valvular disease

133. There is posterior mitral valve prolapse present. With color flow Doppler on, which direction will the mitral regurgitation jet be baffled? a) anterior b) posterior c) inferior d) cephalad

a) anterior anterior mitral valve prolapse will baffle the jet posterior. Prolapse of both mitral valve leaflets for result in a central jet

97. Two dimensional echocardiographic examination reveals thin mobile mitral valve leaflet tips and a Doppler E velocity of 1.8 m/s with a pressure half-time of 180 msec in an elderly patient. The most likely diagnosis is? a) abnormal relaxation of the left ventricle b) aortic regurgitation c) moderate to severe mitral annular calcification d) Rheumatic mitral stenosis

c) moderate to severe mitral annular calcification in mitral stenosis due to severe mitral annular calcification, the Doppler and secondary echocardiography findings are similar Rheumatic mitral stenosis. This type of mitral obstruction is referred to as functional mitral stenosis

131. All of the following are associated with mitral valve prolapse accept? a) mitral regurgitation b) tricuspid valve prolapse c) aortic valve prolapse d) pulmonary atresia

d) pulmonary atresia tricuspid valve prolapse may be present and up to 50% of the patients with mitral valve prolapse. I ordered valve prolapse is uncommon but may be found in patients with mitral valve prolapse, 10% of patients with mitral valve prolapse, or with a cuspid aortic valve

124. The complications of mitral valve prolapse include all of the following except? a) increased risk of infective endocarditis b) significant mitral regurgitation c) mitral valve repair and replacement d) valvular stenosis

d) valvular stenosis other complications of mitral valve prolapse include cerebal embolic events and cardiac arrhythmias for example there are some paroxysmal supraventricular tachycardia, atrial fibrillation. Mitral valve prolapse appears to be the most common reason for mitral valve repair in the United States due to isolated significant mitral regurgitation. There may be an increased risk of sudden death in patients with mitral valve prolapse with severe mitral regurgitation, complex ventricular arrhythmias QT interval prolongation and history of syncope and palpitation

83. Conditions that may lead to clinical symptoms that mimic those associated with Rheumatic mitral stenosis include? a) aortic stenosis b) left atrial myxoma c) pericardial effusion d) ventricular septal defect

b) left atrial myxoma a mobile left atrial myxoma May prolapse into the mitral valve or orifice during ventricular diastole and obstruct flow into the left ventricle mimicking mitral stenosis

120. Cardiac Doppler evidence of severe mitral regurgitation includes all of the following except? a) dance, triangular continuous wave Doppler b) mitral valve E wave velocity <1.0 m/sec c) pulmonary vein systolic flow reversal d) regurgitate jet area/left atrial area ratio >40%

b) mitral valve E wave velocity <1.0 m/s with significant mitral regurgitation, the mitral valve e velocity will be increased, greater than 1.2 meters per second, due to the increase early diastolic pressure gradient between the left atrium and the left ventricle. Mitral valve repair or replacement may be indicated in patients with significant mitral regurgitation when there is evidence of progressive ventricular dilatation, and end diastolic Dimension greater than 45 mm, or a reduction in left ventricular Global systolic function

80. The cardiac valves listed in decreasing order as they are affected by rheumatic heart disease are? a) aortic, pulmonic, tricuspid, mitral b) mitral, aortic, tricuspid, pulmonic c) pulmonic, aortic, tricuspid, mitral d) tricuspid, mitral, pulmonic, aortic

b) mitral, aortic, tricuspid, pulmonic

104. The most likely heart sound to be heard and patients with significant chronic pure mitral regurgitation is? a) loud S1 b) fixed split S2 c) S3 d) ejection click

c) S3 the third heart sound also referred to as the Proto diastolic Gallop or ventricular Gallop, is the result of Rapid feeling and stretching of an abnormal left ventricular. It is frequently and early sign of left ventricular failure. The third heart sound may be present in patients with mitral regurgitation, aortic regurgitation, ventricular septal defect and patent ductus arteriosus. An S3 may also be a normal variant found especially in young adults

85. The three classic M- mode findings for mitral stenosis are?

1) thickened mitral valve leaflets 2) decreased mitral valve E-F slope 3) anterior motion of the posterior mitral valve leaflet

89. Critical mitral valve stenosis is said to be present if the mitral valve area is reduced to? a) <1.0 cm2 b) 1.0 to 1.5 cm2 c) 1.5 - 2.5 cm2 d) 2.5 - 3.5 cm2

a) <1.0 cm2

107. M mode and two-dimensional findings associated with significant chronic mitral regurgitation include all of the following except? a) fine diastolic flutter of the mitral valve b) left atrial enlargement c) left ventricular enlargement d) left ventricular volume overload pattern

a) Define diastolic flutter of the mitral valve May indicate aortic regurgitation the two components of left ventricular volume overload are 1) left ventricular dilatation and 2) hyperkinetic left ventricular wall motion

