Brainscape's Knowledge GenomeTM

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


See full index

Echo > TV, PV, RVOT > Flashcards

TV, PV, RVOT Flashcards

1
Q

What is the General anatomy of the PV?

A

Three cusps, semilunar

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

What forms the RVOT?

A

The area in the ventricle just prior to the valves

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

How many cusps are seen in 2D?

A

Usually only 2 cusps seen

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

How does the AO and PA develop?

A

The AO and PA arise in a parallel fashion. Then rotate such that the RVOT, PV, and proximal PA wrap around the AO and ascending AO.

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

What views are used to evaluate the PA?

Which view can the bifurcation of the PA be seen

A

PLAX
PSAX at base optimal - bifurcation
Subcostal Short and Long.

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

How many cusps are imaged in M-Mode?

What views are used in M-mode

A

one leaflet

M-mode can only intersect one of the leaflets in the PLAX & PSAX views

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

what does each PV waveform looks like on M-Mode?

Normal, Stenotic, HTN, infundibular obstruction, idiopathic dilation

A 
normal valve straight
Stenotic: valve thick
HTN: valve W shape
infundibular obstruction: large spikes
idiopathic dilation; small spikes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the line placement for spectral Doppler of the PA when you use PW vs CW?
What view is this measurement taken at?
What is the difference between the CW & PW wave characteristics?

A

CW - Line should go through the tips of the leaflets
PW- Area immediately prior to flow out the RVOT (prior to annulus
View: Parasternal at the base
Wave is below the baseline
CW: has the highest velocity – no envelope
PW: should have an envelope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What measurements can be taken of the PA in spectral doppler?

A

Acceleration Time: from beginning of wave to peak

VTI: trace wave

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

What happen to the peak when when pulmonary pressure and pulmonary vascular resistance are high?

A

the peak will occur earlier.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are normal pulmonary outflow tract velocity ranges

A

from 1 to 1.5 m/sec.

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

What is Acceleration time and what causes it to decrease?

What are the normal values?

A

the time in milliseconds from the onset of ejection to peak systolic velocity.
In normal individuals, acceleration time exceeds 140 milliseconds and progressively shortens with increasing degrees of pulmonary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the relationship between the pulmonary acceleration time and pulmonary artery systolic, diastolic, and mean pressures.

A

They are inversely related

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

What is an acceleration time of less than 70 to 90 milliseconds is typically indicative of?

A

pulmonary artery systolic pressures ≥70 mmHg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is pulmonary velocity acceleration time (PVAT).

What is the normal value?

A

It is the interval between the onset of flow and peak flow.

The normal PVAT is > 130 msec.

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

Normal PAP time
borderline
Mildly elevated
severely elevated

A 
Severity	                  PVAT
Normal PAP		>130 msec
Borderline PAP	100-130 msec
Mildly elevated	80-100
Severely elevated	less than 80
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is PI?
How is it detected?
What view do we use to assess it?

A

Pulmonary Insufficiency – also known as regurgitation
Use Color doppler
Subcostal PSAX at base view

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where is PI located?

A

They are usually Central or peripherally located on the valve

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

What can PI be confused with?
When is it seen?
What needs to be recognized to avoid any confusion?

A

communication between AO and PA
Only seen in diastole
recognition exclusive diastolic flow

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

What are the differential for PI? Direct and indirect

A

Jet size, depth of penetration into the right ventricle
width of the Vena contracta
Its overall width in relation to the RVOT
Indirect evidence:
Ventricular dilation
Right ventricular overload pattern

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

What causes Pulmonary regurgitation?

A

Everyone has a little PAV and tricuspid regurgitation
stenosis
dilation of annulus (idiopathic or due to pulmonary artery dilation as a consequence of PHT)
congenital absence of one or more pulmonary valve cusps

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

How is Pulmonary regurgitation (PI) detected?

A

color Doppler -detects a diastolic retrograde jet

PW -detect a retrograde spectral profile

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

What type of grading is used to grade PI?

A

Subjective grading
Mild, moderate, severe, ect.
If it can be seen, measure the Vena Contracta (diameter of jet at narrowest point in relation to RVOT diameter)

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

Which is more validated the severity of pulmonary valve regurgitation or AO regurgitation?

A

PV regurgitation is less well validated than of AO regurgitation, in large part due to the lack of reliable standards for comparison

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

What is a known cause of PV stenosis?

