Echo Lecture Notes

Flashcards based on lecture notes about Mitral Stenosis, Tricuspid Regurgitation, Pulmonary Regurgitation, Tricuspid Stenosis, Pulmonic Stenosis, Mitral Regurgitation, Aortic Stenosis, Aortic Regurgitation, and Valvular Regurgitation.

What is the most common cause of Mitral Stenosis (MS)?

Most commonly caused by Rheumatic disease.

What are the features of Rheumatic Mitral Stenosis?

Commissural fusion: anterior and posterior leaflets meet and close; Bowing or doming of the valve leaflets in diastole.

Describe the shape and affect of Rheumatic MS.

Oval shape, predominately affects the tips of the MV leaflets.

Describe Parachute Congenital Mitral Stenosis.

Circular orifice, due to having a singular papillary muscle, rare

What are the Pathological changes attributed to narrowing of mitral orifice?

Increased LA pressure, pulmonary edema, pulmonary hypertension, RV hypertrophy and dilation, right heart failure.

What are the clinical manifestations of rheumatic MS?

High pitched opening snap murmur, dyspnea, fatigue, right heart failure, palpitations.

What calculation is used to estimate Right Ventricular Systolic Pressure (RVSP)?

RVSP = 4V^2 +RAP

What are the Pressure Gradient Severity ranges for Mitral Stenosis?

Mild Stenosis

What is the equation of MVA?

MVA = 220/PHT

What are the valve area ranges in relevance to the severities of Mitral Stenosis?

Mild >1.5, Moderate 1.0 – 1.5, Severe <1.0

Describe Percutaneous Balloon Mitral Commissurotomy

Procedure of choice for patients with symptomatic severe MS. Catheter access through the femoral vein. Balloon is inflated and deflated several times to widen the valve opening and balloon is deflated and removed once the opening of the valve has been widened enough.

What is the M/C cause of primary Tricuspid Regurgitation (TR)?

Myxomatous degeneration (excessive billowing of leaflets in RA and redundancy of TV leaflets.

Describe Carcinoid heart disease

Thickened, shortened and immobile leaflets.

Describe Ebstein's Anomaly

One or more of the TV leaflets are displaced from the tricuspid annulus. Septal leaflets is most often apically displaced. Considered when the separation between the MV and TV planes is greater than 1cm. RA appears severely enlarged due to artialization.

What does RV overload look like on M-mode?

Posterior motion of septum in diastole and anterior motion of the septum in systole (Paradoxical septal motion).

What is the Jet area of Mild TR?

Small, narrow, central jet

What is the Vena Contracta of Mild TR?

<0.3cm

What is the PISA radius of Mild TR?

Radius <0.4cm

What is the EROA of Mild TR?

<0.20cm^2

What is the RVol of Mild TR?

<30mL

Describe Hepatic Vein Flow Reversal of Severe TR.

Systolic flow reversal in the hepatic veins only when sinus rhythm present. In Severe TR = S wave above baseline and D wave below baseline.

What Components are needed to obtain RVSP?

TR Max Jet velocity, IVC size and IVS collapsibility

What is the IVC size in relation to RA pressure?

< or = to 2.1cm

What is the normal RVSP range?

<36mmHg

What is the RVSP range of Severe Pulmonary Hypertension?

70mmHg

What are causes of Pulmonary Regurgitation?

Congenital PV disease, after PV surgery

What is the most common cause of significant PR in adults?

Previous surgery from Tetralogy of Fallot

What does a Wide Jet in PR indicate?

Wide color jet that fills the RVOT

What is the Vena Contracta width that indicates severe PR?

0.5

What is the PHT that indicates severe PR?

<260msec

What is the most common cause of acquired Tricuspid Stenosis (TS)?

Rheumatic Heart disease

In Carcinoid heart disease, which valves are most commonly affected?

The TV is most commonly affected with the PV being the second most commonly affected

What are the findings of Carcinoid?

RA and RV enlargement, Dagger-wave form TR jet on Doppler, prolonged PHT, thickening of ventricular aspect of TV.

What are the TS findings?

Thickening and shortening of the TV leaflets, calcification, restricted mobility of leaflets, commissural fusion and diastolic bowing, RA enlargement

What Mean Pressure Gradient is indicative of Hemodynamically significant TS?

or equal to 5mmHg

What is the Inflow time velocity integral that is indicative of Hemodynamically significant TS?

60cm

What T ½ is indicative of Hemodynamically significant TS?

or equal to190ms

What Valve area by continuity equation is indicative of Hemodynamically significant TS?

< or equal to <1cm

What is the most often cause of Pulmonic Stenosis (PS)?

Congenital disease

What are the Findings of Pulmonic Stenosis?

Thickened leaflets with systolic bowing. If severe is associated with RV hypertrophy, RV enlargement, and RA enlargement

What is the Peak velocity of Mild PS?

