Valvular Heart Disease

During the echo, if you detect a thickened aortic valve with a peak > 2m/sec, the patient has aortic ___. If you detect a thickened aortic valve with a peak velocity < 2m/sec, the patient has aortic ______. A. stenosis/sclerosis B. sclerosis/stenosis

A. stenosis/sclerosis

Pulmonic stenosis is not common in the adult. Which of the following 2D echo findings would indicate pulmonic stenosis? A. thickening of the pulmonic leaflets with systolic doming B. left ventricular hypertrophy with flattening of the IVS C. post-stenotic dilation of the aorta D. all of the above

A. thickening of the pulmonic leaflets with systolic doming

If one detects a diastolic rumble that varies with respiration and has an opening snap, what is most likely present? A. tricuspid stenosis B. tricuspid regurgitation C. mitral regurgitation D. pulmonic stenosis

A. tricuspid stenosis

According to the ICAEL, the aortic stenosis systolic velocity must be evaluated from multiple transducer positions (apical, suprasternal, and right parasternal) with a dedicated non-imaging CW transducer. A. true B. false

A. true

According to the continutity equation, the aortic valve area (AVA) = (.785)(LVOT diameter)^2 (V1)/(V2) A. true B. false

A. true

Diastolic doming of the anterior mitral valve leaflet creates a "hockey stick" appearance when mitral regurgitation is present. A. true B. false

A. true

Doppler echo is the method of choice in diagnosis of valvular aortic stenosis A. true B. false

A. true

Flow reversal in the hepatic veins is an indication of severe tricuspid regurgitation A. true B. false

A. true

If the tricuspid valve area is less than 2 cm squared the patient most likely has severe tricuspid stenos. A. true B. false

A. true

In cases of mild aortic insufficiency, the pressure difference gradually decreases creating a flatter pressure half-time waveform A. true B. false

A. true

In order to acquire a quick maximum pressure gradient, one can utilize the modified Bernoulli's equation. A. true B. false

A. true

In the presence of aortic stenosis, aortic valve replacement is performed if the patient develops symptoms and/or experiences progressive left ventricular hypertrophy A. true B. false

A. true

In the presence of mitral stenosis, we see increased left atrial pressure, enlargement of the left atrium, and possible spontaneous echo contrast and/or left atrial thrombus A. true B. false

A. true

Long standing mitral regurgitation leads to a pulmonary hypertension and heart failure ; whereas, acute mitral regurgitation tends to cause pulmonary edema. A. true B. false

A. true

Mitral regurgitation is the result of an incompetent mitral valve that permits backward flow from the left ventricle, through the mitral valve, into the left atrium during diastole. A. true B. false

A. true

Mitral regurgitation leads to left atrial enlargement and increased left atrial pressure. A. true B. false

A. true

Patients who have mitral valve prolapse with moderate to severe mitral regurgitation are at a significantly increased risk for developing infective endocarditis. A. true B. false

A. true

Planimetry of the Doppler wavefrom will provide the maximum pressure gradient, mean pressure gradient, and peak velocity across a cardiac valve. A. true B. false

A. true

Pulmonic insufficiency creates a low-pitched diastolic murmur that may increase with inspiration. When pulmonary hypertension is present, a high-pitched blowing diastolic murmur may be heard (Graham-Steele murmur). A. true B. false

A. true

Regurgitation increases preload. Stenosis increases afterload. A. true B. false

A. true

Right ventricular hypertrophy, right ventricular dilation, flattening of the IVS, paradoxical wall motion, and a small "D" shaped left ventricle are the result of pulmonary hypertension A. true B. false

A. true

Significant tricuspid regurgitation may lead to enlargement of the right atrium, right ventricle, IVC, hepatic veins, superior VC, and neck veins. A. true B. false

A. true

The Proximal Isovelocity Surface Area (PISA) measurement can be used to estimate of the area of an orifice through which blood flows. In cases of mitral regurgitation, PISA is used to determine the effective regurgitant orifice and the regugitant volume. A. true B. false

A. true

The aortic valve Doppler waveform always appears below the baseline. A. true B. false

A. true

The incidence of valvular heart disease has decreased due to advanced technology and antibiotics. A. true B. false

A. true

Tricuspid regurgitation is detected in the majority of patients and it should be used to calculate the right ventricular systolic pressure. A. true B. false

A. true

Similar to mitral stenosis, the severity of tricuspid stenosis can be assessed with the pressure half-time method; however, it has be proposed that the constant be replaced with the constant ______ A. 90 B. 190 C. 220 D. 390

