Final Pathology Review Part 2

Moderate/severe AS associated with syncope due to?

Decreased oxygenated blood flow reaching the brain

Mild AI will demonstrate pressure half time of?

> 500 ms

In cases of PI, pulmonary HTN will cause?

Increased peak velocity

Murmur associated with AI and PI

Early diastolic murmur

Severe AI causes reverse diastolic doming of the?

MV

In cases of mild PI, which chamber will be dilated?

Mild regurgitation does not cause chamber dilation

How does moderate/severe stenosis affect CO?

Decreases

Murmur associated with severe PI with PAP > 70 mmHg

Graham Steell murmur

Most common bi-leaflet mechanical disk valve

St. Jude

Color m-mode demonstrates?

Aortic regurgitation and dilated aortic root

M-mode demonstrates diastolic fluttering of the IVS

AI

Severe PS diagnosed when the peak systolic velocity exceeds?

4.0 m/s

Murmur associated with mild AS

Systolic ejection click

Waveform associated with valvular AS

B

Name an expected finding with chronic/severe AI

LV dilation

When compared to mechanical valves, porcine bioprosthetic valves have?

Low risk of rejection and thrombus formation

PS leads to?

Pressure overload of the RV

Name a cause of PI

Carcinoid Syndrome

A complication of mechanical valves not seen with bioprosthetic valves

Hemolysis

Tiny fibrous strands most commonly form on the aortic valve

Lambl excrescence

What MPG for prosthetic AV indicates normal function?

< 20 mmHg

Severe aortic regurgitation demonstrates?

Significant difference between the peak velocity at the onset and the end of the regurgitation

Definitive sign of severe aortic regurgitation

Holodiastolic flow reversal in the abdominal aorta

When should you compare signal intensity of retrograde flow with antegrade flow?

Evaluating the severity of AI using CW Doppler

Significant aortic regurgitation can cause the AV velocity to be?

Overestimated

Severe acute aortic regurgitation causes rapid increase in?

LVEDP

Acceleration time across the valve with PS will be?

Decreased

What valve replacement is demonstrated?

Porcine AV

On m-mode, severe AI can lead to?

Premature closure of the MV

Normal finding with prosthetic valves

Valve masking

1. EF 30%

2. Thickened AV with decreased mobility

3. Peak velocity 2.4 m/s

4. PPG 24 mmHg

5. AVA 0.7 cm

Severe AS

Hemolytic anemia can be caused by?

Mechanical valves

How do you differentiate atherosclerotic AS and rheumatic AS?

Rheumatic AS almost always accompanied by rheumatic MS

According to ASE Guidelines, an AVA measurement of 1.1 cm considered?

Moderate AS

Loud S3 associated with?

Severe AI

1. Systolic ejection murmur

2. Thickened AV with normal mobility

3. Velocity of 1.65 m/s

Aortic sclerosis

AI can be detected on m-mode by?

Fluttering of the AMVL or IVS during diastole

Most common cause for AS

Degenerative disease

Severe PI demonstrates a pressure half time of?

< 100 msec

Acute onset of a flail right aortic leaflet will have what initial effect on the LV?

Hyperkinesis

What causes a high pitched diastolic decrescendo murmur heard along the left sternal border?

AI

Bioprosthetic valve that can be used to replace the MV, TV and AV

Ionescu Shiley

An eccentric line of closure of the AV common sign of?

Bicuspid AV

Acute onset of moderate AI in a mechanical valve is expected with?

Endocarditis

How can moderate/severe MS affect the evaluation of suspected AS?

Underestimation

Spectral Doppler finding seen with AS

Increased acceleration time

PPG of 65 mmHG across the PV

Severe PS

AI with a pressure half time of 150 ms

Severe AI

Pathologic regurgitation from prosthetic valve

Jet that originates around the valve sewing ring

Doppler finding of PS

Decreased acceleration time

What would demonstrate systolic aortic regurgitation?

LVAD

Severe AI has a shorter pressure half time than?

Mild AI

What increases the resistance of flow exiting the ventricle which will increase LVESP?

AS

Most common cause of PS

Congenital malformation

E/A ratio with severe acute aortic regurgitation

> 1.5

Austin Flint murmur associated with?

Severe aortic regurgitation causing compression/vibration of the AMVL during diastole

Reversal of flow in the descending aorta that lasts longer than the first third of diastole

Aortic regurgitation

Pre-systolic opening of the AV is a sign of?

Severe AI

Subaortic membrane will cause the highest velocity in?

LVOT

What can cause the AV velocity to be overestimated?

Significant AI

What can cause the AV velocity to be underestimated?

Significant MR