84. The equation used in the cardiac catheterization laboratory to determine mitral valve area is the? a) Gorlin b) Bernoulli c) Doppler d) continuity

a) Gorlin

113. In patients with significant mitral regurgitation, The Continuous wave Doppler tracing of the regurgitant lesion May demonstrate? a) a symmetrical shape of the mitral regurgitation flow velocity spectral display b) jet area of <20% c) jet duration of < 85msec d) symmetrical shape of the mitral regurgitation flow velocity spectral display

a) a symmetrical shape of the mitral regurgitation flow velocity spectral display in patients with significant mitral regurgitation, The Continuous wave Doppler spectral display May demonstrate a dense, a symmetrical, triangular, tapered shape which indicates a rapid rise in left atrial pressure due to the significant mitral regurgitation in patients with significant tricuspid regurgitation The Continuous wave Doppler spectral display May demonstrate a similar pattern for example, dance, asymmetrical, due to a rapid rise in right atrial pressure

1:37. On Emory Road in two-dimensional echocardiography dense Echoes are noted posterior to the normal mitral valve leaflets. The probable diagnosis is mitral valve? a) annular calcification b) aneurysm c) papilloma d) vegetation

a) annulus calcification the mitral valve annulus is part of the fibrous skeleton of the heart and begins to develop fibrosis and calcification by age 65 years. Echocardiography demonstrates a massive dense and highly selective Echoes behind the posterior mitral valve leaflet. mitral annular calcification may be accelerated by the presence of certain disease states such as stomach hypertension, aortic stenosis, diabetes, chronic renal failure in hypertrophic cardiomyopathy

117. A color flow Doppler method for semi-quantitative mitral regurgitation is regurgitant jet? a) area b) height c) length d) turbulence

a) area the regurgitant jet area compared to the left atrial area provides a semi quantitative measure of the severity of mitral regurgitation

138. The etiology of aortic valve stenosis includes all of the following except? a) bacterial b) congenital c) degenerative d) Rheumatic

a) bacterial acquired aortic valve stenosis may be due to degenerative senile calcification or rheumatic fever. Congenital aortic valve stenosis maybe unicuspid, bicuspid, tricuspid, or it may be due to dome-shaped diaphragm quadricuspid aortic valve has been described, is usually not stenotic that maybe regurgitant

115. In patients with severe acute mitral regurgitation, The Continuous wave Doppler Peak velocity of the regurgitant jet is? a)decreased b) dependent largely upon left ventricular Global systolic function c) increased d) unaffected

a) decreased in most cases of mitral regurgitation Peak velocity is expected to fall between 4 to 6 meters per second and is therefore not useful for determining the severity of mitral regurgitation,. In patients with severe acute mitral regurgitation, the peak velocity maybe less than 4 meters per second owning to an elevated left atrial pressure that reduce the pressure difference between the left ventricle and the left atrium during ventricular systole. In addition, there may be tapering, triangular shaped, asymmetrical, of the continuous wave Doppler configuration

100. The most common presenting symptom of significant chronic mitral regurgitation is? a) dyspnea b) hemoptysis c) systemic embolization d) ascites

a) dyspnea. the patient with significant chronic mitral regurgitation present with the sign and symptoms of congested heart failure, dyspnea, orthopedia, orthopnea, paroxysmal nocturnal dyspnea, fatigue, cough and what gain due to the reduction of stroke volume and cardiac output as well as an increase in pulmonary artery pressure

105. The classic description of the murmur of chronic mitral regurgitation is? a) holosystolic murmur heard best at the Apex radiating to the axilla b) continuous Machinery like murmur c) systolic ejection murmur heard best at the right upper sternal border d) diastolic decrescendo murmur heard best at the left sternal border

a) holosystolic murmur heard best at the Apex radiating to the axilla the character of the murmur of mitral regurgitation depends upon whether the mitral regurgitation is mild, moderate or severe. It also depends on whether the anterior or posterior mitral valve leaflet is involved. In patients with posterior mitral valve leaflet defects, the direction of the regurgitant jet maybe anterior and the mitral regurgitation murmur is best heard in the aortic area. In patients with mitral valve prolapse, the murmur maybe Crescendo and late systolic

