Pulmonary Valve Disease

Question 1

PV stenosis (PS) is most often seen in which age demographic?

Answer 1

Pediatrics

Question 2

PS is most commonly acquired or congenital?

Answer 2

Congenital

Question 3

What are the main diseases associated with PS?

Answer 3

Marfans
Ostium secundum defect
Ebstein’s anomaly

Question 4

Which PV leaflets are most commonly affected by PS?

Answer 4

Anterior and/or septal PVL

Question 5

What does PS cause due to poor coaptation?

Answer 5

PI

Question 6

With poor coaptation from PS, what happens to the leaflet?

Answer 6

It gets displaced into the RA during systole

Question 7

What are S&S of PS?

Answer 7

SOBOE/SOB
Angina
Syncope
Fatigue

Question 8

What is the appearance of PV leaflets with PS?

Answer 8

Thickened with doming

Question 9

What happens to the right sided chambers with PS?

Answer 9

RVH
RA dilation

Question 10

What can occur to the MPA as a result of an eccentric stenotic jet?

Answer 10

MPA dilation

Question 11

What M-Mode wave would we see a change in with PS? What change would we see?

Answer 11

Increased a-wave

Question 12

What would happen to the Acceleration Time with PS?

Answer 12

Shorter AT

Question 13

What would happen to the PSV and peak PG with stenosis?

Answer 13

Increase in both

Question 14

What is carcinoid syndrome/how does it affect the right sided valves?

Answer 14

Tumors in GI or panc that increase serotonin levels

Excess serotonin deposits on the TV and PV which leads to stenosis and regurg

Question 15

Why aren’t the left heart valves affected by carcinoid heart syndrome?

Answer 15

Because the lungs filter out the excess serotonin by the time the blood reaches the left heart

Question 16

What is a pulmonary embolism? (PE)

Answer 16

An acute obstruction of PA branches

Question 17

What are S&S of an acute PE

Answer 17

Angina
SOB
Tachypnea
Hypotension

Question 18

What is the gold standard diagnostic tool for PE?

Answer 18

CT pulmonary angiography

Question 19

Why is echo used to assess for PE?

Answer 19

Looking for secondary signs:

Dilated PA
Increased PAP
RV dysfunction, increased RV size
Normal LV function
IVS flattening, paradoxical IVS motion
Significant TR + PI

Question 20

What is McConnel Sign (an indication of an acute PE)

Answer 20

Hyperdynamic RV apex
Akinetic free wall

Question 21

Pulmonary Insufficiency (PI) is most commonly caused by what?

Answer 21

PHTN

Question 22

What else can cause PI?

Answer 22

Bacterial endocarditis
Carcinoid
PS

Question 23

What is the murmur associated with PI?

Answer 23

Low pitched
Early diastolic murmur

Question 24

An increase in the severity of a PI murmur indicates what about the the PI itself?

Answer 24

Decreased duration of the PI

Question 25

What is the Graham Steele murmur?

Answer 25

When PAP is > 70 mmHg from severe PI

Leads to a high pitched diastolic murmur

Question 26

What happens to the RV and RA with PI?

Answer 26

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)

Question 27

What happens to the PV with PI?

Answer 27

Mild = normal PV
Severe = abnormal valve

Question 28

What does the width of the PI jet indicate?

Answer 28

Severity

narrow = mild
wide = severe

Question 29

What does a severe PI waveform look like?

Answer 29

Dense with a low peak velocity and steep DT