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Echo Registry Review > Wk 2 Quiz 2 Valvular Disease Flag Questions > Flashcards

Wk 2 Quiz 2 Valvular Disease Flag Questions Flashcards

1
Q

Murmur Intensity

Grade I

A

barely audible

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2
Q

Murmur Intensity

Grade II

A

faintly heard

louder

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3
Q

Murmur Intensity

Grade III

A

moderately loud but not accompanied by thrill

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4
Q

Murmur Intensity

Grade IV

A

loud and can be heard on either side of the chest.

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5
Q

Murmur Intensity

Grade V

A

very loud ( can be heard with a stethoscope)

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6
Q

Murmur Intensity

Grade VI

A

loud with a thrill

like grade V murmurs, are very loud and can be felt through the chest wall, and are the most severe of the heart murmurs

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7
Q

Crescendo-decrescendo murmur

A

murmur-begins softly, become louder,
and then decreases in intensity

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8
Q

***Systolic murmur, heard best at apex, radiates to L axilla

A

MR

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9
Q

Diastolic murmur
usually heard at apex but faint
Decrescendo, low rumbling murmur

A

MS

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10
Q

Heard is 2nd to 4th left interspaces

Blowing decrescendo murmur may be mistaken for breath sounds

A

AR

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11
Q

R second intercostal
Harsh crescendo, decrescendo murmur
Radiates to the carotids, down the left sternal border, even to the apex

A

AS

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12
Q

Causes of Early systolic murmurs:

A
  1. Small VSD
  2. Large VSD with Pulmonary HTN
  3. Severe acute or tricuspid regurgitation
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13
Q

Causes of Systolic ejection murmurs:

A

AS/PS

Increased rate of ejection (heart block, fever, anemia, exercise, thyrotoxicosis, and sometimes heard in normal individuals)

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14
Q

***Causes of Pansystolic (holosystolic) murmurs:

A
  1. MR or TR
  2. VSDs
  3. Aortopulmonary shunts

*holosystolic/pansystolic: lasting throughout the systole of a heartbeat

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15
Q

Causes of Early diastolic murmurs:

A

AR/PR

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16
Q

***produced by the forward flow of blood through the atrioventricular valves (mid-diastolic and late-diastolic murmurs)

A

MS

TS

LA myxoma

large L to R shunt

MR (increased flow)

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17
Q

***The most frequent complication of myxomatous valvular disease is the ________

A

mitral valve prolapse (MVP)

*note:

Common risk factors in the development of Myxomatous degeneration are Connective tissue disorders like Marfan’s Syndrome, Ehlers-Danlos syndrome, and other conditions with collagen abnormalities

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18
Q

Which valve is affected in Marfan syndrome?

A

Cardiac manifestations of Marfan syndrome include aortic root dilation and mitral valve prolapse (MVP)

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19
Q

What heart condition is associated with Turner’s syndrome?

A

The risk of congenital heart defects such as bicuspid aortic valves, aortic coarctation, other valve abnormalities, and septal defect is increased.

Turner syndrome, a condition that affects only females, results when one of the X chromosomes (sex chromosomes) is missing or partially missing. Turner syndrome can cause a variety of medical and developmental problems, including short height, failure of the ovaries to develop and heart defects.

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20
Q

Causes of continuous murmurs: result from blood flow constantly moving from a high-
pressure area to a low-pressure area.

A
  1. PDA
  2. Systemic arteriovenous fistula
  3. Coronary artery from the pulmonary artery
  4. Communications between the sinus of Valsalva and the right side of the heart
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21
Q

Valsalva Maneuvers: Most murmurs _____ during the strain
phase of the Valsalva maneuver except _________ and _____

A

decrease

hypertrophic obstructive cardiomyopathy

mitral valve prolapse

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22
Q

Isometric Handgrip: Sustained isometric handgrip increases
peripheral resistance, blood pressure, heart rate and cardiac
output.

The handgrip ______ the left heart murmurs of ___
___, ____.

The murmurs of ___ & ____ and
__________ will be reduced with sustained
isometric handgrip.

A

increases

MR/AR/VSD

AS/PS

hypertrophic cardiomyopathy

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23
Q

Amyl Nitrite: Amyl nitrite is a fast acting vasodilator. The
inhalation of amyl nitrite will initially decrease venous return and blood pressure.

It increases: (4)

It decreases: (3)

A

Increase:

  • hypertrophic obstructive cardiomyopathy murmur
  • MVP
  • MS/TS (forward flow murmurs)

Decreases:

  • MR, AR, VSD
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24
Q

Loud S1 with opening snap

Low pitch, rumbling, crescendo-decrescendo murmur

A

MS

*with MR - holosystolic murmur

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25
Q

High pitch Blowing Pansystolic (holosystolic) murmur (chronic)

A

MR

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26
Q

severe AS

AVA ?

A

<1.0cm (<0.75cm)

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27
Q

critical AS

AVA ?

A

<0.6 or 0.5cm

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28
Q

another name for severe AR?

A

Austin-Flint murmur

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29
Q

severe AR murmur best heard at ?

A

apex

in the 5th intercostal space at the midclavicular line

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30
Q

Diastolic mitral regurgitation is associated with:

A. Flail mitral valve
B. Mitral valve prolapse
C. Severe aortic insufficiency
D. Severe tricuspid regurgitation

A

C. Severe aortic insufficiency

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31
Q

A heart sound associated with significant chronic pure mitral regurgitation is:

A. Loud S1
B. Fixed split S2
C. S3
D. S4

A

C. S3

Results from increased atrial pressure leading to increased flow rates

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32
Q

Fixed split S2 indictes

A

ASD

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33
Q

clinical signs of significant AS

A
  • murmur
  • angina pectoris
  • Feeling faint or dizzy or fainting with activity
  • SOB, DOE
  • Fatigue, especially during times of increased activity
  • palpitations
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34
Q

Chronic mitral regurgitation results in all the following EXCEPT:

A. Left atrial enlargement
B. Left ventricular enlargement
C. Left ventricular volume overload pattern
D. Mitral annular calcification

A

D. Mitral annular calcification

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35
Q

Possible etiologies for mitral regurgitation include all the following EXCEPT:

A. Mitral annulus calcification
B. Mitral valve endocarditis
C. Papillary muscle dysfunction
D. Pulmonary hypertension

A

D. Pulmonary hypertension

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36
Q

In patients with significant mitral regurgitation, the isovolumic relaxation time may be:

A. Increased
B. Decreased
C. Affected by respiration
D. Unaffected

A

B. Decreased

*significant MR decrease preload - less blood to pump - decreased IVRT

37
Q

M-mode of Septum in Severe Mitral Stenosis: Impaired Left Ventricle Filling due to Mitral Stenosis Leads to Exaggerated Septal Diastolic Posterior ‘Dip’ (Yellow Arrows), Highlighting Unimpeded Right Ventricle Filling vs. the Left.

A
38
Q

The proximal isovelocity surface area of a mitral regurgitant jet is 7.6 cm2. The aliasing flow velocity is 24 cm/sec. The time velocity integral (TVI) of the mitral regurgitation jet is 150 cm. The maximum velocity of the mitral regurgitation jet is 580 cm/sec. The mitral regurgitant stroke volume is:

A. 24 cc
B. 47 cc
C. 150 cc
D. 580 cc

A

B. 47 cc

Reg Flow = 7.6 cm2 (PISA surface area) x 24 cm/s (V aliasing) = 182.4

EROA = 182. 4 (Reg Flow) / 580 cm/s (Peak V regurgitant) = 0.3144…

Vol regurgitant = 0.3144 (EROA) x 150 cm/s (VTI regurgitant jet) = 47.12

39
Q

_________ is an abnormal increase in left ventricular myocardial mass caused by chronically increased workload on the heart, most commonly resulting from pressure overload-induced by arteriolar vasoconstriction as occurs in, chronic hypertension or aortic stenosis.

A

Concentric left ventricular hypertrophy

40
Q

Flail mitral valve can be differentiated from severe mitral valve prolapsed on two-dimensional echocardiography because flail mitral valve leaflet demonstrates:

A. A thicker mitral valve
B. Chronic mitral regurgitation
C. Leaflet tips that point toward the left ventricle
D. Leaflet tips that point toward the left atrium

A

D. Leaflet tips that point toward the left atrium

41
Q

Signs and symptoms of mitral valve stenosis secondary to rheumatic heart disease include:

A. Angina pectoris
B. Cyanosis
C. Pulmonary Hypertension
D. Vertigo

A

C. Pulmonary Hypertension

42
Q

Conditions that may lead to clinical symptoms that mimic those associated with rheumatic mitral valve stenosis include:

A. Aortic insufficiency
B. Left atrial myxoma
C. Pericardial effusion
D. Ventricular septal defect

A

B. Left atrial myxoma

43
Q

M-mode findings for the mitral valve in patients with rheumatic mitral valve stenosis include all the following EXCEPT:

A. Anterior motion of the posterior mitral valve leaflet
B. B notch of the anterior mitral valve leaflet
C. Decreased E-F slope of the anterior mitral valve leaflet

D. Thickened mitral valve leaflets

A

B. B notch of the anterior mitral valve leaflet

Mitral B bump is essentially a late diastolic phenomenon in which the leaflets keep a semi-open position without LV inflow effectiveness. *Indicates increased LV end-diastolic pressure (> 20mmHg)

44
Q

In the M-mode echocardiogram, features of mitral valve stenosis include all the following EXCEPT:

A. Anterior motion of the posterior mitral valve leaflets
B. Decreased aortic root dimension
C. Systolic anterior motion of the mitral valve leaflets
D. Left atrial dilatation

A

C. Systolic anterior motion of the mitral valve leaflets

45
Q

****Two-dimensional echocardiographic examination reveals thin mobile mitral
valve leaflet tips and a Doppler E velocity of 1.8 m/sec with a pressure half-time of
180 msec. The most likely diagnosis is:

A. Abnormal relaxation of the left ventricle
B. Aortic insufficiency
C. Moderate to severe mitral annular calcification
D. Rheumatic mitral stenosis

A

C. Moderate to severe mitral annular calcification

46
Q

A deceleration time of 800 msec was obtained by pulsed-wave Doppler in a
patient with rheumatic mitral valve stenosis. The pressure half-time is:

A. 220 msec
B. 232 msec
C. 400 msec
D. 800 msec

A

B. 232 msec

47
Q

MS severe mean PG ?

VS

AS severe mean PG ?

A

MS: 10 (12) mmHg *(mild: 5 (6) mmHg)

AS: 40 mmHg *(mild: 20 mmHg)

48
Q

Flail Mitral Valve

A

Failure of leaflets coaptation with rapid systolic movement of the involved leaflet into the left atrium,

due to rupture chordae tendineae or papillary muscle.

May result in acute, subacute or chronic MR.

49
Q

classic MVP cause

A

degenerative myxomatous disease of leaflets

50
Q

___ can be related to pectus excavatum (sunken chaest) or pectus carinetum (pigeon chest)

A

MVP

51
Q

valve leaflet is displaced >2mm above the annular plane in systole indicates

A

MVP

52
Q

IVRT _____ with moderate to severe MR due to increased atrial pressure causing early opening of the MV

A

decrease

53
Q

IVRT _____ with moderate to severe MR due to increased atrial pressure causing early opening of the MV

A

decrease

54
Q

E velocity 1.2 m/s a supportive sign of ____ MR

A

severe

*Severe mitral regurgitation results in an increase in the antegrade volume flow rate across the mitral valve, which is reflected in an increase in the antegrade flow velocity across the valve.

*severe MR increase LA pressure causing higher pressure gradient thus increasing E velocity

A peak velocity (E-wave) >1.5 m/sec suggests severe mitral regurgitation, provided that coexisting mitral stenosis is not associated

*Note: normal E peak velocity - between 0.6 m/s and 0.8 m/s

55
Q

chronic severe MR nearly always leads to dilated ___ & ___

A

LA and LV

56
Q

MR clinical symptoms:

A
  1. systolic murmur (at the apex)
  2. asymptomatic (usually)
  3. atypical chest pain: any chest pain that doesn’t meet criteria for a common or obvious diagnosis
  4. palpitation
  5. fatigue
  6. DOE
  7. pulmonary edema for severe edema
57
Q

secondary or functional MR can occur with any condition that causes severe dilatation of the LV such as:

A

significant AI

large VSD

dilated CM

Afib

CAD

58
Q
  1. A possible pitfall in the pressure half-time (PHT) method of assessing the severity of mitral stenosis is concomitant:

A. Aortic insufficiency
B. MR
C. Pulmonary insufficiency
D. TR

A

A. Aortic insufficiency

59
Q
  1. All the following values increase in patients with mitral valve stenosis during exercise EXCEPT:

A. Left ventricular end diastolic pressure
B. Pressure half-time
C. Systolic pulmonary artery pressure
D. Transvalvular pressure gradient

A

B. Pressure half-time

60
Q
  1. With aortic valve stenosis and significant aortic insufficiency, the severity of the aortic valve stenosis by the Doppler pressure gradient may be:

A. Overestimated
B. Unaffected
C. Underestimated
D. Unpredictable

A

A. Overestimated

61
Q

Paradoxical Septal Motion: ‘Septal Bounce’ and its associate findings:

A

constrictive pericarditis

MS

LBBB

post cardiac surgery

RV pacing

ischemic septum

cor pulmonale

62
Q

AS M-mode

____ mm cusp separation indicated significant obstruction

A

<12mm

63
Q

Diastolic fluttering of the aortic valve: pathognomonic M-mode features of _____

A

flail cusp

64
Q

Myxoma of the Left Atrium Simulating ____

A

Mitral Stenosis

65
Q

average normal AVA

A

3-4 cm2

66
Q

For AS assessment ____ approach is preferred for CW (Pedof) Doppler = most accurate AS evaluation

A

SSN

67
Q

Differentiating Waveforms

AS vs MR

A
68
Q

AR/AI

M mode appearance

A

fluttering of the anterior mitral leaflet or IVS

69
Q

significant AI can cause premature opening of _____

A

AV

70
Q

AR assessment by jet width

mild value

A

<25%

71
Q

AR assessment by jet width

severe value?

A

>65%

72
Q

AR assessment: VC

mild value?

A

0.3cm

73
Q

AR assessment: VC

severe value?

A

>0.6 cm

74
Q

AR assessment: PHT

mild value

A

>500msec

75
Q

AR assessment: PHT

severe value

A

<200 msec

76
Q

What is this?

  • Hole or “window-like” opening in the leaflet or between the leaflets
  • can be congenital or acquired
  • can occur in bioprosthetic valve leaflets
  • cause AR
  • increased risk of valverupture
  • m-mode can be used to diagnose; diastolic flutter of the aortic leaflets considered a definitive finding
A

aortic fenestration

*Aortic fenestration is a method for decompressing the hypertensive false lumen by creating a hole in the distal part of the dissection flap

77
Q

What is Graham-Steel murmur?

A

The Graham Steel murmur is the early blowing diastolic murmur heard along the left border of the sternum due to functional regurgitation through the pulmonic valve.

78
Q

People with severe MR and left ventricular enlargement may eventually develop signs and symptoms of:

A
  • heart failure
  • weakness
  • fatigue
  • shortness of breath with exertion and/or at rest
  • edema (abnormal fluid collection in the lower legs or abdomen)
79
Q

What is the common cause of AR ?

A

infective endocarditis

80
Q

M mode image shows significant increase in PV “a” wave

>____ mm amplitude indicate pulmonary stenosis

A

7

81
Q

symptoms of AR

A

CP

orthopnea

cough

82
Q

chronic severe AR murmur

A

Austin Flint murmur

83
Q

***The waveform of MS and AR can be difficult to distinguish on the Doppler tracing; if the flow pattern begins before the MV opens, the wave form is ____

A

AR

84
Q

***Possible presenting symptoms of significant chronic mitral regurgitation include:

A. Angina pectoris
B. Ascites
C. Fatigue
D. Syncope

A

C. Fatigue

85
Q

M-mode findings associated with significant chronic mitral regurgitation include all the following EXCEPT:

A. Left atrial enlargement

B. Left ventricular enlargement

C. Fine diastolic flutter of the mitral valve

D. Flying W of the pulmonic valve

A

C. Fine diastolic flutter of the mitral valve

*M-mode recording through the mitral valve from the parasternal long axis position demonstrating diastolic fluttering of the anterior mitral valve leaflet in a patient with aortic regurgitation or AFib

*motion of the pulmonary valve (PV) has historically been used to assess for pulmonary hypertension (PH).

Parameters include the characteristic systolic fluttering or notching of the PV (Flying W), its diastolic slope and its a-wave height. Furthermore, the notching can be seen in the Doppler pattern of the PV.

*sever chronic MR - backing up blood causing PHTN

86
Q

An accepted method for determining the severity of mitral regurgitation by continuous-wave Doppler is spectral:

A. Length
B. Strength
C. Velocity
D. Width

A

B. Strength

87
Q

The radius of a mitral regurgitation flow convergence hemisphere is 1.1 cm. The proximal isovelocity surface area (PISA) is:

A. 1.21 cm2
B. 3.8 cm2
C. 7.6 cm2
D. 15.2 cm2

A

C. 7.6 cm2

*note:

Areapisa = 2 x 3.14 x rpisa2

Areapisa = 2 (3.14) (1.1cm)2

Areapisa = 7.5988 = 7.6

88
Q

In pure rheumatic mitral valve stenosis, the left atrium is _______ and the left ventricle is _______.

A. Decreased, decreased
B. Increased, decreased
C. Increased, increased
D. Unchanged, increased

A

C. Increased, increased

89
Q

The formula used to determine mitral valve area in the cardiac catheterization laboratory is:

A. CO ÷ BSA
B. CO ÷ MPG
C. CO ÷ DFP ÷ 38 x √MPG
D. CO ÷SEP ÷44.3 x √MPG

A

C. CO ÷ DFP ÷ 38 x √MPG

Echo Registry Review (25 decks)

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