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Doppler of TV and PV
Lecture #4 2nd Semester
52
Health Care
05/01/2008

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Cards

Term
What is the most common cause of tricuspid stenosis?
Definition
Rheumatic Fever
Term
What type of ausculation will be heard with tricuspid stenosis?
Definition
Opening snap
Term
Where would a tricuspid stenosis murmur be heard and during what cardiac cycle?
Definition
Heard at LSB and during diastole
Term

If a mean gradient or VTI of the tricuspid valve is 15mmHG, what is the resulting symptom?

Definition
Pedal Edema
Term
What is the formula to figure out the tricuspid valve area when using pressure 1/2 time?
Definition
170/ Pressure 1/2 Time
Term
If a VTI or mean gradient for the tricuspid valve measures more than 4 mmHG, what treatment is suggested?
Definition
Commissurotomy
Term
What is a normal range for tricuspid valve area?
Definition
greater than 7 cm2
Term
If a tricuspid valve area measures 5cm2, what does this say about the valve?
Definition

valve is stenotic

Term

What measurement for tricuspid valve area would suggest RV impairment?

Definition
less than 1.5 cm2
Term
What other valve should be assessed if tricuspid stenosis is present from rheumatic fever?
Definition
Mitral valve
Term
What is the most common cause for tricuspid regurgitation?
Definition
Pulmonary Hypertension
Term
What type of ausculation would be heard with tricuspid regurgitation?
Definition
 holosystolic, high- pitched blowing murmur
Term

Where would a tricuspid regurgitation murmur be heard and during what cardiac cycle?

Definition
Heard around xiphoid, LSB during systole
Term
How can a right sided murmur be distinguished from a left sided murmur?
Definition
Right sided murmur will increase with inspiration
Term
How can tricuspid regurgitations severity be determined by color?
Definition
Rely on jet length to determine TR severity
Term

How can 4+ TR be verified?

Definition
 Pulse Wave the hepatic vein during systole to look for flow reversal of the "S" wave
Term
What size sample gate should be used for the hepatic vein?
Definition
SV of 3-4
Term
What will be seen in the short axis view of the left ventricle if there is severe PHTN?
Definition
"D" sign from volume overload
Term
What is the formula to determine RVSP by using TR?
Definition
(TR velocity)2 + IVC = RVSP
Term
If the IVC was to measure 2.5 and collapses completely, what pressure would be used for the RVSP equation?
Definition
10mmHG- dilated and collapses
Term
What is the normal RVSP range when using TR?
Definition
18-30mmHG is normal
Term
When will you NOT be able to calculate the RVSP by using TR?
Definition

If a wide open jet is seen d/t Carcinoid

Term
What wall is commonly affected with an RV infarction?
Definition
Inferior MI
Term
What is the most common cause of Pulmonic Stenosis?
Definition
Congenital
Term
When the RVOT is narrowed, what is the term used to describe this?
Definition
infundibular stenosis
Term
What type of ausculation would be heard with pulmonic stenosis?
Definition
systolic ejection murmur
Term
Where would a pulmonic stenosis murmur be heard and during what cardiac cycle?
Definition
Heard at mid-lower LSB, during systole
Term

When M-mode is done on the pulmonic valve and PS is suggested, what will be seen on the M-Mode?

Definition
An Increased "A" dip more than 7mm
Term
How would Pulmonic stenosis be determined by CW doppler?
Definition
Peaking flow with CW
Term
What is the peak gradient range for moderate PS?
Definition
50-75mmHG - moderate PS
Term
What is the most common cause of Pulmonic Insufficiency?
Definition
Pulmonary Hypertension
Term
What etiology is associated with pulmonic stenosis, overriding aorta, RVH, and VSD?
Definition
Tetralogy of Fallot
Term

Is PI considered physiologically normal?

Definition
yes , seen in 70% of normal children
Term
What type of pulmonic insufficiency murmur is heard when there is severe PHTN?
Definition
Graham Steele
Term
How is PI severity determined?
Definition
Determined by color, PW, and CW
Term
WHat is the most common cause of systemic hypertension?
Definition
idiopathic 90% of the time
Term
What is pheochromocytoma?
Definition
overproduction of acetylcholine
Term
What is a normal Blood Pressure?
Definition
120/ 80
Term
What is considered to be high blood pressure?
Definition
> 140mmHG / >90mmHG
Term
If high blood pressure is present, what other risks may be associated?
Definition
CVA, renal failure, CHF, and MIs
Term
If systemic hypertension is present, what valve should be assessed?
Definition
aortic valve for AI
Term
What is the most common cause for PHTN?
Definition
idiopathic
Term
If pulmonary hypertension is present and pressures on the right side of the heart are higher, what can be assumed?
Definition
Right to Left shunt- Eisenmenger's Syndrome
Term
What will the M-Mode of the pulmonic valve show if there is PHTN?
Definition
An Absent "A" wave   aka flying "W"
Term

If PI is present what is a good indicator of the severity?

Definition
Density of the tracing and slope
Term

How is the RVSP calculated if there is PI present?

Definition
Measure the end diastolic velocity of the PI, put into Bernoulli equation, and add IVC
Term
If the mean PA pressure is 56mmHG, what disease is present?
Definition
PHTN  >40mmHG means PHTN
Term
If there is no TR or PI to determine RVSP, what measurement can be done using the RVOT?
Definition
RVOT acceleration time
Term
What is the formula used when the RVOT acceleration time is used?
Definition
79- (.45 x Acceleration Time) = Mean PA pressure
Term
What is the moderate range used to determine PHTN by acceleration time?
Definition
60-80msec is moderate PHTN
Term
When there is right sided heart failure caused by bronchitis, what is this called?
Definition
Cor Pulmonale
Term
Definition