mitral stenosis ppt exam #1 Flashcards
most common cause WORLDWIDE of MS
rheumatic disease
are there congenital causes of MS? if so, what are they
cor triatriatum, supravalvular mitral ring, parachute mitral valve
“acquired MS” also known as
NONRHEUMATIC MS
what is BECOMING the leading cause of acquired MS in developed countries?
Age-related degenerative MAC’s!
RARE congenital anomaly that can lead to acquired MS
cor triatriatum
this may develop after an infection with strep bacteria such strep throat or scarlet fever and may be considered an autoimmune disease
rheumatic fever which can lead to rheumatic mitral stenosis
these five major findings characterize rheumatic fever
- pancarditis (heart)
- migrating arthritis of large joints (joints)
- subcutaneous nodules (subcutaneous)
- skin rash (skin)
- Sydenham chorea (random dance movements of face and extremities) (brain)
*it can affect the heart, brain, joints, subcutaneous tissues, and skin
leaflets may be thin but also have a dome-shaped, hockey stick appearance - name pathology
rheumatic heart disease
two types of mitral stenosis
rheumatic mitral stenosis
calcific mitral stenosis
characteristics of calcific mitral stenosis
thickened mitral annular region
no doming present
THIS is essentially “diminished mitral valve area”
MITRAL STENOSIS
looking at the graph in the powerpoint on slide 57, in mitral stenosis, the three worst-case-scenario outcomes are
left heart failure
right heart failure
risk of thromboembolism (from atrial fibrillation and LA thrombus)
what is anasarca
Anasarca is a medical condition that leads to general swelling of the whole body. It happens when your body tissues retain too much fluid …
what is ascites
Ascites (ay-SITE-eez) is when too much fluid builds up in your abdomen (belly). This condition often happens in people who have cirrhosis
what is hemoptysis
Hemoptysis is when you cough up blood from your lungs.
MS consists of a pressure overload of what 3 things?
LA, RV, and pulmonary vascular tree
most common type of tumor
myxoma
can sometimes be indistinguishable in an echo from mitral stenosis… but actually can be
an atrial myxoma
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
Parachute Mitral Valve (one of 5 rare causes of MS)
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
Cor Triatriatum
membrane may adhere to valve leaflets, closer to the mitral valve than cor triatriatum
mitral supravalvular stenosing ring (one of five rare causes of MS)
what is rheumatic fever and what parts of the body can it affect?
a systemic inflammatory disease that can affect the heart, brain, joints, skin, or subcutaneous tissue
THIS may develop after an infection with strep throat or scarlet fever
Rheumatic fever or rheumatic MS
scarred and contracted leaflets AND chordae is a sign of
rheumatic heart disease
thickening of leaflets STARTING at tips and going toward base… or from tips to PAP muscles
hallmark of rheumatic MS
MITRAL VALVE AREA CRITERIA
normal MVA?
Mild MS?
Moderate MS?
Severe MS?
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
The smaller the mitral valve area the GREATER the what?
The greater the PRESSURE GRADIENT!
at what point in heart cycle do you measure mitral stenosis leaflet tips in SAX
Measure at mid-diastole at the maximal opening of the leaflet tips
3 measurements for normal sinus rhythm
5 measurements for A-fib
5 ways to evaluate MVA using Doppler
- pressure half-time
- deceleration time index
- continuity equation method
- PISA (proximal isovelocity surface area
- proximal flow convergence
Pressure half time degrees of severity
normal
mild
moderate
severe
normal: 30-60 msec
mild: 90 to 150 msec
moderate: 150 to 219 msec
severe: >220 msec
what 3 measurements do you need for MR PISA?
alias velocity
radius
VTI
normal pattern of flow for pulmonary venous velocities is
BIPHASIC!
FROM WHAT VIEW do you measure Vena Contracta width?
Apical
LA compliance and LV diastolic function influence this so it is ultimately an unreliable measurement
peak pressure gradient not as reliable
MEAN pressure gradient is MORE reliable
How to perform PISA in 3 steps
- alias velocity - shift baseline up for stenosis to around 30 cm/s
- radius - measure valve from vena contract to the first color alias on the atrial side
- VTI - use CW waveform across MV
These 5 things make up VTI
- stroke distance
- peak velocity
- peak gradient
- mean velocity
- mean gradient
for continuity equation, what are we multiplying when we solve for flow in tube?
mean velocity x cross sectional area
750/deceleration time is what
way to solve for MVA
How to get pressure half time in 4 steps:
- get CW of MV inflow
- measure peak E velocity (Vmax)
- Divide Vmax by 1.4 to get VPHT (time difference between the two velocities)
- Draw line down from Vmax and VPHT
- MVA = 220/PHT
grading MS by mean PG:
mild is <5mmHg
moderate is 5-10 mmHg
severe is >10mmHg
In mitral REGURGITATION, the bigger the width of the vena contracta…
the more severe
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…
if S gets blunted, the A wave gets bigger. That’s no bueno.
HUGE A WAVE IS BAD!!!!!
