MID-TERM STUDY GUIDE
MITRAL VALVE PROLAPSE
AMVL &/ or PMVL prolapse beyond MV annulus into LA Happen during Systole.
The characteristic M-mode findings for calcific aortic valve stenosis include all the following EXCEPT:
Aortic cusp separation >1.5cm
Complications of Mitral Stenosis
Chain Reaction, MR, LA enlargement, LA thrombus, decreased cardiac output
When evaluating essentric MR jets, hugging or entrainment of the Mr jet on the LA wall is also called the.
Coanda Effect
When assessing the IVC, you would measure the width of the IVC and.
Collapse of the IVC
Features seen on a 2D Echo with Mitral stenosis are
Commissural fusion, Thickening of the leaflets >3mm, Decreased mitral valve area. All of above
This type of aortic stenosis is associated with bicuspid aortic valve
Congenital
Other Doppler methods for evaluating the severity of MR is ______.
Continuous wave jet intensity, Continuous wave jet morphology, Systolic flow reversal in the pulmonary veins All of the above
Utilizing CW doppler, Tricuspid Stenosis will have a ___________E- F slope
Decreased
With mitral stenosis, the M-mode E-F slope of the anterior mitral valve leaflet is
Decreased
When using the PISA method, the area of interest is optimized by ___________ the Nyquist limit on the color Doppler scale.
Decreasing
The aortic regurgitant jet will appear on the spectral waveform during
Diastole
Aortic Insufficiency/regurgitation is the result of an incompetent AOV that permits backward.
Diastolic flow from the aorta to the LV
Mitral stenosis is associated with what type of murmur?
Diastolic rumble
Mitral stenosis impedes_____blood flow traveling from the ____________ into the ____________.
Diastolic, left atrium, left ventricle.
_________of the valve leaflets is caused by the pressure pushing on the undersurface of the tethered leaflets while they are open
Doming
On a 2D Echo, AS may present and cause
Doming of the aortic valve cusps, Left ventricular hypertrophy, Thickened cusps. All of above
The E wave of the MV spectral Doppler pattern represents:
Early diastolic filling
The image below demonstrates a displacement of the tricuspid valve which is a condition known as
Ebsteins anomaly
Aortic Stenosis creates a turbulent diastolic color flow that travels from the aorta into the left ventricle. T or F?
False
Complications of Mitral stenosis include left mitral regurgitation & increased cardiac output: T or F?
False
D Planimetry of the Aortic valve is performed in the Apical 5 chamber view. T or F?
False
Degenerative mitral regurgitation is caused by a dilated left ventricle. T or F?
False
Mitral regurgitation creates a holodiastolic blowing murmur. T or F?
False
Mitral stenosis creates turbulent systolic flow. T or F?
False
On M-mode Mitral Valve prolapse creates a diastolic dip. T or F?
False
On a 2D Echo, Tricuspid stenosis has an increased tricuspid valve orifice. T or F?
False
The E-F slope of the mitral valve is increased when mitral stenosis is present. T or F?
False
The LVOT velocity is obtained using CW. T or F?
False
Tricuspid regurgitation creates a holosystolic murmur that decreases with respiration. T or F?
False
Tricuspid stenosis impedes systolic blood flow due to narrowing or thickening of the Tricuspid valve. T or F?
False
The tricuspid regurgitant jet can be assessed in the subcostal 4 chamber view at the level of the IVC to assess __________ of the ____________.
Flow reversal, hepatic veins
An MR jet that extends just beyond the mitral valve leaflets is.
Grade I
MR Murmur
Holosystolic murmur that radiates to axilla/ May be blowing high pitched. · Happens during Systole
MITRAL REGURGITATION
Incompetent MV permits backward systolic flow from LV - MV - LA
The characteristic M-mode findings for calcific aortic valve stenosis include all the following EXCEPT:
Increased Aortic cusp separation
The classic cardiac Doppler features of mitral valve stenosis include all the following EXCEPT
Increased mitral valve area
Mitral Regurgitation is. Backflow of blood into the
LA
To achieve an aortic valve area using the continuity equation during an Echocardiogram, the sonographer must measure
LVOT diameter, LVOT velocity and aortic valve velocity
To achieve a Doppler signal that is more parallel to flow, you can optimize the signal by moving the transducer ___________.
Lateral
Complications with mitral regurgitation results in
Left atrial enlargement, Left Ventricle Volume overload, Pulmonary edema. All of the above
What type of murmur is associated with mitral stenosis?
Low pitched, diastolic "rumble" with an opening snap.
Aortic stenosis can sometimes be mistaken for
MR
PISA formula
MR VOLUME = EROA X MR VTI
The color flow in this image is presenting a pathology known as _________, which will be displayed _______ the baseline on the spectral waveform
MR, Below
A systolic click murmur is an indication of
MVP
Cardiologists recommend that patients with mitral valve prolapse _______
Medicate if necessary, Increase exercise, Avoid caffeine.
