Valvular heart disease

Signs and symptoms of mitral stenosis secondary to rheumatic heart disease include?

1. Passive backward transmission of the elevated left atrial pressure 2.Arteriolar constriction 3. Organic obliterative changes in the pulmonary vascular bed, RV pressure increase to to right ventricular failure

A color flow doppler method for semi quantitating mitral regurgitation is regurgitant jet:

Area -The regurgitant jet area compare to the left atrial area

When two dimensional evaluation of a systolic ejection murmur reveals a thickened aortic valve with normal systolic excursion and a peak velocity across the aortic valve of 1.5m/s. The diagnosis is most likely aortic valve: A. Regurgitation B. Sclerosis C. Stenosis D. Prolapse

B. Sclerosis

The cardiac valves listed in decreasing order as they are affected by rheumatic heart disease?

Mitral valve (most common) -rheumatic fever results in four forms of fusion of the mitral valve apparatus. Commissural, cuspal, chordal and combined Aortic valve Tricuspid valve Rarely pulmonic valve

The gold standard 2D echocardiographic view recommended to diagnose the presence of Mitral valve prolapse is

Parasternal long axis

The term myxomatous degeneration is associated with mitral valve?

Prolapse

2D echo findings for rheumatic mitral stenosis include all of the following except:

Reverse doming of the anterior mitral valve may be seen in patients with sever AI Include all of the following: -Hockey stick appearance of the anterior mitral valve leaflet -Increased left atrial dimension -Thickened mitral valve leaflets and subvalvular apparatus

Diastolic Mitral regurgitation is associated with?

Severe AI

The characteristic M mode findings for aortic valve stenosis include all the following except: A. a lack of systolic flutter of the aortic valve leaflets B. Diastolic flutter of the aortic valve leaflets C. Reduced leaflet separation in systole D. Thickening of the Aortic valve leaflets

diastolic flutter of the aortic valve leaflets

in pt with significant mitral regurgitation, the CW doppler tracing of the regurgitant lesion my demonstrate an

Assymetrical shape of the mitral regurgitation flow velocity spectral display which indicates a rapid rise in left atrial pressure due to the significant mitral regurgitation

The most common presenting symptom of significant chronic mitral regurgitation is

Dyspnea, orthopnea similar to CHF

The most common symptoms of mitral valve prolapse include all of the following except:

Except: ascites -chest pain -palpitation -syncope

all of the following are associated with mitral valve prolapse except:

Except:Pulmonary atresia -Mitral regurgitation -Tricuspid valve prolapse -Aortic valve prolapse

The doppler maximum peak instantenous pressure gradient in a patient with aortic stenosis is 100mmHg. the cardiac cath peak to peak pressure gradient will most be

Lower than 100mmHg

Pt with MVP, the murmur is?

May be crescendo and late systolic

The most common cause of acute MR is?q

rupture of the chordae tendinea due to mitral valve prolapse

the murmur of aortic stenosis is described as

systolic ejection murmur heard best at the right upper sternal border

Critical mitral valve stenosis is said to be present if the mitral valve area is reduced to

< 1.0cm^2

The aortic valve area consider critical aortic valve stenosis is

<1.0cm^2

In the parasternal long axis view, severe aortic stenosis is defined as an aortic valve leaflet separation that measures:

<8mm

Premature closure of the mitral valve is associated with all of the following except: A. Acute severe mitral regurgitation B. Acute severe aortic regurgitation C. First degree atrioventricular block D. Loss of sinus rhythm

A. Acure severe mitral regurgitation: premature closure of the mitral valve is defined as when the C point of the mitral valve occurs on or before the onset of the QRS complex.

