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Flashcards

Echo - Aortic Stenosis

Adriana Long Sonography Inglês 69 flashcards

Flashcards do conjunto (69)

  1. 1Cusps Anatomy Right Coronary: • Closest to ___ Left Coronary: • Closest to ___ Non-Coronary: • Closest to ___• RVOT
    • PV
    • IAS
  2. 2Anatomy Review: • ___ of ___ • ___ ___• Sinus of Valsalva
    • Aortic Root
  3. 3Anatomy Review: • ____ ____ ---> ___ ___ that occur at sites of valvular closure ---> They originate as small ___ on endocardial surfaces where the valve margins make contact• Lambl's Excrescence
    ---> Filiform fronds
    ---> Thrombi
  4. 42D Evaluation of Aortic Stenosis: • ___ and ___ • PLAX: Can view ___ anatomy and ___ ___ • PSAX: ___ flow• PLAX ; PSAX
    • Valve ; aortic root
    • Color
  5. 52D Evaluation of Aortic Stenosis: • ____ ---> To assess ___ and ____ valve Doppler flow velocities• Apical
    ---> LVOT ; aortic valve
  6. 62D Measurements: • ___, ___, ___ and ____• LVOT ; AoV ; Root ; Ascending
  7. 7Aortic Stenosis Causes Congenital: • ___ ___ cause• Most common
  8. 8Bicuspid Aortic Valve: • ___ cusps separated by a ___ • Raphe: _____ cusp • ___-___% of population • Most frequent ___ ___• 2 ; raphe
    • Underdeveloped
    • 1-2%
    • AoV malformation
  9. 9Congenital Stenosis: • ___-___ • ___ common• Non-calcific
    • Not
  10. 10Aortic Stenosis Causes Degenerative: • ___ most common cause • Commonly occurs are > ___ • Formation of thick ___ deposits at ___ of ___ and the cusps• Second
    • > 65
    • Calcium ; sinus of Valsalva
  11. 11Aortic Stenosis Causes Rheumatic: • ___ most common cause • Cusps become ___ • Cause commissures/cusps to ___• Third
    • Fibrotic
    • Fuse
  12. 12Clinical Signs and Symptoms of AS: • ____ ---> ___ ___ ejection murmur • ____ • ____ • ____ with ___ • ____• Murmur
    ---> Harsh systolic
    • Angina
    • Syncope
    • Pain with exertion
    • SOB
  13. 132D Findings of AS: • As the ___ are different, so are the findings• Causes
  14. 14Congenital AS (Bicuspid): • 2 cusps with "____" shaped opening seen on PSAX • A ___ or underdeveloped cusp may be present• "Football"
    • Raphe
  15. 15Congenital AS (Bicuspid): • Cusps will appear ___ and may have ___ • In PLAX view, AoV may have "___-___" appearance• Thickened ; doming
    • "Jump-rope"
  16. 16LVH - Left Ventricle Hypertrophy (Thickening) (Bicuspid): • Seen with ___ ___ AS, the LV has to squeeze ___ ___ to get blood through the valve, leading to ___• Long standing ; very hard ; LVH
  17. 17Post Stenotic Dilatation of the Aortic Root and Ascending Aorta (Bicuspid): • As ___ velocities flow through the narrowed aortic valve, the strong, high velocity jet hits the walls of the aortic root and ascending aorta, ____ it• High ; distending
  18. 182D Findings of AS (Bicuspid) MISC.: • Evaluate patient for ____ ---> A "___" in the aorta ---> Bicuspid Aortic Valve and Coarctation of the Aorta are ___ ___• Coarctation
    ---> "Pinch"
    ---> Associated findings
  19. 192D Findings of AS: Rheumatic: • ___ due to pressure overload - ___ __ • ___ due to a volume and pressure overload• LVH
    • LAE
  20. 202D Findings of AS: Rheumatic Late Stage: • LV ____ • ____ systolic function • LV ____• Dilatation
    • Decreased
    • Failure
  21. 212D Findings of AS: Rheumatic: • ___ ____ ____ of the aortic root/ascending aorta• Post stenotic dilatation
  22. 22M-Mode Findings of AS Bicuspid AS: • ___ AoV cusps • Closure of the cusps on M-mode is ____/off center • ___ • Aortic root ___• Thickened
    • Eccentric
    • LVH
    • Dilatation
  23. 23M-Mode Findings of AS Degenerative & Rheumatic AS: • ___, ____ ___ cusps • ___ AoV cusp opening• Bright ; thickened ; dense
    • Decreased
  24. 24M-Mode Findings of AS Degenerative & Rheumatic AS: • ___, ___, ___ • Absence of normal systolic ___ • Aortic root ____• LVH ; LAE ; LVE
    • Flutter
    • Dilatation