AO stenosis murmur
Mid- systolic crescendo decrescendo murmur. · Happens during Systole
The gold-standard two-dimensional echocardiographic view for diagnosing mitral valve prolapse is the:
Parasternal long-axis view
The best two-dimensional view for determining mitral valve area is the:
Parasternal short-axis view
Continuous wave Doppler is used to measure the Mitral regurgitations __________
Peak velocity
In most cases if the AMVL prolapses there is a ________directed jet
Posterior
Mitral regurgitation increases ___________ which creates a left ventricular volume overload pattern and left ventricular enlargement
Preload
The spectral waveform of Aortic regurgitation is measured using the
Pressure half time (PHT)
The etiology of aortic valve stenosis includes all the following EXCEPT
Pulmonic stenosis
Tricuspid regurgitation is leakage of blood backwards from the ___into the ____during _____.
RV, RA, Systole
TR formula
RVSP/SPAP = 4V2 + RAP
When you place color flow over the tricuspid valve to assess the tricuspid regurgitant jet, place the CW Doppler through the tricuspid regurgitation, you compare the ___________ & _________ of the spectral waveform.
Shape, brightness
Using spectral Doppler, the severity of Aortic Stenosis can be assessed by the ___________ of the waveform and the _______________ velocity.
Shape, peak
If the IVC measures 1.8cm and collapses >50% you would use _______ for the RAP. 3 The RAP is calculated by evaluating the IVC's ___& ___ with sniff
Size & Collapse
The PISA measurement measures the____________ of the inner most shell or hemisphere as the regurgitant jet converges towards the regurgitant orifice at the proximal convergent zone. Size and velocity
Size and velocity
The ________view can be used to assess flow reversal from aortic regurgitation, in the _______.
Suprasternal notch, descending aorta
Another name for Mitral valve prolapse is
Systolic click—murmur syndrome, Floppy valve syndrome, Barlow syndrome
What type of murmur is associated with aortic stenosis
Systolic crescendo decrescendo murmur.
TS formula
TVA = 190 / P1/2t
A Tricuspid valve area of < = 1.0 cm2 is indicative of severe tricuspid stenosis. T or F?
True
A complication of Mitral stenosis is decreased cardiac output. T or F?
True
A patient with a pressure half of > or = to 220 indicates severe mitral stenosis. T or F?
True
AR murmur is a high-pitched blowing diastolic decrescendo murmur. T or F?
True
Aortic Regurgitation is possible with Aortic Stenosis? T or F
True
Aortic insufficiency is the result of an incompetent valve that permits backward diastolic flow from the Aortic valve into the left ventricle
True
Aortic sclerosis—AOV peak velocity < = 2.5 m/s with mild thickening/calcification. T or F?
True
Estimation of the right atrial pressure (RAP) is assessed by evaluating the IVC.
True
Mild Tricuspid regurgitation is considered a normal finding. T or F?
True
Mitral Regurgitation is probable with Mitral stenosis. T or F?
True
Mitral Stenosis can cause Pulmonary Hypertension. T or F?
True
Mitral valve prolapse can be hereditary: T or F ?
True
Mitral valve prolapse can cause of mitral regurgitation. T or F?
True
Mitral valve prolapse can occur due to overstretched chordae tendineae. T or F ?
True
Pacing devices can be a cause of functional tricuspid stenosis. T or F?
True
Sometime a Pacing lead (pacemaker wire) through the tricuspid valve can cause Tricuspid Regurgitation. T or F?
True
The Aortic valve velocity increases as the Aortic valve gets smaller. T or F?
True
Tricuspid stenosis rarely occurs as an isolated lesion. It generally accompanies mitral stenosis. T or F?
True
When assessing for mitral regurgitation on an echocardiogram, increasing the color gain too much can create speckling (noise) which can overestimate the degree of mitral regurgitation. T or F?
True
When measuring the Spectral waveform for Aortic stenosis you: Trace the AV waveform Aortic Stenosis creates a turbulent systolic color flow that travels from the Left ventricle into Aorta. T or F?
True
If a patient's blood pressure is low while evaluating the MR jet with CW Doppler, the MR peak velocities and gradients will also be low
True.