B. 190

During the color flow Doppler exam, a systolic jet is detected as it leaves the left ventricle and travels approximately 1/3 of the way back into the left atrium. What is most likely the finding? A. 3+ mitral regurgitation B. 2+ mitral regurgitation C. 1+ mitral regurgitation D. 2+ aortic insufficiency

B. 2+ mitral regurgitation

Which of the following represents the mitral valve area? A. pressure half-time/220 B. 220/pressure half-time C. peak gradient / 220 D. 4(V)^2 where V = peak velocity

B. 220/pressure half-time

During the pulmoary vein Doppler exam, we detect a reversed "s" wave and increased "d" wave. This is known as pulmonary venous systolic flow reversal and indicates _______. A. normal pulmonary vein flow B. mild mitral regurgitation C. moderate mitral regurgitation D. severe mitral regurgitation

D. severe mitral regurgitation

If the mitral valve pressure half-time = 230 msec, what is present? A. normal mitral valve B. mild mitral stenosis C. moderate mitral stenosis D. severe mitral stenosis

D. severe mitral stenosis

What is the most common cause of tricuspid stenosis? A. rheumatic fever B. Ebstein anomaly C. Carcinoid heart disease D. Right atrial clot

A. rheumatic fever

In the echo lab, we use the Bernoulli equation to describe the relationship between pressure and velocity. The simplified Bernoulli equation = _____. A. 4(V) ^2 B. 220/pressure half-time C. (V_LVOT)(A_LVOT)=(V_AOV)(A_AOV) D. none of the above

A. 4(V)^2

The normal mitral valve area equals ______. A. 4 - 6 cm squared B. 1.5 - 2.5 cm squared C. 1.0 - 1.5 cm squared D. < 1.0 cm squared

A. 4-6 cm squared

What pressure half-time would you expect on a patient with mild aortic insufficiency? A. >500 msec B. 350-500 msec C. <200 msec D. 16-36 mmHg

A. >500 msec

The greater the preload, the greater the force of the contraction required to eject the blood. This is known as the ________. A. Frank-Starling Principle B. left ventricular end diastolic pressure (LVEDP) C. Interval-Strength Relationship D. Force-Velocity Relationship

A. Frank-Starling Principle

When the heart has to compensate for increased afterload, the result is _____ of the ventricular walls because the heart has to work harder to pump blood. A. Hypertrophy B. Atrophy C. Hypokinesis D. Dyskinesis

A. Hypertrophy

What is the most common method of calculating the mitral valve area? A. pressure half-time method B. continuity equation C. deceleration slope method D. Proximal Isovelocity Superficial Area (PISA) Method

A. pressure half-time method

What is the most common cause of mitral stenosis? A. rheumatic fever B. mitral annular calcification C. congenital anomaly D. prosthetic valve dysfunction

A. Rheumatic fever

What type of aortic stenosis originates at the sinuses of Valsalva and extends medially to the aortic valve cusps? A. degenerative B. rheumatic C. congenital D. prosthesis

A. degenerative

What would you expect to see on the M-mode of an 11 year old with bicuspid aortic disease? A. eccentric closure B. football shaped opening C. diastolic doming D. presence of a raphe

A. eccentric closure

The patient has a severe aortic insufficiency, what will be heard during auscultation? A. high-pitched, blowing, diastolic decrescendo murmur at the left sternal border B. low-pitched, mid-systolic, "rumble" at the apex C. high-pitched, blowing, diastolic crescendo murmur at the apex D. low-pitched, mid-diastolic, "rumble" at the apex (Austin Flint murmur)

A. high-pitched, blowing, diastolic decrescendo murmur at the left sternal border

What type of murmur is associated with mitral regurgitation? A. holosystolic murmur that radiates to the axilla B. mid-systolic click with/without a systolic murmur C. systolic crescendo decrescendo murmur D. low pitched, diastolic "rumble" with an opening snap

A. holosystolic murmur that radiates to the axilla

Which of the following contributes to acute aortic insufficiency? A. inefective endocarditis B. rheumatic fever C. bicuspid aortic valve D. all of the above

A. ineffective endocarditis

We refer to normal flow as _____ flow. It is smooth and its highest velocity is within the center of the flow. A. laminar B. turbulent C. effortless D. equal

A. laminar

Mitral regurgitation associated with mitral stenosis is most likely due to _______. A. left atrial enlargement B. scarring of the IVS C. left ventricular enlargement D. aortic valve notching

A. left atrial enlargement

A regurgitant valve creates a volume overload pattern because it is dumping extra blood into the _____. A. proximal chamber B. distal chamber C. inferior chamber D. superior chamber

