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