150830
| Question | Answer |
| What is MR? | Backward flow of blood into the left atrium during systole |
| What is the etiology of MR? | Mitral annulus(dilation and calcification) MV leaftlets(prolapse,endocarditis,flail) Chordae tendineae(elongation,rupture) Papillary Muscles(fibrosis,calficification,ischemia,rupture) Ventricular myocardium |
| What is MVP? | systolic displacement of any portion of the mitral valve leaflet beyond the mitral valve annular plane into the LA. Most common cause of MR |
| What does prolapse mean? | To fall out of place |
| What is Myxomatous degeneration? | MV leaflets are thickened, redundant, floppy causes prolapse |
| How do you tell if there is MVP on M-mode? | Hamaking during systole |
| what is the difference between prolapse and flail? | Prolapse bows and flail points to the back of the posterior wall Use PLAX |
| what causes DCM? | due to ventricular enlargement pulling on annulus |
| What can happen as a result of DCM? | Heart dialiates horizontally can change postion of pap muscles Causes tenting of mitral valve |
| ischemic etiology can lead to what? | Acute/severe MR |
| Rheumatic etiology results from what? | Strep infection |
| What does the pressure waveform look like? | During systole pressure increase in LA due to volume coming back Increased systolic LA pressure |
| Factors affecting size of MR jet | pressure gradient flow volume (velocity around 4m/s) size of regurgitant orifice other inflow |
| Color flow MR jet dependent upon | gain setting depth setting PRF Direction of jet Eccentric jets may hit adjacent walls and appear smaller "Coanda effect" |
| Complications of hemodynamically significant MR | LV volume overload,LVE Pulmonary HTN Pulmonary edema (acute) Endocarditis LAE >cm Right heart failure |
| What is the compensatory response to MR | LVE>7.5cm |
| Echo Evaluation of MR | Status of Mitral Valve apparatus L heart dimensions (LA, LV) Peak E velocity>1m/s CW-MR jet PISA PAP Pulmonary vein systolic flow reversal |
| M-mode evaluation of MR | LA dilation LV dilation Color M-mode may help with presence of timing and or duration |
| LV Volume Overload Pattern | Frank Starling effect Hyperdynamic Increase EF Contraction greater than normal |
| 2D Evaluation of MR | Look for anatomic cause LAE LVE Increased LA/RA size ratio;should be 1:1 |
| What will the PW Doppler signal look like? | Mitral E>1.5 m/sec w/ normal fx may indicate severe MR due to increased LA volume Decreased deceleration time Increased antegrade flow |
| What will the pulmonary S wave show with MR | Could be blunted (decreased) or reversed with severe MR |
| TRUE or FALSE: A decreased MR jet velocity may indicate elevated LAP from severe MR | TRUE this reduces LA-LV PG ^velocity ^PG |
| dP/dT tell us what? | about systolic function need an MR jet |
| true or false Asymmetrical shape of MR jet shows rapid rise of LAP due to sever regurg. | TRUE velocity decrease becuase pressure are equalizing between LA and LV |
| What do you report of a color flow doppler evaluation | measure vena contracta> 0.7cm severe Utilize PISA to find: Flow Rate ERO RV |
| Name 2 other things to report on a color flow doppler evaluation | Planimeter LA and color jet area Jet area/LA area > 40% severe |
| MVP MR usually occurs in systole or diastole? | Late systole (30-50% of systole) |
| MVP may not result in _____? | LAE |
| Jet area/LA area may overestimate severity, what tool will help in timing MR with MVP | M-mode |
| Indication for echo:MR | Cause of MR (valvular mophology How bad it is? (ERO RV RF Pulm vein systolic flow Ventricular effects (LV dimension, thickness, and systolic fx Pulmonary effects(PAP MPAP PAEDP |
| What are some treatment options for MR? | Annuloplasty Mitral Valve Repair MVR |
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