A. proximal chamber

Pulmonic insufficiency as seen on Doppler echo from parasternal window appears ______ the baseline during ______. A. above/systole B. above/diastole C. below/systole D. below/diastole

B. above/diastole

Which of the following would most likely cause chronic aortic insufficiency? A. aortic dissection B. aortic stenosis C. trauma D. left atrial myxoma

B. aortic stenosis

Your patient has decreased cardiac output, chest pain, syncope, and a possible cerebral infarct. What is most likely the diagnosis? A. mitral valve prolapse B. aortic stenosis C. tricuspid stenosis D. pulmonary insufficiency

B. aortic stenosis

During the 2D echo exam on a 74 year old patient, we detect left ventricular hypertrophy, left ventricular enlargement, decreased left ventricular systolic function, and post stenotic dilation of the aortic root. What is most likely present? A. acute mitral regurgitation B. degenerative aortic stenosis C. acute aortic insufficiency D. bicuspid aortic valve

B. degenerative aortic stenosis

Aortic insufficiency is the result of an incompetent aortic valve that permits backward systolic flow from the aorta, through the aortic valve, into the left ventricle. A. true B. false

B. false

Holosystolic prolapse of the mitral leaflet(s) greater than or equal to 1 mm below the C-D points classifies mitral valve prolapse by M-mode A. true B. false

B. false

If the area decreases, the cardiac output increases, so the velocity must decrease in an attempt to maintain the cardiac output. A. true B. false

B. false

In most cases, if the posterior mitral valve leaflet prolapses there is a posterior directed jet of mitral regurgitation and if the anterior mitral valve leaflet prolapses there is a anterior directed jet of mitral regurgitation A. true B. false

B. false

Increased E-F slope, increased "A" wave, and decreased leaflet excursion (D-E) may present on M-mode when mitral stenosis is present. A. true B. false

B. false

Pulmonic stenosis creates a harsh diastolic ejection murmur; a thrill may also be present. A. true B. false

B. false

Severe aortic insufficiency causes the aorta's pressure to drop quickly creating a more rapid left ventricular pressure increase and a flatter pressure half-time waveform. A. true B. false

B. false

The apical long axis is the best view to diagnose mitral valve prolapse? A. true B. false

B. false

Tricuspid regurgitation creates a holosystolic murmur that decreases with respiration. A. true B. false

B. false

A false positive mitral valve prolapse may be associated with improper transducer placement or _____. A. Marfan syndrom B. large pericardial effusion C. pectus excavatum D. pectus carinatum

B. large pericardial effusion

What type of murmur is associated with mitral valve prolapse? A. murmur that radiates to the axilla B. mid-systolic click with/without a systolic murmur C. systolic crescendo decrescendo murmur D. low pitched, diastolic "rumble" with an opening soup

B. mid-systolic click with/without a systolic murmur

Regurgitation travels in the ____ direction of the normal flow while stenosis travels in the ____ direction as the normal flow. A. same/opposite B. opposite/same

B. opposite.same

Mitral regurgitation increases _______ which creates a left ventricular volume overload pattern and left ventricular enlargement. A. preload B. afterload

B. preload

An absent "a" wave combined with mid-systolic closure of the pulmonic valve creates a "flying W" appearance in the presence of ____. A. pulmonary capillary pressure B. pulmonary hypertension C. pulmonic stenosis D. pulmonic insufficiency

B. pulmonary hypertension

This type of aortic stenosis originates at the aortic valve cusps and moves out toward the commissures. A. degenerative B. rheumatic C. congenital D. prosthesis

B. rheumatic

If you detect an increased depth of the "a" wave > = 8 mm while acquiring the M-mode of the left pulmonic cusp, what is most likely the diagnosis? A. severe pulmonic regurgitation B. severe pulmonic stenosis C. severe pulmonic hypertension D. none of the above

B. severe pulmonic stenosis

if the pulmonary artery pressure is approximately 80 mmHg and the IVC does not collapse sufficiently during the sniff test, which of the following is most likely the peak velocity of the tricuspid regurgitation? A. 2 m/sec B. 3 m/sec C. 4 m/sec D. 5 m/sec

C. 4 m/sec

While performing the M-mode you detect diastolic flutter of the anterior mitral valve leaflet, diastolic flutter of the aortic valve, early closure of the mitral valve, and early opening of the aortic valve. What is most likely the diagnosis? A. mitral regurgitation B. mitral stenosis C. aortic insufficiency D. aortic stenosis