Cardiac Doppler parameters used to assess the severity of valvular aortic stenosis include all of the following except: A. Aortic pressure half time B. Aortic Velocity ration C. Mean pressure gradient D. Peak aortic valve velocity

A. Aortic pressure half time

The least common valve regurgitation found in normal patients is: A. Aortic regurgitation B. Mitral regurgitation C. Pulmonary regurgitation D. Tricuspid regurgitation

A. Aortic regurgitation

The murmur associated with severe aortic regurgitation is: A. Austin Flint B. Cavallo's C. Graham Steell D. Still

A. Austin Flint

In a pt with severe acute aortic regurgitation the left ventricular end diastolic pressure increases rapidly. This pathophysiology will affect which of the following? A. Closure of the mitral valve B. systolic ejection period C. Left ventricular dimension D. Closure of the pulmonary valve

A. Closure of the mitral valve: acute severe AI will result in an increase in LV end diastolic pressure which may overcome the left atrial pressure and close MV prematurely

Cardiac magnetic resonance imaging provides all of the following information in a patient with aortic regurgitation except: A. Detailed resolution of the aortic valve B. Regurgitant volume C. Effective regurgitant orifice D. Left ventricular volumes

A. Detailed resolution of the aortic valve

The onset of flow to peak aortic velocity Doppler tracing in severe valvular aortic stenosis is: A. Increased B. Decreased C. Decreased with expiration D. Increased with inspiration

A. Increased As valvular aortic stenosis increases in severity, the acceleration time (onset of flow to peak velocity) becomes longer.

A Doppler mean pressure gradient of 18 mmHg is calculated in a patient with valvular aortic stenosis. The severity of the stenosis is: A. Mild B. Moderate C. Moderately severe D. Severe

A. Mild

The characteristic feature of the murmur of chronic aortic regurgitation is a: A. Diastolic decrescendo murmur heard best along the left sternal border B. Diastolic crescendo decrescendo murmur heard best along the left upper sternal border C. Diastolic rumble following an opening snap D. Harsh systolic ejection murmur hear best at the right upper sternal border

A. The murmur of aortic regurgitation is a high pitched blowing decrescendo diastolic murmur ehard best at the third and fourth interspace along the left sternal border

The most common etiology of chronic aortic regurgitation is: A. Dilation of the aortic root and aortic annulus B. Infective endocarditis C. Marfan syndrome D. Trauma

A. dilation of the aortic root and aortic annulus 50%

All of the following are two dimensional echo findings in a patient with significant chronic aortic regurgitation except: A. Left atrial enlargement B. Abnormal aortic valve or aortic root C. Left ventricular enlargement D. Hyperkinetic left ventricular wall motion

AI is volume overload characterized by left ventricular dilation. increased wall motion and increased left ventricular mass

The cardinal symptoms of valvular aortic stenosis include all the following except: -angina pectoris -CHF -Anasarca -Sycope

Anasarca

On M-mode and two dimensional echo dense echoes are noted posterior to normal mitral valve leaflets. The probable diagnosis is mitral valve

Annular calcification

All of the following represent possible etiologies for acute aortic regurgitation except: A. Infective endocarditis B. Aortic valve sclerosis C. Aortic dissection D. Trauma

B. Aortic valve sclerosis

The hallmark M mode finding for aortic regurgitation is: A. Coarse diastolic flutter of the anterior mitral valve leaflet B. Fine diastolic flutter of the anterior mitral valve leaflet C. Chaotic diastolic flutter of the mitral valve D. Systolic flutter of the aortic valve

B. Fine diastolic flutter of the anterior mitral valve leaflet

Of the transvalvular pressure gradients that can be measured in the echocardiography laboratory, the most useful in examining aortic valve stenosis is probably: A. Mean diastolic gradient B. Mean systolic gradient C. Peak instantaneous pressure gradient D. Peak-to-peak gradient

B. Mean systolic gradient The principal role of cardiac cath in patients with aortic stenosis is the evaluation of coexisting CAD

The etiology of aortic valve stenosis includes all the following except: -bacterial -congenital -degenerative -Rheumatic

Bacterial

All of the following all associated with significant chronic aortic regurgitation except: A. Wide pulse pressure B. Congestive heart failure C. Holosystolic murmur heard best at the cardiac apex D. Angina pectoris

C. Holosystolic murmur heart best at the cardiac apex

The two dimensional echo demonstrates a thickened aortic valve with reduce systolic excursion. On physical examination there was a crescendo decrescendo systolic ejection murmur and a diastolic decrescendo murmur heard. The most likely diagnosis in aortic valve: A. Flail B. Regurgitation C.Stenosis and regurgitation D. Stenosis and mitral valve prolapse

C. Stenosis and regurgitation

The most likely etiology of the aortic valve stenosis in a 47 year old patient is

Congenital

The abnormal mitral valve pressure half time for patients with mitral valve stenosis is?

