

A

LARGER

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24
Q

valve destruction from veggies usually results in

A

valvular regurgitation

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25
Q

what side of heart veggies more common

A

left

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26
Q

what valve do veggies affect the most

A

mitral

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27
Q

right sided veggies are more common with the advent of

A

iv drug use, indwelling venous catheters, pacer wires

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28
Q

treat a veggie?

A

antibiotics

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29
Q

least destructive but also LARGEST veggie

A

fungal - can get so large they obstruct flow

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30
Q

NEW NORMAL VARIANT!

A

Lambl’s excrescence located on aortic valve (ventricular side) thin and linear fibroelastic protrusions (age-related - older more likely)

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31
Q

what view do you measure thickness of MAC (severity)

A

PSAX at mitral view

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32
Q

In NBTE, vegetations are caused by

A

physical trauma ex. catheter, cancer

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33
Q

NBTE veggie can be the origin of

A

infection (infective endocarditis, produce emboli, impair valve function) *embolization usually cause of symptoms

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34
Q

what is a lesion

A

any structural abnormality

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35
Q

A patient with lupus, they may have veggies

A

along valve leaflet closures (Libman-Sacks lesions or endocarditis)

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36
Q

Libman–Sacks endocarditis is a

A

form of non-bacterial endocarditis that is seen in association with systemic lupus erythematosus, antiphospholipid syndrome, and malignancies.

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37
Q

WHATS. THE DIFFERENCE BETWEEN infective endocarditis AND nonbacterial thrombotic endocarditis (NBTE)??????

A

In infective endocarditis, the body’s response is inflammation, whereas NBTE does not cause an inflammatory response.

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38
Q

What is another form of NBTE endocarditis seen in patients with chronic wasting diseases, mucin-producing metastatic carcinomas, and/or chronic infections such as TB, pneumonia, etc?????

A

Marantic endocarditis (NBTE)

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39
Q

an easily “friable” vegetation means what

A

it is “fragile” meaning EMBOLIZATION IS VERY EASY!!!

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40
Q

what does “marantic” mean when we talk about Marantic endocarditis (NBTE)

A

marantic endocarditis, which comes from the Greek marantikos, meaning “wasting away”. The term “marantic endocarditis” is still sometimes used to emphasize the association with a wasting state such as cancer.

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41
Q

NBTE affects more of what type of patient

A

chronically ill

42
Q

Negative blood cultures and valvular vegetations suggest

A

NBTE (treated with anticoagulant)

43
Q

Leaflets extend above the plane of the MV annulus in this condition

A

MVP - greater than or equal to 2mm beyond annulus

44
Q

this is histologically identical to the myxomatous degeneration associated with this connective tissue disorder

A

Mitral Valve Prolapse histologically identical to Marfan’s Syndrome

45
Q

abnormal collagen synthesis leads to what in MVP

A

lengthened chordae, abnormally large, floppy leaflets

46
Q

“myxomatous” means what

A

“thickening”

47
Q

Degenerative MV disease
Myxomatous MV disease

Both are the same disease, AKA

A

MVP (mitral valve prolapse)

48
Q

What is the mildest form of MVP called and what is the most severe form of MVP called

A

mildest is “fibroelastic deficiency”

most severe is “Barlow disease”

49
Q

difference between fibroelastic deficiency and Barlow disease is

A

fibroelastic deficiency affects mechanical integrity of leaflets due to impaired production of CT while Barlow disease is EXCESS leaflet tissue (affects whole leaflet - not just thickening at the base like fibroelastic)

50
Q

“Abe Lincoln disease”

A

Marfan’s syndrome

Marfan syndrome is a genetic disorder that changes the proteins that help make healthy connective tissue. This leads to problems with the development of connective tissue, which supports the bones, muscles, organs, and tissues in your body.