112. An accepted method for determining the severity of mitral regurgitation but continuous wave Doppler is spectral? a) jet density b) length c) velocity d) width

a) jet density by comparing the mitral info spectral density (strength) to the spectral density, of the mitral regurgitation a semi quantitative approach to the severity of mitral regurgitation can be achieved. A soft density with a parabolic flow signal suggests mild mitral regurgitation. A dense triangular continuous wave tracing suggest the presence of severe mitral regurgitation

101. Congestive heart failure in a patient with significant chronic mitral regurgitation occurs because of increased pressure in the? a) left atrium b) left ventricle c) right ventricle d) aorta

a) left atrium congestive heart failure, inability of the heart to meet the metabolic demands of the body, can occur in patients with significant chronic mitral regurgitation due to the increase in left atrial pressure. The signs and symptoms of congestive heart failure include dyspnea , orthopedia, proximal nocturnal dyspnea, fatigue, cough and weight gain

132. Which of the following is most commonly associated with mitral valve prolapse? a) left heart volume overload b) left heart pressure overload c) right heart pressure overload d) right heart volume overload

a) left heart volume overload mitral valve prolapse may result in significant chronic mitral regurgitation. Significant chronic mitral regurgitation initially results in left lateral dilatation, left ventricular dilatation and left ventricular volume overload pattern. Left ventricular dilatation with hyperkinetic wall motion. With time pulmonary hypertension May develop

109. Systolic bowing of the intra atrial septum towards the right atrium throughout the cardiac cycle may be an indication of? a) mitral regurgitation b) tricuspid atresia c) tricuspid regurgitation d) tricuspid stenosis

a) mitral regurgitation the inter atrial septum mabo towards the right atrium in significant mitral regurgitation because the left atrial pressure is Markley greater than the right atrial pressure the interatrial septum Mabel towards the left atrium throughout the cardiac cycle in patients with increased right atrial volume and or pressure for example significant tricuspid regurgitation, tricuspid stenosis, tricuspid atresia.

129. The gold standard two dimensional echocardiographic view recommended to diagnose the presence of mitral valve prolapse? a) parasternal long axis b) parasternal short axis of the mitral valve c) apical 4 chamber d) subcostal 5 chamber

a) parasternal long axis because the mitral annulus is Saddle shape, the parasternal long axis is the recommended for you. Is systolic displacement greater than 2 mm of one or both leaflets into the left atrium suggest mitral valve prolapse. If the prolapsing leaflet are greater than 5 mm thickness, classic mitral valve prolapse is present. If the prolapsing leaflet are less than 5 millimeters in thickness, non classic prolapse is present. Use of the apical 4 chamber view as the gold standard for you for several years resulted in the overdiagnosis of mitral valve prolapse, 5 to 15%. Using the stricter criteria described above, the prevalence of mitral valve prolapse is 1.7 to 2.4%. Mitral valve prolapse is twice as frequent in women than in men but significant mitral regurgitation occurs more frequency in older men, greater than 50 years of age, with mitral valve prolapse then in younger women with mitral valve prolapse

145. All of the following may be measured in the cardiac catheterization laboratory when he valuing erotic stenosis except? a) Peak velocity b) maximum Peak instantaneous pressure gradient c) Peak to Peak pressure gradient d) mean pressure gradient

a) peak velocity historically the peak to Peak pressure gradient, mean pressure gradient and aortic valve area are measured in the cardiac catheterization laboratory when evaluating aortic stenosis it is important to note that cardiac Doppler measures the maximum Peak instantaneous pressure gradient. The Doppler maximum Peak instantaneous gradient is nearly always larger than the cardiac catheterization Peak to Peak pressure gradient. Comparing mean pressure gradient and aortic valve area is important when evaluating cardiac Doppler in cardiac catheterization information since these value should be similar in aortic stenosis

130. Secondary causes of mitral valve prolapse include all of the following except,? a) atrial septal defect b) bicuspid aortic valve c) cardiac tamponade d) primary pulmonary hypertension

b) bicuspid aortic valve a disease process that increases right ventricular to mention will decrease the left ventricular Dimension that's causing the mitral valve to prolapse into the left atrium during ventricular systole. For example, atrial septal defects, primary pulmonary hypertension. Moderate to large pericardial effusion May exaggerate valve motion resulting in false positive mitral valve prolapse. Patients who are obese rarely present with mitral valve prolapse because of increased left ventricular volumes

147. an effect of significant aortic valve stenosis on the left ventricle is? a) asymmetrical septal hypertrophy b) concentric left ventricular hypertrophy c) Ecentric left ventricular hypertrophy d) protected insignificant aortic valve stenosis

b) concentric left ventricular hypertrophy insignificant aortic valve stenosis, left ventricular wall thickness is increased due to a pressure overload. When the capacity to develop left ventricular hypertrophy has been exhausted, the left ventricle dilates. Thus, left ventricular cavity dimension, wall thickness and Global left ventricular systolic function should be measured in aortic valve stenosis

