Wk 2 Terry Reynolds *valvular disease

Question 1

The normal mitral valve area is:

A. 1 to 3 cm2
B. 3 to 5 cm2
C. 4 to 6 cm2
D. 7 to 9 cm2

Answer 1

C. 4 to 6 cm2

Question 2

Failed fusion of the superior and inferior endocardial cushions is associated with all of the following EXCEPT:

A. Partial atrioventricular canal defect
B. Complete atrioventricular canal defect
C. Isolated inlet ventricular septal defect
D. Isolated supracristal ventricular septal defect

Answer 2

D. Isolated supracristal ventricular septal defect

Question 3

The control that sets the upper limit to which ultrasound information will be processed and displayed is:

A. Depth
B. Far gain
C. Overall gain
D. Reject

Answer 3

A. Depth

Question 4

The preferred transducer frequency for imaging a barrel-chested patient is:

A. 2.5 MHz
B. 3.5 MHz
C. 5.0 MHz
D. 7.0 MHz

Answer 4

A. 2.5 MHz

Question 5

A maneuver that results in a decrease in venous return is:

A. Inspiration
B. Squatting
C. Straight leg raising
D. Valsalva

Answer 5

D. Valsalva

Question 6

A maneuver that will result in tachycardia and a transient decrease in blood pressure is:

A. Inhalation of amyl nitrate
B. Squatting
C. Standing to supine
D. Straight leg raising

Answer 6

A. Inhalation of amyl nitrate

*Amyl nitrite is related to the nitrate medicines and is used by inhalation to relieve the pain of angina attacks. It works by relaxing blood vessels and increasing the supply of blood and oxygen to the heart while reducing its workload.

Question 7

A maneuver that will increase venous return is:

A. Expiration
B. Squatting to standing
C. Straight leg raising
D. Supine to standing

Answer 7

C. Straight leg raising

Question 8

The best two-dimensional view for determining mitral valve area is the:

A. Apical four-chamber view
B. Parasternal long-axis view
C. Parasternal short-axis view
D. Subcostal four-chamber view

Answer 8

C. Parasternal short-axis view

Question 9

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

Answer 9

B. Parasternal long-axis view

Question 10

Excellent two-dimensional views for imaging the tricuspid valve include all the following EXCEPT:

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

Answer 10

A. Parasternal long-axis view

Question 11

The smallest vegetation that transthoracic two-dimensional echocardiography can detect is:

A. 1 mm
B. 2 mm
C. 3 mm
D. 4 mm

Answer 11

C. 3 mm

Question 12

The hump or break occasionally seen on the M-mode of the mitral valve between the E and F points is designated:

A. B notch
B. f wave
C. Fo
D. h wave

Answer 12

C. Fo ????

The nadir (the lowest point) of the E wave represents the F point.

B notch - The B bump on mitral valve M-mode echogram is predictive of significant elevation of left ventricular end-diastolic pressure (LVEDP)

Question 13

The E-F slope of the M-mode of the anterior mitral valve leaflet reflects the:

A. Opening rate of the anterior mitral valve leaflet
B. Rate of diastolic filling of the left ventricle
C. Rate of left atrial emptying during diastasis
D. Rate of systolic filling of the left ventricle

Answer 13

B. Rate of diastolic filling of the left ventricle

Question 14

The E-F slope of the M-mode of the anterior mitral valve leaflet in mitral valve stenosis is:

A. Decreased
B. Increased
C. Notched
D. Unaffected

Answer 14

A. Decreased

Question 15

The mitral valve M-mode points that denote the beginning and the end of diastole are:

A. C to D
B. D to C
C. D to E
D. E to F

Answer 15

B. D to C

Question 16

The anterior mitral valve leaflet E-F slope is decreased in:

A. Left atrial myxoma
B. Left ventricular volume overload
C. Mitral valve prolapse
D. Mitral valve vegetation

Answer 16

A. Left atrial myxoma

Question 17

The pulmonic valve leaflet most commonly recorded by M-mode is the:

A. Anterior
B. Left
C. Septal
D. Right

Answer 17

B. Left

Question 18

On M-mode, the abrupt downward motion of the pulmonary valve leaflet following atrial contraction is called the:

A. “a” dip
B. “b” dip
C. “c” dip
D. “d” dip

Answer 18

A. “a” dip

Question 19

What is the purpose of the sinuses of Valsalva?