D. 60-90 sec MVA (cm^2)= 220/ PHT(msec) The abnormal range for PHT in a patient with mitral valve stenosis is 90 to 400msec

The M-mode/ two dimensional echo parameter that have been propose as an indicator for aortic valve replacement in severe chronic aortic regurgitation are left ventricular: A. End diastolic dimension >55mm and fractional shortening <25% B. End diastolic dimension <55mm and fractional shortening of >25% C. End diastolic dimension >70mm and left atrial dimension >55mm D End systolic dimension >55mm and fractional shortening of <25%

D. End systolic dimension >55mm and fractional shortening of <25% with significant chronic aortic regurgitation

The echocardiographer may differentiate between the similar systolic flow patterns seen in coexisting severe aortic valve stenosis and mitral regurgitation by all the following except: A. Aortic ejection time is shorter that the mitral regurgitation time B. Mitral regurgitation flow always lasts until mitral valve opening, whereas aortic valve stenosis flow does not C. Mitral diastolic filling profile should be present during recording of the mitral regurgitation, whereas no diastolic flow is observed in aortic valve stenosis D. Since both are systolic flow patterns, it is not possible separate mitral regurgitation from aortic valve stenosis

D. If two high velocity signals of mitral regurg and severe aortic valve stenosis, the two jets must be clearly differentiated. The aortic ejection time is always shorter than the mitral regurg time because no aortic flow occurs during the isovolumic contraction and the relaxation periods.

In significant chronic aortic regurgitation, M-mode and two dimensional evidence includes all of the following except: A. Hyperkinesis of the interventricular septum B. Hyperkinesis of the posterior (inferolateral) wall of the left ventricle C. Left ventricular dilation D. Paradoxical interventricular septal motion

D. Paradoxical interventricular septal motion: combined with right ventricular dilation are the two components of the right ventricular volume overload pattern.

Secondary echocardiographic findings associated with severe valvular aortic stenosis include all the following EXCEPT: A. Decreased left ventricular systolic function (late in course) B. Left ventricular hypertrophy C. Post-stenotic dilatation of the ascending aorta D. Right ventricular hypertrophy

D. Right ventricular hypertrophy LV mass in gram upper limit men: 115g/m women:95g/m

Reverse diastolic doming of the anterior mitral valve leaflet is associated with: A. Flail mitral valve B. Papillary muscle dysfunction C. Rheumatic mitral valve stenosis D. Severe aortic insufficiency

D. Severe AI: due to mechanical deformation of the mitral valve caused by the large volume aortic regurgitation jet

In patients with significant MR, the isovolumic relaxation time may be

Decrease <60msec -due to the increase in the left atrial pressure which causes the MV to open sooner than normal. The normal isovolumic relaxation time is 76msec for adults over 40 years of age

In pts with severe acute MR, the CW doppler peak velocity of the regurgitant jet is

Decreased -MR peak velocity is expected to fall between 4 to 6m/s and is therefore not useful for dtermining the severve MR. In pt with severe acute MR, the peak velocity may be <4m/s owing to an elevated left atrial pressur ethat reduces the pressure diff between the LV and LA during ventricular systole

A strong indication for mitral stenosis on 2D echo is an anaterior mitral valve leaflet that exhibit?

Diastolic doming, caused by commisure fusion

Typical echo findings in a pt with isolated rheumatic mitral stenosis include all of the following except?

Dilated left ventricle -D-shaped left ventricle with persist throughout ventricular systole and diastole suggest a RV pressure overload -D shaped left ventricle during ventricular diastole which become circular in shaped during ventricular systole suggest a right ventricular volume overload -Left atrial enlargment -left atrial thrombus

M mode and to dimensional finding associated with significant chronic mitral regurgitation include all of the following except:

Except: Fine diastolic flutter of the mitral valve, indicate AI -Left atrial enlargement -Left ventricular enlargement -Left ventricular volume overload pattern: left ventricular dilation and hyperkinetic left ventricular wall motion

Secondary echo/doppler findings in pt with rheumatic mitral stenosis include all of the following except?

