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Echo > PS/PR > Flashcards

PS/PR Flashcards

1
Q

Pulmonary Valve

PV has 3 leaflets and sits at the junction of the _____ and _______

A

RVOT & main PA

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2
Q

Pulmonary Valve

What are the name of each cusp?

A

AC (anterior)

LC (left)

RC (right)

*note: anterior is the largest

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3
Q

Pulmonary Stenosis

Definition?

A

narrowing/thickening/obstruction of the PV that impedes systolic flow traveling fro the RV, though the PV, into the PA. Similar to AS

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4
Q

Pulmonary Stenosis

Types of PS?

A
  • subvalvular (infundibular) PS: an obstruction of the RVOT (below the valve)
  • valvular PS: an obstruction of the PV cusps
  • supravalvular PS: an obstruction in the PA (above the valve)
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5
Q

Pulmonary Stenosis

Causes?

A
  • congenital (mainly): the stenotic PV can be trileaflet, bicuspid, or dysplastic
  • a part of more complex congenital anomaly (frequently): Tetralogy of Fallot, atrioventricular canal, double outlet RV etc)
  • carcinoid heart disease: most common form of acquired PS
  • subvalvular PS: *caused by sinus of Valsalva aneurysm which protrudes into the RVOT and obstruct flow
  • Functional PS: tumor that compress the RVOT
  • RHD: possible but uncommon
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6
Q

Pulmonary Stenosis

murmur?

A

harsh systolic ejection murmur heard at the left upper sternal border; a thrill may also be present

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7
Q

Pulmonary Stenosis

complication?

A
  • dyspnea on exertion (*physical/mental effort)
  • Jagular venous distension (enlargement)
  • RVH, eventually RV dilatation & RA enlargement
  • associated congenital anomalies
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8
Q

Pulmonary Stenosis Grading

peak Doppler velocity

mild?

severe?

A

mild: < 3 m/s
severe: > 4 m/s

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9
Q

Pulmonary Stenosis Grading

peak Doppler gradient

mild?

severe?

A

mild: < 36 mmHg
severe: > 64mmHg

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10
Q

Pulmonary Stenosis Grading

mean Doppler gradient

severe?

A

>40mmHg

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11
Q

Pulmonary Stenosis Grading

Always check tricuspid regurgitation gradient to rule out overestimation of PS gradient.

T or F ?

A

T

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12
Q

What is tetralogy of Fallot?

A

Tetralogy of Fallot is a birth defect that affects normal blood flow through the heart. It happens when a baby’s heart does not form correctly as the baby grows and develops in the mother’s womb during pregnancy.

A heart defect that features four problems.

They are:

  • a hole between the lower chambers of the heart (atrioventricular canal/ASD/VSD)
  • an obstruction from the heart to the lungs (PS)
  • The aorta lies over the hole in the lower chambers
  • RV hypertrophy
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13
Q

Pulmonary Stenosis

What are the echo findings?

A
  • thickening if the PV leaflets with systolic doming
  • RV hypertrophy due to RV pressure overload = increased afterload
  • flattening if the IVS due to the RV pressure overload *D shaped LV (can be visualized in PSAX)
  • RA enlargement
  • RV failure in the later stages of PS
  • post-stenotic dilatation of the MPA due to the high velocity PS jet striking the PA wall *similar to AS
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14
Q

Pulmonary Stenosis

What are the M-mod findings?

A

“a” wave dip of the right posterior PV cusp

*normal range: 2-3 mm in depth

*severe: > or = 8mm in depth

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15
Q

Pulmonary Stenosis

Explain how to assess with Doppler

A

similar to AS, assess:

  • peak velocity
  • max & mean PG
  • PVA

via the continuity equation

  • CW focus in the PV; acquire the PV peak velocity & the VTI
  • PW gate in the RVOT; acquire the RVOT peak velocity & VTI

*For a quick PG, utilize the modified Bernouli’s equation: PG = 4V2

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16
Q

Pulmonary Stenosis

PVA equation?

A

PVA = (VTI RVOT) (CSA RVOT) / (VTI PV)

*acquire the RVOT diameter just proximal to the PV

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17
Q

Pulmonary Stenosis

what is the normal range of RVOT proximal?

A

21-35mm

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18
Q

Pulmonary Stenosis

The Gorlin Formula can be used to calculate the PVA.

T or F ?

A

T

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19
Q

Pulmonary Stenosis

What views can be used for PV Doppler assessment?

