1. How does mitral stenosis affect the left atrium?
2. Why do patients with mitral stenosis usually develop atrial fibrillation?
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1. Mitral stenosis causes an increase in the left atrial
pressure, which results in left atrial enlargement.
Severe mitral stenosis can lead to pulmonary
hypertension, right ventricular failure, and right atrial
enlargement.
2. When the left atrium becomes dilated, the atrial
muscle bundles are damaged, resulting in atrial
fibrillation. Such fibrillation causes further atrial
enlargement, as well as atrophy of the atrial muscle,
and may lead to chronic atrial fibrillation.
,1. How does aortic regurgitation affect the stenotic aortic valve gradient, as assessed
by Doppler examination?
2. How does aortic regurgitation affect the aortic valve area, as calculated by the
continuity-of-flow equation?
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1. Mild aortic regurgitation has no effect on the aortic valve gradient.
Moderate or severe regurgitation causes the existing gradient to increase
because of volume overload on the left ventricle.
2. Aortic regurgitation does not affect the aortic valve
area as calculated by the continuity-of-flow equation.
because the velocities for V1 and V2 increase equally.
1. Name seven typical physical findings associated with mitral stenosis.
2. What causes an opening snap (mitral)?
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1. Typical physical findings associated with mitral stenosis
include:
- a diastolic murmur (rumble)
- an opening snap
- atrial fibrillation
- dyspnea on exertion
- fatique
- orthopnea
- hemoptysis (spitting up of blood).
2. An opening mitral snap occurs shortly after the second
heart sound (which signifies aortic and pulmonic closure).
The snap is caused by the abrupt cessation of leaflet
opening when the mitral valve is tethered.
,Infective endocarditis
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Infection of the endocardium. It commonly affects the valve
leaflets and chordae tendineae, as well as prosthetic valves
and implanted devices.
Intravenous drug users are at increased risk with
approximately 2 cases per 1000 in this patient group. It is
more common in men than women (>2:1). In the general
population, it affects more individuals older than 65 years 1.
Once the endocarditic lesion is initiated, the clotting
pathway catalyzes vegetation formation. The microbes
become buried in the vegetation and may form a biofilm
around them, thereby becoming inaccessible to immune
cells or antibiotic drugs for clearance and eradication.
Endocarditic vegetation is the pathologic hallmark of
infective endocarditis and commonly appears as an
irregular, mobile or fixed mass and is usually attached to the
endocardium on the low-pressure side of a valve, chordae
tendineae or ascending aorta. Vegetation fragments can
break off and undergo embolization, causing more
conspicuous clinical signs and symptoms of infection like
pneumonia and stroke.
1. What is the best noninvasive method for quantifying aortic valve stenosis?
2. How does the aortic valve area correlate with the degree of stenosis?
Give this one a try later!
1. The best noninvasive method for quantifying aortic
valve stenosis is to use the continuity-of-flow equation to
calculate the area of the aortic valve.
2. The various degrees of stenosis are associated with
the following aortic valve areas:
- mild >1.5 cm2
, - moderate 1 to 1.5 cm2
- severe <1 cm2
1 A 32-year old female presents with atypical chest pain.
Her blood pressure is 112/50, height 6' and weight 115
lbs. An echocardiogram is performed which shows
mitral valve prolapse. What is the most likely
diagnosis for this patient?
2. Which additional cardiac structures should be
evaluated?
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1. From the physical description of this patient and the
finding on echocardiogram of mitral valve prolapse she
may have Marfan Syndrome.
2. The aortic valve and aorta should be evaluated for the
presence of valvular regurgitation, aortic dilatation and
possible dissection.
1. What is the normal flow velocity (mean value and range) through the mitral valve, as
documented by Doppler imaging in adults and children?
2. Describe the changes seen in the Doppler spectral trace in patients with mitral
stenosis.
Give this one a try later!
1. As documented by Doppler imaging, the normal flow
velocity through the mitral valve in adults is a mean of
0.9 m/sec, with a range of 0.6 to 1.4 m/sec. In children, the
flow velocity is slightly higher, having a mean of 1.0 m/sec
and a range of 0.7 to 1.4 m/sec.
2. The changes seen in the Doppler spectral trace in
patients with mitral stenosis include:
- an increase in flow velocity
2. Why do patients with mitral stenosis usually develop atrial fibrillation?
Give this one a try later!