A

Usually always congenital

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

What is the hallmark of congenital pulmonic stenosis?

A

thickening and systolic doming of the pulmonary valve cusps

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

What are the findings of PV stenosis in M-mode echocardiography?

A

accentuated A-wave amplitude (>6 mm) with thickening of the leaflet.

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

What is the origin of the accentuated A wave?

A

relatively elevated RV pressure in comparison with the PA diastolic pressure

29
Q

What does stenosis look like in the various modes?

A 
Calcification and Thickening of valves
Leaflets grow together (can see commissural but don’t see it open)
May form bicuspid or uni-cuspid valve
Restrict flow
 systolic doming of the PV cusps
30
Q

How is stenosis detected in spectral doppler?

A

CW – VTI, Max velocity

31
Q

What is a Vena Contracta and how do you measure it?

A

Convergence point
The narrowest central flow region of a jet that occurs at, or just downstream to, the orifice of a regurgitant valve
The narrowest portion of the color jet

32
Q

What parameters of color Doppler do you have to consider when evaluating a PV regurgitation jet?

A

Optimize the color to avoid overcalling jet

Avoid having too much gain

33
Q

What other things can be present on a valve? And how do you tell the difference?
(PV)

A

infectious Endocarditis – Less common with this valve (inflammation of the endocardium)

Vegetations may occur (bacteria or fungal growth) - oscillating appearance

Fibroma or papilloma – spherical mass attached by small stalk

Possibility of having a thrombus attached to it

34
Q

What areas do we use PW vs CW?

A

PW- RVOT & LVOT

CW – PV & AOV

35
Q

What is the anatomical makeup of the RVOT?

What type of tissue?

A

The portion of the RV extending from crista supraventricularis to the pulmonary annulus
It is relatively trabeculated
May be dilated
May see congenital abnormalities

36
Q

What causes sub-valvular stenosis?

A

Elevated pulmonary pressure from stenosis causes hypertrophy

37
Q

What the best view for the RVOT?

A

Parasternal views are best, but can be seen from the subcostal view

38
Q

What demographic are idiopathic dilation of the pulmonary artery typically seen in?

A

elderly female patients

.

39
Q

What does idiopathic dilation of the pulmonary artery frequently result in?
what are two more additional findings?

A
  1. secondary pulmonary valve regurgitation
  2. high-frequency oscillation of the pulmonary valve leaflets noted best with M-mode echocardiography.
    3 .occasional isolated aneurysms of the PA
40
Q

What is the area of the RVOT?

A

the portion of the RV extending from the crista supraventricularis to the PA annulus

41
Q

What disease cause hypertrophy of the RVOT?

A

diseases that elevate right ventricular pressure, such as pulmonary hypertension or
pulmonary valve stenosis,

42
Q

What type of motion of the RVOT can be seen on M-mode?

A

coarse fluttering of the pulmonary valve

43
Q

What is the Anatomy of the TV?

Which leaflet is the smallest? Which is the largest?

A 
Most complex of the valves
Three leaflets of differing size
Anterior leaflet is largest
septal is smallest
Posterior in between
44
Q

What are landmarks of the Right heart?

A

Moderator bad and the TV tricuspid

45
Q

What is the position of the TV in relation to MV?
What is the max normal distance between the TV annulus and the MV annulus?
What view is this best measured at?

A

Closers to the ventricular apex. Located further into the ventricle than the MV annular location.
They should not be more than 7mm apart from one another
Apical 4CH

46
Q

What use does 3D have in evaluating the TV?

A

for surgical planning
evaluate the tricuspid valve in cases such as Ebstein anomaly
quantifying functional tricuspid regurgitation

47
Q

What is Ebsteins Anomaly?

A

The TV is formed in the right ventricle making the right atrium appear large.
No more than 7mm between the MV annulus and the TV annulus.
Measure in Apical 4CH
TV prone to severe leaking, which causes a dilated heart
Causes high right heart pressure

48
Q

What views are used for doppler of the TV? Which is the optimal view?

A

PLAX, PSAX and A4CH

Apical optimal view

49
Q

Recognize the views with TTE and TEE

A

RV Inflow tract, PSAX at the base, Apical 4Ch, subcostal 4Ch,
TEE- 60o base, horizontal left atrial 4ch, gastic 1200, Bicaval view

50
Q

Compared to MV what do the Doppler signals look like?

