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Echo > Valvular Heart Disease (VHD): MR/MS > Flashcards

Valvular Heart Disease (VHD): MR/MS Flashcards

1
Q

pulmonic regurgitation is ____ the Doppler baseline during _____.

A

above/diastole

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2
Q

regurgitation travels in the _____ direction of normal flow, while stenosis travels in the ____ direction as normal flow.

A

opposite/same

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3
Q

In the chamber that is _____ to the stenotic valve, the blood backs up, drives the pressure up, and creates a pressure overload pattern.

A

proximal

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4
Q

______ of the valve leaflets is caused by a combination of the pressure pushing on the undersurface of the leaflets and commissural fusion.

  1. calcification
  2. doming
  3. thickening
  4. fusion
A

2

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5
Q

when the heart has to compensate for increased afterload, the result is ____ of the ventricular walls because the heart has to work harder to eject the blood.

  1. atrophy
  2. dyskinesis
  3. hypertrophy
  4. hypokinesis
A

3

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6
Q

a regurgitant valve creates a volume overload pattern because it is dumping extra blood into the ____.

  1. distal chamber
  2. inferior chamber
  3. proximal chamber
  4. superior chamber
A

3

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7
Q

complication of MS includes:

  1. dilatation of Asc Ao
  2. increased LAP
  3. LV enlargement
  4. post stenotic dilatation
A

2

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8
Q

what type of murmur is associated with mitral stenosis?

A

low pitched diastolic rumble with an opening snap

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9
Q

MS creates a volume and pressure overload pattern. this may result in LVH and a small, D-shaped right ventricle. T or F?

A

F: it creates small D-shaped LV

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10
Q

_____ is a treatment option for MS.

  1. percutaneous mitral balloon valvotomy
  2. mitral commissurotomy
  3. MV repair or replacement
  4. all of the above
A

4

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11
Q

signs and symptoms of stenosis include murmur, dyspnea, fatigue, hemoptysis, dizziness, chest pain, syncope, and these may worsen with exercise. T or F?

A

T

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12
Q

echo findings of MS include:

  1. LA spontaneous echo contrast
  2. posterior motion of PMVL
  3. systolic doming of AMVL
  4. thin elongated leaflets
A

1

  • anterior motion of PMVL
  • diastolic doming of AMVL
  • thick calcified leaflets
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13
Q

MR causes diastolic doming of the anterior MV leaflet with a hockey stick appearance. T or F?

A

F
not MR, MS

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14
Q

most MS patients remain asymptomatic until the MVA is ____

A

= or less than 1.5 cm2

*4 cm2 or greater = normal

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15
Q

MR associated with MS is most likely due to ____

A

LA enlargement

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16
Q

increased E-F slope, increased “A” wave, and decreased leaflet excursion are common MS M-mode findings. T or F?

A

F

  • decreased E-F slope
  • decreased or absence of “A” wave
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17
Q

RVH (RV hypertrophy), RV dilatation, flattening of the IVS, paradoxical wall motion, and a small D-shaped LV are the result of PH. T or F?

A

T
*Note: paradoxical - seemingly absurd or self-contradictory

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18
Q

RVH (RV hypertrophy), RV dilatation, flattening of the IVS, paradoxical wall motion, and a small D-shaped LV are the result of PH. T or F?

A

T
*Note: paradoxical - seemingly absurd or self-contradictory

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19
Q

An absent “a” wave combined with mid-systolic closure of the PV are seen in the presence of _____.

A

PH
*mid-systolic closure creating “w”

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20
Q

MS severity is determined by____ (3 parameters).

A
  1. pressure half-time (p1/2t)
  2. MVA (MV area)
  3. mean PG
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21
Q

MVA = _______

A

220/pressure half-time

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22
Q

if the MV pressure half-time = 230m/s, the patient most likely has _____.

A

severe MS

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23
Q

MS severity scale:

what is the normal value?

  1. P1/t2
  2. MVA
  3. mean PG
A
  1. 30-60 m/s
  2. 4-6 cm2
  3. < 5 mmHg
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24
Q

MS severity scale:

what is the sever value?

  1. P1/t2
  2. MVA
  3. mean PG
A
  1. >/= 220
  2. < 1.0cm2
  3. > 10mmHg
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25
Q

planimetry of the Doppler waveform calculates the mean pressure gradient. T or F?

A

T

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26
Q

what is the most common Doppler method utilized to calculate MVA?

A

pressure half time method

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27
Q

acute MR leads to PH and HF; whereas , chronic MR caused pulmonary edema. T or F?

A

F
*pulmonary edema is associated with acute MR - LA can’t compensate for the sudden increase in vol - pressure back up into pulmonary system

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28
Q

MR is backward diastolic flow through the MV. T or F?

A

F
systolic, not diastolic

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29
Q

MR increases _____; this creates a LV vol overload pattern and LV enlargement.

A

preload

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30
Q

what type of murmur is associated with MR?

A

holosystolic (Relating to or lasting throughout the systole of a heartbeat) murmur that radiates to the axilla

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31
Q

the ACC recommends MV repair or replacement for secondary MR, even if the patients asymptomatic. T or F?

