TR

Question 1

What are the 2-D features/characteristics of TR?

Answer 1

Anatomic Causes for TR ( RAE RVE)
PSM (Paradoxical Septal Motion)
D-Shaped LV, “pancaking” of IVS
-Indications of RVVO

Question 2

What is the RVVO pattern?

Answer 2

Abnormal septal motion VARIES throughout the cycle.

RVE and PSM

Question 3

Indirect Support for TR

Answer 3

*IVC dilation, Inspiratory Collapse seen?
Normal IVC <1.7 cm
* IAS bowing toward LA

Question 4

What view is the CS seen in?

Answer 4

PLAX and AP 2 Transverse

Question 5

-Color Doppler of TR-

Regurgitant jet area

Answer 5

Mild < 5 cm squared

Severe > 10 cm squared

Question 6

-Color Doppler of TR-

RJA/RAA

Answer 6

Mild < 20%

Severe > 34%

Question 7

-Color Doppler of TR-

PISA radius

Answer 7

Mild < 0.5 cm

Severe > 0.7 cm

Question 8

-Color Doppler of TR-

Vena Contracta Width

Answer 8

Severe > 0.7 cm

Question 9

What is the normal color of flow in the hepatics?

Answer 9

Blue

Question 10

-CFD in IVC and Hepatics-

Answer 10

Look for lasting CF reversal- holosystolic

c/w severeTR

Question 11

On Spectral Doppler what is the jet shape for TR?

Answer 11

Triangular w/ early peak velocity (asymmetric)

Question 12

-Spectral Doppler of TR-

Answer 12

TR jet density (staining) CW Doppler
Flow reversal in hepatic veins
PW Doppler
Holosystolic c/w severe TR

Question 13

RVSP=

Answer 13

RVSP=4 (TR V squared) + RAP

Question 14

What are the echo signs of Carcinoid Heart Disease?

Answer 14

*RVVO pattern
*Heart Failure Signs
(SOB, orthopnea, PND, fatigue, weight gain)
*TV and PV thickened leaflets fixed in semi-open position
*Elements of both stenosis & regurgitation on TV & and PV

Question 15

What is the murmur heard with TR?

Answer 15

Holosystolic high pitch blowing, that may vary with respiration (Rivero-Carvallo’s sign) heard in xyphoid area

Question 16

What are the treatments for TR?

Answer 16

None or treat underlying condition
Diuretics, salt restriction
Valve replacement, rings

Question 17

What are the clinical signs/symptoms for TR?

Answer 17

Usually asymptomatic (tolerated for years)
JVD
Right Heart Failure
Renal Failure

Question 18

What is TV endocarditis?

Answer 18

Bacterial Infection that affects the heart

staph most common

Question 19

What is the most common cause for TV endocarditis?

Answer 19

IV drug abuse

Question 20

What are the symptoms for TV endocarditis?

Answer 20

Temp > 100 degrees
Positive blood culture for staphylococcus aureus
Murmurs of TR/PI

Question 21

What is the leaflet most commonly involved in TVP?

Answer 21

The Anterior leaflet (can involve any leaflet)