Except: Left ventricular dilation -Abnormal interventricular septal wall motion -Increase right heart dimensions -Increase tricuspid regurgitation jet

chronic significant mitral regurgitation may result in all of the following except:

Except: Mitral annular calcification -LA enlargement -LV enlargement -LV volume overload pattern

Cardiac Doppler evidence of severe mitral regurgitation includes all of the following except:

Except: Mitral valve E wave velocity <1.0 m/sec - E wave will increase >1.2 m/sec due to increase early diastolic pressure gradient Following; -Dense triangular Cw doppler tracing -pulmonary vein systolic flow reversal -regurgitant jet area, left atrial area ration >40%

Mitral stenosis is considered to be severe by all of the following criteria except?

Except: Mitral valve doppler A wave peak velocity >1.3m/s. Mitral stenosis, A wave ignore -Mean pressure gradient >10mmHg -MItral valve area <1.0cm -Pressure half time >220msec

Secondary causes of MVP include all of the following except:

Except: bicuspid aortic valve -ASD -Cardiac tamponade -Primary pulmonary hypertension

Cardiac magnetic resonance imaging provides all of the following information in the evaluation of MR except:

Except: detailed visualization of the mitral valve apparatus -regurgitant volume -left ventricular volumes -left ventricular mass

Echocardiographic characteristics of MVP include all of the following except?

Except: diastolic doming of the mitral valve leaflets -Increased MV annulus diameter -Systolic bowing of the MV leaflet toward the LA -thickened, redudant, myxomatous leaflets

All of the following are possible etiologies of anatomic mitral regurgitation except?

Except: dilated cardiomyopathy. Functional MR is commonly seen in pt with dilated cardiomyopathy or ischemic cardiomyopathy -mitral annular calcification -mitral valve prolapse -ruptured chordae tendinea

The classic cardiac doppler feature of mitral valve stenosis include all of the following except:

Except: mitral valve area -increase E velocity -increase pressure half time -turbulent flow

All of the following are useful color flow doppler technique in the evaluation of mitral regurgitation except:

Except: peak velocity -Vena contracta -Pisa diameter -jet area

Quantitative approaches to determine the severity of mitral regurgitation include all of the except:

Except: regurgitant jet area -Regurgitant volume -Regurgitant fraction -Effective regurgitant orifice

All of the following are causes for chronic mitral regurgitation except:

Except: ruptured papillary muscle, rare complication of acute MI. Rheumatic heart disease Cleft mitral valve Mitral annular calcification

All of the following are true statements concerning MR except:

Except: severity of MR is not affected by afterload -MR may be acure, chornic or intermittment -MR may result in an increase in preload -Regurgitant jet are, Vena contacta width and proximal isovelocity surface area are recommended when determining severity

The complications of mitral valve prolapse include all of the following except:

Except:Valvular stenosis -Endocarditis -MR -Mitral valve repair and replacement

The equation used in the cardiac catherization laboratory to determine mitral valve area is?

Gorlin -Cardiac cath may not be necessary to evluate mitral stenosis hemodynamics including mitral valve area. It's used for CAD

The formula used to determine aortic valve area in the cardiac cath lab is?

Gorlin equation AVA(cm^2)= (CO/SEP) / (43.3x square root MPG) CO: cardiac output SEP: systolic ejection period MPG: mean pressure gradient

The classic description of the murmur of chronic mitral regurgitation is?

Holosystolic murmur heard best at the apex radiating to the axilla

CHF in a patient with significant chronic mitral regurgitation occurs because of increase pressure in the?

LA: increase LA pressure

Flail mitral valve can be differentiated from severe mitral valve prolapsed on two-dimensional echocardiography because flail mitral valve leaflet demonstrates: A. A thicker mitral valve B. Chronic mitral regurgitation C. Leaflet tips that point toward the left ventricle D. Leaflet tips that point toward the left atrium

Leaflet tips that point toward the left atrium

Conditions that may lead to clinical symptoms that mimic those associated with rheumatic mitral stenosis include?

Left atrial myxoma -mobile left atrial mysoma may prolapse into the mitral valve orifice during ventricular diastole and obstruct flow into the LV mimicking mitral stenosis

Which of the following is most commonly associated with mitral valve prolapse?

