Mitral Valve Disease Practice Test

A mean gradient of 6-10mmHg suggests moderate MS. This means that there is a moderate obstruction of blood flow through the mitral valve, which can lead to symptoms such as shortness of breath and fatigue. Severe MS would typically have a higher mean gradient, while mild MS would have a lower mean gradient. No MS would indicate that there is no obstruction of blood flow through the mitral valve.

A diastolic rumble with an opening snap is characteristic of a murmur. A murmur is an abnormal sound heard during the cardiac cycle, typically caused by turbulent blood flow through the heart valves. In this case, the diastolic rumble suggests an abnormal flow of blood during the relaxation phase of the heart, and the opening snap indicates a sudden opening of a valve. This combination of sounds points towards a murmur as the correct answer.

Marfan's Syndrome is a genetic disorder that affects connective tissue. It is characterized by abnormalities in the skeletal, cardiovascular, and ocular systems. People with Marfan's Syndrome often have long limbs, a tall and thin body type, and may experience joint hypermobility. The disorder can also affect the heart valves, leading to conditions such as aortic aneurysms and mitral valve prolapse. Marfan's Syndrome is caused by mutations in the FBN1 gene, which encodes for a protein called fibrillin-1 that is essential for the formation of connective tissue.

A mitral valve area of

The normal MVA is typically between 4-6cm².

The Coanda Effect refers to the tendency of a fluid jet to adhere to a nearby surface. In the context of this question, it suggests that when a fluid jet is measured, it may appear smaller than its actual size due to the Coanda Effect causing it to stick to the surface it is flowing along. Therefore, the statement that the Coanda Effect may underestimate jet size is true.

Rheumatic MV disease is the correct answer because it is known to cause a classic "hockey-stick" appearance on imaging studies. This refers to thickening at the mitral valve (MV) tips and chordal level, which is characteristic of rheumatic MV disease. Congenital malformation, mass obstruction, and MAC (mitral annular calcification) do not typically present with this specific appearance.

The given question states that the MR Jet Area ratio to LA area is severe if the color jet area is greater than 50% of the LA area. This means that if the color jet area covers more than half of the LA area, the MR Jet Area ratio is considered severe.

Although she has no history of rheumatic fever, she is too young to have degenerative mitral disease. Her 2-D echo also exhibits classic findings that indicate rheumatic MS

The question asks for a method that is NOT used to calculate MVA (mitral valve area). MVA is typically calculated using methods such as Pressure Half-Time, Continuity Equation, and PISA (proximal isovelocity surface area). However, Cardiac Output is not a method used to calculate MVA. Cardiac Output is the amount of blood pumped by the heart per minute, and it is not directly related to the calculation of MVA.

A mean gradient of >10 mmHg suggests severe MS. This means that there is a significant obstruction in the flow of blood through the mitral valve, indicating a severe narrowing of the valve opening. This can lead to symptoms such as shortness of breath, fatigue, and fluid retention. Severe MS requires prompt medical intervention, such as valve replacement or repair, to improve symptoms and prevent further complications.

Rheumatic heart disease is a condition that commonly affects the heart valves. The mitral valve is the most frequently affected valve, while the aortic valve is the second most common. This means that after the mitral valve, the aortic valve is the next most likely to be affected by rheumatic heart disease. The tricuspid and pulmonic valves are less commonly affected by this condition.

In atrial fibrillation (A-Fib), the irregular heart rhythm makes it difficult to obtain accurate measurements. Averaging the velocity calculations over a larger number of beats, such as 5-10, helps to minimize the impact of the irregularity and provides a more reliable result. Averaging over a smaller number of beats, like 2, may not provide a representative value due to the variability in the heart rate during A-Fib. Averaging over 20 beats may be excessive and unnecessary. Therefore, averaging over 5-10 beats is the best approach in this scenario.

Endocarditis is an infection of the inner lining of the heart, including the heart valves. It can cause inflammation and damage to the valves, leading to leaflet destruction, perforation, or deformity. This can result in valve dysfunction and potentially serious complications. Myxomatous disease refers to degenerative changes in the heart valves, but it does not typically cause leaflet destruction or perforation. Rheumatic disease can cause valve damage, but it is not specifically associated with leaflet destruction. Marfan's Syndrome is a genetic disorder that can affect connective tissues, including heart valves, but it does not directly cause leaflet destruction either. Therefore, the most likely cause of leaflet destruction, perforation, or deformity is endocarditis.