Your patient is experiencing exertional dyspnea, syncope, and chest pain. The 2D echo reveals left ventricular enlargement and decreased left ventricular function. What is most likely the diagnosis?
aortic insufficiency
A diastolic flutter of the anterior mitral valve leaflet can be caused from
aortic regurgitation
Causes of MVP include:
associated with skeletal abnormalities, Improper transducer placement, Marfans syndrome
Tricuspid stenosis murmur is described as
diastolic rumble
TS murmur
diastolic rumble that varies with respiration & has an opening snap. · Happens during Diastole
TR COMPLICATIONS/SIGNS & SYMPTOMS
enlarged RA, RV, IVC, hepatic veins, SVC, neck veins, and leg & abdominal swelling
murmur AORTIC REGURGITATION
high-pitched, blowing, diastolic decrescendo murmur at LSB. Happen during Diastole
Mitral regurgitation creates a ___________ murmur
holosystolic blowing
TR murmur
holosystolic murmur / increases with inspiration
AORTIC REGURGITATION
incompetent AOV permits backward diastolic flow from AO defective AOV LV.
TRISCUPID REGURGITATION
incompetent TV permits backward systolic flow from RV defective TV RA Happen during Systole
Complications of mitral stenosis include
increase in the left atrial pressure, decreased cardiac output, scarring of the mitral valve apparatus. All of above.
Chronic Mitral stenosis with pulmonary hypertension can cause:
increased right ventricle pressure, right ventricle hypertrophy, right ventricle volume overload. All of above
When measuring the Spectral waveform for Aortic regurgitation you:
measure the pressure half time slope
The Pressure half time measurement is achieved by _________
measuring half of the E-F slope.
MVP murmur presents as a ____ murmur. Best seen in the _____ view
mid systolic click, PSLAX
The murmur of aortic stenosis is typically a ______ murmur
mid-systolic ejection
AORTIC STENOSIS:
narrowing/thickening/obstruction of AOV that impedes systolic flow traveling from LV AOV AO
TRISCUPID STENOSIS
narrowing/thickening/obstruction of TV that impedes diastolic flow traveling from RA TV RV
To provoke MVP the tech can have the patient
perform valsalva maneuver
What is PISA
proximal isovelocity surface area
What is the most common cause of mitral stenosis?
rheumatic fever
On M-mode, Mitral Valve prolapse presents a
systolic prolapse
What equation, is used to calculate the aortic valve area?
the continuity equation
The MV deceleration time measurement is obtained by measuring ________
the time from the peak velocity down the slope to the baseline.
Which of the following represents the formula for calculating the mitral valve area?
220/ pressure half-time
A (an) __________involves a tear in the intimal lining of the aorta. The tear creates a false lumen. When blood enters the false lumen, it destroys the media and strips the intima from the adventitia possibly causing the tear to extend further
. Aortic dissection
The normal value for the mitral flow peak E velocity is ___
0.6-1.4m/s
The normal velocity range across the aortic valve
1.0 - 1.7 m/sec.
A normal diastolic IVC measurement is
1.2 -2.1cm
What is the valve area calculation for Tricuspid valve area
190 / pressure half-time
Mild MR jets cover less than ________
20% of the total LA area
The normal value for the mitral pressure half time is ______
30-60ms
How do you measure RVSP
4(V) ²+ RAP
The normal mitral valve area equals:
4-6 cm squared
The normal value for MVA is ____.
4-6cm2
When severe tricuspid regurgitation is suspected, enlargement may be noted in the
: IVC,RA, Hepatic Veins. All of the above
MVP Murmur:
: Mid-systolic click/ systolic click
Severe aortic stenosis AVA is
< 1.0 cm ²
Severe Mitral stenosis, the MVA is __________cm squared
<1.0
The M-mode measurement of the aortic cusp separation when aortic stenosis is present is
<1.5 cm.
The normal value for mitral deccelration time is ________.
<220ms
The normal value for mitral mean pressure gradient is _________.
<5mmHg
What pressure half-time would you expect on a patient with mild aortic insufficiency?
> 500ms
A mean pressure of ____________ indicates severe tricuspid stenosis
> 5mmHg
With severe Pulmonary HTN, the SPAP is
> 70 mmHg
A vena contracta __________ indicates severe MR.
>0.7cm
Tricuspid stenosis doppler veloctity is
>1.0m/s
Severe aortic stenosis peak velocity is
>4.0
Severe aortic stenosis peak velocity is
>4.0 m/s.
A vena contracta __________ indicates severe MR.
>7mm
The AVA is calculated by using the following equation
AVA=(.785) (LVOT diameter ²) (V1)/ (V2)
The RAP is calculated by
Accessing the IVC diameter and collapse during inspiration
Quantification of Aortic Stenosis on an Echocardiogram, includes velocity, pression gradients, planimetry
All of the above
Placing a ring around the base of the mitral valve is called a (an)_________
Annuloplasty.
Aortic regurgitation spectral waveform
Antegrade
Aortic regurgitation can be caused from an abnormality with the _________, it can also be caused from a dilated ____________.
