Know It Pt.3! Flashcards by Anyssa Palma

What is the most common cause of pulmonic stenosis?

Congenital

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What is the most rare and unlikely cause of pulmonic stenosis?

Rheumatic fever

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Is carcinoid heart disease, a cause for pulmonic stenosis

Yes

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What is carcinoid heart disease?

A tumor that is secreting high levels of serotonin.

This can cause congestive heart failure, affect the valves and cause right sided failure

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What other things can cause pulmonic stenosis?

-Pulmonic stenosis of Peripheral junction of the right and left pulmonary arteries

-Infundibular(Subvalvular)

-Prosthetic valve dysfunction

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Infundibular just means?

Subvalvular

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What is Noonan syndrome?

A cardio facial genetic syndrome that causes heart problems, short facial features, and other issues

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What disease is classified as a genetic cardio facial syndrome?

Noonan syndrome

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Noonan syndrome is classified with what three cardiac things?

Pulmonic stenosis
HCM
ASD (30%)

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What percentage of patients with Noonan -syndrome have an ASD

30 %

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With pulmonic stenosis, what secondary issues occur

Systolic pressure overload leads to RVH

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Regional hypertrophy may lead to?

Infundibular stenosis

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With Pulmonic stenosis the ___ chamber usually remains normal and it’s the ____ chamber that will enlarge

RV ; RA

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What is a big physical symptom of pulmonic stenosis?

Dyspnea on exertion

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What is the murmur for pulmonic stenosis?

Systolic ejection murmur -left upper sternal border

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With pulmonic stenosis m-mode may show an increase in what?

Increase in the a dip

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What is pulmonic stenosis What occurs on m mode with the a dip?

A dip increases

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If the a- dip on m mode of a pulmonic valve increases more than 7 mm. What do we consider this?

Severe PS

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Describe the pulmonic valve differences on m mode between pulmonic stenosis and pulmonary hypertension

PS = increased a dip (>7mm is severe PS)

PHTN= flying “w” a dip decreases

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In which direction do the pulmonic valve tether with pulmonic stenosis?

Systolic doming or tethering for PS

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Pulmonic stenosis can cause post stenotic ____ of the pulmonary artery

Dilation

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With infundibular pulmonic stenosis, what is narrowed

RVOT

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Pulmonic stenosis does ___ cause PHTN

NOT

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Pulmonic stenosis causes ___ and right side ___ it does not cause ____

CHF; dilation ;PHTN

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With pulmonic stenosis what should you use to locate the level of obstruction?

Pulse wave and color

When trying to locate the level of obstruction, why would you not use continuous wave?

Because continuous waves is going to pick up all velocities and we are looking for a very specific area, which is why we use pulse wave

With pulmonic stenosis measure ___ & ___ gradients

Peak ; mean

What two views are best for measuring gradients for pulmonic stenosis

-RVOT PLAX -RVOT PSAX

What is the normal normal pulmonary artery velocity?

1 m/sec

A patient has a pulmonic stenosis velocity of 5 m/s. How would you calculate getting the gradient?

You take the velocity and put it into the Berniollui equation. Answer is 100mmhg

If you cannot obtain a pulmonic stenosis gradient from your parasternal, window, where else can you go?

Subcostal short axis

What’s is the mild, mid & severe velocity for PS?

Mild = <3 Mod= 3-4 Severe = >4

What is the mild, mid & severe PS gradients ?

Mild= <36mmhg Mod= 36-64mmhg Severe = > 64mmhg

True or false- phonic stenosis gradients will not vary with respiration

False

With pulmonic stenosis Doppler what other technique should you use when Dopplering?

Respirometer because pulmonic stenosis can vary with respirations

What is the most common cause of TS?

Rhuematic fever

What are two rare or unlikely causes of tricuspid stenosis?

-Congenital -Carcinoid heart disease

Carcinoid heart disease causes what characteristic to the leaflets?

Fixed body

Rheumatic heart disease causes what characteristic to the leaflets?

Tethered (doming) leaflets tips

With tricuspid stenosis, what chamber has increased pressure and causes dilation)

Rheumatic tricuspid stenosis is almost always associated with?

Mitral rheumatic stenosis

Carcinoid heart disease results from an increase in ____ production this increase in _____production causes ____ of the right heart endocardium, causing right side stenosis.

Serotonin; serotonin; fibrosis

What disease causes induced fibrosis of the right heart endocardium, causing stenosis?

Carcinoid heart disease

What organ filters out serotonin?

Lungs

Signed and symptoms of tricuspid stenosis may be masked by?

What is the murmur for tricuspid stenosis?

Opening snap diastolic murmur

Does tricuspid stenosis and it’s murmur vary with respiration

Yes

Tricuspid stenosis can end of causing what three secondary issues/symptomd

RH failure Ascites Pulmonary edema

If a patient has tricuspid stenosis, what will the M mode of TAPSE show?