  25. 25AS Doppler Findings: • ___ Doppler methods are used to evaluate stenosis• 2
  26. 26AS Doppler Findings 1) LVOT Velocity • ___ Doppler • Place Doppler sample in the ___ ___... ____ the aortic valve in Apical 5 view• PW
    • Outflow tract ; BEFORE
  27. 27AS Doppler Findings 2) Aortic Valve Velocity • ___ Doppler • Place doppler in the ___ ___ in Apical 5 view• CW
    • Aortic valve
  28. 28Doppler Evaluation of LVOT: • ____ is vital in Doppler!!! • Best angle is ___ degrees or ___ degrees (parallel) to the flow• Angulation
    • 0 ; 180
  29. 29Doppler Evaluation of LVOT LVOT Measurement Method: • 1) ___ view is utilized • 2) Obtain the best view possible, ___ image, freeze!• PLAX
    • Zoom
  30. 30Doppler Evaluation of LVOT: • Measure the LVOT at the ___ of the cusps during ___ ---> AoV is ___ ---> ___ ___ to ___ ___ • Obtain __ to __ measurements to ensure accuracy• Base ; systole
    ---> Open
    ---> Hinge point ; hinge point
    • 2 ; 3
  31. 31Doppler Evaluation of LVOT PW of LVOT (V1): • ___ is utilized (AP3 can also be used)• AP5
  32. 32Doppler Evaluation of LVOT: • Place PW gate in the ___ ---> Be certain to be ___ the AoV apparatus• LVOT
    ---> Outside
  33. 33Doppler Evaluation of LVOT To ensure you are in the correct area: • Move from the AoV towards the LVOT using the ___ Doppler... "___ ___ ___" • There will be a sudden ___ in velocity• PW ; "Walk through LVOT"
    • Decrease
  34. 34Doppler Evaluation of LVOT: • Obtain ___ velocity (V1) ---> Trace or take ___ velocity• Peak
    ---> Max.
  35. 35Doppler Evaluation of Aortic Valve CW of AoV (V2): • Utilize ___ views to obtain accurate V2 measurement ---> ___, ___, ___ and ___ ___• AP5 ; AP3 ; Suprasternal ; Right Parasternal
  36. 36Doppler Evaluation of Aortic Valve: • Place the CW cursor ___ the AoV ---> Make sure you are ___ to flow!!• Within
    ---> Parallel
  37. 37Doppler Evaluation of Aortic Valve: • Obtain the ___ velocity and a clean ___ ---> Trace the waveform beginning at the ___ baseline• Peak ; envelope
    ---> Zero
  38. 38Doppler Evaluation of Aortic Valve: • Tracing the V2 provides the ___ PG, ___ PG and ___ velocity ---> Note: ___ can be used to assure the peak velocity is obtained!• Max. ; mean ; peak
    ---> Pedoff
  39. 39Doppler Evaluation Tips: • Remember, valvular disease often affects more than ___ valve• One
  40. 40Doppler Evaluation Tips: • Be careful not to confuse ___ with ___ ---> MR jet is ___ because it includes ____ contracting and relaxation• MR ; AS
    ---> Wider ; isovolumic
  41. 41Doppler Evaluation Tips: • Always check where your Doppler is ___ • Be sure you are evaluating ___/___ flow• Located
    • LVOT ; AoV
  42. 42Doppler Evaluation Tips: • AS can be ___/___ estimated with cardiac output • Poor angle can also ___ degree of AS• Over/under
    • Underestimate
  43. 43AS Doppler Findings: • Use the 2 velocities to determine ___ of aortic stenosis & aortic valve area• Severity
  44. 44Continuity Equation: • This equation assumes that "flow through a tube is ___" • Flow is ___ to the velocity multiplied by the ___ • If area ___, velocity ___ to maintain flow• Constant
    • Equal ; area
    • Decreases ; increases
  45. 45Continuity Equation: • ___ is a constant • LVOT diameter = diameter of LVOT from ___ view • V1 = Peak velocity of the ___ (PW of LVOT) • V2 = Peak velocity through the ___ (CW of the AoV)• .785
    • PLAX
    • LVOT
    • AoV
  46. 46Degree of AS Criteria by AORTIC VALVE AREA/CONTINUITY EQUATION: • Normal: ___-___ cm^2 • Mild: ___-___ cm^2 • Moderate-Severe: ___-___ cm^2 • Severe: <____ cm^2• 2.5 - 4.5 cm^2
    • 1.1 - 1.9 cm^2
    • 0.75 - 1.0 cm^2
    • < .75 cm^2
  47. 47Modified Bernoulli's Equation: • ______ • ___ the Aortic Valve CW Doppler wavform (V2)• 4(V)^2
    • Trace
  48. 48Modified Bernoulli's Equation: • The machine will determine the ____ PG and ___ PG by the V2 tracing • This provides a _____ ____ ___ (PG)• Max ; mean