Longstanding MS (mitral stenosis) is a condition characterized by the narrowing of the mitral valve in the heart. This narrowing impedes the flow of blood from the left atrium to the left ventricle. Over time, this can lead to various complications. Congestive heart failure can occur as a result of the increased pressure in the left atrium and lungs. Pulmonary hypertension is another potential consequence, as the increased pressure in the lungs can cause damage. LA (left atrium) dilatation is a common finding in longstanding MS, as the left atrium enlarges to compensate for the restricted blood flow. However, LV (left ventricle) dilatation is not typically associated with MS.

A parachute mitral valve is a congenital heart defect where the mitral valve has only one papillary muscle instead of the usual two. This condition is considered a normal variant and is not physically impossible or rheumatic in origin. In a parachute mitral valve, the chordae tendineae are inserted into a single papillary muscle, which is the characteristic feature of this condition.

Left atrial pressure can be measured from the mitral regurgitation jet because when the mitral valve fails to close properly, blood flows back into the left atrium during systole. This regurgitation jet can be visualized using echocardiography, and the characteristics of the jet can provide information about the pressure in the left atrium. By analyzing the velocity, duration, and other parameters of the mitral regurgitation jet, clinicians can estimate the left atrial pressure, which is an important parameter for assessing cardiac function and diagnosing conditions such as heart failure.

MS, or Mitral Stenosis, is a heart condition characterized by the narrowing of the mitral valve. The etiology refers to the cause or origin of a disease. In this case, the correct answer is "RA myxoma" because it is not a known cause of MS. Rheumatic fever, parachute MV (mitral valve), and annular calcification are all recognized etiologies of MS.

Flow convergence is the correct answer because PISA (proximal isovelocity surface area) is a method used to measure the flow convergence in the heart. It is based on the principle of conservation of mass, which states that the flow rate of blood entering a region must be equal to the flow rate leaving that region. By measuring the flow convergence, PISA can provide information about the severity of certain heart conditions, such as valvular regurgitation. Therefore, flow convergence is the basis for PISA, which in turn is based on the conservation of mass.

A mitral valve area of 1.0-1.5cm² is considered to be moderate mitral stenosis. This means that the opening of the mitral valve, which allows blood to flow from the left atrium to the left ventricle, is narrowed to a moderate degree. This narrowing can impede the flow of blood and lead to symptoms such as shortness of breath and fatigue. Severe mitral stenosis would have a smaller valve area, while mild mitral stenosis would have a larger valve area. A valve area within this range is not considered normal, as it indicates some degree of narrowing in the mitral valve.

Mitral valve area = 220/pressure half time

Based on the given information, the patient has a significant regurgitant volume of 65ml and an effective regurgitant orifice area (EROA) of 0.51cm². These values indicate a large amount of blood is flowing back through the mitral valve during systole, suggesting severe mitral regurgitation (MR).

The correct answer is "

MS shows a DECREASED E-F slope on an M-Mode

Patients with multiple sclerosis (MS) often develop atrial fibrillation. Atrial fibrillation is a common cardiac arrhythmia characterized by irregular and rapid heartbeats. MS is an autoimmune disease that affects the central nervous system, but it can also have systemic effects on other organs, including the heart. The exact cause of the association between MS and atrial fibrillation is not fully understood, but it is believed that inflammation and autonomic dysfunction may play a role. Additionally, some medications used to treat MS, such as corticosteroids, can increase the risk of developing atrial fibrillation.

The given options represent different ranges of area measurements. The correct answer is 0.20-0.30cm², which means that the area being referred to falls within this range.

Mitral Valve Prolapse is defined as posterior displacement of the mitral leaflets during SYSTOLE

Rheumatic disease can cause commissural fusion and chordal fusion, which refers to the abnormal fusion of the valve leaflets and the tendons that support them. This fusion leads to the shortening of the valve, resulting in a reduction in its ability to open and close properly. This can lead to valve stenosis or regurgitation, causing symptoms such as breathlessness, fatigue, and heart murmurs.