Answer 19

The sinuses sit behind each valve cusp and function as support for the valves in systole and a reservoir of blood for coronary artery flow in diastole

Question 20

The best two-dimensional view for determining mitral valve area is the:

A. Apical four-chamber view
B. Parasternal long-axis view
C. Parasternal short-axis view
D. Subcostal four-chamber view

Answer 20

C. Parasternal short-axis view

*planimetry

Question 21

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

Answer 21

B. Parasternal long-axis view

Question 22

Excellent two-dimensional views for imaging the tricuspid valve include all the following EXCEPT:

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

Answer 22

A. Parasternal long-axis view

Question 23

The E-F slope of the M-mode of the anterior mitral valve leaflet reflects the:

A. Opening rate of the anterior mitral valve leaflet
B. Rate of diastolic filling of the left ventricle
C. Rate of left atrial emptying during diastasis
D. Rate of systolic filling of the left ventricle

Answer 23

B. Rate of diastolic filling of the left ventricle

Question 24

The E-F slope of the M-mode of the anterior mitral valve leaflet in mitral valve stenosis is:

A. Decreased
B. Increased
C. Notched
D. Unaffected

Answer 24

A. Decreased

Question 25

The mitral valve M-mode points that denote the beginning and the end of diastole are:

A. C to D
B. D to C
C. D to E
D. E to F

Answer 25

B. D to C

Question 26

The pulmonic valve leaflet most commonly recorded by M-mode is the:

A. Anterior
B. Left
C. Septal
D. Right

Answer 26

B. Left

*right???

Question 27

On M-mode, the abrupt downward motion of the pulmonary valve leaflet following atrial contraction is called the:

A. “a” dip
B. “b” dip
C. “c” dip
D. “d” dip

Answer 27

A. “a” dip

Question 28

Maneuvers that will increase the duration and severity of mitral valve prolapsed include all of the following EXCEPT:

A. Inhalation of amyl nitrate
B. Valsalva maneuver
C. Supine to standing
D. Squatting

Answer 28

D. Squatting

*note:

squatting

• most murmurs become louder
• murmur of hypertrophic CM becomes softer
• murmur of MVP becomes shorten

Question 29

Possible complications of chronic mitral regurgitation include all the following EXCEPT:

A. Atrial fibrillation
B. Congestive heart failure
C. Increased risk of sudden death
D. Pulmonary hypertension

Answer 29

C. Increased risk of sudden death

Question 30

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

Answer 30

A. Left atrium

Question 31

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

Answer 31

B. “v” wave

Question 32

Diastolic mitral regurgitation is associated with:

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

Answer 32

C. Severe aortic insufficiency

Question 33

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

Answer 33

B. Mitral valve area

Question 34

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

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

Answer 34

C. S3

Question 35

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

Answer 35

C. Left ventriculography

Question 36

Possible complications of acute, severe mitral regurgitation include:

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

Answer 36

C. Pulmonary edema

Question 37

Possible presenting symptoms of significant chronic mitral regurgitation include:

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

Answer 37

C. Fatigue

Question 38

!!!

A common finding associated with a regurgitant murmur in the elderly is:

A. Aortic valve stenosis
B. Mitral annular calcification
C. Mitral valve stenosis
D. Mitral valve vegetation

Answer 38

B. Mitral annular calcification

Question 39

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

Answer 39

D. Mitral annular calcification

Question 40

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

Answer 40

D. Pulmonary hypertension

Question 41

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

Answer 41

C. Right atrial enlargement

Question 42

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

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

Answer 42

B. Decreased

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

Question 43

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

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

Answer 43

C. Hyperkinesis

heart needs to work harder to pump the blood out

Question 44

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

Answer 44

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

Question 45

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

Answer 45

B. Mitral regurgitation

Question 46

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

Answer 46

C. S wave decreases, D wave increases

Question 47

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

Answer 47

B

Question 48

The Doppler finding of mitral valve regurgitation in coronary artery disease is most likely due to:

A. Flail mitral valve
B. Mitral valve prolapsed
C. Papillary muscle dysfunction
D. Subaortic stenosis

Answer 48

C. Papillary muscle dysfunction

Question 49

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

Answer 49

A. Mapping technique

Question 50

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

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

Answer 50

B. Strength

Question 51

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

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

Answer 51

A. Area

Question 52

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

Answer 52

C. 7.6 cm2

*note:

