Midterm Review Echo Pathology
The characteristic M-mode finding for calcific aortic valve stenosis include all of the following except:
Aortic cusp separation > 1.5 cm
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
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
What is the difference between aortic stenosis and aortic sclerosis?
Aortic sclerosis is thickened AOV without decreased excursion (peak velocity <2.5 m/s; a sclerotic valve may or may not become stenotic in the future. Aortic stenosis is thickened AOV with decreased excursion (peak velocity >2.6 m/s)
Disorders involved with Tricuspid valve disease include __ and __
Carcinoid heart disease; Ebstein's disorder
When evaluating eccentric MR jets, hugging or entertainment 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
Aortic insufficiency/ regurgitation is the result of an incompetent AOV that permits backward __.
Diastolic flow from the aorta to the LV
2D planimetry of the Aortic valve is performed in Apical 5 chamber view.
False
An advantage of CW doppler is that is is precise to flow using the sample gate.
False
Aortic regurgitation is possible with Aortic stenosis.
False
Aortic stenosis creates a turbulent diastolic color flow that travels from the aorta into the left ventricle.
False
Mitral regurgitation creates a diastolic blowing murmur.
False
Mitral stenosis color flow presents as turbulent systolic flow through the mitral valve into the left ventricle.
False
On a 2D echo, tricuspid stenosis has an increased tricuspid valve orifice.
False
The E-F slope of the mitral valve is increased when mitral stenosis is present.
False
The LVOT velocity is obtained using CW.
False
Tricuspid stenosis impedes systolic blood flow due to narrowing or thickening of the tricuspid valve.
False
When evaluating the aorta, the Debakey system is based on the velocity of the blood flow.
False
Tricuspid regurgitation creates a holosystolic murmur that decreases with respiration.
False (it will increase with respiration)
Complications of Mitral stenosis include left mitral regurgitation and increased cardiac output
Falseq
An MR jet that extends just beyond the mitral valve leaflets is:
Grade I
What is diastolic doming?
Hockey-stick appearance of the anterior mitral valve leaflet
When severe tricuspid regurgitation is suspected, enlargement may be noted in the:
IVC, RA, and hepatic veins
Characteristics M-mode findings for calcific AVS includes all of the following except:
Increased aortic cusp separation
The continuity equation includes measurements of the __, __, and __.
LVOT diameter, LVOT velocity, and aortic valve velocity
What type of murmur is associated with mitral stenosis?
Low pitched, diastolic rumble with an opening snap
Aortic stenosis can sometimes be mistaken for __ __.
Mitral regurgitation
Echocardiographic assessment for evaluating the severity of MR include all of the following except:
PW at the MV leaflet tips
The gold standard two - dimensional echocardiographic view for diagnosing mitral valve prolapse is the __.
Parasternal long -axis view
CW doppler is used to measure the Mitral regurgitations ___.
Peak velocity
Mitral stenosis chain reaction can lead to?
Pulmonary Hypertension
The etiology of the AO valve stenosis includes all of the following except:
Pulmonary stenosis
Tricuspid regurgitation is the leakage of blood backwards form the __ into the __ during __.
RV; RA; systole.
Aortic stenosis obstructs __ flow form the __ and out of the __.
Systolic; LV; Aorta
Should we diagnose MVP from the apical 4 chamber view?
The best view to evaluate MVP is the LAX, but we evaluate in all views. (DO NOT DIAGNOSE MVP SOLEY FROM 4 CHAMBER BECAUSE A NORMAL MV OFTEN LOOKS PROLAPSED IN 4 CHAMBER)
What equation is sued to calculate the aortic valve area?
The continuity equation
A patient with a mean pressure gradient >10mmHg indicates severe mitral stenosis.
True
AR murmur is a high-pitched blowing diastolic decrescendo murmur.
True
An advantage of CW doppler is it detects high and low velocities.
True
Aortic insufficiency is the result of an incompetent valve that permits diastolic flow into the LV from the aorta
True
Estimation of right atrial pressure (RAP) is assessed by evaluating the IVC.
True
If the patients blood pressure is low while evaluating the MR jet with CW doppler, the MR peak velocities and gradients will also be low.
True
It is common for patients with MVP to have mitral regurgitation.
True
Mitral stenosis can cause pulmonary hypertension.
True
Mitral valve prolapse can occur due to overstretched chordae tendinea.
True
Mitral valve prolapse is the most common cause of mitral regurgitation in developed countries.
True
Pacing devices can be a cause of functional tricuspid stenosis.
True
The aortic valve velocity increases as the aortic valve gets smaller.
True
Tricuspid regurgitation assessment is a parameter used to quantify pulmonary hypertension.