In mitral stenosis, the mitral valve becomes narrowed, causing obstruction to the flow of blood from the left atrium to the left ventricle. On an M-mode echocardiogram, the anterior mitral leaflet (AML) and posterior mitral leaflet (PML) should normally move in opposite directions during diastole. However, in mitral stenosis, the AML and PML move together anteriorly instead of moving apart. This is due to the restricted opening of the mitral valve. Therefore, the statement is true.

Performing 2-D planimetry of the mitral orifice in the short-axis view is the most accurate method of calculating the MVA. This method involves measuring the area of the mitral valve orifice using 2-dimensional imaging in the short-axis view. By directly measuring the area, it provides a more precise calculation of the mitral valve area compared to other methods such as using m-mode echo to determine the E-F slope or determining the Doppler pressure half-time.

A mitral valve area of >1.5cm² is considered to be mild mitral stenosis. Mitral stenosis refers to the narrowing of the mitral valve, which is responsible for regulating blood flow between the left atrium and left ventricle of the heart. When the valve area is greater than 1.5cm², it indicates a mild narrowing, meaning that there is some restriction in blood flow but it is not severe. This can lead to symptoms such as shortness of breath and fatigue, but it is not as significant as moderate or severe mitral stenosis.

A mean gradient of 5mmHg suggests mild MS because it falls within the range of 3-5mmHg, which is considered mild stenosis. MS stands for mitral stenosis, a condition where the mitral valve in the heart is narrowed, causing obstruction of blood flow from the left atrium to the left ventricle. The severity of MS is determined by the mean gradient across the valve, with higher gradients indicating more severe stenosis. In this case, a mean gradient of 5mmHg indicates mild stenosis.

Mitral stenosis is a condition characterized by the narrowing of the mitral valve, which is located between the left atrium and left ventricle of the heart. This narrowing restricts blood flow from the left atrium to the left ventricle. However, it does not directly affect the aorta, which is the main artery that carries oxygenated blood from the heart to the rest of the body. Therefore, the statement that mitral stenosis has no effect on the aorta is true.

A vena contracta is a narrow jet of blood that occurs when blood flows through a narrowed or constricted opening. This phenomenon is commonly seen in dilated cardiomyopathy, where the heart becomes enlarged and weakened, leading to poor pumping function. The dilation of the heart chambers causes the valves to become stretched and inefficient, resulting in blood flowing through a narrowed opening and forming a vena contracta. In restrictive cardiomyopathy, the heart muscle becomes stiff and rigid, which does not typically result in a vena contracta. Infiltrative cardiomyopathy refers to the infiltration of abnormal substances into the heart muscle, which may or may not cause a vena contracta. HOCM (hypertrophic obstructive cardiomyopathy) is characterized by thickening of the heart muscle, but it does not typically cause a vena contracta.

In the presence of severe, long-standing MS that results in pulmonary hypertension, the pulmonary artery may become dilated. Pulmonary hypertension is a condition characterized by increased pressure in the pulmonary arteries, which carry blood from the heart to the lungs. This increased pressure can cause the walls of the pulmonary artery to stretch and become dilated. This dilation is a compensatory mechanism that allows for increased blood flow and helps to alleviate the increased pressure in the pulmonary circulation.

The correct answer is 30-59mL. This range indicates a moderate regurgitant volume (RVol) in the PISA (proximal isovelocity surface area) measurement. PISA is a method used to assess the severity of regurgitation in the heart. The RVol represents the amount of blood that flows backward through a valve during each heartbeat. A moderate RVol suggests a moderate degree of regurgitation, which means there is some backflow of blood but it is not severe.

The easiest method of calculating the MVA is by determining the Doppler pressure-half time. This method involves using Doppler echocardiography to measure the time it takes for the pressure gradient across the mitral valve to decrease by half. This measurement can then be used to calculate the mitral valve area. This method is considered the easiest because it does not require complex measurements or calculations like the other options mentioned.

In cases of suspected severe MR (mitral regurgitation), it is important to look for other potential abnormalities. One area to investigate is the pulmonary vein. This is because severe MR can cause a volume overload in the left atrium, leading to increased pressure in the pulmonary veins. Therefore, examining the pulmonary vein can provide valuable information about the severity and potential complications of the MR.