<3m/s

What is the Peak gradient of Mild PS?

<36mmHg

What causes Mitral Regurgitation (MR)?

Either due to primary (direct) abnormalities of the MV apparatus or secondary changes due to cardiac disease

What diseases can cause Mitral Regurgitation?

Mitral annular dilation caused by LA or LV dilation, MAC

Describe Ischemic MR:

Regional LV dysfunction with abnormal contraction of the papillary muscle or underlying ventricular wall. Characterized by: restricted valve motion or tethering of valve closure resulting in the appearance of “tenting” of the MV in systole

Describe Acute MR

Pulmonary edema and high LA pressure. LA of normal size and relatively non compliant to volume overload.

Describe Chronic MR

Dilated LA and is more compliant with less elevated pressure. Symptoms of low CO during exertion, fatigue and weight loss

Auscultation of MVP is described as:

Mid systolic click that is highly pitched sound heard during the heart cycle

Describe Mitral Valve Prolapse.

Displacement of all or part of the MV leaflet(s) into the LA during Systole

What is the Characteristic in Flail Leaflet of MV?

Leaflet edge located in LA with free motion

What is the Vena Contracta Width that indicates Severe MR?

0.7cm

When should you perform PISA?

When there is more than mild MR

What should aliasing velocity be set to when performing PISA?

Set to 30-40cm/s in the direction of blood flow

What is the EROA (cm^2) indicating Mild MR?

<0.20

What is the EROA (cm^2) indicating Severe MR?

or equal to 0.40

What is the RVol (mL) indicating Mild MR?

< 30

What is the RVol (mL) indicating Severe MR?

or equal to 60

EROA using Stroke Volume Method =

RV of MR/VTI MR jet

What is a Medical Treatment used for MR?

Decrease forward CW, IV diuretics

What is the medical treatment used for MR?

Increase in forward CW and IV diuretics

What are indications for Surgery in MR?

Progressive ventricular dilation, and end diastolic dimension 40mm or greater or any reduction in LV systolic function (EF of 60% or less)

What is the cause of S1 heart sound?

Closure of MV and TV

What is the cause of S2 heart sound?

Closure of AoV and PV

What is the mechanism of murmurs of AS?

Flow across partial obstruction

What is the mechanism of murmurs of Aortic Aneurysm?

Aortic systolic murmur associated with aortic aneurysm – ejection into a dilated chamber

What is the mechanism of murmurs of MR?

Regurgitant flow across an incompetent valve

What is the mechanism of murmurs of VSD?

Abnormal shunting of blood from one chamber to another low pressure chamber

What does a grade 6 murmur sound like?

Heard with a stethoscope off the chest

When do Pansystolic (holosystolic) murmurs occur?

Occurs between S1 and S2

When do Late systolic murmurs occur?

Occurs mid-late systole to S2

When do Early Diastolic murmurs occur?

After S2

When do Mid-diastolic murmurs occur?

Between S2 and S1

What are the causes of AS?

Congenitally abnormal valve (ex; bicuspid aortic valve) or post-inflammatory process (rheumatic) or age related calcifications

The risk of aortic dissection and rupture ___ when pertaining to the ascending aorta

Increases if the ascending aorta measures >45mm

What does imaging show for Rheumatic AS?

Increased echogenicity along the leaflet edges, commissural fusion and systolic doming of the aortic leaflets

What Measurements are needed for calculating Aortic Valve Area (AVA)?

Peak aortic jet velocity, Mean aortic pressure gradient and LVOT

What is the conservation of mass?

Blood volume cannot be lost, what flows in must flow out

What Aortic Jet Velocity is indicative of Severe AS?

4.0m/s

What Mean Gradient is indicative of Severe AS?

40mmHg

What AVA is indicative of Severe AS?

<1.0cm2

What Velocity ratio is indicative of Mild AS?

0.5

What are the causes of Aortic Regurgitation (AR)?

Leaflet abnormalities (primary) or abnormalities of the aorta (secondary)

Describe Marfan's syndrome

Dilation of ascending aorta, AR, dilation of aortic root

What are the Clinical presentation of Acute AR?

Pulmonary edema, refractory heart failure

What is the Jet width ratio for Mild AR?

<25%

What is the Jet width ratio for Moderate AR?

25-64%

What is the Vena Contracta for Severe AR?

0.6cm

What window can evaluate Aortic Diastolic Flow Reversal?

PW Doppler from the SSN window in the descending thoracic aorta

What is the PHT for Mild AR?

500ms

What is the PHT for Severe AR?

<200ms

Describe what the Austin flint murmur

Early diastolic rumble heard at the apex due to the AR jet striking the anterior leaflet of the MV causing it to vibrate

Chronic valvular regurgitation leads to ___

Progressive volume overload of the ventricles

What are the Recommended settings for colour flow imaging?

NL at 50-70cm/s