Test 2 Practice Questions

What factors influence stroke volume?

Preload, afterload, and myocardial contractility

What is the right heart’s normal oxygen saturation?

75%

What is the left heart’s normal oxygen saturation?

95%

The _________ is a low pressure, low resistance, low oxygen saturation (O₂ Sat) system.

Right heart

The _________ is a high pressure, high resistance, high oxygen saturation (O₂ Sat) system.

Left Heart

The right heart is associated with the:

Pulmonary circulation system

The left heart is associated with the:

Systemic circulatory system

Why do valves open and close?

Pressure gradients

What is the method for calculating the mitral valve area using PHT?

220 / PHT

Which two dimensional view is best for assessing coarctation of the aorta?

Suprasternal

What view is best for determining mitral valve area?

PSAX

What changes occur in the left atrium in response to chronic mitral regurgitation?

Hypertrophy and dilation (LAE)

What symptom is typically seen in mitral valve stenosis caused by rheumatic heart disease?

Pulmonary hypertension

In patients with mitral valve stenosis, left atrial enlargement, and atrial fibrillation, what condition are they at increased risk for developing?

Left atrial thrombus

What condition may lead to symptoms that may mimic those associated with mitral valve stenosis?

Left atrial myxoma

The most common etiology of mitral valve stenosis is:

Rheumatic fever

Secondary findings in mitral valve stenosis may include:

Left atrial dilatation and a normal or small left ventricular dimension

What three measurements needed for the continuity equation?

LVOT velocity, LVOT diameter, AV velocity

A 23-year-old woman complaining of dyspnea presents to the cardiologist. Upon examination, a diastolic rumble and opening snap are heard. The patient remembers having rheumatic fever at the age of 10. Her electrocardiogram demonstrated left atrial enlargement and right ventricular hypertrophy. The diagnosis is:

Mitral Stenosis

The principle electrocardiographic finding in severe valvular aortic stenosis is:

Left Ventricular Hypertrophy

The Doppler systolic component of the pulmonary vein in a patient with severe mitral regurgitation demonstrate:

Flow Reversal

Which of the following two-dimensional echo criteria may be most useful in defining mitral regurgitation?

Left Atrial Enlargement

The two dimensional view best for Doppler analysis of mitral regurgitation is:

A4C

What auscultatory findings are typically present in mitral stenosis?

Opening snap

True or False. A high Nyquist Limit will increase the color Doppler of a regurgitant jet area.

False

What is the most common cause of acute mitral regurgitation?

Ruptured papillary muscle

Heart sound auscultation of the 2nd right parasternal intercostal space is associated with:

Aortic Stenosis & Aortic Regurgitation

What is one of the most common errors in determining the parameters for calculating the effective regurgitant orifice area (EROA) in mitral valvular regurgitation?

Eccentric jet of mitral regurgitation (an eccentric jet is a contraindication of the PISA method and underestimate EROA)

For normal mitral valve inflow pattern, which of the following is true?

The E wave has a higher velocity than the A wave

What is the best view to visualize intracardiac catheters?

A4C

In the context of blood flow, what describes the relationship between fluid velocity and pressure drop in a constricted vessel?

Bernoulli’s equation

A flail Mitral leaflet is defined by:

The flail leaflet tip is pointing to the back of the Left Atrium with free motion

The simplified Bernoulli equation primarily relies on what measured variables to calculate the pressure difference across a stenotic region?

Flow velocity

What best describes vena contracta?

Minimum cross section of the blood flow jet as it exits a heart valve

What is the normal mitral valve area?

4-6 cm²

What is the severe mitral valve area?

<1.0 cm²

The two-dimensional echo view that best allows calculation of the mitral orifice is the:

PSAX, MV level

WHat term describes the narrowest portion of the regurgitant flow that occurs at or immediately downstream of the regurgitant orifice?