True
Tricuspid stenosis rarely occurs as an isolated lesion. It generally accompanies mitral stenosis
True
When assessing for mitral regurgitation on an echocardiogram, increasing the color gain too much can create a speckling noise which can overestimate the degree of MR?
True
Quantification of aortic stenosis on an echocardiogram includes __, __, and __.
Velocity, planimetry, pressure gradients
When you place color flow over the tricuspid valve to assess the tricuspid regurgitant jet, place the CW Doppler through the __ in case of severe tricuspid regurgitation.
Vena Contracta
How do we estimate RAP?
acquire the IVC diameter (normal range 1.2-2.1cm) at end expiration, just proximal to the entrance of the hepatic vein, and observe for inspiratory collapse. (if the IVC does not collapse at least 50% with normal inspiration, ask the patient to sniff and the collapse should improve - sniff test)
Chronic Mitral stenosis with pulmonary hypertension can cause:
all of the above
Features seen on a 2D Echo with mitral stenosis are:
all of the above
Placing a ring around the base of the mitral valve is called an
annuloplasty
Aortic regurgitation spectral waveform is __
antegrade
Regurgitant flow through the Aortic Valve is:
antegrade
A diastolic flutter of the anterior mitral valve leaflet can be caused from __.
aortic regurgitation
Utilizing CW doppler, Tricuspid stenosis will have a __ E-F slope.
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
Mitral stenosis is associated with what type of murmur?
diastolic rumble
Tricuspid stenosis murmur is described as a __ __.
diastolic rumble
Mitral valve stenosis impedes __ blood flow traveling from the __ into the __.
diastolic, left atrium, left ventricle
The E wave of the MV spectral doppler pattern represents:
early diastolic filling
Aliasing can occur when using CW doppler.
false
Atrial systole (a kick) occurs during ventricular systole.
false
Degenerative mitral regurgitation is caused by a dilated left ventricle
false
Mitral regurgitation creates a __ __ murmur.
holosytolic blowing
The measurement of mitral inflow velocity, measures __.
how fast the blood flows into the LV during diastole
Cardiologist recommend that patients with MVP __, __, and __.
increase exercise, avoid caffeine, and medicate if necessary
The classic cardiac doppler features of mitral valve stenosis include all of the following except:
increased mitral valve area
To achieve a doppler signal that is more parallel to flow, you can optimize the signal by moving the transducer __.
lateral
A disadvantage of PW doppler is it only detects __.
low velocities
When measuring the spectral waveform for the aortic regurgitation you:
measure the pressure half - time slope
The Deceleration time measurement is achieved by __.
measuring from the peak velocity down the slope back to the baseline
MVP murmur presents as a __
mid- systolic click
If the MR jet is just beyond MV leaflets, what is the degree of MR severity?
mild mitral regurgitation
Aortic stenosis is __ of the aortic valve that impedes __ blood flow.
narrowing; systolic
To qualify AS with spectral doppler, you can assess flow through the aortic valve using __ in the __ view.
pencil probe; right parasternal approach (right side)
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)
Tricuspid stenosis creates__ overload in the right atrium which will eventually produce __ __ and __ __
pressure; peripheral edema; cardac output
PISA stands for:
proximal isovelocity surface area
When the left atrial pressure is elevated and there is a systolic flow reversal into the left atrium, the flow in the __ may be reversed.
pulmonary veins
When the left atrial pressure is elevated and there is systolic flow reversal into the left atrium, the flow in the __ may be reversed.
pulmonary veins
Abnormal flow (regurgitation) through the Tricuspid valve in the SAX aorta view is:
retrograde
This type of aortic stenosis originates at the aortic valve cusps and moves outward.
rheumatic
The most common cause of mitral stenosis is:
rheumatic fever
The tricuspid regurgitant jet can be assessed in the apical 4 chamber view and also in the __.
right parasternal long axis of the RV
3 echo views used to obtain doppler velocity when assessing aortic stenosis severity using the non imaging probe are:
right parasternal, suprasternal notch, and apical 5 chamber
The aortic stenosis doppler signal compared to the mitral regurgitation doppler signal, can be differentiated as the mitral regurgitation has a __ appearance.
rounder
The PISA measurement measures the __ and __ of the inner most shell or hemisphere as the regurgitant jet converges towards the regurgitant orifice at the proximal convergent zone.
size and velocity
Continuous wave doppler is used to access mitral regurgitation spectral __ & __.
strength & shape
Continuous wave doppler is used to access MR spectral __ and __.
strength and shape
The __ view can be used to assess flow reversal from aortic regurgitation in the __.
suprasternal notch; descending aorta
What type of murmur is associated with aortic stenosis?
systolic crescendo and decrescendo murmur
On M-mode, mitral valve prolapse presents a __.
systolic prolapse
To provoke MVP the tech can have the patient preform __
the Valslva maneuver
You are preforming an echocardiogram on a patient with mitral regurgitant. The color flow jet is an eccentric jet, that wraps around the atrial wall, this is known as:
the coanda effect
What is a normal ACS?
thin cusps may flutter when blood goes through them
The MV mean pressure gradient is obtained by __.
tracing the spectral waveform
Aortic sclerosis- AOV peak velocity <= 2.5 m/s with mild thickening/ calci
true
Other doppler methods for evaluating the severity of MR is __.
