DeWitt Echocardiography CH: 8 Valvular Heart
Disease questions with correct answers
Valvular Heart Disease (VHD) Correct Answer-either acquired (age,
rheumatic heart disease, coronary artery disease, endocarditis, other) or
congenital (born with it)
*incidence has decreased
Rheumatic Fever (RF) Correct Answer-an inflammatory disease that can
affect the heart (RHD), joints, skin, and brain
*strep is usually diagnosed and treated before RF sets in
Normal Flow Correct Answer-Laminar or Parabolic Flow; laminar flow
is smooth and its peak velocity is within the center of flow
When a normal valve is open: Correct Answer-FLOW = FLOW =
FLOW; pressure on either side of valve is effectively equal; flow travels
effortlessly from chamber to chamber; laminar/parabolic flow
Stenotic (obstructed) Valve and/or Regurgitant (leaky) Valve Correct
Answer-creates chaos within the system resulting in a loss of laminar
flow, areas of turbulent flow, and pressure and/or volume overload
*stenotic valve leads to pressure overload, turbulent flow, and
hypertrophy
*regurgitant valve leads to volume overload, turbulent flow, and
dilatation
,Valvular Stenosis Correct Answer-a narrowing, thickening, fusion, or
blockage of a valve that impedes or obstructs blood flow through the
valve; impact on 3 levels: proximal, at level of, and distal
Proximal to the Stenotic Valve Correct Answer-1. blood backs up and
the pressure increases
2. ventricular hypertrophy
3. atrial enlargement
At the Level of the Stenotic Valve Correct Answer-doming and valvular
area decreases = inc. pressure pushes on the undersurface of the tethered
leaflets while they are open --> doming AND the
thickening/fusion/calcification of the valve leaflets dec. the valve's area
within its orifice --> so velocity must inc. in an attempt to maintain the
CO
Distal to the Stenotic Valve Correct Answer-flow is turbulent & the
pressure decreases
*inc. velocity + dec. area = turbulent flow; more severe the stenosis -->
smaller the area, greater the velocity, & more turbulent the blood flow;
dec. flow distally decreases the distal pressure; inc. pressure proximal +
the dec. distal pressure = generates a PG across the open valve
TTE w/ Doppler is usually the 1st imaging technique to locate and
evaluate a stenotic valve Correct Answer-PT HT, WT, BSA, BP, HR
and rhythm; anatomic information; surrounding chamber function, size,
and wall thickness; hemodynamic assessment
,*normal sinus rhythm (NSR) = average 3+ beats; irregular rhythm =
average 5+ consecutive beats and avoid post extrasystolic beats
Atrioventricular Valves: MS and TS Correct Answer-Pressure Half-
Time (P1/2t); Mitral Valve Area (MVA); Mean Pressure Gradient (mean
PG)
Semilunar Valves: AS and PS Correct Answer-Peak Velocity; Aortic
Valve Area (AVA) and Pulmonic Valve Area (PVA); mean pressure
gradient (mean PG); maximum pressure gradient (max PG)
Valvular Regurgitation (insufficiency) Correct Answer-a valve that does
not close completely; this allows a regurgitant jet to travel from the
distal chamber --> backward through the closed valve --> into the
proximal chamber (the receiving chamber)
Variety of Etiologies that Prevent Complete Apposition Correct Answer-
1. Primary (organic) regurge
2. Functional (secondary) regurge
*apposition = position of adjacent structures so they can come into
contact
Primary (organic) Regurgitation Correct Answer-structural changes to
the valve itself (degeneration, inflammation, infection, trauma,
congenital, iatrogenic - response to medical treatment)
, Functional (secondary) Regurgitation Correct Answer-due to chamber
remodeling that leads to incomplete coaptation of the valve
Regurgitant Valve Doppler Assessment/Calculations: Correct Answer-
flow convergence; vena contracta (high velocity laminar flow within the
narrowest portion of the regurgitant jet); regurgitant jet area; regurgitant
jet characteristics (central, eccentric, anterior/posterior direction); CWD
spectral density, contour, timing; flow reversal in the preceding vessels;
Pressure Half-Time (AR & PR); ventricular CWD filling patterns (MR
& TR); RV systolic pressure (RVSP( / systolic pulmonary artery
pressure (SPAP) (TR)
Impact on Cardiac Remodeling Correct Answer-(1) chronic
regurgitation w/ preserved ventricular fxt: a volume overload pattern
(inc. preload) results --> chamber dilatation which accommodates for the
increased volume w/o causing an inc. in pressure (*concept may not
apply); (2) acute severe regurgitation: large regurgitant orifice w/ limited
cavity dilatation
*TEE, Cardiac MRI, or CT may be required
MS Definition Correct Answer-narrowing/thickening/obstruction of the
MV that impedes diastolic flow traveling from the LA --> MV --> LV
MS Murmur Correct Answer-low-pitched, diastolic rumble with an
opening snap
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