Week 4 PS and PI Flashcards
Etiology of PS
Congenital (most common)
- valvular PS (valve cusps)
- subvalvular PS (RVOT)
- supravalvular PS (PA)
Acquired (rare)
- rheumatic
- carcinoid (affects TV first then PV)
Hemodynamics of PS
RV hypertrophy
= RV press overload and RV failure
= Incr RA press
Right heart failure
**right heart is not built for high press!
Signs and symptoms of PS
Murmur in systole
(bc not enough blood)
- chest pain
- syncope
- SOB
- fatigue
if right heart failure… fluid issues (blood pooling in feet)
Role of echo in PS
- determine site of obstruction: valv, subvalv, supravalv, branches?
- Assess valve: systolic doming?
- Assess RV size and sys funct: linear meas, TAPSE or Tissue Doppler
- Assess severity of PS: measure peak vel and gradient from CW through PV (SAX)
- Measure RV free wall thickness: SC at level of Ant TV leaflet at ED
How do you determine the location of PS, if you cannot see it in 2D
- PW of RVOT
- CW through PV
… if high vel, do PW walk down from PV to determine location of step up in vel and PS
When assessing the severity of PS, do you measure peak or mean velocity?
Peak velocity (vs. other valve disease - mean vel)
SAX, CW through PV
put cursor on peak and get peak vel and peak grad
Can you calculate PAP from TR jet if patient has PS?
No, bc RVSP does not equal the RAP (RV has to overcome stenotic valve to push blood into PA)
How do you calculate PASP if patient has PS?
- do TR but don’t report RVSP or PAP bc not valid
- doctor can calculate PAP with this formula if needed:
PAP = RVSP (via TR vel) - PV PG (via CW trace)
Can you use the continuity eqn for PS?
No
Treatment for PS
Meds
Cath lab - balloon valvuloplasty to crack valve open
Surgical to replace valve
PI - is it normal?
Yes, normal to have trivial - mild - mod
severe PI is rare
Etiology of PI
Functional PI (dilated RV)
- congenital with dilated RV
- PA dilation/PH
- RV cardiomyopathy
- RV infarct
Organic (problem with valve)
- carcinoid
- congenital
- Iatrogenic - pacemaker
- endocarditis
- rheumatic
- trauma
Role of sonography in PI
- Determine etiology: functional (dilated RV) or organic (valve)?
- Assess for RV size and sys funct
- linear meas
- TAPSE or Tissue Doppler - Estimate PA press: PASP or PAEDP
- Estimate severity of PI
- Visual (colour): mild, mod, severe
*this is all for in BC
- look at intensity of CW trace: the brighter the PI waveform, the worse the PI
- look at deceleration of CW trace: steeper slope is more severe PI
Signs and symptoms of PI
often asymptomatic
Murmur in diastole
Treatment of PI
Fix underlying cause
surgical intervention - valve replacement is rare
vegetation is another word for
endocarditis