Left heart volume overload, with time pulmonary hypertension may develop

108. The M-mode shown is demonstrating?

Left ventricular volume overload pattern -left ventricular dilation -left ventricular wall hyperkinesis

The severity of aortic valve stenosis may be underestimated if only the maximum velocity measurement is used in the following condition? A. Anemia B. Doppler intercept angle of 0 degree C. Low cardiac output D. Significant aortic regurgitation

Low cardiac output

The peak mitral regurgitation velocity as determined with CW doppler reflects the

Maximum pressure difference between the LA and LV

A common finding associated with a regurgitant murmur in the elderly is

Mitral annular calcification

Mitral valve chordal rupture usually results in:

Mitral regurgitation

Systolic bowing of the interatrial septum toward the right atrium throughout the cardiac cycle may be an indication of:

Mitral regurgitation

85. The M-mode being demonstrated below is an example of?

Mitral stenosis -Thickened mitral valve leaflet -decreased mitral valve E-F slope -Anterior motion of the posterior mitral valve leaflet

Pathologies that my result in a left ventricular pressure overload include all the following except:

Mitral valve stenosis

2D echo examination reveals thin mobile mitral valve leaflet tips and a Doppler E velocity of 1.8 m/s with a pressure half time of 180msec in an elderly pt. The most likely diagnosis is

Ms due to severe mitral calcification, funcitonal mitral stenosis

The M-mode finding that indicates severe acute aortic regurgitation is premature aortic valve: A. Closure B.systolic flutter C. Mid systolic closure D. Opening

Opening: severe acute aortic regurgitation the left ventricular diastolic pressure may be so great that the aortic valve opening prematurely

The two dimensional view which best visualizes systolic doming of the aortic valve leaflets is the

Parasternal long axis view

All of the following may be measure in the cardiac cath lab when evluating aortic stenosis except: -peak velocity -Maximum peak instantaneous pressure gradient -peak to peak pressure gradient -mean pressure gradient

Peak velocity

The most accurate method for determining the severity of mitral valve stenosis is?

Performing planimetry of the mitral valve orifice by two dimensional echo

Possible 2D echo findings in significant aortic valve stenosis include all the following except: A. aortic valve calcification B. left ventricular hypertrophy C. Post stenotic dilation of the ascending aorta D. Post stenotic dilation of the descending aorta

Post stenotic dilation of the descending aorta

A deceleration time of 800 msec was obtained by CW in a pt with rheumatic mitral valve stenosis. The pressure half time is?

Pressure half time (msec)= Deceleration time x0.29 800msec x 0.29 = 232

Possible signs and symptoms associated with acute severe mitral regurgitation include:

Pulmonary edema: accumulation of fluid in the lung. PT with severe MR, LA pressure is reflected back into the pulmonary circuit. There is rapid rise in pulmonary pressures at the venous level, fluid is forced out of the pulmonary capillaries and veins into the lung

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

Pulsus parvus et tardus

A key word that is often used to describe the characteristics of the valve leaflets in mitral valve prolapsed is: A. Dense B. Doming C. Redundant D. Sclerotic

Redundant

The most common etiology of mitral stenosis in adult is?

Rheumatic fever (99%) -Congenital (parachute mitral valve)

The effect significant mitral regurgitation has on the PW doppler tracing of the pulmonary veins may be described as

S wave is blunted or even reversed and the D wave is increased

The most likely heart sound to be heard in pts with significant chronic pure MR is

S3

A doppler mean pressure gradient across a stenotic mitral valve of 22mmHg is obtained. The severity of the mitral stenosis is?

Severe

in pt with significant pure MR, the E velocity of the mitral valve PW doppler tracing is

The E wave increased because regurgitant flow is added to the normal mitral flow. >1.2m/s

Pts with mitral stenosis, left atrial enlargement and atrial fibrillation are at increased risk for the development of?

Thromboembolism is an important complication of mitral stenosis.

There is posterior mitral valve prolapse present. With color flow doppler on, which direction will the mitral regurgitation jet be baffled?

anterior

An effect of significant aortic valve stenosis on the left ventricle is: A. Asymmetrical septal hypertrophy B. Concentric left ventricular hypertrophy C. Eccentric left ventricular hypertrophy D. Protected in significant aortic valve stenosis

concentric left ventricular hypertrophy

An accepted method for determining the severity of mitral regurgitation by continuous wave Doppler is spectral

jet density

The associated auscultatory findings for mitral valve prolapse include

mid systolic click