Stenosis/Final

Question 1

What are the two types of information categories one must use to assess stenosis?

Answer 1

Hemodynamic information and anatomic information

Question 2

What type of hemodynamic information do we use in assessing a stenosis?

Answer 2

Peak velocity, maximum pressure gradient, mean pressure gradient

Question 3

What is the units for the peak velocity and what type of Doppler is used to obtain the peak velocity?

Answer 3

Meters per second, CW

Question 4

How is the maximum pressure gradient obtained and what are the units?

Answer 4

Obtain the peak velocity and then plug it into Bernoulli’s equation.
mmHg

Question 5

What is the equation for obtaining the maximum pressure gradient?

Answer 5

Maximum PG (mmHg) = 4(V)2

Question 6

What is the mean pressure gradient?

Answer 6

The average of all velocities

Question 7

What are the methods to assess valves with stenosis?

Answer 7

Continuity equation, pressure halftime, Decel time method, PISA

Question 8

Bernoulli’s equation explains the relationship between what two factors?

Answer 8

Pressure and velocity

Question 9

When is flow considered stenotic flow?

Answer 9

When it is greater than 2 m/s

Question 10

What type of pressure gradient does the Bernoulli’s equation provide?

Answer 10

The peak instantaneous pressure gradient

Question 11

How is the mean pressure gradient obtained?

Answer 11

By Planimetry of the Doppler signal

Question 12

What is the murmur for aortic stenosis?

Answer 12

A systolic crescendo decrescendo

Question 13

What is the peak velocity for aortic stenosis? What is the peak velocity for aortic sclerosis?

Answer 13

The peak velocity for aortic stenosis is >2.0 m/s. The peak velocity for aortic sclerosis is <2.0 m/s.

Question 14

What is seen in M mode with a bicuspid aortic valve?

Answer 14

An eccentric closure line

Question 15

When using PEDOFF in the right parasternal window the waveform for aortic Doppler flow will appear above or below the baseline?

Answer 15

Above the baseline

Question 16

What information needs to be obtained in order to assess aortic stenosis?

Answer 16

Peak velocity, maximum pressure gradient, mean pressure gradient, and the aortic valve area

Question 17

Doppler provides instantaneous pressure gradient the Cath Lab provides what type of pressure gradient?

Answer 17

Peak to Peak pressure gradient

Question 18

What is the letter that represents flow? What equation represents flow? What happens if the area decreases?

Answer 18

Q
Flow = velocity x area
The velocity increases

Question 19

What equation helps us obtain the aortic valve area? What is the equation to obtain the aortic valve area?

Answer 19

Continuity equation

AVA (cm2) = CSA (LVOT cm2) x VTI (LVOT)/VTI (AoV)

Question 20

What is the continuity equation?

Answer 20

Q1= Q2 or,
V1(A1) = V2(A2) or,
V(LVOT) x A(LVOT) = V(AoV) x A(AoV)

Question 21

What Doppler information can be used to find the aortic valve area? Looking for the two equations the information would be plugged into.

Answer 21

VTI or PW and CW Doppler
AVA = CSA(LVOT) x V(LVOT PW)/V(AoV CW) or
AVA = CSA (LVOT) x VTI (LVOT)/VTI (AoV)

Question 22

What is the equation to obtain the cross-sectional area of a valve?

Answer 22

CSA (LVOT cm2) = .785 x LVOT diameter squared

Question 23

What type of velocity is obtained to plug into the continuity equation?

Answer 23

Peak velocity

Question 24

What is the shorthand equation for the aortic valve area utilizing the continuity equation?

Answer 24

A2= A1 x V1/V2

Question 25

What is the equation for the velocity ratio in regard to aortic stenosis?

Answer 25

VR = V (Lvot)/V (Aov)

Question 26

What are three conditions that can overestimate aortic stenosis values?

Answer 26

Anemia, aortic insufficiency, pregnancy

Question 27

What are four conditions that can under estimate aortic stenosis values?

Answer 27

Low cardiac output, mitral regurgitation, dysrhythmias, poor Doppler angle

Question 28

How can you discern the aortic stenosis jet from the mitral regurgitation jet?

Answer 28

The mitral regurgitation jet is wider than the aortic stenosis jet because the mitral regurgitation jet encompasses the I VCT through the I VRT.

Question 29

What is the peak velocity for mild aortic stenosis? What is the peak velocity for severe aortic stenosis?

Answer 29

Mild is 2.6-2.9 m/s and severe is >/= 4.0 m/s

Question 30

What is the mean gradient for mild aortic stenosis? What is the mean gradient for severe aortic stenosis?

Answer 30

Mild is <20 mmHg and severe is >/= 40 mmHg

Question 31

What is the aortic valve area for mild aortic stenosis? What is the aortic valve area for severe aortic stenosis?

Answer 31

Mild is greater than 1.5 cm² and severe is less than 1.0 cm²

Question 32

What is the indexed aortic valve area for mild aortic stenosis? What is the indexed aortic valve area for severe aortic stenosis?

Answer 32

Mild >0.85 cm²/m2 and severe <0.6 cm²/m2

Question 33

What is the velocity ratio for mild aortic stenosis? What is the velocity ratio for severe aortic stenosis?

Answer 33

Mild >0.50 and severe <0.25

Question 34

What does the echocardiographer perform in the case of aortic stenosis as required by Sentara protocol?

Answer 34

For aortic stenosis per sentara protocol, the echocardiographer would obtain the LVOT diameter, the LVOT VTI, the AOV VTI, and PEDOFF

Question 35

What is the pressure prior to the stenosis and the pressure after the stenosis?

Answer 35

Increased pressure prior to the stenosis, decreased pressure after the stenosis