ECHO 2 EXAM 3 - Complete

tricuspid stenosis

a narrowing of the tricuspid orifice restricting blood flow from the RA to RV

tricuspid valve normal orifice

7-9cm^2

what is the most common cause of tricuspid stenosis

acquired rheumatic valve disease

rheumatic tricuspid stenosis almost never occurs as an isolated lesion and is almost always associated with ...

rheumatic mitral and aortic valve disease

What is less commonly cause of acquired tricuspid stenosis is?

carcinoid heart disease

tricuspid stenosis has pacemaker ____ ____

induced adhesions

what is another etiology of tricuspid stenosis

infective endocarditis

when effective decreases the tv area and results in the obstruction of RA emptying during ____

diastole

In an attempt to maintain an adequate forward flow through the TV, The RA pressure increase in order to...

increase the driving pressure across the stenotic valve

While have tricuspid stenosis this can increase in pressure lead to ..

dilation of the RA

When there is tricuspid stenosis and there is increased RA pressure also effects venous return into the RA and this leads to ...

systemic venous congestion, jugular distention, ascites and peripheral edema

what is the role of echo in tricuspid stenosis assess _____

RA size

what is the role of echo in tricuspid stenosis asses in RV ___ and ______

size and systolic function

what is the role of echo in tricuspid stenosis assess IVC and ____

hepatic veins

normal hepatic veins

0.5 - 1.1 cm

role of echo in tricuspid stenosis has leftward protrusion of IAS and indicated ...

increased RA pressures

role of echo in tricuspid stenosis have presence and severity of ..

tricuspid regurgitation

role of echo in tricuspid stenosis have presence and severity of coexisting ...

stenosis / regurgitation (mitral)

estimating the severity of tricuspid stenosis estimate ...

right ventricular systolic pressure

estimating the severity of tricuspid has a ..

mean pressure gradient

estimating the severity of tricuspid stenosis PHT has the same as with ..

mitral stenosis

the tricuspid stenosis has a constant of ____ instead of 220 has been proposed for deterring TVA by the PHT method

190

TVA continuity equation

LVOT d^2 x 0.785 x LVOT VTI(pw) / TV VTI (cw)

normal right ventricular systolic pressure

15 - 30 mmHg

(RVSP) The peak velocity of the TR signal reflects systolic pressure difference between the ..

RV and RA

(RVSP) therefore, from the TR velocity and from and estimation of the _________ it is possible to estimate the RVSP

right atrial pressure

RVSP formula

RVSP = 4V^2 + RAP

where RVSP

right ventricular systolic pressure

RVSP is measured in ..

mmHg

Vtr equals ....

peak systolic TR velocity (in CW Doppler)

Vtr is measure in ...

m/s

RAP equals ..

right atrial pressure

views used for RVSP

- apical 4 or RVIT for tricuspid regurgitation

- subcostal ivc for ivc reactivity of RA pressure

(RVSP) in the absence of ______ or _______ the RVSP is the same as pulmonary artery systolic pressure

RV outflow tract obstruction or pulmonary stenosis

normal RA pressure

2-8 mmHg

for the RAP estimation using the IVC from the _____

subcostal view (sniff test)

RAP for RVSP view

subcostal IVC

In the absence of Tricuspid Stenosis, the RVEDP can be assumed to be the same as the..

RAP

when the IVC diameter is less than 2.1 cm with sniff, what is the change with respiration and estimated RAP mmHg

collapse >50% and 3 mmHg

when the IVC diameter is less than 2.1 cm with change of respiration of collapse less 50% what is the estimated RAP mmHg

8 mmHg

when the IVC diameter is greater than 2.1 cm what is the change with respiration and estimated RAP mmHg

collapse greater 50% and 8 mmHg

when the IVC diameter is >2.1 cm hepatic veins dilated what is the change with respiration and estimated RAP mmHg

<50% or no collapse and 15 mmHg

velocities are measure via ...

cw doppler (making sure to be parallel to flow otherwise underestimation of velocities will occur)

the transtricuspid velocities fluctuate with respiration and therefor all measurements should be ...

averaged over the respiratory cycle or measure at end of expiration

in addition tachycardia can increase transvalvular pressure gradients, measurements should be done as ...