139. The most likely etiology of aortic valve stenosis in a 47 year old patient is? a) annular b) congenital c) endocarditis d) degenerative

b) congenital differentiation of congenital bicuspid, and acquire aortic valve stenosis may be difficult. An indication of A congenital etiology is the age of the patient. Patients with bicuspid aortic valve usually become symptomatic between the ages of 20 and 50, while senile aortic stenosis occurs at a much later age

116. In patients with significant mitral regurgitation, the isovolumic relaxation time maybe? a) increased b) decreased c) affected by respiration d) unaffected

b) decreased the isovolumic relaxation time is the period from aortic valve closure to mitral valve opening. The isovolumic relaxation time can be measured during post wave Doppler, continuous wave Doppler or tissue Doppler Imaging. With severe mitral regurgitation, that I supposed to like relaxation time maybe less than 60 microseconds. This is due to the increase in left atrial pressure which causes the mitral valve to open sooner than normal. The normal isovolumic relaxation time is 76 +/- 13 milliseconds for adults over 40 years of age

86. A strong indication for mitral stenosis on two dimensional echocardiography is an anterior mitral valve leaflet that exhibits? a) course, chaotic diastolic motion b) diastolic doming c) reverse doming d) systolic bowing

b) diastolic doming diastolic domain of the anterior mitral valve leaflet it's an important two-dimensional finding in patients with Rheumatic mitral valve stenosis. This classic finding is thought to be caused by commissural fusion

90. Typical echocardiographic findings in a patient with isolated Rheumatic mitral stenosis include all of the following except? a) D shaped left ventricle b) dilated left ventricle c) left atrial enlargement d) left atrial thrombus

b) dilated left ventricle in pure isolated mitral stenosis, the left ventricle does not become dilated. It may dialate if mitral valve regurgitation accompanies the stenosis. A D shaped left ventricle which persist throughout ventricular systole and ventricular diastole suggestive right ventricular pressure overload. A D shaped left ventricle during ventricular diastole which becomes circular in shape during ventricular systole suggest a right ventricular volume overload

92. The classic cardiac Doppler features of mitral valve stenosis include all of the following except? a) increased E velocity b) increased mitral valve area c) increased pressure half time d) turbulent flow

b) increased mitral valve area the expected cardiac Doppler findings in Rheumatic mitral valve stenosis are increased velocities, turbulent flow and increase pressure half time. The increased mitral inflow E velocity corresponds to the increased trans mitral pressure gradient. The turbulent flow is due to the disturbance of flow caused by the valvular stenosis. The prolonged Doppler pressure halftime corresponds to the decrease in mitral valve area

82. patients with mitral stenosis, left atrial enlargement and atrial fibrillation are at increased risk for the development of? a) left atrial myxoma b) left atrial thrombus c) left ventricular dilatation d) left ventricular thrombus

b) left atrial thrombus thromboembolism is an important complication of mitral stenosis. The tendency for embolisation correlates inversely with cardiac output and directly with age in the size of the left atrium with 80% of the patients in whom systemic emboli develop are in atrial fib

136. A common finding associated with regurgitant murmur in the elderly is? a) aortic valve stenosis b) mitral annular calcification c) mitral valve stenosis d) mitral valve vegetation

b) mitral annular calcification the mitral annulus decreases in diameter by 25% during ventricular systole. Mitral annular calcification prevents that production during ventricular systole which allows blood flow back into the left atrium. Severe mitral annular calcification can result in obstructing blood flow during ventricular diastole resulting in function of mitral stenosis

135. Mitral valve chordal rupture usually results in? a) aortic regurgitation b) mitral regurgitation c) pulmonary regurgitation d) tricuspid regurgitation

b) mitral regurgitation the most common cause of chordae tendineae ruptured is mitral valve prolapse. Other causes include rheumatic heart disease, infective endocarditis, connective tissue disorders, myocardial infraction, hypertrophic cardiomyopathy and Trauma. Ruptured chordae tendineae may result in flail mitral valve leaflet in mitral regurgitation. The severity of the mitral regurgitation is dependent upon the number of chordae tendineae ruptured and if the ruptured chordae tendineae are primary, secondary or tertiary. if the mitral regurgitation is significant, the patient may be made present with acute pulmonary edema and congestive heart failure