1. Mitral stenosis causes an increase in the left atrial
pressure, which results in left atrial enlargement.
Severe mitral stenosis can lead to pulmonary
hypertension, right ventricular failure, and right atrial
enlargement.
2. When the left atrium becomes dilated, the atrial
muscle bundles are damaged, resulting in atrial
fibrillation. Such fibrillation causes further atrial
enlargement, as well as atrophy of the atrial muscle,
and may lead to chronic atrial fibrillation.
,1. How does aortic regurgitation affect the stenotic aortic valve gradient, as assessed
by Doppler examination?
2. How does aortic regurgitation affect the aortic valve area, as calculated by the
continuity-of-flow equation?
Give this one a try later!
1. Mild aortic regurgitation has no effect on the aortic valve gradient.
Moderate or severe regurgitation causes the existing gradient to increase
because of volume overload on the left ventricle.
2. Aortic regurgitation does not affect the aortic valve
area as calculated by the continuity-of-flow equation.
because the velocities for V1 and V2 increase equally.
1. Name seven typical physical findings associated with mitral stenosis.
2. What causes an opening snap (mitral)?
Give this one a try later!
1. Typical physical findings associated with mitral stenosis
include:
- a diastolic murmur (rumble)
- an opening snap
- atrial fibrillation
- dyspnea on exertion
- fatique
- orthopnea
- hemoptysis (spitting up of blood).
2. An opening mitral snap occurs shortly after the second
heart sound (which signifies aortic and pulmonic closure).
The snap is caused by the abrupt cessation of leaflet
opening when the mitral valve is tethered.
,Infective endocarditis
Give this one a try later!
Infection of the endocardium. It commonly affects the valve
leaflets and chordae tendineae, as well as prosthetic valves
and implanted devices.
Intravenous drug users are at increased risk with
approximately 2 cases per 1000 in this patient group. It is
more common in men than women (>2:1). In the general
population, it affects more individuals older than 65 years 1.
Once the endocarditic lesion is initiated, the clotting
pathway catalyzes vegetation formation. The microbes
become buried in the vegetation and may form a biofilm
around them, thereby becoming inaccessible to immune
cells or antibiotic drugs for clearance and eradication.
Endocarditic vegetation is the pathologic hallmark of
infective endocarditis and commonly appears as an
irregular, mobile or fixed mass and is usually attached to the
endocardium on the low-pressure side of a valve, chordae
tendineae or ascending aorta. Vegetation fragments can
break off and undergo embolization, causing more
conspicuous clinical signs and symptoms of infection like
pneumonia and stroke.
1. What is the best noninvasive method for quantifying aortic valve stenosis?
2. How does the aortic valve area correlate with the degree of stenosis?
Give this one a try later!
1. The best noninvasive method for quantifying aortic
valve stenosis is to use the continuity-of-flow equation to
calculate the area of the aortic valve.
2. The various degrees of stenosis are associated with
the following aortic valve areas:
- mild >1.5 cm2
, - moderate 1 to 1.5 cm2
- severe <1 cm2
1 A 32-year old female presents with atypical chest pain.
Her blood pressure is 112/50, height 6' and weight 115
lbs. An echocardiogram is performed which shows
mitral valve prolapse. What is the most likely
diagnosis for this patient?
2. Which additional cardiac structures should be
evaluated?
Give this one a try later!
1. From the physical description of this patient and the
finding on echocardiogram of mitral valve prolapse she
may have Marfan Syndrome.
2. The aortic valve and aorta should be evaluated for the
presence of valvular regurgitation, aortic dilatation and
possible dissection.
1. What is the normal flow velocity (mean value and range) through the mitral valve, as
documented by Doppler imaging in adults and children?
2. Describe the changes seen in the Doppler spectral trace in patients with mitral
stenosis.
Give this one a try later!
1. As documented by Doppler imaging, the normal flow
velocity through the mitral valve in adults is a mean of
0.9 m/sec, with a range of 0.6 to 1.4 m/sec. In children, the
flow velocity is slightly higher, having a mean of 1.0 m/sec
and a range of 0.7 to 1.4 m/sec.
2. The changes seen in the Doppler spectral trace in
patients with mitral stenosis include:
- an increase in flow velocity
