Echo final
Pulmonic Regurgitation permits backward
Diastolic blood flow traveling from the PA, through the PV into the RV
A strong indication for mitral valve stenosis on two-dimensional echocardiography is an anterior mitral valve leaflet that exhibits:
Diastolic doming
Aortic insufficiency/regurgitation is the results 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
Severe aortic regurg creates a _____________ called the ____________ murmur
Diastolic rumble, austin flint
Mitral valve stenosis impedes __________blood flow traveling from the ___________ into the ________
Diastolic, left atrium, left ventricle
What would you expect to see on the M-mode of an 11 year old with bicuspid aortic stenosis?
Eccentric closure
Increased E-F is present when mitral stenosis is present
False
The left ventricle can be seen in the SAX Aorta view
False
The pedof probe is designed for the acquisition of the CW Doppler but has low sensitivity
False
The right atrium can be seen in the PSLAX view?
False
to acquire doppler of the pulmonary vein you would use CW. T/F
False
Calcific/Rheumatic Aortic stenosis presents on an M-mode with decreased aortic cusp separation (ACS)= 2.6-3.5
False ( = less than 1.5 cm )
The AVA is calculated by measuring the RVOT diameter , LVOT velocity and the aortic valve velocity
False - measures LVOT diameter
Atrioventricular valves are open during systole T/F
False - open during diastole
An MR jet that extends just beyond the mitral valve leaflets is
Grade 1
When pulmonary hypertension is present a high pitched blowing diastolic murmur is called a____________ murmur.
Graham steele
When severe tricuspid regurgitation is suspected, enlargement may be noted in the:
IVC SVC Hepatic veins
Increased LAVi indicates
Left atrial filling pressure in the absence of MV disease Possible diastolic dysfunction The outcome of heart failure
What does LAVi stand for?
Left atrial volume index
The most common location for beginning the adult echocardiographic examination is:
Left parasternal
Complications that can occur with AS are;
Left ventricular pressure overload left ventricular hyperthrophy infective endocarditis
Reasons LA enlargement can occur despite a normal LV diastolic function
MV disease Bradycardia
Where should the PW gate be placed to obtain MV flow?
MV leaflet tips
When obtaining the PSLAX view what anatomy do we see in this view?
MV,LA,LV
Causes of MVP include
Marfans syndrome Hereditary factors A&B
_______________ is the most common heart problem associated with MVP
Mitral regurgitation
Name two views where we could evaluate the aortic valve
PSLAX, SAX AO
Which spectral Doppler is used to assess normal specific atrioventricular valvular inflow?
PW
When measuring flow through the MV, we measure normal flow, using ____________, at the MV __________.
PW, leaflet tips
To provoke MVP the tech can have the patient ___________
Perform valsalva maneuver
Causes of TR
Pulmonary stenosis Rheumatic fever TV infection Ebstein's anomaly
Possible two-dimensional echocardiographic findings for valvular pulmonic stenosis include all the following EXCEPT:
Pulmonic valve prolapse
The apical 5 chamber shows the anatomy of the
RV, RA, TV, LA, LV, MV, AV
Tricuspid regurgitation is leakage of blood backwards from the ______into the ________during_____.
RV,RA,Systole
To calculate the RVSP you would:
TR max = RAP
The right ventricle can be seen in the SAX Aorta view
TRUE
Which spectral Doppler measurement is obtained to calculate the mitral valve mean pressure gradient?
Trace the E and A wave
Aortic insufficiency is the result of an incompetent valve that permits backward diastolic flow from the Aortic valve into the left ventricle
True
Ar murmur is a high pitched blowing diastolic decrescendo murmur T/F
True
Mitral stenosis creates turbulent diastolic flow
True
PW Doppler advantage is that it is precise to flow using the sample gate
True
The left atrium can be seen in the SAX Aorta view
True
diastolic doming of the anterior mitral valve leaflet creates a "hockey stick" appearance with Mitral stenosis
True
What does an E/e' >14 indicate?
abnormal LV filling pressure
Pulmonic stenosis as seen on Doppler echo from the parasternal window appears _____________ the base line during _______________.
above/diastole
The resistance to ejection of blood encountered by the contracting ventricle is called
afterload
Which of the following is not a limitation of continuous wave Doppler?