51
Q

syndrome where symptoms include hyper elastic skin and extreme joint mobility

A

Ehlers-Danlos syndrome

52
Q

A ballet dancer or anorexic person may be prone to this

53
Q

I HAVE A DIVERSE ARRAY OF SYMPTOMS BUT MY MOST COMMON SYMPTOM IS ARRYTHMIA AND HEART PALPITATIONS… WHAT AM I

A

MVP

can be ASYMPTOMATIC
other symptoms include:
NON-EXERTIONAL chest pain, fatigue, dyspnea, systemic emboli

54
Q

Most common cause of MR in developed countries

55
Q

MVP can cause MR… varying degrees of MR can cause (think about the flow of regurgitating blood)

A

Pulmonary hypertension,
pulmonary edema (acute),

56
Q

thick MV leaflets are susceptible to disease such as

A

bacterial endocarditis
flail MV
ruptured chordae tendineae

57
Q

an increase in MVP equals in increase in

A

mitral regurgitation

58
Q

MVP usually associated with these sounds

A

systolic click and a late systolic murmur (cardiac auscultation)

59
Q

“vasalva” or holding your breath and “bearing down” does what to the venous blood flow in your body

A

slows venous return

60
Q

supine to standing, what happens to venous blood flow

A

when a supine person abruptly transitions to an upright position, the following events take place: The contents of the venous circulation is redistributed to the legs, decreasing the thoracic venous blood volume.

61
Q

Standing to squatting VS squatting to standing (moves the click and murmur sound of an MVP patient) which way does it move with each

A

standing to squatting or standing to supine moves click and murmur TOWARD second heart sound (increases LV volume)

supine to standing (reduces LV volume) and moves click and murmur toward earlier in systole (pan-systolic or “hammock” prolapse)

62
Q

In diagnosing MVP, use THIS view and NOT this view

A

Use Parasternal LAX

DO NOT use Apical view

63
Q

pericardial effusion alters the overall motion of the heart in an echo, so take note if the patient has pericardial effusion if trying to diagnose this

A

MVP
can give a FALSE POSITIVE!

64
Q

Treatments for MVP

A

none!

here’s what we can do
endocarditis prophylaxis
holter monitor
treadmill stress test
beta blockers for arrhythmias
stop stimulate aka caffeine/alcohol
follow up
Mitral Valve Repair when that is imperative*

65
Q

In MV flail, the leaflets are where in systole and in diastole?

A

in systole, they are in LA

in diastole, they are in LV

66
Q

What is seen in MV Flail (significant)

A

significant Mitral Regurgitation

67
Q

is more commonly found on anterior leaflet, is generally uncommon, and is usually associated with infective endocarditis

A

MV Aneurysm

68
Q

what is prophylaxis

A

Preventive healthcare, or prophylaxis is the application of healthcare measures to prevent diseases

69
Q

LOOKING FOR LEFT VENTRICULAR HYPERTROPHY and finding it is a sign of what possible conditions?????

A

IT IS A SIGN OF ELEVATED LV SYSTOLIC PRESSURE WHICH CAN INDICATE

  1. hypertension
  2. hypertrophic cardiomyopathy
  3. aortic stenosis
70
Q

what do you measure for MAC to determine severity? what view?

A

can measure THICKNESS in PSAX of the MV

Mild: 1.5 - 5mm
Moderate: 6-10mm
Severe: >10mm

71
Q

Calcific Mitral Stenosis can be caused by

A

MAC, where MAC calcification extends to the base of the leaflets, impairing motion, restricting diastolic flow area, although the leaflet tips are still thin and mobile.

Thin/mobile leaflets differentiate this from rheumatic heart disease.

72
Q

a developing perivalvular abscess (advanced by infective endocarditis) can cause what?

A

fistula or fistulous communications

73
Q

echo appearances THIS can ALSO be laminated along the surface of the valve or valve apparatus… appearing as a more diffuse focal thickening of the leaflet…

74
Q

2 weeks following the initiation of antimicrobial treatment… what is likely to occur with a pedunculated veggie

A

RISK OF EMBOLIZATION!

75
Q

difference between embolization of left-sided heart veggie and right-sided heart veggie

A

left-sided lesions: petachiae/purperic skin lesions, stroke, transient ischemic events

right-sided lesions: pneumonia-like symptoms

76
Q

valve destruction from veggies usually result in valvular

A

REGURGITATION - easily detected by echo

77
Q

type of endocarditis (specific): large thrombotic vegetations may form on valves and produce significant emboli to the brain, kidneys, spleen, mesentery, extremities, and coronary arteries. Tend to form on congenitally abnormal cardiac valves and those damaged by rheumatic fever.

