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57 Cards in this Set
- Front
- Back
What are the leaflets of the tricuspid valve called? |
- anterior - septal *(also called medial)* - posterior (you can see when angling medially and inferiorly |
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What happens with tricuspid stenosis (TS)? |
RAE (right atrium enlargement) - volume overload - pressure overload - dilated IVC (>2.3cm)
NOTE: 3 chamber view for TV will have to be modified, over-rotated |
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What is RAP? |
right atrial pressure |
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What is the doppler constant for MVA? |
220/PHT |
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What is the doppler constant for the TVA? |
190/PHT |
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What is the measurement for normal TVA? |
7-9cm squared |
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What is the area measurement for severe TS? |
<2cm squared |
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What type of murmur does TS have? |
diastolic "rumble" with respiratory variations and an opening snap
creates a turbulent, mosaic, high velocity jet from the RA through the TV to the RV during DIASTOLE |
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What are the causes of TS? |
- *MOST COMMON* rheumatic fever (RHDz) - most likely started in the MV - congenital: ebstein's anomaly - carcinoid heart disease - prosthetic valve dysfunction
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Is TS an isolated vavlular pathology? |
NO, always evaluate other valves for abnormalities |
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What is tricuspid regurgitation (TR)? |
back flow of blood from the RV into the RA during SYSTOLE |
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What happens with TR? |
- right atrial enlargement (RAE): dilated TV annulus, IVC, hepatic veins - right ventricular volume overload (RVVO) |
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What is the percentage of TVP being associated with MVP? |
10-15% |
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What are the optimal views for TVP? |
- PSLA/RV inflow tract - AP4 - subcostal |
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What is the measurement for RVE? |
> 3-4cm |
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What is the percentage of patients that have trace-mild TR? |
93% |
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What is the normal RVSP/RVDP? |
25/5 |
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What is the normal PAP? |
25/10
*RVSP=PAP* |
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What type of murmur does TR have? |
- holosystolic and can increase with respiration - creates a turbulent, mosaic SYSTOLIC flow in a backward direction from the RV into the RA |
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What are the causes of TR? |
PHTN
Incomplete closure of the TV - RV infarct - papillary muscle dysfx - ruptured TV chordae - pacemaker wire - tumor
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What are the complications of TR? |
RAE/RVE may lead to a-fib
dilatation peripheral veins - IVC/hepatics - SVC/neck veins - portal HTN: liver enlargement, pedal edema |
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What do you see in doppler in a patient with TS? |
- increased velocity - CW doppler >1m/sec - decreased E-F slope |
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What happens with RV pressure during PS? |
RV pressure overload causes D shaped septum in diastole
*D shaped septum in diastole and systole is due to PHTN. RV overload rounds in systole.* |
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What is the normal measurement of the "a" wave dip? |
2-3 mm |
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What is the measurement of the "a" wave during PS? |
> or = 8mm |
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What is the normal PV velocity? |
< 1.7 m/sec |
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What is pressure for mild PS? |
5-30mmHg |
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What is the pressure for severe PS? |
>64mmHg |
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What needs to be obtained for PS and PI during doppler? |
substitute RVOT diameter and PV data in place of the LVOT and Aov data |
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What type of murmur occurs during PS? |
- harsh systolic ejection murmur, "thrill" - creates a turbulent, mosaic, high velocity flow during SYSTOLE from the RV, RVOT through the PV into the MPA |
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What are the causes of PS? |
- MOST COMMON: congenital - carcinoid heart dz - RHDz: uncommon - sinus valsalva aneurysm (AOV) |
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What is the difference between subvalvular and supravalvular stenosis? |
- SUBvalvular stenosis is an obstruction in the RVOT (BELOW the valve)
- SUPRAvavlular stenosis is an obstruction in the PA (ABOVE the valve) |
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What are the complications of PS? |
- DOE (dyspnea on exertion) - jugular vein distention - *RVH* - R/O associated anomalies |
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What is the percentage of normal patients that have PI? |
87% |
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What type of murmur does PI have? |
- low-pitched diastolic murmur: may increase with inspiration
- Graham steele murmur: PHTN & PI, high-pitched blowing diastolic murmur |
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What part of the heart does infective endocarditis effect? |
- affects the endothelial layer of the heart - valves = MOST COMMON |
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What are the types of infective endocarditis? |
- bacteremia = most common - fungemia = less common - vegetation (VEG) |
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What is the primary site of infective endocarditis (SBE - subacute bacterial endocarditis)? |
flow side of the valve |
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Who is at high risk for infective endocarditis? |
- prosthetic valves - AOV Dz - coarctation of the AO - MR - PDA's - VSD's - ** IV drug users ** - Marfan's syndrome |
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What are the signs and symptoms of infective endocarditis? |
- FUO (fever of unknown origin) - night sweats/joint pain (arthralgia) - weight loss/anemia - new murmur - tachycardia |
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What are the complications of infective endocarditis? |
embolization - increased incidence with vegetations that are >5mm, mobile, and pedunculated (attached by a stalk) |
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What is the size of veg? |
>2-3 mm visible by TTE |
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What are the two ways to measure a veg? |
- using calipers - planimetry - use zoom |
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What does vegetative obstruction result in? |
valvular stenosis
- perform appropriate calculations - PHT & MVA for MV - continuity equation for AOV |
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What is the measurement of the "a" wave for PHTN? |
THERE IS NO "a" WAVE IN PHTN |
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What are the two types of prosthetic valves? |
- bioprosthetic (tissue) - mechanical |
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What are the three types of bioprothetic valves? |
- auto-graft (self to self, PV used in AOV position) - homograft (allograft) transfer from one human to another - heterograft (xenograft) animal to human |
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Prosthetic valves are inherently ________. |
Prosthetic valves are inherently stenotic |
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________ leaks are abnormal, small leaks are normal |
Perivalvular leaks are abnormal, small leaks are normal. |
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Who are the candidates for mechanical valves? |
- children/young adults, excluding women of child-bearing years - for patients with renal failure, small valve annulus, high re-operative risk, and A-fib
(lasts up to 20 yrs without complications) but require lifelong anticoagulation therapy |
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Who are the candidates for bioprosthetic valves? |
- elderly patients where long term durability is less important
(lasts up to 10-12 yrs, do not require anticoagulation) |
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Why do we replace native valves with prosthetic valves? |
- stenosis - SBE (bacterial infection) - severe regurgitation - aortic dissection with severe regurge - valves rings to repair valves |
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* this will be a true or false question and the answer will be TRUE*
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infective endocarditis secondary regurge is probable |
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What is carcinoid heart disease? |
rare, but interesting and important cause of intrinsic tricuspid and pulmonary valve disease leading to significant morbidity and mortality caused by right heart failure |
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How do pathogens get introduced into the circulatory system? |
- oral cavity e.g. dental procedures - upper respiratory tract - GI tract - female reproductive tract - skin |
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What are the examples of heterograft (xenograft) animal to human prosthetic valves? |
- porcine (pig) - bovine (cow) - carpentier-edwards |
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What are the causes of MS? |
- rheumatic fever (most common) - mitral annular calcification - congenital - prosthetic valve dysfx - LA mass, tumor, vegetation (SBE) |