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ECHO 325 > Mitral Regurgitation > Flashcards

Mitral Regurgitation Flashcards

1
Q

Describe why mitral valve prolapse occurs?

A

The fibrosa layer is thinner than the spongiosa layer and this causes it to bend more during systole because of the high pressure gradient.

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2
Q

MVP is defined by what measurement?

A

Systolic bowing into the LA >2mm

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3
Q

Mitral valve prolapse can be associated with what? (3)

A
  • Pectus excavatum (caved in chest abnormality)
  • Marfan’s
  • Ehler Danlos syndrome
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4
Q

What is the most common symptom of significant MR?

A

Dyspnea

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5
Q

What is a very common heart rhythm with MR?

A

Atrial fibrillation

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6
Q

In acute MR, LA pressures are increased due to what?

A

LA has not had time to compensate and the MR is going back into the chamber along with all the other inflow volumes

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7
Q

Why is tachycardia usually present in someone with acute MR?

A

Blood pressure has lowered due to it going back in to the LA and not towards the aorta, theres not enough blood going to the brain so your heart rate will increase to compensate

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8
Q

How does a chamber adapt to volume overload?

A

Dilation

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9
Q

How does a chamber adapt to pressure overload?

A

Hypertrophy

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10
Q

What is eccentric hypertrophy?

A

Dilated chamber, normal wall thickness

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11
Q

With eccentric hypertrophy, the LV mass will do what?

A

Increase

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12
Q

If LV dilation is left for too long, what could happen?

A

Irreversible decrease in LV systolic function and LVH

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13
Q

What is the difference between acute and chronic MR?

A

Chronic MR has had time to develop compensatory mechanisms

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14
Q

With chronic compensated MR, the LA is able to accommodate the extra volume at a lower pressure. How?

A

The atrium has dilated to keep pressures down.

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15
Q

Chronic compensated MR will do what to forward stroke volume?

A

Increase

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16
Q

Once chronic compensated MR is maxed out, what will happen?

A

Chronic decompensated MR

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17
Q

With decompensated MR, the muscle fibers in the LV become damaged and it fails, doing what to EF?

A

Decreases it

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18
Q

Once the muscle fibers of the LV fail in decompensated MR, what will happen to LVESV and why?

A

It will increase because the walls can no longer contract to eject all of it

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19
Q

What happens to LVEDP and LAP with chronic decompensated MR?

A

Both pressures will increase

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20
Q

Why is EF not a good marker of systolic function with chronic MR?

A

Because a lot of the stroke volume is actually going back into the LA

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21
Q

Which way does a regurg jet shoot in relation to the prolapsed leaflet?

A

Contralaterally

If the posterior leaflet is prolapsing the jet shoots anterior and vice versa

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22
Q

A tented MV usually has an increased what?

A

Coaptation depth (depth from MV leaflet tips to annulus)

23
Q

What causes tented MV?

A

When the LV dilates the Pap muscles are pulled apart and the MV is pulled into a triangle shape.

24
Q

Which is more severe, acute or chronic MR?

A

Acute (small LA + large MR)

25
Q

Why is acute MR most severe?

A

Because the MR is taking up more space in the atrium

26
Q

What are methods of indirect grading of MR?

A
  1. Trace MR jet area to LA area % (MR/LA= %)
  2. Vena contracta
  3. PISA radius
27
Q

What is entrainment?

A

Blood already in the LA gets displaced by incoming jet

28
Q

What is the concern with entrainment?

A

Can make MR look worse than it is

29
Q

What is the best view to measure vena contracta and PISA?

A

VC: PLAX, uses axial resolution to measure leak

PISA: Apical, same reason

30
Q

What is the vena contracta?

A

Narrowest part of the jet downstream from the narrowed orifice

31
Q

What is the flow convergence zone and how does it indicate severity of MR?

A

PISA radius

Larger zone = more severe regurg

32
Q

What are the values for jet width ratio and what is it assessing?

A

Jet width compares jet area to LA area

Mild = < 4 cm sq or < 20% of LA

Severe = > 8 cm sq or > 40 % of LA

33
Q

What are the values for Vena Contracta?

A

Mild: < 0.3 cm

Severe: ≥ 0.7

34
Q

What are the values for PISA radius in cm?

A

Mild = < 0.4 cm convergence zone

Severe = ≥ 0.9 cm convergence zone

35
Q

The higher velocity the E wave, the more MR exists due to what?

A

Increased preload

36
Q

Why can MR not be severe if the E wave is less than the A wave?

A

The E wave would have to be higher than the A

37
Q

What do you compare the density of the regurgitant jet to when judging the severity of MR?

A

Inflow signal

38
Q

What does a triangular contour with MR suggest?

A

Large regurgitant pressure wave and hemodynamic significance

39
Q

What does a bright CW signal of MR indicate?

A

Significant leak

40
Q

Describe pressure, pressure gradient, and velocity in a severe MR jet:

A

Increased pressures, decreased pressure gradient (triangular shape), decreased velocity

41
Q

Late systolic MR can be a sign of what?

A

MV prolapse

42
Q

Why does the pressure gradient decrease with severe MR?

A

Because the LA pressure rises

43
Q

What are the 3 main methods for assessing MR quantitatively?

A
  1. Regurgitant volume
  2. Regurgitant fraction
  3. Effective regurgitant orifice area (EROA)
44
Q

What method does the ASE recommend to assess regurgitant volume?

A

Stroke volume method

45
Q

Total stroke volume includes what?

A

All blood leaving the ventricle no matter what direction

46
Q

What is forward stroke volume?

A

The amount of blood leaving the ventricle and going the right way

47
Q

What is regurgitant stroke volume?

A

The amount of blood that flows backward across the abnormal valve

48
Q

What is the formula for determining regurgitant volume?

A

RV = (SVregurg) - (SVnormal)

RV = (CSAregurg x VTIregurg) - (CSAnormal x VTIregurg)

49
Q

What is the formula for regurgitant fraction?

A

RF = (RV/SVregurg) x 100

50
Q

What are the values for regurgitant volume?

A

Mild: <30mL

Severe: ≥ 60 mL

51
Q

What are the values for regurgitant fraction?

A

Mild : < 30%

Severe: ≥ 50

52
Q

What are the values for ERO area?

A

Mild: < 0.2 cm2

Severe: ≥ 0.4 cm2

53
Q

How does MR and MS affect the LA differently?

A

MS causes pressure overload

MR causes volume overload

53
Q

What does MVP look like on m-mode?

A

Posterior displacement of the leaflets in systole (near end of T-wave)

ECHO 325 (19 decks)

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