A

NBTE Marantic Endocarditis

78
Q

anticoagulants is often needed in noninfective endocarditis (NBTE) but is contraindicated in

A

INFECTIVE ENDOCARDITIS

79
Q

patients with this type of endocarditis usually have a very severe underlying disease

A

Non-Bacterial Thrombotic Endocarditis

80
Q

MVP is the buckling of one or both leaflets into the LA in systole or diastole?

A

SYSTOLE!
>2mm beyond annulus

81
Q

THIS condidition is histologically identical to thickening degeneration of MV associated with Marfan’s syndrome…

82
Q

all varying degrees of the SAME disease:
degenerative MV disease
myxomatous MV disease
fibroelastic deficiency
Barlow disease

83
Q

Varying degrees of mitral regurgitation (MR) can cause a few different things…

A

Cardiac Heart Failure

Pulmonary HTN

Acute Pulmonary Edema

84
Q

TRUE or FALSE: DO NOT USE APICAL VIEWS FOR MVP diagnostics…

A

TRUE

only use PLAX view in 2-D and m-mode

85
Q

chronically ill patients are more likely to have this TYPE of endocarditis

A

non-bacterial thrombotic endocarditis (check for negative blood cultures and valvular veggies) can’t be on antibiotics though… would making check for blood cultures IMPOSSIBLE

86
Q

the nature and timing of MVP (in auscultation) is influenced by what? what maneuvers can help with diagnosis?

A

influenced by STROKE VOLUME

maneuvers that influence stroke volume are
1. vasalva
2. amyl nitrate inhalation

87
Q

what is the unit to attach to any answers calculating MVA (mitral valve area)?

A

cm2 (squared)

88
Q

what is the unit to attach to any answers calculating pressure or a pressure gradients?

89
Q

you measure the time from the peak diastolic velocity to the baseline. that is called what? you can measure mitral valve area with this information. how so?

A

mitral deceleration time.

MVA = 750 / deceleration time

answer in cm2 (squared)

90
Q

what is Bernoulli’s equation

A

mva = 4v2(squared)

answer is in cm2(squared)

91
Q

what is the continuity equation

A

MVA = (CSA)(LVOT) x (VTI)(LVOT) x (VTI)(MV)

(cross section area of left ventricular outflow tract) x (velocity time integral of left ventricular outflow tract) x (velocity time integral of mitral valve) = answer in cm2(squared)

velocity time integral is a waveform through the valve in CW.

92
Q

Can you grade MS by “mean pressure gradient”?

A

yes, the more severe the MS the higher the pressure gradient

mild is less than 5 mmHg
moderate is 5-10 mmHg
severe is greater than 10mmHg

mean pressure gradient and MVA have an INVERSE relationship

93
Q

Peak pressure gradient is not as reliable as the “mean pressure gradient” … why? what factors influence peak, making in unreliable…

A

Because it is influenced by other factors, namely LA compliance and LV diastolic function

94
Q

what is preferred OVER valve replacement? lower incidence of MORTALITY, lower incidence of MORBIDITY, lower incidence of POSTOPERATIVE COMPLICATIONS

A

percutaneous balloon mitral valvotomy

95
Q

where is the balloon positioned in a MV valvotomy

A

balloon is passed across IAS, positioned in MV orifice, inflated and splits valve on the commissures without damage to leaflets

96
Q

treatment for MS

A

diuretics, heart controlling agents like beta blockers and calcium channel blockers (and digoxin), management of a-fib, chronic anticoagulation therapy especially with a-fib

97
Q

SO many causes of MR, but can you see MR in a normal heart too? Like a completely normal heart?

98
Q

what’s the difference between a heart with acute MR and a heart with chronic MR?

A

acute won’t see any changes in LA or LV size or function

chronic will see changes in LV/LA volume and LV function will be impaired due to volume overload

100
Q

Starts at leaflet TIPS and spreads toward annulus

A

Rheumatic Mitral Stenosis

101
Q

Dome shaped hockey stick appearance (starts at tips, spreads toward annulus)

A

Rheumatic mitral stenosis