148. Pathologies that may result in a left ventricular pressure overload include all of the following except? a) discrete subaortic stenosis b) mitral valve stenosis c) systemic hypertension d) valvular aortic stenosis

b) mitral valve stenosis left ventricular hypertrophy results from left ventricular pressure overload. Physiologic hypertrophy New Yorker and competitive athletes. Eccentric less than regular hypertrophy, hypertrophy with dilatation, may occur and volume overload cases. Significant chronic aortic regurgitation, significant chronic mitral regurgitation. asymmetric hypertrophy is the non-uniform increase in wall thickness for example hypertrophic cardiomyopathy

127. The term myxomatous degeneration is associated with mitral valve? a) flail b) prolapse c) stenosis d) vegetation

b) prolapse classic mitral valve prolapse is characterized by an increase in the amount of loose myxomatous tissue in the spongiosa component, the middle layer of the leaflet, which encroaches on the fibrosa, the left ventricular surface of the leaflet. The associated redundancy or myxomatous degeneration in the valve leaflet and chordae tendineae permit prolapse during ventricular systole. The terms thick, redundant or myxomatousmay be used to describe a mitral valve prolapse if the valve leaflet thickness is greater than 5 mm. This is called classic mitral valve prolapse

94. A deceleration time of 800 msec was obtained by continuous wave Doppler and a patient with Rheumatic mitral valve stenosis. The pressure half time is? a) 220 msec b) 232 msec c) 400 msec d) 800 msec

b)232 msec PHT (msec) = deceleration time x 0.29 in this example, the pressure have time is 800 msec x 0.29= 232 msec mitral valve area (cm2)= 220 ÷ PHT

118. All of the following are useful color flow Doppler techniques in the evaluation of mitral regurgitation except? a) Vena contracta width b)PISA diameter c) Peak velocity d) jet area

c) Peak velocity a vena contracta with of greater than or equal to 0.7 CM indicates severe mitral regurgitation. A piece of diameter of greater than or equal to 0.9 CM indicates severe mitral regurgitation. Area greater than 8 cm squared indicates severe mitral regurgitation. Color flow Doppler demonstrates the mean velocity. In general, the peak velocity of mitral regurgitation is between 4 to 6 meters per second and it's determined with continuous wave Doppler. In most cases, the peak velocity of the mitral regurgitation is not used to determine severity since the Peak velocity represents the pressure gradient between the left ventricle and the left atrium during ventricular systole. One exception is in the presence of severe mitral regurgitation, for example flail mitral valve is papillary muscle rupture, where a peak velocity of less than four meters per second may be obtained due to the reduced systolic left ventricle, left atrial static pressure gradient

111. The effect significant mitral regurgitation has on the pulse wave Doppler tracing of the pulmonary veins may be described as? a) S wave increases, D wave decreases b) S wave increases, D wave increases c) S wave reverses, D wave decreases d) unaffected

c) S wave reverses, D wave deceases in severe mitral regurgitation, the S Wave is blunted or even reverse and the D wave is increased

1:40. The Cardinal symptoms of valvular aortic stenosis include all of the following except? a) angina pectoris b) congestive heart failure c) anasarca d) syncope

c) anasarca the Cardinal symptoms of valvular aortic stenosis, which commenced most commonly in sixth decade of life, our Anjanette pectoris, syncope and congestive heart failure. Once the symptoms become manifest, the prognosis is poor. Survival curves show that the interval from the onset of symptoms to the time of death was about 2 years and patients with heart failure, three years in those with syncope and five years in those with Angina

106. Cardiac magnetic resonance imaging provides all of the following information in the evaluation of mitral regurgitation except? a) regurgitant volume b) left ventricular volumes c) detailed visualization of the mitral valve apparatus d) left ventricular Mass

c) detailed visualization of the mitral valve apparatus echocardiography provides reliable and detailed information concerning the mitral valve apparatus and function

110. The patient with significant pure mitral regurgitation, the E velocity of the mitral valve pulse wave Doppler tracing is? a) decreased b) increased with inspiration c) increased d) unaffected

c) increased in the presence of mitral regurgitation, the velocity of antegrade mitroflow is increased because regards to flow is added to the normal mitral flow. Regurgitation produces an increased the wave in the left atrial pressure curve, resulting in an increased left atrial - left ventricle pressure difference in early diastole. This leads to an increase forward flow velocity (mitral E wave) in early diastole > 1.2 m/ s

146. The Doppler maximum Peak instantaneous pressure gradient in a patient with aortic stenosis is 100 mm of mercury. The cardiac catheterization Peak to Peak pressure gradient will most likely be? a) equal to 100 mm of mercury b) higher than a 100 mm HG c) lower than 100 mm HG d) dependent upon respiration

c) lower than 100 mm HG cardiac catheterization hysterically measures the peak to Peak pressure gradient, mean pressure gradient and aortic valve area in the evaluation of aortic stenosis. Doppler measures the maximum pecan Santini is pressure gradient, mean pressure gradient and aortic valve area by the continuity equation. The Doppler maximum Peak instantaneous pressure gradient will nearly always be greater than the cardiac catheterization Peak to Peak pressure gradient and aortic stenosis. the Doppler mean pressure gradient and aortic valve area should be compared to the cardiac catheterization laboratories mean pressure gradient and aortic valve area because the value should be similar

