Pulmonary Valve Disease Flashcards
PV stenosis (PS) is most often seen in which age demographic?
Pediatrics
PS is most commonly acquired or congenital?
Congenital
What are the main diseases associated with PS?
Marfans
Ostium secundum defect
Ebstein’s anomaly
Which PV leaflets are most commonly affected by PS?
Anterior and/or septal PVL
What does PS cause due to poor coaptation?
PI
With poor coaptation from PS, what happens to the leaflet?
It gets displaced into the RA during systole
What are S&S of PS?
SOBOE/SOB
Angina
Syncope
Fatigue
What is the appearance of PV leaflets with PS?
Thickened with doming
What happens to the right sided chambers with PS?
RVH
RA dilation
What can occur to the MPA as a result of an eccentric stenotic jet?
MPA dilation
What M-Mode wave would we see a change in with PS? What change would we see?
Increased a-wave
What would happen to the Acceleration Time with PS?
Shorter AT
What would happen to the PSV and peak PG with stenosis?
Increase in both
What is carcinoid syndrome/how does it affect the right sided valves?
Tumors in GI or panc that increase serotonin levels
Excess serotonin deposits on the TV and PV which leads to stenosis and regurg
Why aren’t the left heart valves affected by carcinoid heart syndrome?
Because the lungs filter out the excess serotonin by the time the blood reaches the left heart
What is a pulmonary embolism? (PE)
An acute obstruction of PA branches
What are S&S of an acute PE
Angina
SOB
Tachypnea
Hypotension
What is the gold standard diagnostic tool for PE?
CT pulmonary angiography
Why is echo used to assess for PE?
Looking for secondary signs:
Dilated PA
Increased PAP
RV dysfunction, increased RV size
Normal LV function
IVS flattening, paradoxical IVS motion
Significant TR + PI
What is McConnel Sign (an indication of an acute PE)
Hyperdynamic RV apex
Akinetic free wall
Pulmonary Insufficiency (PI) is most commonly caused by what?
PHTN
What else can cause PI?
Bacterial endocarditis
Carcinoid
PS
What is the murmur associated with PI?
Low pitched
Early diastolic murmur
An increase in the severity of a PI murmur indicates what about the the PI itself?
Decreased duration of the PI
What is the Graham Steele murmur?
When PAP is > 70 mmHg from severe PI
Leads to a high pitched diastolic murmur
What happens to the RV and RA with PI?
Varying degrees of RVH and RA dilation depending on the RVPO/VO
*Mild PI doesn’t change morphology
*Severe PI causes RV dilation (esp when chronic)
What happens to the PV with PI?
Mild = normal PV
Severe = abnormal valve
What does the width of the PI jet indicate?
Severity
narrow = mild
wide = severe
What does a severe PI waveform look like?
Dense with a low peak velocity and steep DT
