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Mitral Stenosis > Mitral Stenosis > Flashcards

Mitral Stenosis Flashcards

1
Q

What is MAC(Mitral Annular Calcification) or CMA?

A

Calcium deposits on the annulus, maybe leaflets

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2
Q

What artifact results from MAC?

A

Shadowing from the calcium deposits on the leaflets or annulus

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3
Q

What is the cause of MAC?

A

Degenerative process associated with aging, exact cause not fully known, diseases that stress the MV apparatus

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4
Q

What are the echo findings of MAC?

A

Bright echogenic reflections, shadowing can obscure view of leaflets, can extend into MV leaflets & AOV cusps

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5
Q

What is MS (Mitral Stenosis)?

A

Narrowing, thickening, and/or obstruction of the MV that impedes diastolic blood flow traveling from the left atrium through the MV into the LV

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6
Q

What is the #1 cause of MS?

A

Rheumatic Fever

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7
Q

Other causes of MS?

A

MAC, Congential, Left atrial mass or vegetation, prosthetic valve dysfunction, thrombus

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8
Q

What is the process of Rheumatic MS?

A

Leaflets & chordae become scarred & contracted, adhesions, fused commissures, restricted leaflet motion, leaflets become tethered, orifice becomes funnel shaped and narrowed, leads to LA pressure * Stenosis is at leaflet tips

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9
Q

What is the MS appearance on echo?

A

Hockey stick appearance of the anterior leaflet(diastolic doming), thickening of leaflets >3mm.

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10
Q

What is the hockey stick appearance of the anterior MV leaflet caused by?

A

Increased pressure in the proximal chamber pushing on the undersurface of the tethered leaflets while they are open

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11
Q

What is the MS murmur?

A

Low pitched rumbling diastolic murmur with opening snap

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12
Q

What are MS symptoms?

A

SOB, Dyspnea on exertion, hemoptysis, CP, Palpitations, fatigue, heart failure if untreated

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13
Q

What kind of load does MS have?

A

Increased LA pressure overload, which
causes LA enlargement&raquo_space;a-fib, Overload of pressure in lungs = PHTN & RV, Increased HR = shorter diasatolic filling period and if left untreated can lead to right heart failure

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14
Q

Other complications due to MS?

A
  • Thrombus in LA or LAA due to increased LA size & stasis of flow from reduced LA function
  • MR due to annular stretching from LAE
  • PHTN due to increased resistance to pulmonary venous flow
  • Decreased CO
  • Heart Failure
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15
Q

What is Smoke in LAA?

A

Spontaneous echo contrast- swirling effect and stagnant blood in LAA

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16
Q

2D findings of MS?

A

Echogenic leaflets, restricted leaflet motion, Hockey stick appearance, diastolic doming, fusion of commissures, smoke in LA/LAA, LAE

17
Q

M-Mode findings of MS?

A

E-F slope & A wave decreased, thickened leaflets, anterior motion of the PMVL, reduced D-E leaflet excursion, LAE, paradoxical septal motion

18
Q

What color doppler findings of MS do you see?

A

Blue Candle flame jet, turbulent diastolic flow that travels from LA thru MV while open into LV

19
Q

Which is best view to assess MS?

A

Apical 4

20
Q

What are Spectral doppler findings of MS?

A

Increased peak E velocity, decreased E-F

slope, flatter the slope = more severe stenosis, P1/2T increases = more severe

21
Q

When MS is long standing what may happen?

A

PHTN

22
Q

MS with assoc PHTN, what will you see on 2D echo?

A

RV hypertrophy, RV dilation. Flattened IVS from increased pressure in RV (flatness persists) best seen in SAX. Paradoxical wall motion may result. D-Shape LV in diastole and systole

23
Q

MS with assoc PHTN what will you see on M-Mode?

A

RV hypertrophy of RVFW, RVE, Flattened IVS, small LV with possible paradoxical septal motion, absent ‘a’ wave on the PV (normal would be 2.7mm), mid systolic closure of PV creating flying W

24
Q

Normal IVC diameter?

A

1.2 - 2.3 cm

25
Q

Normal hepatic vein diameter?

A

0.5 - 1.1 cm

26
Q

What equation used for MS?

A

P1/2T ( MVA=220/P1/2T) or

P1/2T=Mdt x 0.29

27
Q

Normal MVA
Mild MS
Moderate MS
Severe MS

A

4-6 cm squared
>1.5 cm squared
1.0-1.5 cm squared
<1.0 cm squared

28
Q

Normal P1/2T
Mild MS
Moderate MS
Severe MS

A

30-60 msec
90-150 msec
150-219 msec
>220 msec

29
Q

Anatominc MVA > Doppler MVA? T or F

A

True

30
Q

Planimetery MVA?

A

PSAX, enlarge MV at level of leaflet tips, freeze, trace opening of valve during
smallest opening at early diastole.

31
Q

What is Gorlin Method?

A

Cath lab method of finding MVA

Mitral Stenosis (1 decks)

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