Area_pisa = 2 x 3.14 x r_pisa²

Area_{pisa = 2 (3.14) (1.1cm)²}

Area_{pisa =} 7.5988 = 7.6

Question 53

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

Answer 53

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

Question 54

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

Answer 54

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

Question 55

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

Answer 55

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

Question 56

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

Answer 56

B. Mitral valve E velocity <1.5 m/sec

Question 57

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

Answer 57

D. Leaflet tips that point toward the left atrium

Question 58

In patients with severe acute mitral regurgitation, the continuous-wave Doppler maximum velocity of the regurgitant jet is:

A. Decreased
B. Dependent largely upon left ventricular function
C. Increased
D. Unaffected

Answer 58

**A. Decreased

*note: With chronic mitral regurgitation, the left atrium hypertrophies and dilates, increasing LA compliance to accommodate volume loading at near-normal pressure. In contrast, acute mitral regurgitation results in pressure and volume loading of a normal, relatively non-compliant atrium.

Question 59

The most common etiology of mitral valve stenosis is:

A. Congenital
B. Left atrial myxoma
C. Rheumatic fever
D. Severe mitral annular calcification

Answer 59

C. Rheumatic fever

Question 60

The cardiac valves listed in decreasing order as they are affected by rheumatic heart disease are:

A. Aortic, pulmonic, tricuspid, and mitral
B. Mitral, aortic, tricuspid, and pulmonic
C. Pulmonic, aortic, tricuspid, and mitral
D. Tricuspid, mitral, pulmonic, and aortic

Answer 60

B. Mitral, aortic, tricuspid, and pulmonic

Question 61

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

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

Answer 61

C. Pulmonary Hypertension

Question 62

Auscultatory findings for mitral valve stenosis include all the following EXCEPT:

A. Diastolic rumble at the apex
B. Loud first heart sound
C. Opening snap
D. Systolic ejection murmur heard at the base

Answer 62

D. Systolic ejection murmur heard at the base

*MS - blood flows during diastole from LA to LV

Question 63

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

Answer 63

C. Rhumatic mitral valve stenosis

Question 64

Patients with mitral valve stenosis, left atrial enlargement, and atrial fibrillation are at increased risk for the development of:

A. Left atrial myxoma
B. Left atrial thrombus
C. Left ventricular dilatation
D. Left ventricular thrombus

Answer 64

B. Left atrial thrombus

Question 65

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

Answer 65

D. Rheumatic mitral valve stenosis

Question 66

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

Answer 66

B. Left atrial myxoma

Question 67

!!!

Auscultatory findings in rheumatic mitral valve stenosis include:

A. Austin Flint murmur
B. Fixed splitting of S2
C. Loud S1
D. Mid-systolic click

Answer 67

C. Loud S1

Question 68

Left atrial thrombus is most often associated with:

A. Cor triatriatum
B. Infective endocarditis
C. Mitral valve prolapsed
D. Rheumatic mitral valve stenosis

Answer 68

D. Rheumatic mitral valve stenosis

*A left atrial thrombus is most often associated with atrial fibrillation and/or rheumatic mitral stenosis.

Question 69

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

Answer 69

C. Increased, increased

Question 70

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

Answer 70

C. CO ÷ DFP ÷ 38 x √MPG

Question 71

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

Answer 71

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)

Question 72

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

Answer 72

C. Systolic anterior motion of the mitral valve leaflets

SAM caused by obstructive LVH - increased velocity = lower pressure = anterior leaflet is pulled toward aorta causing aobstruction

Question 73

In mitral valve stenosis, the posterior mitral valve leaflet on M-mode moves:

A. Anteriorly
B. Laterally
C. Medially
D. Posteriorly

Answer 73

A. Anteriorly

Question 74

Critical mitral valve stenosis is said to be presented if the mitral valve area is reduced to:

A. <1.0 cm2
B. to 1.5 cm2
C. 1.5 to 2.5 cm2
D. 2.5 to 3.5 cm2

Answer 74

A. <1.0 cm2

Question 75

Secondary findings in mitral valve stenosis may include:

A. Left atrial dilatation and a normal or small left ventricular dimension
B. Left atrial dilatation and pulmonary venous stenosis
C. Left ventricular and left atrial dilatation
D. Left ventricular hypertrophy and left atrial dilatation

Answer 75

A. Left atrial dilatation and a normal or small left ventricular dimension

Question 76

Typical echocardiographic findings in a patient with isolated rheumatic mitral
valve stenosis include all the following EXCEPT:

A. D-shaped left ventricle
B. Dilated left ventricle
C. Left atrial enlargement
D. Left atrial thrombus

Answer 76

B. Dilated left ventricle

*In MS, blood volume via MV towrd LV decreases & blood backing up to LA, pulmonary system then right heart

Question 77

A strong indication for mitral valve stenosis on two-dimensional
echocardiography is an anterior mitral valve leaflet that exhibits:

A. Coarse, chaotic diastolic motion
B. Diastolic doming
C. Reverse doming
D. Systolic bowing

Answer 77

B. Diastolic doming

Question 78

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

Answer 78

C. Moderate to severe mitral annular calcification

Question 79

The most accurate method for determining the severity of mitral valve stenosis is:

A. Determining the maximum velocity across the mitral valve by pulsed-wave
Doppler
B. Measuring the E-F slope of the anterior mitral valve leaflet by M-mode
C. Measuring the thickness of the mitral valve leaflets
D. Performing planimetry of the mitral valve orifice by two-dimensional
echocardiograph

Answer 79

D. Performing planimetry of the mitral valve orifice by two-dimensional
echocardiograph

Question 80

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

Answer 80

C. Reverse doming of the anterior mitral valve leaflet

Question 81

The classic cardiac Doppler features of mitral valve stenosis include all the following EXCEPT:

A. Increased E velocity
B. Increased mitral valve area
C. Increased pressure half-time
D. Turbulent flow

Answer 81

B. Increased mitral valve area

Question 82

The classic cardiac Doppler features of mitral valve stenosis include all the following EXCEPT:

A. Increased E velocity
B. Increased mitral valve area
C. Increased pressure half-time
D. Turbulent flow

Answer 82

B. Increased mitral valve area

Question 83

The abnormal mitral valve pressure half-time for patients with mitral valve
stenosis is:

A. 0 to 30 msec
B. 30 to 60 msec
C. 60 to 90 msec
D. 90 to 400 msec

Answer 83

D. 90 to 400 msec

Question 84

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

Answer 84

B. 232 msec

*PHT = 0.29 x DT

Question 85

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

Answer 85

D. Severe

***C. Moderately severe???

Question 86

Pulmonary artery banding may result in all the following EXCEPT:

1 Pseudoaneurysm formation

2 Right ventricular hypertrophy

3 Supravalvular pulmonary stenosis

4 Valvular pulmonic stenosis

Answer 86

4 Valvular pulmonic stenosis

*note: Pulmonary artery banding (PAB) is a palliative surgical technique used for the correction of congenital cardiac defects, characterized by pulmonary over-circulation caused by left-to-right shunting of blood. PAB is reserved for palliation in a certain subset of infants with complex congenital heart disease.[1] [Level 3] PAB protects pulmonary vasculature by reducing excessive pulmonary blood flow, thereby preventing the onset of irreversible remodeling of the pulmonary vasculature and pulmonary hypertension.

Question 87

Infective endocarditis is a greater risk in patients with:

1. AFib
2. CAD
3. LV aneurysm
4. prosthetic heart valve

Answer 87

prosthetic heart valve

Question 88

The mitral valve is considered to be prematurely closed due to severe acute insufficiency when the C point of mitral valve closure occurs:

1. On or before inception of the Q wave
2. Less than 0.05 seconds after the Q wave
3. 0.05 to 0.07 seconds after the Q wave of the electrocardiogram
4. On or before inception of the T wave

Answer 88

1. On or before inception of the Q wave

*Note:

Premature mitral valve (MV) closure is a specific and sensitive noninvasive indicator of acute severe AI.³ Measurement of the mitral valve from a parasternal long axis view with simultaneous ECG tracing allows this measurement to be easily performed.

Mild AI causes the MV to close around 50 msec before the Q wave, while severe AI will result in the mitral valve closing 200 msec or more before the Q wave on the tracing

Question 89

The usual site of attachment for vegetations on the mitral and tricuspid valves is the:

1 Annulus

2 Atrial side of the valve leaflets

3 Papillary muscles

4 Ventricular side of valve leaflet

Answer 89

2 Atrial side of the valve leaflets

Question 90

The vegetation diameter as determined by two-dimensional echocardiography that is most often associated with systemic emboli is:

1 3 mm

2 5 mm

3 7 mm

4 10 mm

Answer 90

4 10 mm

Question 91

Aortic ring abscess is usually caused by:

1 Infective endocarditis

2 Rheumatic fever

3 Valvular prolapsed

4 Valvular regurgitation

Answer 91

1 Infective endocarditis

Question 92

Complications associated with infective endocarditis that may be indications for surgery include all the following EXCEPT:

1. Congestive heart failure
2. Dyspnea
3. Myocardial or annular abscess
4. Recurrent systemic emboli

Answer 92

Dyspnea

Question 93

Another term for a homograft prosthetic valve is:

1. Allograft
2. Autograft
3. Biograft
4. Heterograf

Answer 93

Allograft

Question 94

All the following are porcine tissue prosthetic valves EXCEPT:

1. Bjork-Shiley
2. Carpentier-Edwards
3. Hancock
4. Intact

Answer 94

1. Bjork-Shiley

*note:

The Björk–Shiley valve is a mechanical artificial heart valve.

Carpentier-Edwards Stentless bioprosthetic valves are made from porcine aortic roots

The Hancock Mitral-Tricuspid is a porcine tissue valve, and has a pliable sewing ring. Advantages of having a tissue valve is that one need not take blood-thinner/anticoagulant medication after receiving the valve

The Medtronic Intact porcine valve provides superior results in the aortic position in patients older than 40 years and in the tricuspid position at all ages.

Question 95

A pulmonic valve relocated to the aortic position is called a(n):

1 Allograft

2 Autograft

3 Heterograft

4 Homograft

Answer 95

2 Autograft

Question 96

Coarse fluttering of a tissue prosthetic valve leaflet on M-mode is associated with:

1 Insufficiency

2 Normal function

3 Stenosis

4 Vegetation

Answer 96

1 Insufficiency

Question 97

A shortened interval between the aortic second sound (A2) and mitral valve opening recorded for a mitral valve prosthesis may indicate all the following EXCEPT:

1 Perivalvular leak

2 Poor left ventricular function

3 Prolonged PR interval on the electrocardiogram

4 Prosthetic

Answer 97

3 Prolonged PR interval on the electrocardiogram

Question 98

Bioprosthetic leaflet degeneration and calcification occurs:

1 Only in adults

2 More frequently in children

3 Equally in children and adults

4 Primarily in women 40 years of age or older

Answer 98

2 More frequently in children

Question 99

A prosthetic heart valve is associated with a relatively high rate of outlet strut fracture is:

1 Bjork-Shiley

2 Carpentier-Edwards

3 Ionescu Shiley

4 Starr-Edwards

Answer 99

1 Bjork-Shiley

Question 100

An example of a bileaflet tilting disc prosthetic heart valve is:

1 Medtronic-Hall

2 Omniscience

3 St. Jude’s

4 Starr-Edwards

Answer 100

3 St. Jude’s

Question 101

The cardiac Doppler formula that accurately determines the pressure gradient in the prosthetic aortic valve is:

1 4 x (V 2 2 )

2 4 x (V 1 2 - V 2 2 )

3 4 x (V 2 2 - V 1 2 )

4 Area x V 1

Answer 101

3 4 x (V 2 2 - V 1 2 )

Question 102

The best Doppler formula for calculating the effective orifice area (EOA) in a patient with mitral valve replacement is:

1 4 x (V 2 ) 2

2 4 x (V 2 2 - V 1 2 )

3 (CSA LVOT x TVI LVOT) ÷ TVI MV

4 220 ÷ pressure half-time

Answer 102

3 (CSA LVOT x TVI LVOT) ÷ TVI MV

*note: CSA = cross sectional area = 3.14 x r² (it’s a continuity equation)

Question 103

The best Doppler method for evaluating an aortic valve replacement is probably:

1 Deceleration slope

2 Maximum peak instantaneous gradient

3 Pressure half-time

4 Velocity ratio

Answer 103

4 Velocity ratio

The aortic valve velocity ratio (AVVR) is defined as the peak left ventricular outflow tract (LVOT) Doppler velocity divided by the maximal aortic valve (AV) velocity.