Decreased E-F slope Reduced E because of the stenotic valves, the LV cannot fill

Why would the E wave on TAPSE be decreased with tricuspid stenosis?

because of the stenotic valves, the LV cannot fill resulting in decreased E

Incarcerate disease, the tricuspid of leaflets are thickened and may appear?

Fixed

What is the mean gradient for severe tricuspid stenosis?

> or equal to 5mmhg

What is the VTI for severe tricuspid stenosis?

> 60cm

What is the tricuspid valve area that indicates severe tricuspid stenosis?

<1cm

What is the most common cause of mitral stenosis?

Rheumatic heart disease- commissarul fusion

What congenital disease can cause mitral stenosis and is it common?

A congenital parachute mitral valve can cause a mitral stenosis, but it is a rare etiology

What is acquired mitral stenosis?

MAC

Mitral annus calcification is a ___ form of mitral stenosis

Acquired

With mitral stenosis, you have leaflet ____, ____ & chordae ____ & fusion

Thickening ; scarring ; shortening

With MS which chamber has increased pressure and dilation

Long-standing mitral stenosis obstruction leads to what process?

Pulmonary hypertension

Pulmonary hypertension due to long-standing mitral stenosis obstruction causes what two chambers to enlarge?

RV & RA

True or false- mitral stenosis has an increase in cardiac output

False

Acute rheumatic fever is caused by what?

Beta hemolytic, strep

___% of people that they get acute rheumatic fever end up developing mitral stenosis

Acute rheumatic fever caused by ____ causes what symptoms

Beta hemolytic strep; Polyarthritis, fever, subcutaneous nodules, carditis & rash

What is the murmur for mitral stenosis?

Low frequency, opening snap diastolic rumble

What is common with the left atrium regarding mitral stenosis?

A fib

What is hemoptysis?

Bloody sputum

What are some symptoms of CHF?

Fatigue Orthopnea Dyspena Peripheral edema Hemoptysis

What is orthopena?

Shortness of breath when lying flat

What is the famous presentation of mitral stenosis on Echo ?

Hockey stick appearance

Are the leaflet tips of the mitral valve tethered or fixed with mitral stenosis?

Tethered

With MS what is the best plan to determine severity of mitral stenosis?

PSAX with planimetry

Which cardiac valve is the second most common to be affected by rheumatic heart disease?

Aortic valve

What does the m-mode of a mitral stenosis valve look like?

It looks blocky

M-mode of mitral stenosis has a decreased?

E-F slope

Mitral stenosis patients become very symptomatic with what secondary disease process

A-fib

Mitral stenosis patients may lose up to ___% of ____ ____ since they are very dependent on ___ contraction

50% ; diastolic filling; atrial

What is the mild, mid & severe mean gradient for MS?

Mild = <5mmhg Mod= 5-10mmhg Severe = >10mmhg

What is the mild,mid & severe PAP for MS?

Mild = <30mmhg Mod= 30-50mmhg Severe = >50mmhg

Why would we measure pulmonary artery pressure for mitral stenosis? What does that tell us?

pulmonary artery pressure tells us what the LA pressure is So this is another measurement that helps support this severity of mitral stenosis

Why would we use pressure halftime for a mitral valve Doppler in CW and/or PW?

Pleasure halftime would tell us the severity of MV area

What is the formula for pressure halftime?

220/PHT

What is the normal mitral valve area?

4-6cm

With atrial fibrillation mitral stenosis velocity calculations are best performed? A) unable to measure in a fib B) averaged over 20 beats C) averaged over 5 to 10 beats D) averaged over two beats

How do you determine the maximum velocity (VMAX) for MVA with MV pressure halftime?

Draw a line at the end diastolic slope ignoring the a wave and any valve clicks This slope at the E wave tells us pressure halftime and from this we can get the MVA

How do you calculate the MVA with the of MV pressure halftime?

You take 220 divided by your MV PHT that you got by measuring the E wave slope

A patient has a mitral valve pressure halftime of 400 m/s what is the area?

1. 220÷400 (220/PHT) Answer is 0.5cm

What is the difference in measuring MV pressure halftime versus MV Decel time

With MV PHT - we are measuring just the E wave and are NOT going all the way down to the baseline With MV Decel time - we measured at the end all the way down to the baseline

With MV decel time we’re measuring from?

The E wave down to the baseline

With mitral valve pressure halftime, we are measuring from?

Just the E wave (DO NOT GO ALL THE WAY DOWN TO THE BASELINE)

What mitral valve measurement measures only the peak early diastolic slope?

MV PHT

Which mitral valve measurement measures from the peak early diastolic flow all the way to the baseline?

MV DECEL TIME

If you are measuring mitral valve decel time, what is the calculation for using that to calculate mitral valve area?

759/decel time

How do you convert mitral valve deceleration time to pressure halftime?

Decel time X 0.29

A patient has a mitral valve deceleration time of 400 ms. Please calculate the pressure halftime.

The calculation to convert MV decel time to pressure halftime is: DECEL TIME X 0.29 Answer= 116

If LA pressure is higher than LV pressure in diastoleon a tracing. What does this represent?

Know It Pt.3! Flashcards

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