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ECHO 325 > Tricuspid And Pulmonary Regurgitation > Flashcards

Tricuspid And Pulmonary Regurgitation Flashcards

1
Q

The eitology of TR can be divided into what 3 subgroups?

A

Functional (primary), organic (secondary), mechanical

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2
Q

What is responsible for functional cases of TR?

A

Annular dilation

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3
Q

What are functional causes of TR?

A

Atrial fibrillation, ASD, dilated cardiomyopathy, pulmonary hypertension, pulmonary regurgitation, RV dysplasia, RV CHF, RV infarction

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4
Q

What are the organic causes of TR?

A

Carcinoid heart disease, congenital abnormalities of the TV, connective tissue disorders, iatrogenic, inefective endocarditis, myxomatous disease, radiation injury, rheumatic TV disease, RV infarction, trauma

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5
Q

What are mechanical causes of TR?

A

Packemaker leads, implantable cardioverter defibrillator leads

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6
Q

What can leads do to the tricuspid leaflets?

A

Perforate

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7
Q

What is rheumatic TV disease characterized by? (2)

A

Thickened and retracted TV leaflets

Tenting and/or doming

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8
Q

Doming causes an issue in which phase of the cardiac cycle and why?

A

Diastole, causes stenosis

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9
Q

Tenting causes an issue in which phase of the cardiac cycle and why?

A

Systole, causes regurgitation

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10
Q

What is the key difference between carcinoid and rheumatic disease?

A

The involvement of the MV/AV with rheumatic HD

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11
Q

Why is the TV more susceptible to traumatic TV rupture?

A

Because the RV is more easily compressed

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12
Q

What is the systolic bowing of the belly of the leaflets into the RA during systole?

A

Tricuspid valve prolapse

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13
Q

What is Ebstein’s anomaly?

A

Malformation of the TV leaflets during development

Ebstein on TV = Frankenstein on TV

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14
Q

What are the 4 main characteristics of Ebstein’s anomaly?

A
  1. Adhesion of the septal and posterior leaflets to the underlying myocardium
  2. Exaggerated apical displacement of the septal leaflet
  3. Atrialization and dilation of a portion of the RV inflow tract
  4. Small functional RV
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15
Q

What is Ebstein’s anomaly associated with?

A

PFO, ASD, congenitally corrected transposition of the great arteries, VSD’s, hypoplastic pulmonary artery

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16
Q

What may Ebstein’s lead to?

A

Maldevelopment of the conduction pathway from atria to ventricle

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17
Q

When can Ebstein’s be diagnosed?

A

When the septal TV leaflet is displaced apically >20mm

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18
Q

Shunt direction with Ebstein’s anomaly may be what?

A

Right to left (known as Eisenemnger’s syndrome)

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19
Q

How will the leaflets appear with annular dilation?

A

Incomplete coaptation due to the stretched annulus

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20
Q

What are 3 common causes of annular dilation?

A

Dilated cardiomyopathy, ASD’s, and pulmonary hypertension

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21
Q

Chronic, severe pulmonary hypertension is associated with what?

A

RV and TV annular dilation

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22
Q

If shunts aren’t fixed with an ASD, what can happen?

A

Pulmonary vascular resistance increases

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23
Q

If the TR peak velocity does not reflect the severity of TR, what does it reflect?

A

Pressure difference between RV and RA during systole

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24
Q

If a patient has pulmonary hypertension, what will you see during a sniff test?

A

IVC will not collapse

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25
Q

If the RV is undergoing volume overload and has a D sign, what phase of the cardiac cycle would this be seen?

A

Systole

26
Q

If the RV is undergoing pressure overload and has a D sign, what phase of the cardiac cycle would this be seen?

A

Systole and diastole

27
Q

Clinical features of TR include what examples of right heart failure?

A

Increased JVP (jugular venous pulse), hepatomegaly, peripheral edema, and ascites

28
Q

What are indirect signs of the severity of TR regurg using color Doppler?

A

Color jet area, vena contracta width, flow convergence radius

29
Q

What are indirect signs of the severity of TR regurg using Spectral Doppler?

A

Tricuspid inflow (PW), hepatic vein profile (PW), intensity of TR signal (CW), TR jet contour (CW)

30
Q

What is the coanda effect?

A

When the eccentric jet does not look severe (but actually is) and hugs the wall

31
Q

Are PISA and vena contracta normals dependent on the valve and when can they not be used?

A

Nope, same same on every valve.

Multiple jets

32
Q

What does a hepatic vein doppler profile look like with normal TV function?

A

Inverted pulmonary vein

33
Q

What does the hepatic vein Doppler profile look like with severe TR?

A

Reversed S wave

34
Q

Mild TR waveforms have what kind of shape?

A

Parabolic

35
Q

Significant TR waveforms have what kind of shape?

A

Triangular

36
Q

The triangular shape of a significant TR waveform is known as the what?

A

V cut off

37
Q

What does the wave look like with severe tricuspid inflow?

A

Dominant E wave (≥1m/s)

38
Q

What does the hepatic vein look like with mild TR?

A

Systolic dominance

39
Q

What does the hepatic vein look like with moderate TR?

A

Systolic blunting

40
Q

What does the hepatic vein look like with severe TR?

A

Systolic reversal

41
Q

What does the TR jet intensity look like with mild TR?

A

Incomplete or faint

42
Q

What does TR jet intensity look like with moderate TR?

A

Dense

43
Q

What does TR jet intensity look like with severe TR?

A

Dense

44
Q

What does TR jet contour look like with mild TR?

A

Parabolic

45
Q

What does TR jet contour look like with moderate TR?

A

Usually parabolic

46
Q

What does TR jet contour look like with severe TR?

A

Early peaking or triangular

47
Q

What are the 2 main methods used to quantify the amount of regurgitation using the PISA principle?

A

Regurgitant volume and EROA (Size of hole)

48
Q

As flow advances closer to the hole, the area of each hemispheric shell decreases while the velocity of each shell does what?

A

Increases

49
Q

What is considered a mild regurgitant volume?

A

<30

50
Q

What is considered a moderate regurgitant volume?

A

30-44

51
Q

What is considered to be a severe regurgitant volume?

A

≥45

52
Q

What can the etiology of pulmonary regurgitation be divided into?

A

Functional and organic

53
Q

What does organic pulmonary regurgitation refer to?

A

PR due to an abnormality of the cusps

54
Q

Functional pulmonary regurgitation refers to what?

A

Causes which cause annular dilation which leads to poor cusp coaptation

55
Q

What are some symptoms of severe pulmonary regurgitation?

A

Dyspnea, peripheral edema, fatigue, increased JVP, and liver engorgement

56
Q

What is the PR jet width ratio?

A

Width of the PR jet compared to the RVOT diameter (PR JET WIDTH / RVOTd)

57
Q

What is a severe PR PRI?

A

<0.77

58
Q

What is PRI?

A

Pulmonary Regurgitation Index

Ratio of the PR duration to the total duration of diastole

59
Q

What are the values for PI pressure half time?

A

Mod PI: > 100 ms

Sev: <100 ms

60
Q

What are PAEDP and mPAP and when are they calculated?

A

Pulm art end dia pressure

Mean pulm art pressure

Calculated in the presence of PI

61
Q

How do you calculate PAEDP?

A

PAEDP = 4Vpi-ed^2 + RAP

Vpi-ed = End diastole (top caliper on PI slope)

62
Q

How do you calculate mPAP?

A

mPAP = 4Vpi-endpeak-^2 + RAP

Vpi-endpeak = End diastole (bottom caliper on PI slope)

ECHO 325 (19 decks)

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