A
  • PLAX RVOT
  • PSAX RVOT
  • Subcostal base
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20
Q

Pulmonic Regurgitation

definition

A

the backward or regurgitant flow of blood through the PV into the RV during ventricular diastole; may be acute or chronic

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21
Q

Pulmonic Regurgitation

etiology

A
  • incomplete PV closure due to PH (high pressure pulmonary disease): causes PA/PV annulus dilatation *most common cause
  • infective endocarditis/vegetation *second most common
  • RHD: uncommon; usually affect MV, AoV prior to PV
  • Myxomatous (non cancerous tumor) degeneration
  • Connective tissue disorder e.g. Marfan’s syndrome
  • Congenital anomalies: Tetralogy of Fallot, VSD, valvular PS, absence of the PV etc
  • iatrogenic: relating to illness caused by medical examination or treatment e.g. post surgical repair
  • PA catheter
  • Carcinoid heart disease
  • Syphillis
  • Tuberculosis
  • chest trauma
  • prosthetic heart valve
  • physiologic
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22
Q

Pulmonary Regurgitation

symptoms & signs

A
  • asymptomatic; may be tolerated for years due solely to PR is rare
  • dyspnea
  • fatigue
  • palpable RV impulse along left sternal border
  • systolic/diastolic thrills (a vibratory movement or resonance) at the left upper sternal border
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23
Q

Pulmonary Regurgitation

murmur

A

a low-pitched diastolic murmur that may increase with inspiration

right-sided Austin Flint murmur: low frequency presystolic murmur

Graham-Steele murmur: a high-pitched blowing diastolic murmur may be heard when PH is present with PR

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24
Q

Pulmonary Regurgitation

treatment

A
  • PR usually well tolerated
  • endocarditis prophylaxis (prevention)
  • Digitalis (Digitalis medicines strengthen the force of the heartbeat by increasing the amount of calcium in the heart’s cells) for RHF
  • valvuloplasty/valve replacement
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25
Q

Pulmonary Regurgitation

Trivial/mild PR is present in up to ____% of patient

A

87

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26
Q

Pulmonary Regurgitation

M-mode findings

A
  • RV dilatation
  • RV dilatation with paradoxical (seemingly absurd or self-contradictory) septal motion - due to RV vol overload
  • premature opening of the PV due to severe, acute PR that increases the RVED pressure
  • fine diastolic flutter of the TV
  • diastolic flutter of the pulmonic valve
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27
Q

Pulmonary Regurgitation

2D echo findings

A
  • PH (common cause)
  • anatomic basis/defect that prevents coaptation: annulus dilatation, PA dilatation, infective endocarditis, RHD, carcinoid heart disease, PS etc
  • RA dilatation
  • RV dilatation with paradoxical septal motion due to vol overload pattern
  • D-shaped LV
  • determine RV dimensions, volumes and EF
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28
Q

Pulmonary Regurgitation

Doppler assessment

A

acquire the end-diastolic pulmonic regurgitation (EDPR) velocity and calculate the EDPR gradient with modified Bernouli’s equation = 4V2

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29
Q

Pulmonary Regurgitation

Doppler assessment

What is the normal range?

A

0-5 mHg

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30
Q

Pulmonary Regurgitation

Doppler Assessment

PR grade

A

mild

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31
Q

Pulmonary Regurgitation

Doppler Assessment

PR grade

A

severe

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32
Q

Pulmonary Regurgitation

Doppler Assessment

PR grade

A

trivial

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33
Q

Pulmonary Regurgitation

Doppler Assessment

PR grade

A

mild

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34
Q

Pulmonary Regurgitation

Doppler Assessment

PR grade

A

moderate

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35
Q

Pulmonary Regurgitation

Doppler Assessment

PR grade

A

severe

36
Q

Pulmonary Regurgitation

Color Doppler Assessment

physiologic regurgitation: _____ in length and not holodiastolic in duration with normal PA pressure

let area/width _____ RVOT diameter

A

< 1 cm

< ⅓

37
Q

Pulmonary Regurgitation

Color Doppler Assessment

Borderline regurgitation: _____ in length and holodiastolic in duration

jet area/width: _____ RVOT diameter

A

1-2 cm

>⅓ and < ⅔

38
Q

Pulmonary Regurgitation

Color Doppler Assessment

clinically significant: ____ in length with peak velocity _____ and holodiastolic in duration

jet area/width: _____RVOT diameter

A

> 2cm> or = 1.5 m/s> ⅔

39
Q

PH is an elevation in the pressure of the PAs caused by another disease such as diastolic heart failure or left heart disease.

