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Left atrial enlargement is assoicated with:
significant mitral regurgitation
increased pulmonary pressures
patent ductus arteriosus
all of the above
all of above abnormalities can affect the size of the atrium
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The E-F slope of the mitral valve corresponds to which cardiac event in the cardiac cycle?
the "conduit phase"
rapid diastolic filling
early systole
late systole
rapid diastolic filling
in a normal anatomy the mitral valve opens in diastole to a low-pressure left ventricle and fills rapidly
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True/False: The posterior leaflet of the MV appears to have a smaller excursion than the anterior leaflet because:
* it is intersected at an angle that does not show its full size
* the leaflet never completely opens
* its excursion is smaller
* the shape is different than that of the anterior leaflet
F, F, T, T
posterior leaflet of the mitral valve is smaller that the anterior leaflet and also scalloped
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True/False: Generally, the E-F slope of the mitral valve has been considered to provided a reliable assessment of:
left atrial enlargement
left atrial myxoma
mitral stenosis
left ventricular function
- F, F, T, T
-
- neither LA englargement nor LA myxoma is indicated by the E-F slope. The pliability of the leaflets and free motion of the valve give an indication of any valvular stenois. The rate of the slope will also be affected by changes in the left ventricular function
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True/False: An increase in the size of the A wave of the mitral valve suggests.
left ventricular enlargement
aortic insufficiency
an increase in left ventricular end diastolic pressure
left ventricular hypokinesis
F, T, T, F
severe arotic insufficiency increases the left ventricular end-diastolic pressure, thereby diminishing the D-E point separation and highlighting the atrial component and the A kick
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True/False: Normal opening of the mitral valve is caused by the pressure being higher in the left ventricle than the left atrium.
False
higher atrial pressures open the mitral valve
-
True/False: The mitral valve is composed of
chordae tendineae
mitral annuli
fibrous bands
papillary muscles
T, T, F, T
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The M-mode criterion that defines mitral stenosis the LEAST is:
anterior movement of the posterior leaflet
a reduced E-F slope
an increased A-C interval
a dense, thickened appearance of the valve
an increased A-C interval
increased A-C suggests increased LVED pressure and possible poor left ventricular function
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The mitral 2D echo view that best allows calcualation of the mitral orifice is the:
PLAX
Apical 2 chamber
PSAX
subcostal 4C
PSAX
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True/False: Factors that influence the short-axis 2D measurement of the mitral valve are:
the lateral resolution
gain
transducer frequency
axial resolution
T, T, F, F
lateral and medial walls appear wider because of lateral resolution. Too high a gain setting will make the orifice too small. Transducer frequency and axial resolution do not affect the measurements
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True/False: The color-flow examination of the stenotic mitral valve would typically display.
a narrow jet
central blue jet
central red jet
surrounding yellow and red hues
T, T, F, T
color flow depiction of mitral stenosis shows a narrow jet with a blue central core(aliased) surrounded by yeloow and red hues.
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The criterion that is the most helpful in defining mitral stenosis is:
left ventricular enlargement
left atrial enlargement
left ventricular hypertrophy
aortic root dilatation
left atrial enlargement
left artial enlargement is a direct physiological effect of mitral stenosis
-
Following a mitral commissurotomy, the valve orifice can be accurately evaluated with the:
* M-mode, by defining the leaflet separation
* 2D echo, by imaging the actual orifice
* Doppler, by the velocity of the flow and Bernoull's equation
* Doppler, by estimating valve area using the Pressure 1/2 time
Doppler, by estimating valve area using the Pressure 1/2 time
M-mode has never been optimal for valve orifice, and the Bernoulli equation gives velocity information but not orifice size. Most accurate way to determine valve size is with P 1/2 time equation
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Which of the following mitral conditions could cause mitral regurgitation?
mitral stenosis
mitral prolapse
mitral vegetation
all of the above
all of the above
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True/False: The aortic M-mode motion is often abnormal in patients with mitral regurgitation, demonstrating.
a flutter of the aortic leaflets in systole
early systolic closure
gradual closure during systole
all of the above
F, T, T, F
flutter of the aortic leaflets in systole is frequently observed in normal subjects, so it is not considered to be abnormal motion. Early and also gradual systolic closure are frequently seen because of the reduced blood flow.
-
True/False: The M-mode findings in mitral regurgitation.
left ventricular dilatation
left atrial enlargement
flutter of the IVS
flutter of the posterior aortic root
T, T, F, T
- flutter of the IVS is seen in arotic insufficiency, not mitral.