(ALL OF THE ABOVE) -Continuous wave jet morphology - Continuous wave jet intensity - Systolic flow reversal in pulmonary veins
The normal velocity range across the aortic valve is __.
1.0-1.7 m/s
The normal diastolic IVC measurement is __.
1.2-2.1 cm
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
How do you measure RVSP?
4(v)^2 + RAP or TR velocity + RAP
The normal mitral valve area equals:
4-6 cm squared
Tricuspid regurgitation is present in more than __ % of the adult population.
75
Which moderate pulmonary HTN is SPAP?
<70mmHg
What pressure half-time would you expect on a patient with mild aortic insufficiency?
> 500 msec
With severe pulmonary HTN, the SPAP is __.
> 70mmHg
The vena contracta __ indicates severe MR.
>0.7 cm or >70 mm
Tricuspid stenosis doppler velocity is __.
>1.0m/s
Severe aortic peak velocity is:
>4.0 m/s
When measuring the spectral waveform for aortic stenosis you measure:
AR AHT
The RAP is calculated by __.
Accessing the IVC diameter and collapse during inspiration
An inflammatory disease that inflames, thickens, and dilates the aorta is known as __.
Ankylosing spondylitis
Aortic regurgitation can be caused from an abnormality with the __, it can be caused from a dilated __.
Aortic valve; aortic root
The best view to obtain MV velocity is the:
Apical 4 chamber view
Echo views used to evaluate Aortic regurgitation are:
Apical 5 chamber & apical 3 chamber
The LVOT velocity is achieved using the __ view.
Apical 5 chamber view
Severe aortic regurgitation is called a (an) __ murmur.
Austin flint
Mitral regurgitation is the __.
Backflow of blood into the left atrium
SPAP is calculated using the __ and the __.
Bernoulli equation; the RAP
In the apical 5 chamber view, normal color flow though the aortic valve is:
Blue
Regurgitant flow through the Mitral valve in the apical 4 chamber view, is seen with color flow as __.
Blue
Tricuspid valve leaflets that are fixed, thick, and rigid is seen with:
Carcinoid heart disease
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 __ in the Apical __
CW; 5 chamber view
To assess Tricuspid regurgitation using spectral doppler, you would use __.
Cw
The flow convergence method can be used to estimate the MR volume. This method is also called:
PISA
Mitral stenosis is considered to be severe by all of the following criteria except:
Mitral valve Doppler A velocity >1.3m/sec
A systolic click murmur is an indication of __.
Mitral valve prolapse
You are scanning a patient with mitral regurgitation. The vena contracta measures 4.5mm, with a turbulent color flow jet that extends a third way into the left atrium. The severity of the mitral regurgitation is __.
Moderate
If the MVA = 1.3cm^2, P1/2t = 200 mc, and mean PG = 9mmHG, what is the MS severity?
Moderate Mitral Stenosis
The vena contracta is the narrow __ of the MR jet as it travels the regurgitant orfice.
Neck
Color flow is used in detecting the mitral regurgitant jet __.
Origin, spatial relation, and direction (ALL OF THE ABOVE)
Tricuspid regurgitation is seen on the Doppler baseline as __.
Retrograde flow
Tricuspid stenosis etiology (causes) include all of the following:
Rheumatic fever, Fabry's disease, carcinoid heart disease, congenital and Whipple's disease
What is the most common cause of tricuspid stenosis?
Rheumatic heart disease
2D planimetry is performed in the __ view during __.
SAX; systole
The most common cause of tricuspid regurgitation is __.
Secondary, such as RA/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
2D echo, AS may present and cause:
Thickened cusps Doming AO valve cusps Left Ventricular hypertrophy
What is an Austin Flint murmur?
This murmur is associated with severe aortic regurgitation and described as a low- pitched mid to late diastolic rumble at the cardiac apex
Patients with mitral stenosis are at increased risk for developing a __ in the left atrium.
Thrombus
A raphe is typically seen with __ and is due to __.
bicuspid aortic valve; underdeveloped cusp
The method for determining the severity of mitral regurgitation using spectral doppler relies on the comparison of the __.
brightness of the doppler signal
This type of aortic stenosis originates at the sinus of Valsalva.
calcific
This type of aortic stenosis is associated with bicuspid aortic valve.
congenital
tricuspid stenosis etiology (causes) include all of the following except:
connective tissue disorders