114. The peak mitral regurgitation velocity as determined with continuous wave Doppler reflects the? a) direction of the regurgitant jet b) etiology of the mitral regurgitation c) maximum pressure difference between the left atrium and the left ventricle d) severity of the mitral regurgitation

c) maximum pressure difference between the left atrium and the left ventricle the maximum velocity of the mitral regurgitation that tells the examiner the maximum Peak pressure difference between the left atrium and the left ventricle. The maximum velocity of the mitral regurgitation is generally 4 to 6 meters per second since the pressure difference between the left atrium and the left ventricle is normally approximately 100 millimeters per Mercury during ventricular systole

125. The associated auscultatory findings for mitral valve prolapse include? a) ejection click b) friction rub c) mid systolic click d) pericardial knock

c) mid systolic click the classic escalatory findings of mitral valve prolapse are mid systolic click in late systolic murmur. They may systolic click is thought to originate from the ten scene of the chordae tendineae and the late systolic murmur originates from mitral regurgitation

96. Mitral stenosis is considered to be severe by all of the following criteria except? a) mean pressure gradient >/= 10 mmHg b) mitral valve area </= 1.0 cm2 c) mitral valve Doppler A wave Peak velocity is > 1.3 m/s d) pressure half-time > 220 msec

c) mitral valve Doppler A wave Peak velocity is > 1.3 m/s

102. Possible signs and symptoms associated with acute severe mitral regurgitation include? a) hemoptysis b) anasarca c) pulmonary edema d) systemic embolism

c) pulmonary edema edema is the accumulation of fluid in cells tissue of body cavities. Pulmonary edema is the accumulation of fluid in the lungs. In patients who develop severe acute mitral regurgitation, the left atrial pressure is reflected back into the pulmonary circuit. Because there is a rapid rise and Pulmonary pressures at the venous level, fluid is forced out of the pulmonary capillaries and veins into the lungs

81. Signs and symptoms of mitral stenosis secondary to Rheumatic heart disease include? a) angina pectoris b) cyanosis c) pulmonary hypertension d) vertigo

c) pulmonary hypertension is commonly associated with mitral stenosis because 1) passive backward transmission of the elevated left atrial pressure, 2) arteriolar constriction and 3) organic obliterative changes in the pulmonary vascular bed. Eventually, right ventricular pressure increases increase may lead to right ventricular failure

126. A keyword that is often used to describe the characteristics of the valve leaflets in mitral valve prolapse is? a) dense b) doming c) redundant d) sclerotic

c) redundant the term redundant, thick in myxomatous are used to describe the valve leaflets in patients with classic mitral valve prolapse due to myxomatous degeneration. And I'm classic mitral valve prolapse, the mitral valve leaflets are normal in sickness, less than 5 mm.

119. Quantitative approaches to determine the severity of mitral regurgitation include all of the following except? a) regurgitant volume b) regurgitant fraction c) regurgitant jet area d) effective regurgitant orifice

c) regurgitant jet area regurgitant volume, regurgitant fraction and effective regurgitant orifice can be determined by using two dimensional echocardiography with pulse wave Doppler. The proximal isovelocity surface area (PISA) method allows determination of regurgitant volume and effective for Gretchen orifice. A regurgitant volume of greater than or 60 mL a regurgitant fraction of greater than or equal to 50% and an effective regurgitant orifice greater than or equal to 0.40 cm square indicate the presence of severe mitral regurgitation

87. Two dimensional echocardiographic findings of rheumatic mitral stenosis include all of the following except? a) hockey stick appearance of the anterior mitral valve leaflet b) increased left atrial dimension c) reverse doming of the anterior mitral valve leaflet d) thickened mitral valve leaflets and subvalvular apparatus

c) reverse doming of the anterior mitral valve leaflet mitral stenosis is must always caused by Rheumatic involvement at the mitral valve. The mitral valve leaflets are thickened with diastolic doming (hockey stick appearance), at the mitral valve. The left atrium is enlarged. And that parasternal short axis of the mitral valve leaflets, the orifice of the mitral valve has a fish mouth appearance. Reverse doming of the anterior mitral valve may be seen in patients with severe aortic regurgitation