A

F
recommended for primary MR, not secondary

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32
Q

echo findings include right and left ventricular enlargement, hyperkinetic wall motion, LA enlargement, AoV notching; what is most likely the diagnosis?

A

MR

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33
Q

CFD findings include a systolic jet traveling from the LV approximately 1/3 of the way back into the LA; what is most likely the diagnosis?

A

2+ mild MR

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34
Q

Carpentier classification of MV dysfunction based on leaflet motion:
what is type1?

A

normal leaflet motion
annulus dilatation
leaflet perforation

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35
Q

what is type 2?

A

increased leaflet motion
ruptured chordae
elongated chordae and/or pap muscle

36
Q

what is type 3-a?

A

systolic leaflet restriction
commissure fusion
leaflet thickening
chordae fusiopn

37
Q

what is type 3-b?

A

diastoli leaflet restriction
ventricular dilatation
ventricular dyskinesia

38
Q

what are the signs/symptoms of MR?

A

dyspnea
fatigue
irregular heart rhythm
orthopnea (SOB when flat)
palpitations

39
Q

what is PISA ?

A

proximal isovelocity hemispheric surface area

40
Q

PISA is also known as:

A

flow convergence method

41
Q

what does PISA do ?

A

estimate the size of the coaptation defect (EROA)

42
Q

what is EROA ?

A

effective regurgitant orifice area = the size of coaptation defect

43
Q

how to do PISA ?

A
  1. with CFD, zoom and optimize the regurgitant jet
  2. shift the CFD baseline down to appx. 20-40cm/s to highlight the hemispheric shape of the flow convergence
  3. acquire mid-systolic or peak PISAr (radius) from the orifice where the color changes abruptly from blue to yellow
  4. acquire Vmax from CW
  5. acquire aliasing velocity (Va) from CFD to calculate EROA
  6. acquire MR VTI to calculate the MR volume
44
Q

what is the equation for MR volume ?

A

MR vol = EROA x MR VTI

*note: EROA = 2pi (PISAr)2 / MR Vmax x Va

45
Q

MR severity scale: MR vol & EROA

what is the mildvalue ?

A

MR vol < 30ml
EROA < 0.20 cm2

46
Q

what is severe value ?

A

MR vol > 60
EROA > 0.40 cm2

47
Q

what is severe MR as far as PV profile?

A

reversed “s” wave
increased “D” wave

48
Q

MVP with moderate to severe MR requires prophylactic antibiotics. T or F ?

A

F
AHA does not recommend it

49
Q

what type of murmur is associated with MVP ?

A

mid-systolic click with/without a systolic murmur

50
Q

a false positive MVP may result from improper TDR placement or ____.

A

large pericardial effusion

51
Q

in most cases, if the PMVL prolapse there is a posterior directed jet of MR, and if the AMVL prolapses, there is an anterior directed jet of MR. T or F ?

A

F
PMVL - anteriorly directed jet
AMVL - posteriorly doiected jet

52
Q

holysystolic MVP > or = 1 mm below the C-D points classifies MVP my M-mode. T or F ?

A

F

  • mid-to-late systolic prolapse > 2mm below
  • holysystolic > or = 3 mm below
53
Q

4 signs/symptoms of MR

A
  1. orthopnea
  2. dyspnea
  3. palpitations
  4. irregular heart beat
54
Q

a MVA of < 1.0cm2 and a mean PG of > 10mmHg indicates______ MS

A

severe

55
Q

grade III MR - jet is _______

A

moderate to severe: MR jet 1/2 way into the LA

56
Q

grade I MR - jet is__________

A

mild MR: small central jet
< 4cm2 & < 20% LA area

57
Q

describe color Doppler characteristics of severe MR

A

MR jet: mid to back wall of LA
EROA > 0.40

58
Q

list different methods of calculating MS

A
  • planimetry
  • pressure half time
  • deceleration time method
  • PISA
  • continuity equation
59
Q

describe color Doppler characteristics of mild MR

A

MR jet: beyond MV leaflets
>10cm2 or >40% of LA are

60
Q

a stress echo with treadmill exercise is indicated when symptoms match the resting gradient. T or F ?

A

F
a stress echo with treadmill is indicated when symptoms do NOT match the resting gradient

61
Q

list the steps of Doppler assessment of MS (4)

A
  1. acquire pressure half time with CW
  2. acquire MVA by measuring: peak E velocity and deceleration time
  3. calculate pressure half time by DT x .29
  4. calculate MVA by 220/PHT
62
Q

grade IV MR - jet is _____

A

mid-to-back wall of the LA

63
Q

List 8 common signs/symptoms of MS.

A

chest pain
shortness of breath
dizziness
coughing
dyspnea
fatigue
heart palpitation
Arrhythmia
Swollen feet/legs
hemoptysis
murmur
right heart failure
Symptoms of stroke
Symptoms may appear/worsen with exercise or stress

64
Q
A

Vena contracta

65
Q

List 4 Signs/Symptoms of MR.