- LV & LA enlargement and also flutter of the posterior aortic root may be observed. Pulsations of the right atrial wall may also be observed
-
Peak mitral regurgitant velocity tells the examiner:
* the severity of mitral regurgitation
* maximum instantaneous pressure difference between the LV & LA
* cause of the mitral regurgitation
* direction of the regurgitation jet
maximum instantaneous pressure difference between the LV & LA
MR velocity tells nothing about the degree of regurgitation, its etiology, or its direction-only the difference in pressure between the LV and LA
-
A 2D echo criterion that can be very helpful in determining mitral regurgitation is:
high frequency oscillations of the mitral valve
premature closure of the aortic valve
left ventricular enlargement
left ventricular hypertrophy
premature closure of the arotic valve
MR causes a a reduction in LVOT, thus reducing the amount of flow through the opening of the valve, valve closes early
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True/False: Left atrial enlargement could be a criterion for determining mitral regurgitation.
True
left artial enlargement is a direct physiological effect of mitral regurgitation
-
True/False: Mitral regurgitation is always associated with mitral valve prolapse.
False
mitral regurgitation may be caused by a number of mirtal valve problems. mitral prolapse does not guarantte mitral regurgiation.
-
True/False: Which of the mitral conditions listed below could be associated with mitral regurgitation?
rupture of the chrodae
flail leaflet
annular calcification
all of the above
All of the above
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True/False: The echo/Doppler finding in papillary muscle dysfuntions are:
left ventriclar enlargment
mitral regurgitation
mitral annulus dilatation
incomplete mitral valve closure
All these conditions can be found in patients with papillary muscle dysfunction. dilated mitral annulus may be the cause of MR, the incomplete mitral closure is due to scarring of the papillary muscles secondary to myocardial infarction. And the papillary muscles shiring, pulling the chordae away from the mitral orifice
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The term myxomatous degeneration used to describe a mitral valve prolapse denotes:
thickening of the mitral valve leaflets
myxoma in the vicinity of the mitral valve
redundancy of the mitral valve leaflets
vegetation on the mitral valve leaflets
thickening of the mitral valve leaflets
describes histologic changes seen in the mitral valve by the pathologist.
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True/False: M-mode findings with a flail mitral valve are:
fine systolic flutter of the mitral valve
coarse, choatic diastolic flutter of the anterior or posterior mitral leaflet
mitral leaflets noted in the LA during systole
noncoaptation of the anterior and posterior mitral valve leaflet
True for all of them
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True/False: Doming of the anterior mitral leaflet is seen in:
mitral stenosis
redundant, floppy mitral valve
flail mitral leaflet
vegetation/mass involving free edge at the anterior leaflet
T, T, F, T
the only described instance that does not produce doming is the flail mitral leaflet, which exhibits exaggerated, eccentric motion
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Which set of echo features best predicts the presence of mitral stenosis in combined mitral stenosis and mitral insufficiency?
separation of the mitral valve leaflets on the PSAX
doming on the PLAX
reduced E-F slope on the M-mode
thickened leaflets, seen on A4 chamber view
doming on the PLAX
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True/False: Mitral annular calcifications may obscure the:
anterior mitral valve leaflet
posterior mitral valve leaflet
endocardial echoes
epicardial echoes
F, T, T, F
mitral annular calcification can obscure the posterior mitral valve leaflet because of the close proximity of these structures. Because of acoustic shadowing, the posterior left ventricular endocardium may also be obscured
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True/False: Mitral and tricuspid regurgitation are easily differentiated by Doppler because of:
differences in timing of valve opening and closing
different locations of the jets
different directions of the jets
differences in forward flow velocity curves
All are True
-
The normal brief posterior displacement of the IVS with the onset of diastole(diastolic dip) may be exaggerated in:
mitral insufficiency
mitral stenosis
aortic insufficiency
aortic stenosis
mitral stenosis
in mitral stenosis, early diastolic left ventricular filling is restricted, whereas the right ventricle fills rapidly. Therefore the septum bulges toward the left ventricle in early diastole
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True/False: Common echo-Doppler finding in patient with Marfan's syndrome are:
aortic root dilatation
mitral valve prolapse
pulmonary insufficiency
aortic regurgitation
T, T, F, T
-
True/False: Mitral leaflet motion is influenced by.
relative pressures in the LA & LV
velocity and volume of blood flow through the mitral orifice
left ventricular diastolic compliance
systolic performance of the LV
All of them True
-
In the M-mode recording of mitral stenosis, the posterior leaflet of the mitral valve moves anteriorly with the anterior leaflet:
always
80-90% of cases
30-40% of cases
never
80-90% of cases
posterior leaflet usually moves anteriorly with the anterior leaflet, but if the leaflets are not fused, the posterior leaflet moves posteriorly
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True/False: A reduced E-F slope of the mitral valve on M-mode is seen with:
arotic valve disease
reduced left ventricular compliance
mitral stenosis
dilated cardiomyopathy
T, T, T, F
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True/False: 2D determination of the size of the stenotic mitral orifice is optimal only if
viewed in the PSAX
gain setting are carefully set
doming of the anterior mitral leaflet is observed
the scan plane is parallel to and passes directly throught the valve orifice
T, T, F, T
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