C. aortic insufficiency

Your patient is experiencing exertional dyspnea, syncope, and chest pain. The 2D echo reveals left ventricular enlargement, decreased left ventricular function, and diastolic dysfunction. What is most likely the diagnosis? A. mitral regurgitation B. tricuspid regurgitation C. aortic insufficiency D. pulmonic insufficiency

C. aortic insufficiency

Which of the following is the most common cause of pulmonic stenosis? A. rheumatic heart disease B. carcinoid heart disease C. congenital heart disease D. pulmonary artery aneurysm

C. congenital heart disease

While performing the M-mode, you detect right ventricular enlargement, hyperkinetic left ventricular wall, left atrial enlargement, and aortic valve notching due to a sudden decrease in the amount of volume leaving the left ventricle. What is the most likely present? A. aortic insufficiency B. aortic stenosis C. mitral regurgitation D. mitral stenosis

C. mitral regurgitation

What condition is most likely present if the pressure gradient across the pulmonic valve is 50 mmHg? A. normal pulmonic valve B. mild pulmonic stenosis C. moderate pulmonic stenosis D. severe pulmonic stenosis

C. moderate pulmonic stenosis

What type of murmur is associated with aortic stenosis? A. murmur that radiates to the axilla B. mid-systolic click with/without a systolic murmur C. systolic crescendo decrescendo murmur D. low pitched, diastolic "rumble" with an opening snap

C. systolic crescendo decrescendo murmur

Diastolic flutter of the tricuspid valve may be detected in the presence of _______. A. pulmonic insufficiency B. pulmonic stenosis C. tricuspid regurgitation D. tricsupid stenosis

C. tricuspid regurgitation

During the sniff test, you notice the IVC does not collapse properly and must measure its diameter. What is the normal IVC diastolic diameter? A. 0.12 - 0.23 cm B. 1.2 - 3.0 cm C. 2.3 - 3.3 cm D. 1.2 - 2.3 cm

D. 1-2 - 2.3 cm

While performing the Doppler study, you detect tricuspid regurgitation with a peak velocity of 2m/sec. Assuming the patient has a normal right atrial pressure, what is the right ventricular systolic pressure? A. 14 mmHg B. 16 mmHg C. 18 mmHg D. 26 mmHg

D. 26 mmHg

Acquired valvular heart disease may be due to ______ A. age B. rheumatic heart disease C. endocarditis D. all of the above

D. All the above

As soon as you turn on the M-mode, you notice that the anterior mitral valve leaflet prolapses into the left atrium. Before calling it mitral valve prolapse, you should ______. A. make sure the transducer is not placed too high on the chest wall. B. rule out pericardial effusion C. check other views D. all of the above

D. all of the above

Complications of mitral stenosis include _____. A. increase in the left atrial pressure B. scarring of the mitral valve apparatus C. dilation of the inferior vena cava and superior vena cava. D. All of the above

D. all of the above

Mitral stenosis creates a volume and pressure overload pattern, which may result in _______. A. right ventricular hypertrophy B. right ventricular enlargement C. small, "D" shaped left ventricle D. all of the above

D. all of the above

The aortic stenosis patient typically undergoes serial echos in order to track changes in the ______. A. degree of aortic stenosis B. systolic and diastolic function C. chamber and wall size D. all of the above

D. all of the above

The patient with mitral stenosis would most likely present with______? A. dyspnea B.hemoptysis C. fatigue D. all of the above

D. all of the above

What treatment might be indicated in the patient with mitral stenosis? A. mitral commissurotomy B. catheter balloon valvuloplasty C. mitral valve repair or replacement D. all of the above

D. all of the above

Which of the following is considered a cause of mitral regurgitation? A. rheumatic fever B. cardiomyopathy C. mitral valve prolapse D. all of the above

D. all of the above

The patient has a high-pitched, blowing, diastolic decrescendo murmur at the left sternal border. What would you expect to find on echo? A. mitral stenosis B. patent ductus arteriosus C. pulmonic insufficiency D. aortic insufficiency

D. aortic insufficiency

________ of the valve leaflets is caused by the pressure pushing on the undersurface of the leaflets along with commissural fusion. A. Calcification B. Fusion C. Thickening D. Doming

D. doming

What type of murmur is associated with mitral stenosis? A. holosystolic murmur that radiates to the axilla B. mid-systolic click with/without a systolic murmur C. systolic crescendo decrescendo murmur D. low pitched, diastolic "rumble" with an opening snap

D. low pitched, diastolic "rumble" with an opening snap

In the chamber that is ______ to the stenotic valve, the blood backs up, drives the pressure up, and creates a pressure overload pattern. A. closest B. distal C. superior D. proximal

D. proximal