Question 104

Doppler evaluation of a prosthetic mitral valve should include all the following EXCEPT:

1. Effective orifice area (continuity equation)
2. Peak A velocity
3. Peak and mean pressure gradients
4. Pressure half-time

Answer 104

Peak A velocity

Question 105

Diastolic mitral regurgitation is associated with

Answer 105

Severe aortic insufficiency

Question 106

A regurgitant jet area <1.0 cm 2 is noted in a prosthetic aortic valve. This can be explained by:
A. Ball variance
B. Closing volume
C. Disc embolization
D. Disc occlusion

Answer 106

B. Closing volume

Question 107

399. A B notch of the mitral valve on M-mode indicates increased left ventricular:
     A. End-diastolic pressure
     B. End-systolic pressure
     C. Mean pressure
     D. Peak-to-peak pressure

Answer 107

A. End-diastolic pressure

Question 108

473. As a valve orifice narrows because of stenosis, pressure proximal to the stenosis will:

A. Decrease
B. Equilibrate
C. Increase with inspiration, decrease with expiration

D. Increase

Answer 108

D. Increase

Question 109

479. In patient with aortic valve stenosis, the continuous-wave Doppler recordings demonstrate a maximum systolic velocity across the aortic valve of 5 m/sec. The maximum peak instantaneous pressure gradient is:

A. 5 mmHg
B. 25 mmHg
C. 50 mmHg
D. 100 mmHg

Answer 109

D. 100 mmHg

pressure gradient = 4V2

Question 110

481. The formula used to estimate left ventricular end-diastolic pressure (LVEDP) from the continuous-wave Doppler recording of aortic insufficiency is LVEDP is equal to:

A. BPs - Vmax AI
B. BPd - Vmax AI
C. BPd - 4× EDV AI
D. BPd - 4× EDV AI^2

Answer 110

D. BPd - 4× EDV AI^2

Question 111

482. A maximum velocity of 2 m/sec is obtained in a patient with rheumatic mitral valve stenosis:

A. 2 mmHg
B. 4 mmHg
C. 8 mmHg
D. 16 mmHg

Answer 111

D. 16 mmHg

Question 112

483. The time (in milliseconds) for the pressure difference across a valve to fall to one-half of the initial peak pressure difference is known as the:

A. Acceleration half-time
B. Deceleration half-time
C. Pressure half-time
D. Velocity half-time

Answer 112

C. Pressure half-time

Question 113

484. The mitral valve area can be determined by Doppler with the following formula:

A. 220 ÷ pressure half-time
B. 220 ÷ deceleration time
C. Deceleration time ÷pressure half-time
D. Pressure half-time ÷ 220

Answer 113

A. 220 ÷ pressure half-time

*note: PHT = 0.29 x DT

Question 114

485. 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

Answer 114

D. Regurgitant fraction

Question 115

486. The formula that allows for calculation of mitral valve area by Doppler is the:

A. Bernoulli equation
B. Continuity equation
C. Gorlin equation
D. Velocity equation

Answer 115

B. Continuity equation

Question 116

487. 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

Answer 116

A. Aortic insufficiency

*note:

Although the PHT technique is easy to use, there are numerous conditions in which the calculated mitral valve area is unreliable and this method should be used with caution. Especially in the following settings:

• Diastolic dysfunction -can lead to over estimation of MS severity
• Aortic regurgitation - can lead to under estimation of MS severity
• After valvuloplasty – PHT is unreliable
• Heavily calcified valves - - unreliable

Question 117

488. 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

Answer 117

B. Pressure half-time

Quantification using the pressure half-time method is based on the assumption that the rate at which the gradient drops during diastole corresponds to the severity of mitral stenosis. The larger the mitral valve orifice area is, the quicker the left ventricle will fill and the more rapidly the gradients will drop.

The steeper the curve, the larger is the mitral valve orifice area (and the less severe is mitral stenosis).

Question 118

489. 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

Answer 118

C. Increased

*note:

PW DOPPLER MV INFLOW

The inflow pattern and velocity can help us identify supportive signs of severe MR!

This velocity informs us of the forward stroke volume (SV) across the mitral valve. It can be increased if regurgitation is present.

• E-Wave Dominant: supportive sign of severe MR
  
  • Increased E Wave (>1.2 m/s)
  • Increased E/A Ratio
  • decreased DT
• Reliable to assess primary MR
  
  • Challenge for secondary
  • Unable to differentiate between LV filling pressures or regurgitation
• Dominant A-Wave inflow pattern excludes severe MR

Question 119

490. The following two-dimensional and cardiac Doppler information is gathered: the mitral annulus diameter is 4.5 cm, the aortic annulus is 2.0 cm, the mitral time velocity integral is 20 c, and the aortic time velocity integral is 17 cm. The mitral regurgitant fraction is:

A. 26.5%
B. 31.8%
C. 53%
D. 83%

Answer 119

D. 83%

*note:

SV (stroke volume) = CSA (cross sectional area: 0.785 x d² ) x VTI

SV via MV should be as same as SV via AV

MV SV = (0.785 x 4.5²) x 20

MV SV = 318 mL

AV SV = (0.785 x 2.0²) x 17

AV SV = 53.38 mL

The difference between the volume at MV and AV = 318 mL - 53.38 mL = 264.62mL (regurgitant flow)

Mitral Regurgitant Fraction = 264.62mL / 318mL = 0.83 = 83%

inflow VTI for LVOT & MV inflow ***make sure to use PW to place the gate in between the annulus

Question 120

491. 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

Answer 120

A. Overestimated

Question 121

492. In patients with aortic valve stenosis, the pressure gradients measured by cardiac Doppler include:

A. Maximum peak instantaneous gradient and peak-to-peak gradient
B. Maximum peak instantaneous gradient
C. Peak-to-mean gradient
D. peak-to-peak gradient

Answer 121

B. Maximum peak instantaneous gradient

*note:

cardiac cath measures the peak-to-peak gradient

Doppler measures the peak maximum instaneous pressure gradient

Question 122

493. 494. The following data is obtained: left ventricular outflow tract diameter is 2.2 cm, left ventricular outflow tract maximum velocity is 1.1 m/sec, and peak aortic velocity is 6 m/sec. The aortic valve area is:

A. 0.4 cm^2
B. 0.75cm^2
C. 0.68 cm
D. 0.69 cm^2

Answer 122

D. 0.69 cm²

*note:

A1V1 = A2V2

solving for A2 = A1V1 / V2

A2 = (0.785 x 2.2²) x (1.1 m/s) / 6 m/s

AVA (A2) = 0.69

Question 123

494. The following data is obtained: left ventricular outflow tract diameter is 2.2 cm, left ventricular outflow tract maximum velocity is 1.1 m/sec, and peak aortic velocity is 6 m/sec. The aortic velocity ratio is:

A. 0.18
B. 0.18cm
C. 0.18cm^2
D. 0.69cm^2

Answer 123

A. 0.18

*note:

aortic velocity ratio = 1.1 / 6 = 0.18

Question 124

495. The following data is obtained in a patient with aortic valve stenosis, left ventricular outflow tract diameter is 2.0 cm, and aortic time velocity integral is 40 cm. The aortic valve area is:

A. 0.3 cm^2
B. 0.75 cm^2
C. 0.9 cm^2
D. 3.14 cm^2

Answer 124

C. 0.9 cm^2

Question 125

496. The continuous-wave Doppler maximum aortic insufficiency velocity reflects the:

A. Maximum instantaneous systolic pressure gradient between the aorta and the left ventricle
B. Maximum peak instantaneous diastolic pressure difference between the aorta and the left ventricle
C. Mean diastolic pressure gradient between the aorta and the left ventricle
D. Mean systolic pressure gradient between the aorta and the left ventricle

Answer 125

B. Maximum peak instantaneous diastolic pressure difference between the aorta and the left ventricle

Question 126

497. The regurgitant fraction (RF%)for aortic insufficiency may be calculated by the following pulsed-wave Doppler formula:

A. Aortic RF%= mitral SV-aortic SV÷mitral SV
B. Aortic RF%=aortic SV-tricuspid SV÷aortic SV
C. Aortic RF%=aortic SV-mitral SV÷aortic SV
D. RF% is solely a cardiac catheterization technique that cannot be duplicated in the echocardiography lab

Answer 126

C. Aortic RF%=aortic SV-mitral SV÷aortic SV

Question 127

498. In tricuspid valve stenosis, the Doppler formula used for determining tricuspid valve area (TVA) is:

A. Pressure half-time ÷220
B. 190 ÷ pressure half-time
C. 220 ÷ deceleration time
D. 0.5 ×deceleration time

Answer 127

B. 190 ÷ pressure half-time

???

Question 128

499. Formulas that may be used to calculate the cross-sectional area of an orifice or vessel through which blood is flowing include all the following EXCEPT:

A. 2×π×r²
B. π× (D÷2)²
C. 0.785 × D²
D. π×D²÷4

Answer 128

A. 2×π×r²

Question 129

The cardinal symptoms of valvular aortic stenosis include all the following EXCEPT:

A. Angina pectoris
B. Congestive heart failure
C. Palpitations
D. Syncope

Answer 129

C. Palpitations