Aortic valve, aortic root
Echo views used to evaluate Aortic regurgitation are;
Apical 5 chamber & Apical 3 chamber
The LVOT velocity is achieved in the ___________.
Apical 5 chamber view
The best view to obtain MV velocity is the:
Apical four-chamber view
The 3 Echo views used to assess aortic stenosis using Doppler, are
Apical, Right Parasternal, Suprasternal
Severe Aortic regurg is called a (an) ________murmur.
Austin Flint
Mitral Regurgitation is
Backflow of blood into the Left Atrium
SPAP is calculated using the ___________ and the _________.
Bernoulli Equation and the RAP
When is a raphe typically seen?
Bicuspid aortic valve
The method for determining the severity of mitral regurgitation using spectral Doppler relies on the comparison of the
Brightness of the Doppler signal
Disorders involved with Tricuspid valve disease include
Carcinoid heart disease & Ebsteins disorder.
Tricuspid stenosis is measured using
CW
Which Doppler signal is used to calculate the tricuspid stenosis mean pressure gradient
CW
Which spectral Doppler is used to assess valvular regurgitation?
CW
Using spectral Doppler, you can measure aortic regurgitation using ________ Doppler in the Apical _________ view.
CW, 5 chamber
To quantify aortic stenosis with spectral Doppler, you can assess flow through the aortic valve using ______in the ________ view.
CW, Apical 5 chamber
This type of aortic stenosis originates at the sinuses of Valsalva.
Calcific
AO stenosis causes
Calcific AS (Most common in U.S) Congenital Bicuspid AS (only 2 cusps) Rheumatic AS (Most common worldwide)
Tricuspid valve leaflets that are fixed, thick and rigid is seen with
Carcinoid heart disease
Mitral stenosis is considered to be severe by all the following criteria EXCEPT:
Mitral valve Doppler A velocity >1.3 m/sec
Treatment for Mitral Regurgitation includes all of the following:
Mitral valve repair, Mitral valve replacement. All of the above
What treatment might be indicated in the patient with mitral stenosis?
Mitral valve replacement, mitral balloon valvotomy, surgical commissurotomy repair.All of above
Grade 3+ MR, is indicative of.
Moderate
You are scanning a patient with mitral regurgitation. There is a turbulent color flow jet that extends a third (1/3) way into the left atrium during systole. The severity of the mitral regurgitation is _______
Moderate
Aortic stenosis is_-----_ of the aortic valve that impedes _----_blood flow
Narrowing, systolic.
MITRAL STENOSIS
Narrowing/ thickening/ Obstruction of MV that impedes diastolic flow traveling from LA - MV - LV
The vena contracta is the narrow ___________ of the MR jet as it traverses the regurgitant orifice
Neck
Color flow is useful in detecting the mitral regurgitant jet ________.
Origin, direction, spatial relation. All of the above
The flow convergence method can be used to estimate the MR volume. This method is also called
PISA
Atrioventricular regurgitant blood flow will appear on which side of the spectral Doppler baseline.
Retrograde
Tricuspid valve regurgitation is seen on the Doppler baseline as
Retrograde flow
This type of aortic stenosis originates at the aortic valve cusps and moves outward.
Rheumatic
Causes of Mitral stenosis
Rheumatic Fever, Mitral annular calcification, congenital anomaly, LA mass, prosthetic valve dysfunction
Mitral regurgitation can be seen in all of the following 2D Echo views EXCEPT.
Right Ventricular Outflow Tract (RVOT) View
The tricuspid regurgitant jet can be assessed in the apical 4 chamber view and also the
Right parasternal long axis of the RV
To quantify aortic stenosis from a right parasternal approach, you would turn the patient on their __________ side, and use the ___________ probe
Right, pencil
The aortic stenosis Doppler signal compared to the mitral regurgitation Doppler signal, can be differentiated, as the mitral regurgitant signal has a ____________ appearance.
Rounder
2D Planimetry of the Aortic valve is performed in the
SAX Aorta view
Views you can evaluate mitral valve pathology are the
SAX of the mitral valve, Apical 3 chamber & PSLAX views
2D Planimetry of the aorta is performed in the _________ view during _________.
SAX, systole
The most common cause of tricuspid regurgitation
Secondary, such as RA or RV enlargement and Pulmonary hypertension
For patients with MVP, the main source of treatment before surgery is
Serial Echocardiograms
Grade 4+ MR, is indicative of
Severe MR
If the mitral valve pressure half-time is >220 msec, what is present?
Severe mitral stenosis
Patients with mitral stenosis are at increased risk for developing a ________in the left atrium.
Thrombus
The image represents a football shaped opening known as
bicuspid aortic valve
A raphe is typically seen with ____________ and is due to __________.
bicuspid aortic valve, underdeveloped cusp