Vena Contracta

The horizontal wavy lines seen in this mitral regurgitation spectral Doppler waveform, sometimes referred to as “Tiger Stripes” are caused by:

An Artifact

In a patient with atrial fibrillation and suspected mitral stenosis, both the pressure half time (PHT) and which other parameter should be measured to assess the severity of mitral stenosis?

Velocity Time Integral (VTI) for Mean Pressure Gradient (PG) averaged for 5 waveforms

A patient with known mitral stenosis presents for a follow up. The Doppler findings are a mean pressure gradient of 10 mmHg, and a pressure half time of 200 msec. Based on these findings, how should the severity of the mitral stenosis be graded?

Moderate

Which of the following best describes the hemodynamic effect of valvular regurgitation?

Volume Overload

What type of Mitral Regurgitation may cause pulmonary edema?

Acute MR

Where can you find the highest Mitral Valve regurgitation velocity?

Directly behind MV

In the context of heart valve anatomy, which statement accurately describes the mitral valve?

The mitral valve is the only valve with two leaflets

Which two-dimensional view is best for observing congenital mitral stenosis?

PSAX

Which of the Doppler-derived techniques measures the time from the peak systolic velocity to the baseline?

Deceleration Time

What is the method of choice to determine AI severity?

CFI

Spectral Stain will help with diagnosing the level of:

Regurgitation

Eccentric closure of the AoV leaflets is indicative of:

BAoV

If the patient has AI, but the sonographer has not turned color on yet, what might one think is happening cased on the PLAX 2D image alone:

MS

AI may be due to a ________ VSD.

Membranous

Severe aortic stenosis is best defined by which of the following measurements at rest?

4.0 m/s

At the end of diastole, which of the following is true?

The aortic valve is closed and the ventricle has maximum volume

How does a decreasing PHT correlate with the severity of aortic insufficiency?

Increases

In a patient with aortic stenosis, which of the following windows (in addition to the apical window) can be used to accurately measure aortic valve velocities?

Right Parasternal

Which of the following is used to calculate the severity of aortic stenosis?

Continuity Equation

Which echocardiographic view is best for spectral Doppler evaluation of Aortic Regurgitation?

A5C

In the absence of mitral stenosis, which of the following conditions may be indicated by increased E-point septal separation (EPSS)?

Aortic regurgitation

A PHT of 250 ms puts the pt in the ______ range for MS.

Severe

True or False. The A3C aka is Apical Long

True

An intracardiac pressure that can be derived from the continuous wave spectrum of TR is:

Pulmonary Artery Systolic Pressure

True or False. The continuity equation is used to find MS.

True. (in rare cases, but mainly used for AS)

The mean LA pressure is _____ mmHg

10-12

What will initially cause the LA pressure to increase?

MS

‘Opening snap w/ mid to late diastolic rumble’ describes:

MS

Which of the following EKG findings is most consistent with the underlying diagnosis of aortic stenosis?

LVH

Rt Atrial Pressure (RAP) ~

2-6 mmHg (0-5)

RVEDP ~

2-6 mmHg

RVSP ~

25 mmHg

SPAP ~

25 mmHg

DPAP ~

10-12 mmHg

MPAP ~

16 mmHg

MPCP ~

10-12 mmHg

MLAP ~

10-12 mmHg

LVEDP ~

10-12 mmHg

LVSP ~

120 mmHg

SAP ~

120 mmHg

DAP ~

80 mmHg

MAP ~

92 mmHg

Norm resting CO =

4-8 L/min

Normal LVOT diameter:

< 2.2cm

‘Opening snap w/ mid to late diastolic rumble’ describes:

MS

What causes the mid to late diastolic rumble?

A-kick

Harsh systolic crescendo-decrescendo ejection murmur’ describes:

AS

‘High-pitched blowing diastolic decrescendo murmur’ describes:

AI

An intracardiac pressure that can be derived from the continuous wave spectrum of TR is:

Pulmonary Artery Systolic Pressure

True or False. The A3C view can be used to perform Doppler and Color flow imaging of the Aortic Valve.

True