A

dyspnea
fatigue
irregular rhythms
orthopnea
palpitations

66
Q

What type of murmur is found with MVP?

A

Mid-systolic click with or without a systolic murmur

67
Q

A MVA of < 1.0 cm2 and a mean gradient of > 10 mmHg indicates _______ MS

A

Severe

68
Q

Describe the type of murmur associated with MS.

A

low-pitched, diastolic rumble with an opening snap

69
Q

List 6 causes of MR.

A

Rheumatic heart disease
Annulus dilatation displaces the papillary muscles and chordae tendineae
(cardiomyopathy, coronary artery disease)
Mitral annular calcification
Flail, prolapse, stenotic leaflets
Elongation or rupture of chordae tendineae
Papillary muscle fibrosis, calcification, ischemia or rupture
Infective endocarditis (vegetation/abscess)
Prosthetic valve dysfunction
Congenital anomalies (cleft mitral valve)

70
Q

MVP is more common in women < 40.
T or F?

A

T

71
Q

List 4 common causes of MS.

A

Rheumatic fever (RF, complication of strep throat)
Rheumatic heart disease (RHD, most common cause of MS)
Severe mitral annular calcifications
Congenital anomaly i.e. MV atresia, parachute MV
Secondary MS due to left atrial mass/tumor or MV vegetation from infective endocarditis
Prosthetic valve dysfunction
Radiation to the chest
Autoimmune disease i.e Lupus

72
Q

Grade III (3) MR - Jet is _______________.

A

Moderate to severe MR: MR jet ½ way into the left atrium

73
Q

List at least 8 complications of MS that indicate a progression of the disease process.

A
  1. Increase in LA pressure
  2. MV leaflet doming
  3. LA enlargement
  4. Possible Afib
  5. Back up/enlargement of PVs
  6. Increase in PA pressure
  7. PH
  8. Increase in RA/RV pressure
  9. Right heart enlargement
  10. TR due to TV annular dilatation
  11. Dilatation of SVC/IVC
  12. Dilatation of HV/JV
  13. Dilatation of systemic vein
  14. Ascites, ankle edema, and other peripheral symptoms
  15. Associated MR
  16. Associated LA thrombus and systemic embolization
  17. Possible increased risk of infective endocarditis
  18. Decreased CO
74
Q

Color Doppler of MR demonstrates turbulent systolic flow that travels backward from the left ventricle, through the opened MV into the LA.

T or F?

A

F

Color Doppler of MR demonstrates turbulent systolic flow that travels backward from the left ventricle, through the closed MV into the LA.

75
Q

Grade I MR — Jet is _________

A

Mild MR: MR jet just beyond the MV leaflets

Mild to moderate: MR jet between mild and moderate

76
Q

Grade II MR - Jet is _________.

A

Moderate MR: MR jet ⅓ way into the LA

77
Q

Describe Color Doppler characteristics of Severe MR.

A

MR jet mid-to-back wall of the LA

EROA > 0.40

78
Q

List at least 2 different methods of calculating MS.

A
  1. Planimetry
  2. Pressure halftime method
  3. Deceleration time (DT) method
  4. PISA method
  5. Continuity equation
79
Q

A M-mode recording through the mitral valve will demonstrate marked thickening and increased echogenicity of both mitral leaflets and a very flat ejection fraction slope indicative of significant mitral stenosis.

T or F?

A

T

80
Q

Describe Color Doppler characteristics of mild MR.

A

MR jet just beyond the MV leaflets

EROA < 0.20

81
Q

A Stress echo with treadmill exercise is indicated when symptoms match the resting gradient.

T or F?

A

F:

A Stress echo with treadmill exercise is indicated when symptoms do not match the resting gradient.

82
Q

What does PISA stand for?

A

Proximal Isovelocity Surface Area

83
Q

The MR murmur is a holosystolic murmur that radiates to the axilla; it may be described as a blowing or high-pitched murmur.

T or F?

A

T

84
Q

List the steps of Doppler assessment of MS. (4)

A
  • Acquire pressure halftime with CW
  • Acquire mitral valve area by measuring: peak E velocity & deceleration time
  • Calculate pressure halftime by DT (deceleration time) x 0.29
  • Calculate MVA by 220/PHT
85
Q

Carpentier classification of mitral valve dysfunction based on leaflet motion has ___________ types. Briefly describe and List.

A
  1. Type 1: normal leaflet motion (Annulus dilation/leaflet perforation)
  2. Type 2: Increased leaflet motion (ruptured chordae/elongated chordae/papillary muscle)
  3. Type 3-a: Systolic leaflet restriction (Commissure fusion/leaflet thickening/chordae fusion)
  4. Type 3-b: Diastolic leaflet restriction (Ventricular dilation/Ventricular dyskinesia)
86
Q

Grade IV MR - Jet is _____.

A

MR jet Mid-to-Back wall of the Left atrium

87
Q

MR is the result of an incompetent mitral valve that permits backward systolic flow from the left ventricle, through the MV ( while it is closed), into the left atrium. T or F?

A

T

Echo (35 decks)

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