A

Much lower velocities due to size

E/A typically exceeds 1.0

51
Q

How do we evaluate TR?

A

Color Doppler most common method for TR evaluation

52
Q

How does TR change with age?

A

TR increases with age and virtually everyone has TR

53
Q

What causes TV stenosis and how common is it?

Infrequent occurrence

A

Stenosis is caused from congenital origin, rheumatic heart disease or carcinoid syndrome

54
Q

What causes TR?

A

Very common
Dilation of RV caused from PHT

rupture of cords from blunt trauma or papillary muscle infarction

simple prolapse- slip back a little bit, but not flail which is when the tips pointing back in the wrong direction.

55
Q

What causes severe TR?

A

tethering of valves with cordae (causing them to be restricted and unable to shut properly (coaptation)).

56
Q

How do foreign objects affect the Tricuspid Valve?

A

Catheters, pacemaker leads
leakage and prevent from squeezing down all the way and getting good coaptation
thickening and scarring of leaflets
Inflammation process initiates damaging the leaflet
Found in 20% of individuals with implanted device have some process going on that is affecting the valves

57
Q

How is the Tricuspid Valve effected by Ischemic Heart Disease?

A

Almost always associated with inferior wall (RCA)
Causes remodeling of RV
causing outward dilation of lateral wall and consequently TR

58
Q

How do you grade TR?

A

Trace, Mild, Moderate and Severe
If significant TR, can see reverse flow in IVC and Hepatic Veins
PW sample looking at S,D, A reversal- normally downward
A will be upward – S will be significantly depressed/smaller or reversed.
Reversal indicates greater significance of TR
If using contrast, you can see bubbles confined in RA or back flowing into IVC

59
Q

What is RVSP and how do we determine it?

A

Right ventricular systolic pressure (RVSP)
Use TR jet and measure the peak velocity. (Normal 3-4m/sec)
Plug into Bernoulli equation to get pressure.
In addition you will add the right atrial pressure from the sniff test of the IVC
5-10mmHg
Bernoulli Equation P=4V2
TR jet velocity acquired pressure + RA pressure from IVC = RVSP

60
Q

What is Carcinoid Heart Disease?

What effect does it have on the right and right heart?

A

occurs when a neuroendocrine secreting tumor releases high levels of serotonin and metabolites are released into the bloodstream.
These cause inflammation of the endothelial surface of the valves and endocardium.
They are deactivated by lung therefore only the right heart is affected
May affect the left if there is a shunt allowing bypass of lungs

61
Q

What is fibrosis?

A

formation of the elastic fibers of the endocardium
It is seen in a variety of diseases including hyperesoinophila syndrome and tropical forms of endocardial fibroelastosisFiber

62
Q

What does Endocardial Fibroelastosis do to the TV?

A

Affects the chordae and valve leaflets via inflammation process
Leaflets appear “bound down” to the ventricular wall (tethered to the wall, fibers won’t let leaflets close all the way because they are holding them back)
Associated with the obliteration of the RV apex due to inflammation and secondary thrombosis – particularly associated with hypereosinophilia
LV and MV are similarly involved

63
Q

What effect does persistent elevation of right heart pressure have on the IVC?
(due to TR)

A

THe IVC dilates and loses its normal respiratory variation in size.

64
Q

What is Ebstein Anomaly? what do we see in echo?

A

Congenital defect causing apical displacement of the Tricuspid valve. TV valve form in RV, cause appearance of a large atrium
Causes severe TR
Valves get tethered to the RV wall

65
Q

What is valve resection and how does it affect the valve?

Why and When was valve resection a popular treatment and what are is the current results?

A

Any kind of resection will cause the valve to scar and not function as it should
Resection is usually done due to bacterial endocarditis (usually vegetations or masses)
Many patients in the late 1970’s and early 1980’s had removal of a tricuspid valve leaflet
Obviously severe TR
Now they have significant right heart failure

66
Q

What effect does the complete absence of the TV tissue of on TR?

A

There is no organized flow from the RV to the RA and no increase in velocity or organize jet. . This results in the absence of a convergence zone

67
Q

When would a biopsy be done on the TV?

A

Biopsies done after transplant to make sure it is not experiencing rejection

68
Q

What types of primary tumors can arise on the TV?

How often is this seen?

A

myxomas and occasional fibroelastoma

Rarely

Echo (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions