Unit 3 Flashcards
What is the first 3 indications of mitral regurgitation?
LA dilated, LV dilated, and LVVO pattern
How thick are the mitral valve leaflets?
1 mm
Which leaflet of the MV is longer?
Anterior. Larger from the base to the center. About 2.0 cm
Which leaflet of the MV is shorter?
Posterior. Takes up about 1/3 of the base but is only 1.2 cm in width
About how many chordae tendonae arise from each papillary muscle?
12 Primary chordae
What else should you always look for with MR?
blood pressure
You should evaluate the MV and the _________ for the cause of MR.
left ventricle
What is primary MR?
Something is structurally wrong with the valve.
What is secondary MR?
Due to enlarged LV or other cause
Where is the jet with primary MR?
eccentric, aka the edges of the valve
Where is the jet with secondary MR?
central jet
Ischemic MR is caused by?
LV remodeling. Coronary artery disease
Non-ischemic MR is caused by?
chronic cardiomyopathies
What is symmetric tethering?
both leaflets tethered causing global LV systolic dysfunction and remodeling
What type of MR jet is common with symmetric tethering?
centrally located jet
What is asymmetric tethering?
one leaflet tethers due to localized remodeling and dysfunction of posterior wall
What type of MR jet is common with asymmetric tethering?
eccentrically posterior directed MR jet
What two things can cause tenting of the MV?
inferior MI and non-ischemic cardiomyopathy
Mitral stenosis has a ________ gradient for a stronger severity.
higher. (5-10mmHg is moderate for MS)
Mitral regurgitation has a __________ for a stronger severity
lower. (EX on powerpoint was 4.5 m/s is severe MR)
LA dilation is one of the first symptoms of MR. Which direction can the LA be dilated?
vertically or horizontally. Sometimes PLAX isn’t accurate because it only measures inferior to superior.
Vena Contracta represents the effective flow area with MR. What is mild and what is severe?
Mild = less than or equal to 0.3 cm
Severe = greater than or equal to 0.7 cm
We use color flow to subjectively determine MR severity. What is mild MR?
Jet is just beyond the MV leaflets
We use color flow to subjectively determine MR severity. What is moderate MR?
Jet is 1/3 way into left atrium
We use color flow to subjectively determine MR severity. What is severe MR?
Jet mid to back wall of left atrium. Goes back towards the pulmonary veins.
MR happens in what cardiac cycle?
systole
What type of murmur is heard with MR?
holosystolic that radiates to the armpit. Blowing or high-pitched murmur
What side of the baseline is MR seen on with Doppler?
below the baseline
What type of murmur is heard with AR?
high-pitched, blowing, diastolic decrescendo murmur at the left sternal boarder.
Severe AR creates a low-pitched, mid-diastolic, rumble at the apex (Austin-Flint murmur)
What cardiac phase does AI occur in?
Diastole
What are the first three cardiac sequelae for AR?
LVVO, dilated LV, and increased LV end-diastolic pressure (lean patient forward)
What cardiac phase is a bicuspid aortic valve best seen in?
systole
What does Phen-fen do to the valves?
Adds a gristle-like material
What characteristics are seen with Marfan’s syndrome?
dilated aortic root with associated MVP connective disease
When is surgery indicated for severe AI?
Early closure of the MV and early opening of the AOV
What is the pressure half time for mild AI?
Greater than 400 milliseconds
What is the pressure half time for moderate AI?
400 - 200 miliseconds
What is the pressure half time for severe AI?
Less than 200 milliseconds
How can you tell the difference in chronic and acute AI in regards to the Doppler velocities?
Chronic is wider and flatter. Acute has more of an angle for pressure halftime
How can you tell the difference in MS and AI?
MS does not reach high velocities like AI. AI occurs in the isovolumic phases. AI has a greater end diastolic velocity
The ___________ the jet, the more severe the AI.
Wider. Not about distance, it’s about width of jet. Unlike MR.
If the eccentric jet of AR hits the AMVL, what does this cause?
A smiley sign. Diastolic doming. Reverse doming.
