Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DMST 283 ECHO 2 > Tricuspid Regurgitation > Flashcards

Tricuspid Regurgitation Flashcards

1
Q

What is involved in the tricuspid valve complex? 5

A
  1. TV annulus
  2. Three leaflets
  3. Chordae tendinae
  4. 2 discrete pap muscles
  5. RV myocardium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the three leaflet tips of the tricuspid valve? 3

A
  1. Septal
  2. Anterior
  3. Posterior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the three TV commissures? 3

A
  1. Anteroseptal commissures
  2. Anteriorposterior commissures
  3. Posteroseptal Commisure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is the anterioseptal commissures located?

A

Between the anterior and septal leaflets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is the anteroposterior commissure located?

A

Lies between the anterior and posterior leaflets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where is the posteroseptal commissures located?

A

Lies between the posterior and septal leaflets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some clinical features of TR? 3

A
  1. Usually well tolerated
  2. Severe/ progressive TR may show signs of right sided heart failure
  3. May show clinical features of underlying cardiac conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some clinical features of ECG/ EXR for TR? 3

A
  1. RA enlargement
  2. A-Fib
  3. RBBB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some clinical features of auscultation for TR?

A

Holosystolic murmur along LT sternal border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the role of echo to assess TR? 5

A
  1. Determine etiology of the lesion
  2. Assess RA size
  3. Assess RV size and function
  4. Estimate severity of the regurgitation
  5. Estimate right heart pressures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is tricuspid regurgitation?

A

The backward flow of blood from the RV and the RA during systole due to an incompetent TV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Etiology of TR can be divided into 3 subgroups, what are they? 3

A
  1. Functional (secondary) causes
  2. Organic primary causes
  3. Mechanical causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

As with MR, TR may occur due to what?

A

Disorders affecting any part of the TV complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some examples of functional causes of TR? 6

A
  1. Atrial fibrillation
  2. Atrial septal defect
  3. Pulmonary hypertension
  4. Dilated cardiomyopathy
  5. RV CHF
  6. RV infarction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are functional causes?

A

Any thing that causes annular dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are organic causes?

A

Disorders of the TV complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some organic causes examples? 4

A
  1. Carcinoid heart disease
  2. Infective endocarditis
  3. Epstein anomaly
  4. Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some examples of mechanical causes?

A

Pacemaker leads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Rheumatic TV disease almost never occurs when/ where?

A

In isolation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is almost always involved with rheumatic TV disease?

A

MV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Rheumatic TV disease is characterized by what?

A

Thickened and retracted TV leaflets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is seen with the TV in 2D when there is rheumatic TV disease?

A

Diastolic doming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Besides the thickened and retracted TV leaflets what else may happen to the annulus?

A

Dilation May occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a carcinoid heart disease?

A

When there is a rare malignant tumour which damages right heart valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What happens to the TV with carcinoid heart disease?

A

The TV becomes thickened, retracted and rigid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does carcinoid heart disease lead to?

A

TS and TR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

With carcinoid heart disease, how is the valve of the TV?

A

The valve remains in a fixed semi-open position throughout the cardiac cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the key difference between carcinoid and rheumatic heart disease?

A

The involvement of the MV/AV with Rheumatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What does aliasing during systole and diastole indicative of during carcinoid HD?

A

MS and MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What disease has thickened, retracted TV leaflets and normal MV mobility?

A

Carcinoid HD TR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What happens with traumatic TV rupture?

A

Trauma puts extreme pressure on the TV chordae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

The RV is more easily what? What does this lead to?

A

Compressed than LV, making TV more susceptible to rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Traumatic TV rupture may lead to what?

A

Chordal rupture or flail leaflet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What would be an example of acute TR with flail?

A

Traumatic TV rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is TVP or Tricuspid valve prolapse?

A

Systolic bowing of the belly of the leaflets into the RA during systole?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What does TVP normally occur with?

A

In association with MVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is Epstein anomaly?

A

Malformation of the TV leaflets during development leading to them being placed higher up on the RV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the four major characteristics of Ebstein anomaly? 4

A
  1. Apical displacement of the septal leaflet
  2. Atrialization and dilation of a portion of the RV inflow tract
  3. Small functional RV
  4. “Struck” septal/posterior leaflets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is ebstein anomaly associated with? 4

A
  1. PFO/ ASD
  2. L-TGA
  3. VSD
  4. Hypoplastic pulmonary artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Epstein may lead to maldevelopment of what?

A

The conduction pathway from atria to ventricle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What syndrome may ebstein lead to eventually?

A

Wolfe-Parkinson’s white syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What view should we use to view ebstein anomaly?

A

A4C view

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Ebstein s can be diagnosed when the septal TV leaflet is displaced how much apically?

44
Q

During Ebstein anomaly, which leaflet may have restricted motion?

A

The anterior TV leaflet

45
Q

Which leaflet may have a whiplike motion and be longer with redundant tissue, in terms of Ebstein anomaly?

A

Septal TV leaflet

46
Q

When we assess ebstein with colour, how will it present? why?

A

There will invariably be some degree of TR due to lack of coaptation

47
Q

When we use spectral doppler to interrogate Ebstein what might we see? 2

A
  1. ASD or PFO with colour in colour or pulsed wave doppler
  2. Shunt direction being right to left instead of left to right
48
Q

What is eisenmenger’s syndrome?

A

When the shunt direction reverses from being left to right to right to left

49
Q

What does PFO stand for?

A

Patent foramen ovale

50
Q

What is a functional cause of TR?

A

Annular dilatation

51
Q

What is ASD or atrial septal disease?

A

A birth defect of the heart in which there is a hole in the wall (septum) that divides the chambers (atria) of the heart

52
Q

Why do we have have TR with annular dilation?