The regurgitant flow rate refers to the amount of regurgitant flow that is being pushed back into the left atrium. It is measured in terms of time, specifically in seconds. This measurement helps determine the severity of regurgitation and assess the efficiency of the heart's function.

Myxomatous disease is the correct answer because it is characterized by a loss of collagen from the leaflet and an accumulation of glycosaminoglycan. This condition affects the connective tissue in the heart valves, leading to valve dysfunction and potentially causing symptoms such as regurgitation or prolapse. Endocarditis is an infection of the heart valves, Rheumatic disease is an inflammatory condition that can affect the heart valves, and Marfan's Syndrome is a genetic disorder that can cause abnormalities in the connective tissue, including the heart valves. None of these conditions specifically match the given description.

The radius of the flow convergence is the greatest source of error in measuring PISA. This is because accurately measuring the radius of the flow convergence is crucial in determining the flow rate. Any error in measuring the radius will directly affect the accuracy of the calculated flow rate.

This answer indicates that the effective regurgitant orifice area (EROA) in the case of mild regurgitation is 0.40 cm². The range of EROA for mild regurgitation is typically between 0.20-0.30 cm².

Pressure half-time = Deceleration time x 0.29

The given answer is a list of progressive symptoms of mitral stenosis. Mitral stenosis is a condition where the mitral valve in the heart narrows, causing blood flow from the left atrium to the left ventricle to be restricted. This leads to symptoms such as shortness of breath and dyspnea on exertion, as the heart is unable to pump sufficient blood to meet the body's needs. As the condition worsens, it can lead to syncope (fainting) due to decreased blood flow to the brain, and even TIA or stroke due to blood clots forming in the stagnant blood.

The given answer suggests that the patient has a severe regurgitant effective regurgitant orifice area (EROA) measured by PISA (proximal isovelocity surface area) of 0.40cm². This indicates a significant amount of backflow of blood through the valve during diastole. The normal range for EROA is 0.20-0.30cm², so a measurement of 0.40cm² indicates a more severe regurgitation.

This question is asking about the severity of regurgitant volume (RVol) as measured using the proximal isovelocity surface area (PISA) method. The PISA method is a way to estimate the volume of blood regurgitating through a heart valve. In this case, the options given are 30-59mL, >40mL, and >60mL. The correct answer is likely ">60mL" because a higher regurgitant volume indicates a more severe condition. However, without additional context or information, it is difficult to provide a definitive explanation.

The given etiologies are all potential causes of mitral stenosis. Rheumatic Heart Disease is a common cause, resulting from damage to the mitral valve due to a prior streptococcal infection. Mitral Annular Calcification (MAC) refers to the calcification and stiffening of the mitral valve annulus, which can lead to narrowing of the valve opening. Mass Obstruction, such as a left atrial myxoma, can physically obstruct the flow of blood through the mitral valve. Congenital Malformation, specifically a parachute mitral valve, is a rare condition where the mitral valve has a single papillary muscle instead of the usual two, leading to stenosis.

Obstruction of the Mitral orifice leads to a back up of blood flow, causing an increase in regurgitant volume over time. This leads to progressive LA dilatation and an increase in LA pressure. Despite the obstruction, the left ventricle (LV) function is preserved. The increased pressures in the pulmonary circuit are then transmitted to the right-sided size and pressures, leading to further complications.

The Left Atrial Pressure (LAP) can be calculated by subtracting the Mitral Regurgitation (MR) gradient from the Systolic Blood Pressure (BP). This formula is used to determine the pressure in the left atrium, which can provide valuable information about cardiac function and potential abnormalities. By subtracting the MR gradient from the systolic BP, the LAP can be estimated, allowing for further assessment and diagnosis of cardiovascular conditions.

The correct answer includes various etiologies or causes of mitral regurgitation. Myxomatous disease, Marfan's Syndrome, Rheumatic heart disease, and Endocarditis are all known to be associated with mitral regurgitation. Myxomatous disease refers to a condition where the mitral valve becomes floppy and weak, leading to regurgitation. Marfan's Syndrome is a genetic disorder that affects the connective tissues, including those in the heart valves. Rheumatic heart disease is a complication of untreated strep throat, which can cause damage to the heart valves. Endocarditis is an infection of the inner lining of the heart, which can also lead to valve damage and regurgitation.