Unit 2 Flashcards
Normal flow for Mitral Valve
.6 - 1.3 m/s
Normal flow for tricuspid valve
.3 - .7 m/s
Normal flow for pulmonary artery
.6 - .9 m/s
Normal flow for LVOT
.7 - 1.1 m/s
Normal flow for aortic valve
1.0 - 1.7 m/s
Where is MV flow obtained from?
Apical 4 chamber
What type of flow does the mitral valve display?
biphasic flow
Where is the TV flow obtained from?
Apical 4 chamber, RV inflow, Parasternal short at AO valve
What type of flow does the tricuspid valve display?
biphasic flow
Where is aortic valve flow taken from?
apical 5 chamber, subcostal
Where is the pulmonic valve flow taken from?
parasternal short at AO valve, pulmonary artery outflow tract, subcostal
What is different in the LA and the LV in mitral stenosis?
There is an increased gradient. LA pressure is increased causing pulmonary hypertension.
What must you check if a patient has mitral stenosis?
RVSP
What physical symptoms might someone have with mitral stenosis?
Sleeping on two pillows at night because their heart rate drops and blood backs up into the pulmonary system causing a dry cough in the morning. (PHTN)
When might you see hockey stick leaflets of the mitral valve?
Rheumatic mitral stenosis
What are the four things noted in m-mode if someone has mitral stenosis? Which is most important?
- Thickened leaflets
- Decreased E-F slope
- Anterior movement of the PMVL
- LA enlargement
What is planimetry of the MV orifice?
Measuring the orifice
In Doppler, the MV normally looks like an M. What does an abnormal (stenotic) MV look like/ what characteristics does it have?
Looks like a trapezoid. It has spectral broadening and a persistent gradient
What is pressure half time?
The amount of time it takes the initial peak pressure gradient to fall to one half its original pressure
If a patient’s MV mean gradient is between 5-10 they have what type of stenosis?
Moderate
What is the pulmonary artery pressure for someone with moderate MS?
30-50
What is the valve area for someone with moderate MS?
1.0 - 1.5
What does color flow Doppler look like for someone with mitral stenosis?
Candle flow, aliased flow
Why would a stress Doppler be used for MS?
Exercise increased volume of the heart. This will increase the mean gradient and the RVSP
What does mitral stenosis with smoke in the left atrium indicate?
precursor for clot formation with an organized clot in the LAA
What is a bicuspid aortic valve?
2 cusps
What might someone with a bicuspid aortic valve experience in the first 5-7 decades of their life?
Early calcification of their leaflets
50% of people with bicuspid aortic valves have what condition as well?
coarctation of the descending aorta
How might the leaflets of the aorta look with someone who has aortic stenosis?
Doming
What is the hemodynamics of aortic stenosis?
Rise in LV pressure, LVP overload, LVH, rise in LVEDP, rise in LA pressure, eventually it will lead to LV systolic dysfunction
What are some 2-D findings for someone with aortic stenosis?
Thickened leaflets, systolic/diastolic doming, how many cusps, dilated AO root, LV systolic and diastolic function, concentric LVH, co-existing lesions
Normal pressure gradient flow for the aortic valve?
.7 - 1.9 m/sec
What level of AS does a patient have if their pressure gradient is 3 - 4 m/sec
Moderate
When do we use the Bernoulli equation?
To convert velocity to a pressure gradient
What is the Bernoulli equation?
4(V2)squared - 4(V1)squared
What is different with Echo and Cath gradients?
Echo measures peak instantaneous and Cath measure peak to peak. Echo will be higher so we compare the MEAN gradient from both
What do V1 and V2 represent?
V1 is pre-aorta (outflow tract) and V2 is in the aorta
What is the formula for A2 or the AVA?
(Area1 x velocity 1) divided by velocity 2
Tricuspid flow and Mitral flow are seen in what cardiac phase? (same as stenosis)
Diastole
Tricuspid flow and Mitral flow are seen above or below the baseline? (same as stenosis)
Above
Tricuspid/mitral regurgitation are seen in what cardiac phase?
Systole
Tricuspid/mitral regurgitation are seen above or below the baseline?
Below
The pulmonic and aortic valve, normal flow, is seen in what cardiac phase?
systole
The pulmonic and aortic valve, normal flow, is seen above or below the baseline?
Below
The pulmonic and aortic valve, regurgitation, is seen in what cardiac phase?
diastole
The pulmonic and aortic valve, regurgitation, is seen above or below the baseline?
above
Higher frequencies mean _________ wavelengths
Smaller
Lower frequencies mean ___________ wavelengths
higher
Doppler tracings must be ____________ to flow
parallel
What is the Doppler shift? (Doppler equation)
Cos0 is 0 degrees = 1
90 degrees = 0 (as the denominator)
Mild mitral stenosis will have __________ gradient during ____________
persistent gradient
diastasis
Severe mitral stenosis will have ___________ gradient
high
The higher the _____________ in the LA the lower the ___________
pressure, velocity
respirations do not play a role in _____ or ______ but do with _________
MS or MR, Tricuspid regurgitation
Pressure 1/2 time in the MVA is under what number?
220
Pressure 1/2 time in the TVA is under what number?
190
Pulmonic stenosis has a _______ velocity with a _______________________
low, diastolic shelf
How can you tell the difference in AI and MS?
AI peaks early and reaches higher velocities. Peaks during the IV times. MS not as high as 3.0 and only occurs when the MV is open.
In stenosis, the chamber ________ the valve will be ______ and have a ____________
behind
dilated
pressure overload
Echo uses ________ gradients but Cath uses _____________. Use the __________ for both.
peak instantaneous
peak to peak
mean gradient
AOV uses ____________.
MV uses ______________.
Peak
Mean
What kind of murmur is heard with AS?
systolic crescendo decrescendo murmur
What kind of murmur is heard with MS?
diastolic rumble. not loud. decrescendo-crescendo
What is the continuity equation?
LVOTD^2 x .785 x LVOTTVI
What is the AVA equation?
LVOTD^2 x .785 x LVOTTVI/ AOVTVI (V2)