    • Instantaneous pressure gradient
  49. 49Degree of AS by MEAN PG/BERNOULLI'S EQUATION: • Mild: < ____ mmHg • Moderate: ___ - ___ mmHg • Severe: > ____ mmHg• < 20 mmHg
    • 20 - 49 mmHg
    • > 50 mmHg
  50. 50Degree of AS by MAX PG/BERNOULLI'S EQUATION: • Mild: ___ - ___ mmHg • Moderate: ___-___ mmHg • Severe: > ____ mmHg• 16 - 36 mmHg
    • 36 - 50 mmHg
    • > 64 mmHg
  51. 51AS Doppler Findings: • The degree of aortic stenosis can also be determined using the ___ ___• Peak velocity
  52. 52AS Doppler Findings: • Peak velocity acquired by placing a ____ at the ___ of V2 Doppler Waveform ---> ____ done once waveform is traced• Caliper
    ---> Automatically
  53. 53Degree of AS by PEAK VELOCITY: • Mild: < ____ m/sec • Moderate: ___ - ____ m/sec • Severe: > ___ m/sec• < 3.0 m/sec
    • 3.0 - 4.0 m/sec
    • > 4.0 m/sec
  54. 54AS Doppler Findings: • Cath lab uses ___ ___ to calculate AoV area• Gorlin Formula
  55. 55Gorlin Formula: • Area = ___ x ____ • Uses ___ pressure gradient ---> Which correlates best with mean Doppler ____ ___• Flow x velocity
    • Mean
    ---> Pressure gradient
  56. 56Aortic Sclerosis: • Aortic sclerosis may ___ aortic stenosis ---> AoV is ___ but not ___ ---> Velocity is < ___ m/sec ---> Usually can visualize the valve ___ well• Mimic
    ---> Thickened ; restricted
    ---> < 2 m/sec
    ---> Opening
  57. 57Non-Hemodynamic Eval of AS • ____ ---> Utilize ___ ---> During ___, trace OPENING of AoV ---> Accompanies ___ findings for diagnosis• Panimetry
    ---> PSAX
    ---> Systole
    ---> Doppler
  58. 58Color Flow AS: • AS creates a ____ ____ jet • Stenotic jet can be detected through the ____, from the ____ into the ___ ___• Turbulent systolic
    • AoV ; LVOT ; aortic root
  59. 59Complications from AS: • LA and LV pressure overload creates ___ • ____ • ____ CO • ____ or ____ infarct• LVH
    • Endocarditis
    • Decreased
    • Myocardial ; cerebral
  60. 60Complications from AS: • ____ • ___ ___ • ____ • ____ ___ --> Note: Symptoms for ___ AS do not present usually until adulthood• CHF
    • Pulmonary Edema
    • Dysrhythmias
    • Sudden death
    ---> Bicuspid
  61. 61Treatment for AS: • AoV ____ ---> Performed when patient becomes ____ ---> Experiences ____ ____ ---> Ideally done before patient goes into ___• Replacement
    ---> Symptomatic
    ---> Progressive LVH
    ---> CHF
  62. 62Treatment for AS: • AoV ____ or ___ ____ ---> ____ done• Debridement ; balloon valvuloplasty
    • Rarely
  63. 63Subvalvular Aortic Stenosis: • Obstructions of the ___ ___ • There are ___ types: ---> ___ ____ ---> ___ ____ stenosis ---> ___ ___• LVOT outflow
    • 3
    ---> Discrete Membranous
    ---> Diffuse Fibromuscular
    ---. Sigmoid Septum
  64. 64Discrete Membranous: • ___ membrane in the LVOT obstructing the aortic ___ • ____• Thin ; orifice
    • Congenital
  65. 65Diffuse Fibromuscular Stenosis: • ____ thickening of the LV myocardium • It is ___ to the point that is obstructs the blood flow to the ___• Symmetrical
    • Thickened ; aorta
  66. 66Sigmoid Septum: • Occurs in ___ patients • ___ portion of the septum ___ and ___ the outflow tract • When seen young, congenital disorder known as ___ or ___• Elderly
    • Basal ; enlarges ; impinges
    • IHSS ; HOCM
  67. 67Supravalvular AS: • Obstruction of flow happens ___ (distal) to the AoV • There are ___ distinct forms • These are all ___ disorders!• Superior
    • 3
    • Congenital
  68. 68Supravalvular AS Forms: • ___ • ____ ___ • ____ of Aorta• Membranous
    • Hourglass deformity
    • Hypoplasia
  69. 69Wigger's AS: • Ventricular systolic pressure ___ creating a systolic pressure gradient between ____ & ___ or ___• Increases ; ventricle ; AoV ; PV

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Sonography (Echo) FlashCards sobre Echo - Aortic Stenosis, criado por Adriana Long em 16-10-2019.
Criado por
Adriana Long
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