T or F?

A

T

40
Q

Echo provides a noninvasive assessment of PH and an accurate systolic PA pressure.

T or F?

A

T

41
Q

______ is the most common cause of PS

A

congenital heart disease

42
Q

PS creates a harsh diastolic ejection murmur and a thrill may also be present

T or F?

A

F

*harsh systolic ejection murmur not diastolic

43
Q

echo findings include a PV “a” wave of 10mm; what is most likely the diagnosis?

  • severe PH
  • severe PR
  • severe PS
  • all of the above
A

severe PS

44
Q

The patient presents with congenital PS with a peak velocity of 3.5 m/s; what is most likely the diagnosis?

  • normal PV
  • peak PG = 14 mmHg, mild PS
  • peak PG = 49 mmHg, moderate PS
  • peak PG = 52 mmHg, severe PS
A

moderate PS

45
Q

______ is an indication of PS?

  • LVH with flattening of the IVS
  • post-stenotic dilatation of the aorta
  • thickening of the pulmonic leaflets with systolic doming
  • all of the above
A

thickening of the pulmonic leaflets with systolic doming

46
Q

A Graham-Steele murmur is a high-pitched blowing diastolic murmur may that may be heard in case of PS with PH

T or F?

A

F

Graham-Steele murmur (a high-pitched blowing diastolic murmur) is present with PR & PH

47
Q

Calculate the ______ with the end-diastolic PR velocity and Bernoulli equation

  • EDPR gradient
  • RVEDP
  • RVSP
  • all of the above
A

EDPR gradient

48
Q

The pulmonary valve has 3 leaflets and sits at the junction of the LV outflow tract (LVOT) and the main pulmonary artery (PA)

T or F ?

A
49
Q

Structural abnormalities are the cause of tricuspid regurgitation at least 25% of the time. Please list at least 4

A
50
Q

Severe hemodynamic changes due solely to pulmonary regurgitation is rare

T or F ?

A
51
Q

List 5 clinical symptoms associated with Right Heart Failure

A
52
Q

A progressive increase in degree of TR can lead to RV volume overload

T or F ?

A
53
Q

Always check tricuspid regurgitation gradient to rule out overestimation of pulmonary stenosis gradient

T or F ?

A
54
Q

Up to 87% of normal patients appear to have PR

T or F ?

A
55
Q

For cases of tricuspid stenosis, our Doppler finding would demonstrate a spectral wave form similar to the waveform demonstrated with this finding _________________.

A
56
Q

The pulmonic valve (PV) has a saddle shape because of anterior and posterior high points and mid septal and lateral wall low points

T or F ?

A
57
Q

List 5 causes of pulmonary regurgitation (PI)

A
58
Q

Signs and symptoms of Pulmonic stenosis include: Dyspnea, Fatigue, Right Upper quadrant abdominal pain

T or F ?

A
59
Q

Describe the TS (tricuspid stenosis) murmur

A
60
Q

List 4 causes of TS (tricuspid stenosis)

A
61
Q

Functional Tricuspid Regurgitation occurs 75% of the time. Please list 4 causes.

A
  • Left heart disease (left ventricular dysfunction or valve diseases) resulting in pulmonary hypertension
  • Primary pulmonary hypertension
  • Secondary pulmonary hypertension (e.g. chronic lung disease, pulmonary thromboembolism, left-to-right shunt)
  • Atrial fibrillation
  • Cardiac tumors (particularly right atrial myxomas
62
Q

What do the following statements describe?

Low-pitched, diastolic murmur, usually best heard along the third or fourth intercostal spaces adjacent to the left sternal border (accentuated with inspiration)

Low frequency presystolic murmur (right-sided Austin Flint)

A
63
Q

List 3 M-Mode findings for Pulmonary Regurgitation (PI)

A
  • RV dilatation
  • Right ventricular volume overload pattern (right ventricular dilatation withparadoxical septal motion)
  • Fine diastolic flutter of theTricuspid valve
  • Diastolic flutter of the pulmonic valve
64
Q

How many papillary muscles does the tricuspid valve have?

A

3

65
Q

Hepatojugular reflux, Peripheral edema, Ascites, Atrial fibrillation, and Hyperdynamic RV impulse are considered physical findings associated with PR

T or F ?