close to normal heart rates

tricuspid stenosis severity mean pressure gradient

> or equal 5 mmHg

tricuspid stenosis severity VTI

> 60 cm

tricuspid stenosis severity PHT

> or equal 190 msec

tricuspid stenosis continuity equation

< or equal 1 cm^2

tricuspid regurgitation

the backward flow of blood from the RV to the RA during systole

tricuspid regurgitation etiology

is described in terms of functional or secondary and or organic or primary

tricuspid regurgitation organic or primary regurgitation refers to ...

disease that involves the leaflets

tricuspid regurgitation functional or secondary regurgitation refers to ...

diseases that alter the annular geometry - so annular dilation and subsequent poor leaflet computation of an otherwise normal TV

tricuspid regurgitation another unusual cause is ...

mechanical interference cause by pacemaker wires and or implantable cardioverter defibrillator

chronic severe tricuspid regurgitation leads to ..

- right atrial and right ventricular dilation

- elevated right atrial pressures, venous pressures and elevated right ventricular diastolic pressure

role of echo in TR determine ____

etiology

role of echo in TR assess ...

RA size, RV size and systolic function

role of echo in TR estimate the severity via ...

color doppler

spectral doppler

estimation of RVSP

color doppler in TR

jet area and flow convergence

spectral doppler in TR

jet density (spectral strength), flow velocity envelope, shape of jet, peak regurgitant velocity, reversal of flow into hepatic veins

TR assessment always assess in ____ windows, regardless in one acquisition is technically excellent

multiple

what are the multiple windows in TR

RVIT

PSSA AOV

Apical 4

Subcostal 4 chamber

pulmonic stenosis

the obstruction of blood flow from the RV across the pulmonary valve into the pulmonary artery

what is the far most common cause of pulmonic stenosis

congenital

what is the less common cases of pulmonic stenosis

acquired

what are the pathophysiology of pulmonic stenosis

chronic elevation in RV pressure results in RVH

(pathophysiology: PS)As RV becomes less compliant RVEDP increases and RV _____

dilates

(pathophysiology:PS) increases end-systolic wall stress results in a reduction of the ...

RV stroke volume and contractility

role of echo in PS determine the ..

site of obstruction

role of echo in PS asses RV ...

size and systolic and diastolic function

role of echo in PS estimate the severity of...

stenosis (maximum pressure gradient)

role of echo in PS estimate the pulmonary artery ____ pressure

systolic

pulmonary regurgitation

refers to the backward flow of blood from the PA to the RV during diastole

pulmonary regurgitation etiology

can result from abnormalities of the PV (organic PR)

pulmonary regurgitation etiology examples

infective endocarditis , rheumatic valve disease, congenital lesion

pulmonary regurgitation more commonly secondary to ...

annular dilation (functional PR)

example of pulmonary regurgitation secondary

rv dilation , pulmonary artery dilation, pulmonary hypertension, Marfan's syndrome

role of echo in PR determine the

etiology

role of echo in PR asses

RV size and systolic function

role of echo in PR estimate the severity via ..

indirect signs on color flow imaging (jet width)

indirect signs by spectral doppler ( intensity of PR jet, dec of PR jet)

estimate PAEDP

Estimate mPAP

PAEDP formula

4V^2ed pr jet + RAP

mPAP formula

4V^2 peak pr jet + RAP

mPAP and PAEDP units

mmHg

RVSP VSD

the peak systolic velocity across a VSD reflects the systolic pressure difference between the LV and RV

(RVSP VSD) VSD velocity and form an estimation of the ________ it is possible to estimate RVSP

left ventricular systolic pressure

RVSP VSD formula

SBP - 4 vsd velocity ^2

where rvsp

right ventricular systolic pressure

RVSP units

mmHg

SBP means

systolic blood pressure

SBP units

mmHg

V vsd mean

peak systolic VSD velocity (cw doppler)

V vsd units

m/s

views used for RVSP VSD

PSLA for VSD velocity

(RVSP VSD) in the absence of LV outflow tract obstruction or aortic stenosis , the LVSP can be assumed to be the same as ...

aortic systolic pressure

QP/QS

quantify pulm / quantify systemic

QP/QS in the presence of an intracardiac shunt, the stroke volume through the one side of the heart will be ...

great than that through the other side of the heart

(QP/QS) the hemodynamics significance of the intracardiac shunt lesions can be ...

estimated based on the comparisons of flow through individual valves

(QP/QS) what happens in the normal heart?

the stroke volume through the left and right side of the heart is equal

QP

pulmonary blood flow

QS

systemic blood flow