aliasing
Several windows should be utilized when acquiring the aortic valve Doppler waveform, to include the
all of the above -apical window -suprasternal window -right parasternal window
a diastolic flutter of the anterior mitral valve leaflet can be caused from
aortic regurgitation
The E-F slope of the M-mode of the anterior mitral valve leaflet in mitral valve stenosis is:
decreased
Utilizing CW Doppler, tricuspid stenosis will have a ______ E-F slope
decreased
In the SAX view of the mitral valve, tracing the opening of the mitral valve with mitral stenosis it will present a
decreased MVA
Aortic regurgitation creates a high pitched
diastolic blowing
TS murmur
diastolic rumble that varies with respiration and has an opening snap
spectral Doppler measure flow velocity and
direction of flow
M-mode bicuspid AS presents
eccetric closure
Trace the LA during
end ventricular systole
A complication of mitral stenosis is increased cardiac output
false
aortic stenosis creates a turbulent diastolic color flow that travels from the aorta into the left ventricle
false
aortic regurgitation
flow of blood backward from the aorta into the heart; caused by a weak heart valve
AI murmur
high-pitched, blowing, diastolic decrescendo murmur at the left sternal border
Mitral regurgitation creates a ______________ murmur
holosystolic blowing
TR Murmur
holosystolic murmur that increases with respiration
Complications with mitral regurgitation results in
left atrial enlargment pilmonary hypertension possible left atrial thrombus answer: all of the above
MVP murmur presents as a
mid systolic click
The most common cause of mitral stenosis is
mitral regurgitation
When acquiring the LA length freeze the image prior to the _________ opening
mitral valve
tricuspid stenosis
narrowing, thickening or obstruction of the TV that impeded Diastolic flow.
What does an E/e' <8 indicate?
normal LV filling pressure
Excellent two-dimensional views for imaging the tricuspid valve include all the following EXCEPT:
parasternal long-axis view
The best two-dimensional view for determining mitral valve area is the:
parasternal short-axis view
In most cases if the AMVL prolapses there is a ___________ direct jet
posterior
The volume or pressure that exists in the ventricle at end-diastole is called:
preload
the semilunar valves are open in
systole
on M-mode mitral valve prolapse creates a
systolic dip
A reason LA measurements may be inaccurate may be due to suboptimal views
true
Mitral stenosis can eventually cause pulmonary hypertension
true
aortic regurgitation is possible with stenosis
true
in order to acquire a pressure gradient, one can utilize the modified Bernoulli's equation.
true
you measure aortic regurgitation using the pressure half time method (PHT)
true
aortic insufficiency (AI)
when failure of a valve to close completely allows blood to move backward ( diastolic)
on M-mode, pulmonic stenosis presents an increased depth of
"a" wave
which of the following represents the formula for calculating the mitral valve area (MVA)?
220/PHT (pressure half time)
How far should you place the pw Doppler gate into the pulmonary veins
1-2cm
TVA=
190/PHT ( pressure half time)
When tracing the LA use the _________ chamber and the ___________chamber view
4 chamber and 2 chamber view
To acquire mitral valve velocity in a normal mitral valve, you would use the _______ view, using _________ doppler at the ___________ of the mitral valve leaflets
4 chamber, PW tips
continuity equation
785xLVOT2
with serve mitral stenosis, the MVA is _____________ cm squared
<1.0
Normal peak velocity for the mitral valve flow is
<1.3m/sec
severe aortic stenosis peak velocity is
>4.0 m/s
AI treatments
AOV repair/replacement
Name a treatment for AS
AOV replacement
Normal MV inflow antegrade or retrograde?
Antegrade
The best view to obtain the MV velocity is the
Apical 4 chamber view
What view could you use to evaluate stenosis?
Apical 5CH, Apical 3CH
The best view to obtain spectral Doppler of the mitral valve is the
Apical view
The murmur associated with severe aortic insufficiency is:
Austin Flint murmur
Mitral regurgitation is
Backflow of blood into the left atrium
Tricuspid regurgitation
Backflow of blood through incompetent tricuspid valve into RA during Systole
Which Doppler signal is used to calculate the tricuspid valve mean pressure gradient?
CW
Which spectral Doppler is used to assess valvular regurgitation?
CW
which spectral Doppler is used to assess valvular stenosis
CW
When pulmonic stenosis is detected using Doppler, you should use ___________ and ______________ the wave form.
CW/Trace
The flow convergence method can be used to estimate the MR volume. This method is also called
PISA
When MR is present you should look at your 2D image and evaluate
Mitral valve apparatus Left atrium Both a&b
Mitral stenosis is
Narrowing, thickening of the hearts mitral valve
Atrioventricular regurgitant blood flow will appear on which side of the spectral doppler baseline?
Retrograde
Causes of TS
Rheumatic fever ( most common) Ebstein's anomaly Carcinoid Heart Disease
Name 2 views you could use to evaluate pulmonic regurgitation
SAX AO, RVOT
Name 2 views where the Tricuspid valve is visualized
SUBCOSTAL 4CH, APICAL 5CH
Grade 4+ MR, is indicative of
Severe MR
on a 2D echo, AS may present;
Thickened cusps left ventricular hypertrophy both A&B
Pulmonic stenosis is not that common in the adult. Which od the following 2D echo findings would indicated pulmonic stenosis?
Thickening of the pulmonic leaflets with systolic doming
When measuring spectral Doppler Aortic stenosis you:
Trace the AV waveform
aortic stenosis
calcification of aortic valve cusps that restricts forward flow of blood during systole
3 s&s of AS
chest pain,syncope,heart failure
What type of Doppler is NOT considered spectral Doppler?
color Doppler
what type of aortic stenosis originates at the aortic valve cusps?
congenital