79. The most common etiology of mitral stenosis in adults is? a) congenital b) left atrial myxoma c) rheumatic fever d) severe mitral annulus calcification

c) rheumatic fever

99. All of the following are causes for chronic mitral regurgitation except? a) rheumatic heart disease b) cleft mitral valve c) ruptured papillary muscle d) mitral annular calcification

c) ruptured papillary muscle papillary muscle rupture is it rare complication of acute myocardial infraction and generally occurs during the second to Third Day following infraction. Rupture of the posterior medial papillary muscle is three times more common than rupture of the anterior lateral papillary muscle. This is because the interior lateral papillary muscle is supplied by branches of the left anterior descending coronary artery in circumflex coronary artery. The posterior medial papillary muscle is supplied only and by the posterior descending coronary artery. The most common cause of acute mitral regurgitation is ruptured of the chordae tendineae due to mitral valve prolapse

122. Diastolic mitral regurgitation is associated with? a) flail mitral valve b) mitral valve prolapse c) severe aortic regurgitation d) severe tricuspid regurgitation

c) severe aortic regurgitation although mitral regurgitation is generally thought to occur during systole, and may also occur during diastole. Diastolic mitral regurgitation is due to a positive left ventricular to left atrial pressure gradient. Other causes of diastolic mitral regurgitation include AV block, atrial flutter, atrial fibrillation and disorders associated with reduced ventricular compliance such as in restrictive cardiomyopathy or severe diastolic dysfunction

121. All of the following are true statements concerning mitral regurgitation except? a) mitral regurgitation may be acute, chronic or intermittent b) mitral regurgitation may result in an increase in preload c) severity of mitral regurgitation is not affected by afterload d) regurgitant jet area, Vena contracta width and proximal isovelocity surface area are recommended when determining severity

c) severity of mitral regurgitation is not affected by afterload afterload is the resistance to the ejection blood and can affect the severity of mitral regurgitation. An excellent example is when attempting to determine the severity of mitral regurgitation in the operating room when the patient is under anesthesia. The severity of mitral regurgitation is usually less than reported preoperatively. Noting the blood pressure and if using isoproterenol may be required in the operating room to determine the severity of mitral regurgitation

141. The murmur of aortic stenosis is described as? a) holosystolic murmur heard best at the cardiac Apex b) holodiastolic decrescendo murmur heard best at the right sternal border c) systolic ejection murmur heard best at the right upper sternal border d) diastolic Rumble

c) systolic ejection murmur heard best at the right upper sternal border the mid systolic murmur of aortic valve stenosis is heard best at the right upper sternal border but is often well transmitted along the Carotid vessels and to the Apex. The murmur of aortic stenosis is Harsh and rusting, Crescendo decrescendo in shape at the right upper sternal border. High frequency components May selectively radiate to the Apex, the Gallavardin phenomenon. a reversal of S2 or absent S1 is associated with the ausculatory findings in these patients

93. The abnormal mitral valve pressure half-time for patients with mitral valve stenosis is? a) 0 - 30 msec b) 30 - 60 msec c) 60 - 90 msec d) 90 - 400 msec

d) 90 - 400 msec mitral valve stenosis is considered severe when the pressure have time is 220 msec or longer in the mitral valve area is 1.0 cm square or smaller MVA (cm2) = 220 ÷ PHT (msec)

143. The aortic valve area considered critical aortic valve stenosis is? a) < 3 cm2 b)< 2 cm2 c)< 1.5 cm2 d) </= 0.75 cm2

d) </= 0.75 cm2

144. The formula used to determine aortic valve area in the cardiac catheterization laboratory is the? a) Bernoulli's equation b) continuity equation c,) Doppler equation d) Gorlin equation

d) Gorlin equation it should be noted that the peak to Peak radiant calculated in the cardiac catheterization laboratory will usually be lower than the Doppler maximum Peak instantaneous pressure gradient calculated in the echocardiography laboratory. The mean pressure gradient in aortic valve area are comparable

123. The most common symptoms of mitral valve prolapse include all of the following except? a) atypical chest pain b) palpitations c) syncope d) ascites

d) ascites the vast majority of patients with mitral valve prolapse are asymptomatic. Symptoms of congestive heart failure, Mia, orthopedia, para paroxysmal paroxysmal nocturnal dyspnea. Fatigue. Call. What game, may occur in patients with mitral valve prolapse who have significant mitral regurgitation. Panic attacks have been associated with mitral valve prolapse but this is a situation has not been confirmed using the new, stricter criteria for the presence of mitral valve prolapse. Mitral valve prolapse appears to exhibit a strong hereditary component