A

F

  • Jugular venous distention with prominent “v” wave
  • Hepatomegaly
  • Pulsatile liver
  • Hepatojugular reflux
  • Peripheral edema
  • Ascites
  • Atrial fibrillation
  • Hyperdynamic RV impulse

These are all the clinical presentation of TR

66
Q

A patient with Pulmonary Regurgitation my exhibit systolic/diastolic thrills at the left upper sternal border

T or F ?

A

T

Also, palpable right ventricular impulse along left sternal border is present

67
Q

Signs and symptoms of PS:

Dyspnea, fatigue, RUQ abdominal pain

T or F ?

A

F

*Dyspnea, Fatigue, Right Upper quadrant
abdominal pain are signs of TS

68
Q

The pulmonary valve has 3 leaflets and sits at the junction of the LV outflow tract (LVOT) and the main pulmonary artery (PA).

T or F ?

A

False

The pulmonary valve has 3 leaflets and sits at the junction of the RVOT and the main pulmonary artery

69
Q

Structural abnormalities are the cause of tricuspid regurgitation at least 25% of the time. Please list at least 4.

A

Rheumatic, endocarditis, traumatic (blunt chest injury, laceration), congenital, prolapse, carcinoid disease, endomyocardial fibrosis

70
Q

Severe hemodynamic changes due solely to pulmonary regurgitation is rare.

T or F ?

A

T

71
Q

List 5 clinical symptoms associated with Right Heart Failure.

A
72
Q

A progressive increase in degree of TR can lead to RV volume overload.

T or F ?

A

T

73
Q

Always check tricuspid regurgitation gradient to rule out overestimation of pulmonary stenosis gradient.

T or F ?

A

T

74
Q

Up to 87% of normal patients appear to have PR.

T or F ?

A

T

75
Q

For cases of tricuspid stenosis, our Doppler finding would demonstrate a spectral wave form similar to the waveform demonstrated with this finding _________________.

A
76
Q

For cases of tricuspid stenosis, our Doppler finding would demonstrate a spectral wave form similar to the waveform demonstrated with this finding _________________.

A
77
Q

The pulmonic valve (PV) has a saddle shape because of anterior and posterior high points and mid septal and lateral wall low points.

T or F ?

A

T

78
Q

List 5 causes of pulmonary regurgitation (PI).

A
  • Incomplete PV closure (pulmonary hypertension causes pulmonary artery and PV annulus dilatation)
  • Infective endocarditis/ veg
  • Rheumatic heart disease, although it usually attacks the mitral valve and AOV prior to the PV
  • Congenital anomalies (tetrafallot of fallot, ventricular septal defect, valvular pulmonic stenosis)
  • Carcinoid heart disease
79
Q

Signs and symptoms of Pulmonic stenosis include: Dyspnea, Fatigue, Right Upper quadrant abdominal pain.

T or F ?

A
80
Q

Describe the TS (tricuspid stenosis) murmur.

A

High pitched diastolic rumble that varies with respiration and has an opening snap

81
Q

List 4 causes of TS (tricuspid stenosis).

A

Rheumatic heart disease

Congenital TS (Ebstein anomaly)

Carcinoid heart disease

Secondary TS due to intracardiac wires/pacemaker, right atrial clot/tumor, or TV veg

Secondary TS due to other medical conditions (systemic Lupus Erythematosus)

Prosthetic valve dysfunction

82
Q

Functional Tricuspid Regurgitation occurs 75% of the time. Please list 4 causes.

A
  • Left heart disease (left ventricular dysfunction or valve diseases) resulting in pulmonary hypertension
  • Primary pulmonary hypertension
  • Secondary pulmonary hypertension (e.g. chronic lung disease, pulmonary thromboembolism, left-to-right shunt)
  • A fib
  • Cardiac tumor (right atrial myxomas)
83
Q

What do the following statements describe?

Low-pitched, diastolic murmur, usually best heard along the third or fourth intercostal spaces adjacent to the left sternal border (accentuated with inspiration)

A

Low frequency presystolic murmur (right-sided Austin Flint)

84
Q

List 3 M-Mode findings for Pulmonary Regurgitation (PI).

A
85
Q

How many papillary muscles does the tricuspid valve have?

A
86
Q

Hepatojugular reflux, Peripheral edema, Ascites, Atrial fibrillation, and Hyperdynamic RV impulse are considered physical findings associated with PR.

T or F ?

A

Echo (35 decks)

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