mitral stenosis ppt exam #1

Question 1

most common cause WORLDWIDE of MS

Answer 1

rheumatic disease

Question 2

are there congenital causes of MS? if so, what are they

Answer 2

cor triatriatum, supravalvular mitral ring, parachute mitral valve

Question 3

“acquired MS” also known as

Answer 3

NONRHEUMATIC MS

Question 4

what is BECOMING the leading cause of acquired MS in developed countries?

Answer 4

Age-related degenerative MAC’s!

Question 5

RARE congenital anomaly that can lead to acquired MS

Answer 5

cor triatriatum

Question 6

this may develop after an infection with strep bacteria such strep throat or scarlet fever and may be considered an autoimmune disease

Answer 6

rheumatic fever which can lead to rheumatic mitral stenosis

Question 7

these five major findings characterize rheumatic fever

Answer 7

1. pancarditis (heart)
2. migrating arthritis of large joints (joints)
3. subcutaneous nodules (subcutaneous)
4. skin rash (skin)
5. Sydenham chorea (random dance movements of face and extremities) (brain)

*it can affect the heart, brain, joints, subcutaneous tissues, and skin

Question 8

leaflets may be thin but also have a dome-shaped, hockey stick appearance - name pathology

Answer 8

rheumatic heart disease

Question 9

two types of mitral stenosis

Answer 9

rheumatic mitral stenosis

calcific mitral stenosis

Question 10

characteristics of calcific mitral stenosis

Answer 10

thickened mitral annular region

no doming present

Question 11

THIS is essentially “diminished mitral valve area”

Answer 11

MITRAL STENOSIS

Question 12

looking at the graph in the powerpoint on slide 57, in mitral stenosis, the three worst-case-scenario outcomes are

Answer 12

left heart failure

right heart failure

risk of thromboembolism (from atrial fibrillation and LA thrombus)

Question 13

what is anasarca

Answer 13

Anasarca is a medical condition that leads to general swelling of the whole body. It happens when your body tissues retain too much fluid …

Question 14

what is ascites

Answer 14

Ascites (ay-SITE-eez) is when too much fluid builds up in your abdomen (belly). This condition often happens in people who have cirrhosis

Question 15

what is hemoptysis

Answer 15

Hemoptysis is when you cough up blood from your lungs.

Question 16

MS consists of a pressure overload of what 3 things?

Answer 16

LA, RV, and pulmonary vascular tree

Question 17

most common type of tumor

Answer 17

myxoma

Question 18

can sometimes be indistinguishable in an echo from mitral stenosis… but actually can be

Answer 18

an atrial myxoma

Question 19

a subvalvular obstruction where there is only one papillary muscle (one or two close together) in the LV and the chordae of both MV leaflets attache to this single muscle

Answer 19

Parachute Mitral Valve (one of 5 rare causes of MS)

Question 20

this rare congenital disease can cause MS whose echo appearance is a linear echodensity that stretches across the LA in the middle of the chamber

Answer 20

Cor Triatriatum

Question 21

membrane may adhere to valve leaflets, closer to the mitral valve than cor triatriatum

Answer 21

mitral supravalvular stenosing ring (one of five rare causes of MS)

Question 22

what is rheumatic fever and what parts of the body can it affect?

Answer 22

a systemic inflammatory disease that can affect the heart, brain, joints, skin, or subcutaneous tissue

Question 23

THIS may develop after an infection with strep throat or scarlet fever

Answer 23

Rheumatic fever or rheumatic MS

Question 24

scarred and contracted leaflets AND chordae is a sign of

Answer 24

rheumatic heart disease

Question 25

thickening of leaflets STARTING at tips and going toward base… or from tips to PAP muscles

Answer 25

hallmark of rheumatic MS

Question 26

MITRAL VALVE AREA CRITERIA
normal MVA?
Mild MS?
Moderate MS?
Severe MS?

Answer 26

Normal MVA = 4-6cm2(squared) because its an area measurement

Mild MS: greater than 1.5cm2

Moderate MS: 1.0 - 1.5cm2

Severe MS: <1.0cm2

Question 27

The smaller the mitral valve area the GREATER the what?

Answer 27

The greater the PRESSURE GRADIENT!

Question 28

at what point in heart cycle do you measure mitral stenosis leaflet tips in SAX

Answer 28

Measure at mid-diastole at the maximal opening of the leaflet tips
3 measurements for normal sinus rhythm
5 measurements for A-fib

Question 29

5 ways to evaluate MVA using Doppler

Answer 29

1. pressure half-time
2. deceleration time index
3. continuity equation method
4. PISA (proximal isovelocity surface area
5. proximal flow convergence

Question 30

Pressure half time degrees of severity
normal
mild
moderate
severe

Answer 30

normal: 30-60 msec
mild: 90 to 150 msec
moderate: 150 to 219 msec
severe: >220 msec

Question 31

what 3 measurements do you need for MR PISA?

Answer 31

alias velocity
radius
VTI

Question 32

normal pattern of flow for pulmonary venous velocities is

Answer 32

BIPHASIC!

Question 33

FROM WHAT VIEW do you measure Vena Contracta width?

Answer 33

Apical

Question 34

LA compliance and LV diastolic function influence this so it is ultimately an unreliable measurement

Answer 34

peak pressure gradient not as reliable

MEAN pressure gradient is MORE reliable

Question 35

How to perform PISA in 3 steps

Answer 35

1. alias velocity - shift baseline up for stenosis to around 30 cm/s
2. radius - measure valve from vena contract to the first color alias on the atrial side
3. VTI - use CW waveform across MV

Question 36

These 5 things make up VTI

Answer 36

1. stroke distance
2. peak velocity
3. peak gradient
4. mean velocity
5. mean gradient

Question 37

for continuity equation, what are we multiplying when we solve for flow in tube?

Answer 37

mean velocity x cross sectional area

Question 38

750/deceleration time is what

Answer 38

way to solve for MVA

Question 39

How to get pressure half time in 4 steps:

Answer 39

1. get CW of MV inflow
2. measure peak E velocity (Vmax)
3. Divide Vmax by 1.4 to get VPHT (time difference between the two velocities)
4. Draw line down from Vmax and VPHT
5. MVA = 220/PHT

Question 40

grading MS by mean PG:

Answer 40

mild is <5mmHg
moderate is 5-10 mmHg
severe is >10mmHg

Question 41

In mitral REGURGITATION, the bigger the width of the vena contracta…

Answer 41

the more severe

Question 42

in assessing MR, when looking at Doppler waveforms for pulmonary vein flow, you have an S D and A wave. Describe what a bad waveform looks like…

Answer 42

if S gets blunted, the A wave gets bigger. That’s no bueno.

HUGE A WAVE IS BAD!!!!!