128. Echocardiographic characteristics of mitral valve prolapse include all of the following except? a) increase mitral valve annulus diameter b) systolic bowing of the mitral valve leaflet towards the left atrium c) second, redundant, myxomatous leaflets d) diastolic doming of the mitral valve leaflets

d) diastolic domain at the mitral valve leaflets mitral valve prolapse is defined as systolic displacement greater than 2 mm of one or both mitral valve leaflets into the left atrium above the plane of the mitral annulus. The parasternal long axis view is the recommended view due to the fact the mitral annulus is saddled shape. The mitral annulus maybe Markley dilated in patients with mitral valve prolapse. M mode may be useful to determine whether the mitral valve prolapse is mid-to-late systolic or holosystolic

98. All of the following are possible ideologies of an atomic mitral regurgitation except? a) mitral annular calcification b) mitral valve prolapse c) ruptured chordae tendineae d) dilated cardiomyopathy

d) dilated cardiomyopathy mitral regurgitation cause by segmental or Global abnormalities without structural abnormalities of the mitral valve is turned functional mitral regurgitation and is commonly seen in patients with dilated cardiomyopathy or ischemic cardiomyopathy

134. Flail mitral valve can be differentiated from severe mitral valve prolapse on two dimensional echocardiography because flail mitral valve leaflets demonstrates? a) is thicker mitral valve b) chronic mitral regurgitation c) leaflet tip that points towards the left ventricle d) leaflet tip that points towards left atrium

d) leaflet tips that points towards the left atrium a flail mitral valve leaflet will present on two dimensional echocardiography with exaggerated motion and the tip of the affected leaflet loses its point of co-optation and moves into the left atrium with its tip pointing superiorly and to the left atrium. Severe mitral regurgitation is associated with flail mitral valve although the jet maybe baffled in such a way as to hug the valve leaflet and left atrial wall. This will make the regurgitant jet appear to be smaller with color flow Doppler on (coanda effect)

91. Secondary echocardiographic Doppler findings in patients with Rheumatic mitral stenosis include all of the following except? a) abnormal interventricular septum wall motion b) increase right heart dimension c) increase tricuspid regurgitation jet velocity d) left ventricular dilatation

d) left ventricular dilatation because of the increased pulmonary artery pressure, the right ventricle and the right atrium will eventually dilate. As pulmonary artery pressure increases, the tricuspid valve systolic regurgitant peak velocity will follow. Abnormal septal wall motion due to right ventricular volume and or pressure overload will lead to septal flattening and or paradoxical septal motion

103. Chronic significant mitral regurgitation may result in all of the following except? a) left atrial enlargement b) left ventricular enlargement c) left ventricular volume overload pattern d) mitral annular calcification

d) mitral annular calcification chronic significant mitral regurgitation may lead to a volume overload in which the left atrium and the left ventricle bear the burden. If significant, the left ventricle will eventually fail because of the volume overload. I left ventricular volume overload pattern is left ventricular dilatation with hyperkinetic wall mitral annular calcification is a common reason for the systolic murmur of mitral regurgitation in the elderly

88. The most accurate method for determining the severity of mitral valve stenosis is? a) determining the maximum velocity across the mitral valve by pulse wave Doppler b) measuring E-F slope of the anterior mitral valve leaflet by M-mode c) measuring the thickness of the mitral valve leaflets d) performing planimetry of the mitral valve orifice for two dimensional echocardiography

d) performing planimetry of the mitral valve orifice for two dimensional echocardiography the short axis view of the mitral valve demonstrates the orifice of the stenotic valve and provides the opportunity for determining the degree of mitral valve stenosis

142. The pulse that is characteristic of significant valvular aortic stenosis is? a) pulsus alternans b) pulsus bisferiens c) pulsus paradoxus d) pulsus parvus et tardus

d) pulsus parvus et tardus the atrial pulse associated with significant valvular aortic stenosis is one that rises slowly and it's small and sustained, pulsus parvus tardus. pulsus parvus ET tardus maybe best detected by palpation of the right carotid artery. pulsus alternans is alternating weak and strong beats and is associated with severely reduced Global ventricular systolic function pulsus bisferiens is 2 beats within one and is associated with hypertrophic obstructive cardiomyopathy or severe aortic regurgitation pulsus paradoxus is a drop in blood pressure with inspiration by more than 10 mm of mercury and its associated with cardiac tamponade

95. A Doppler mean pressure gradient across a stenotic mitral valve a 22 mmHg is obtained. The severity of the mitral stenosis is? a) mild b) moderate c) moderately severe d) severe

d) severe mild mitral stenosis is present when the mean pressure gradient is <4 mmHg and severe is >10 mmHg tracing the continuous wave Doppler spectral waveform will allow computation of the Peak pressure gradient, mean pressure gradient a velocity-time integral