A

The atria gets so big that the leaflets can’t touch.

53
Q

How are the TV leaflets with annular dilation?

A

They are normal and fully functional

54
Q

What are common causes of annular dilation? 3

A
  1. Dilated cardiomyopathy
  2. Atrial septal defect
  3. Pulmonary hypertension
55
Q

How does Pulmonary hypertension lead to functional TR?

A

PHTN leads to RV dilation then functional TR

56
Q

How does RV dilation affect the TV? 2

A
  1. Incomplete coaptation of the TV leaflets
  2. Pap muscles pulled artery from TV
57
Q

TR peak velocity does not reflect on what?

A

The velocity of the TR but simply the pressure difference between RV and RA during systole

58
Q

With pulmonary hypertension, What does TR look like? 2

A
  1. Mild TR with high jet velocity
  2. Severe TR with Low jet velocity
59
Q

What does paradoxical septal motion look like with PAH and TR?

A

The IVS looks flat because the high RV pressure is pushing it to the LT side in a “shape”

60
Q

PAH and TR can be caused by what two things? 2

A
  1. RV volume overload
  2. RV pressure overload
61
Q

What does a RV volume overload look like

A

D sign only during diastole

62
Q

What does RV pressure overload look like?

A

D sign throughout the entire cycle

63
Q

How do we determine the RA size?

A

RA volume index

64
Q

What is the RA volume index numbers for Male and female? 2

A
  1. Male: 32 ml/m
  2. Female 27ml/m
65
Q

What is the normal range for TAPSE

66
Q

What is the S prime normal value?

A

> 9.5 cm/s

67
Q

What normal FAC ranges?

68
Q

What is normal RIMP values?

69
Q

What are three ways to estimate severity of Regurgitation? 3

A
  1. Qualitative assessment
  2. Semi-qualitative assessment
  3. Quantitative assessment
70
Q

What are some examples of qualitative assessment? 3

A
  1. Colour jet area
  2. Vena Contracta width
  3. Flow convergence radius
71
Q

What are some examples of semi-qualitative assessment? 4

A

Spectral doppler
1. Tricuspid inflow PW
2. Hepatic vein profile PW
3. Intensity of TR signal CW
4. TR jet contour CW

72
Q

What quantitative assessment examples? 2

A
  1. Regurgitation volume (RV)
  2. Effective Regurgitant orifice area (EROA)
73
Q

What the Mild, moderate, severe values for TR jet area measurement? 3

A
  1. Mild <5cm
  2. Moderate 5-10cm
  3. Severe >10cm
74
Q

How often is TR jet area measurements taken?

A

Still performed in some labs but not common

75
Q

How do we get TR jet area measurements?

A

Trace around the aliased portion of the TR jet only using the calc package.

trace only the aliased jet to avoid overestimation

76
Q

How many planes should we use for TR jet area measurement?

A

Multiple planes

77
Q

Label the regurgitation? 3

A
  1. Mild central
  2. Several Central
  3. Severe Eccentric
78
Q

When do we have an underestimation of TR jets?

A

When there is an eccentric jet

79
Q

What does the Coanda effect?

A

When there is an eccentric jet that will hug the atrial wall

80
Q

What happens when there is a severe lack of TV coaptation?

A

A huge hold in the TV during systole is formed

81
Q

When there is a huge hole in the TV during systole due to a lack of TV coaptation, is there Aliasing and why?

A

No aliasing due to the low velocity of the TR jet.

82
Q

What does TR jet velocity represent?

A

The pressure gradient between RV and RA

83
Q

Label the image?

84
Q

What are the valves for Vena contracta and PISA radius? Know the PISA radius numbers VC is a bonus

A

Same as MR

85
Q

Can we use Vena contracta and PISA if there are multiple jets?

86
Q

What is a tip for measuring Vena contracta?

A

Zoom on any window

87
Q

PISA should be measured in which view?

A

A4C with zoom

88
Q

What should the Nyquist limit be set for PISA radius?

A

20-40 cm/s

89
Q

In terms of TV inflow pulsed wave doppler, the E and A wave velocity should be lower than what?

90
Q

What might >1.0 m/s indicate when interrogating for a TV inflow PW doppler?

91
Q

What should Normal TV flow be?

92
Q

When two volumes are combined what happens in the TV?

A

Regurgitant volume increases, but for this to happen more flow must travel through the TV

93
Q

What happens when there is less forward flow into the IVC due to TR?

A

The liver becomes engorged

94
Q

TR signal intensity depends on what?

A

The number of RBCs moving in the same direction

95
Q

More/ Less RBCs mean what in terms of waveform?

A

More = brighter TR signal and vice versa

96
Q

What re some technical factors we might need to consider when looking at the intensity of TR doppler signals? 2

A
  1. Gain
  2. Doppler angle
97
Q

What do we need to compare in terms of TR brightness when adjust gain?

A

Antegrade flow

98
Q

Label the image

99
Q

With Mild TR, The high PG is affected how?

A

It is maintained throughout systole

100
Q

What is the appearance of mild TR?

A

Parabolic appearance

101
Q

What is the appearance of significant TR?

A

Triangular cutoff or V cut off

102
Q

With significant TR, The PG does what?

A

Reduces as the TR enters the RA during systole

103
Q

What happens in the Hepatic vein when there is severe TR?

A

Systolic reversal

104
Q

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

A
  1. Regurgitant volume
  2. EROA (effective Regurgitant orifice area)
105
Q

What are ways we can estimate right heart pressures? 4

A
  1. RVSP
  2. PAT
  3. mPAP
  4. PAEDP

DMST 283 ECHO 2 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions