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Echo Registry Review > Wk 2 Terry Reynolds *MR/MS > Flashcards

Wk 2 Terry Reynolds *MR/MS Flashcards

1
Q

Two-dimensional echocardiographic findings for rheumatic mitral stenosis
include all the following EXCEPT:

A. Hockey -stick appearance of the anterior mitral valve leaflet

B. Increased left atrial dimension

C. Reverse doming of the anterior mitral valve leaflet

D. Thickened mitral valve leaflets and subvalvular apparatus

A

C. Reverse doming of the anterior mitral valve leaflet

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2
Q

A Doppler mean pressure gradient across a stenotic mitral valve of 12 mm HG
is obtained. The severity of the mitral stenosis is:

A. Mild
B. Moderate
C. Moderately severe
D. Severe

A

D. Severe

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3
Q

Mitral stenosis is considered to be severe by all the following criteria EXCEPT:

A. Mean pressure gradient ≥ 12 mmHg
B. Mitral valve area <1.0 cm2
C. Mitral valve Doppler A velocity > 1.3 m/sec
D. Pressure half-time > 220 msec

A

C. Mitral valve Doppler A velocity > 1.3 m/sec

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4
Q

Secondary echocardiographic/Doppler findings in patients with rheumatic
mitral stenosis include all the following EXCEPT:

A. Abnormal interventricular septal wall motion
B. Increased right heart dimensions
C. Increased tricuspid regurgitant jet velocity
D. Left ventricular dilatation

A

D. Left ventricular dilatation

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5
Q

The Doppler signal of aortic insufficiency may be differentiated from the Doppler signal of mitral stenosis by the following guideline:

A. If the diastolic flow pattern commences before mitral valve opening, then the signal is due to aortic insufficiency

B. If the diastolic flow pattern commences after mitral valve opening, then the signal is due to aortic insufficiency

C. The Doppler flow velocity pattern of mitral valve stenosis is laminar, while the Doppler flow velocity pattern of aortic insufficiency is turbulent

D. Since both mitral valve stenosis and aortic insufficiency are diastolic, it is not possible to differentiate the Doppler flow velocity patterns.

A

A. If the diastolic flow pattern commences before mitral valve opening, then the signal is due to aortic insufficiency

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6
Q

Low voltage of the QRS complex throughout the electrocardiogram is often found in:

A. Constrictive pericarditis
B. Mitral stenosis
C. Pericardial effusion
D. Pleural effusion

A

C. Pericardial effusion

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7
Q
  1. The Doppler hemodynamic parameters that should be evaluated inpatients with rheumatic mitral stenosis include all the following EXCEPT:

A. Mitral valve area
B. Pressure half-time
C. Pulmonary artery pressure
D. Regurgitant fraction

A

D. Regurgitant fraction

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8
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

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9
Q

!!!
Congestive heart failure in a patient with significant mitral regurgitation occurs because of increased pressure in the:

A. Left atrium
B. Right atrium
C. Right ventricle
D. Aorta

A

A. Left atrium

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10
Q

The left atrial cardiac catheterization pressure tracing in a patient with significant mitral regurgitation may demonstrate an increase in the:

A. “a” wave
B. “v” wave
C. “x” wave
D. “y” wave

A

B. “v” wave

*Note: The v-wave represents the passive filling before the opening of the mitral valve. This will occur directly with T-wave.

The y-descent represents the opening of the mitral valve and the rapid filling of the ventricle from the atrium.

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11
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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12
Q

In patients with mitral regurgitation, cardiac catheterization measurements include all the following EXCEPT:

A. Left ventricular systolic/diastolic pressure
B. Mitral valve area
C. Pulmonary artery pressures
D. Pulmonary capillary wedge pressure

A

B. Mitral valve area

*MVA is an assessment for MS not MR

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13
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

*The third heart sound (S3), also known as the “ventricular gallop,” occurs just after S2 when the mitral valve opens, allowing passive filling of the left ventricle.

The S3 sound is actually produced by the large amount of blood striking a very compliant left ventricle.

CLINICAL PEARL: A S3 heart sound is produced during passive left ventricular filling when blood strikes a compliant LV.

CLINICAL PEARL: A S3 heart sound is often a sign of systolic heart failure, and also present in patients with: MR, AI, VSD< and PDA.

However it may sometimes be a normal finding i.e children, pregnant women, and trained athlete.

A S3 can be an important sign of systolic heart failure because, in this setting, the myocardium is usually overly compliant, resulting in a dilated LV.

An S2 that is widely split in both inspiration and expiration (fixed split S2) is a feature of right ventricular volume overload lesions, most commonly atrial septal defect. This feature can also occur in patients with total or partial anomalous pulmonary venous return or large arteriovenous malformations

The fourth heart sound, S4, also known as ‘atrial gallop’ results from the contraction of the atria pushing blood into a stiff or hypertrophic ventricle, indicating failure of the left ventricle.

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14
Q

A cardiac catherization technique used to determine the severity of mitral regurgitation is:

A. Cardiac fluoroscopy
B. Coronary arteriography
C. Left ventriculography
D. Supravalvular angiography

A

C. Left ventriculography

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15
Q

Possible complications of acute, severe mitral regurgitation include:

A. Syncope
B. Hemoptysis
C. Pulmonary edema
D. Systemic embolization

A

C. Pulmonary edema

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16
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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17
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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18
Q

!!!
Possible electrocardiographic findings for patients with significant mitral regurgitation include all the following EXCEPT:

A. Left atrial enlargement
B. Left ventricular hypertrophy
C. Right atrial enlargement
D. Right ventricular hypertrophy

A

C. Right atrial enlargement

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19
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

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20
Q

The effects of chronic mitral regurgitation on interventricular septal motion include:

A. Akinesis
B. Dyskinesis
C. Hyperkinesis
D. Paradoxical motion

A

C. Hyperkinesis

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21
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

22
Q

!!!
A two dimensional echocardiographic finding that may indicate significant chronic mitral regurgitation is:

A. Fine diastolic oscillations of the mitral valve
B. Left ventricular enlargement
C. Left ventricular hypertrophy
D. Premature closure of the mitral valve

A

B. Left ventricular enlargement

23
Q

Systolic bowing of the interatrial septum toward the right atrium may be an indication of:

A. Atrial septal defect
B. Mitral regurgitation
C. Tricuspid regurgitation
D. Tricuspid stenosis

A

B. Mitral regurgitation

24
Q

The effect significant mitral regurgitation has on the pulsed-wave Doppler tracing of the pulmonary veins may be described as:

A. S wave increases, D wave decreases
B. S wave increases, D wave increases
C. S wave decreases, D wave increases
D. Unaffected

A

C. S wave decreases, D wave increases

*Note:

Normal PW on PV: S (systole) wave is higher than D (diastole) wave

With moderate to severe MR: S wave is lower than D wave

With severe MR: reversed S wave and increased D wave

25
Q

Possible secondary echocardiographic/Doppler findings in patients with severe chronic mitral regurgitation include all the following EXCEPT:

A. Increased mitral valve E velocity
B. Increased peak aortic valve velocity
C. Increased right ventricular dimension
D. Shortened time too peak velocity of the right ventricular outflow tract

A

B. Increased peak aortic valve velocity

26
Q

An accepted method for the semi-quantitation of mitral regurgitation with pulsed-wave Doppler is:

A. Mapping technique
B. Maximum velocity of the mitral regurgitation
C. Peak A velocity
D. Pressure half-time

A

A. Mapping technique

27
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

28
Q

A color flow Doppler method for semi-quantitating mitral regurgitation is regurgitant jet:

A. Area
B. Height
C. Length
D. Turbulence

A

A. Area

29
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:
2 x 3.14 x (1.1)2 = 7.5988 = 7.6

30
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

31
Q

The peak mitral reguritant velocity reflects the:

A. Direction of the regurgitant jet
B. Etiology of the mitral regurgitation
C. Maximum pressure difference between the left atrium and the left ventricle
D. Severity of the mitral regurgitation

A

C. Maximum pressure difference between the left atrium and the left ventricle

32
Q

In patients with significant mitral regurgitation, the continuous-wave Doppler tracing of the regurgitant lesion may demonstrate a(n):

A. Asymmetrical shape of the mitral regurgitation flow velocity spectral display

B. Jet area of 20%

C. Jet duration of less than 85 msec

D. Symmetrical shape of the mitral regurgitation flow velocity spectral display

A

A. Asymmetrical shape of the mitral regurgitation flow velocity spectral display

33
Q

Cardiac Doppler evidence of severe mitral regurgitation includes all the following EXCEPT:

A. Darkly stained continuous-wave Doppler tracing
B. Mitral valve E velocity <1.5 m/sec
C. Pulmonary vein systolic flow reversal
D. Regurgitant jet area >8.0 cm2

A

B. Mitral valve E velocity <1.5 m/sec

34
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

35
Q

A 23-year-old woman complaining of dyspnea presents to the cardiologist. Upon examination, a diastolic rumble and opening snap are heard. The patient remembers having rheumatic fever at the age of 10. Her electrocardiogram demonstrated left atrial enlargement and right ventricular hypertrophy. The diagnosis is:

A. Aortic valve stenosis
B. Mitral regurgitation
C. Rhumatic mitral valve stenosis
D. Valvular pulmonic valve stenosis

A

C. Rhumatic mitral valve stenosis

36
Q

Mitral valve leaflet chordal rupture usually results in:

A. Aortic insufficiency
B. Mitral regurgitation
C. Pulmonary insufficiency
D. Tricuspid regurgitation

A

B. Mitral regurgitation

37
Q

!!!
The echocardiographer may differentiate between the similar systolic flow pattern seen in coexisting severe aortic valve stenosis and mitral regurgitation by all the following methods EXCEPT:

A. The aortic ejection time is shorter than the mitral regurgitation time

B. Mitral regurgitation flow always lasts until mitral valve opening, whereas aortic valve stenosis flow does not

C. Mitral diastolic filling profile should be present during recording of the mitral regurgitation, whereas no diastolic flow is observed in aortic valve stenosis

D. Since both are systolic flow patterns, it is not possible to separate mitral regurgitation from aortic valve stenosis

A

D. Since both are systolic flow patterns, it is not possible to separate mitral regurgitation from aortic valve stenosis

38
Q

Premature closure of the mitral valve is associated with all the following EXCEPT:

A. Acute severe mitral regurgitation
B. Acute severe aortic insufficiency
C. First-degree atrioventricular block
D. Loss of sinus rhythm

A

A. Acute severe mitral regurgitation

39
Q
  1. Possible mechanisms in the development of mitral regurgitation following an acute myocardial infarction include all the following EXCEPT:

A. Fibrosis of the papillary muscle
B. Incomplete closure of the mitral valve
C. Mitral valve prolapsed
D. Papillary muscle rupture

A

C. Mitral valve prolapsed

40
Q

!!!
The descent of the mitral annulus in the apical four-chamber view may be used to evaluate:

A. Global left ventricular systolic function
B. Segmental left ventricular function
C. Severity of mitral regurgitation
D. Severity of aortic valve stenosis

A

A. Global left ventricular systolic function

41
Q
  1. In patients with significant pure mitral regurgitation, the E velocity of the mitral valve pulsed-wave Doppler tracing is:

A. Decreased
B. Increased with inspiration
C. Increased
D. Unaffected

A

C. Increased

42
Q

The gold-standard two-dimensional echocardiographic view for diagnosing mitral valve prolapsed is the:

A. Apical four-chamber view
B. Parasternal long-axis view
C. Parasternal short-axis view of the mitral valve
D. Subcostal four-chamber

A

B. Parasternal long-axis view

43
Q

The valvular disease with which atrial fibrillation is most commonly associated is:

A. Acute aortic insufficiency
B. Aortic valve stenosis
C. Mitral valve prolapse
D. Rheumatic mitral valve stenosis

A

D. Rheumatic mitral valve stenosis

44
Q

A key word that is often used to describe the characteristics of the valve
leaflets in mitral valve prolapsed is:

A. Dense
B. Doming
C. Redundant
D. Sclerotic

A

C. Redundant

45
Q

!!!
The term myxomatous degeneration is associated with mitral valve:

A. Flail leaflet
B. Prolapse
C. Stenosis
D. Vegetation

A

B. Prolapse

46
Q

The associated auscultatory findings for mitral valve prolapsed include:

A. Ejection click
B. Friction rub
C. Mid-systolic click
D. Pericardial knock

A

C. Mid-systolic click

47
Q

!!!
Secondary causes of mitral valve prolapsed include all the following EXCEPT:

A. Atrial septal defect
B. Bicuspid aortic valve
C. Cardiac tamponade
D. Primary pulmonary hypertension

A

B. Bicuspid aortic valve

*Note: BAV and MV prolapse tend to occur together but it’s not a cause of MVP

48
Q

Echocardiographic characteristics of mitral valve prolapsed include all the following EXCEPT:

A. Increased mitral valve annulus
B. Systolic bowing of the mitral valve toward the left atrium
C. Systolic doming of the leaflets
D. Thickened, redundant leaflets

A

C. Systolic doming of the leaflets - MS

49
Q

When performing an echocardiogram on a patient with a thoracic skeletal abnormality (e.g., pectus excavatum), the echocardiographer must be careful to rule out:

A. Atrial septal defect
B. Bicuspid valve prolapsed
C. Coarctation of the aorta
D. Mitral valve prolapsed

A

D. Mitral valve prolapsed

50
Q

Possible causes of ruptured chordae tendineae of the mitral valve include all the following EXCEPT:

A. Carciniod heart disease
B. Infective endocarditis
C. Mitral valve prolapsed
D. Trauma

A

A. Carciniod heart disease

Echo Registry Review (25 decks)

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