ARDMS ECHO CORRECT EXAMS ANSWERS AND
QUESTIONS SET A+
✔✔What is the easiest method of calculating the MVA? - ✔✔- Doppler P1/2t.
✔✔2D echo of a 55 year old woman with an opening mitral snap and a diastolic murmur
reveals LAE and thickening and tethering of the MV leaflets. What is the most likely
diagnosis? What other noninvasive test should be performed to further clarify the
diagnosis? - ✔✔- Rheumatic MS. Although she has no history of rheumatic fever, she is
too young to have degenerative mitral disease. Also her 2D echo exhibits classic
findings that indicate rheumatic MS.
- To determine the severity of her MS, this patient should undergo a Doppler
examination, and the P1/2t equation should be used to calculate her MVA.
✔✔What is the normal MVA? - ✔✔4-6 cm squared
✔✔What valve areas are associated with mild, moderate, and severe MS? - ✔✔- Mild=
>1.5 cm²
- Moderate= 1.0-1.5 cm²
- Severe= <1 cm²
✔✔VCS = - ✔✔SVC
✔✔VCI = - ✔✔IVC
✔✔What is the definition of MVP, as documented by M-mode echocardiography? -
✔✔In M-mode, MVP is defined as posterior displacement of the mitral leaflets during
systole. This displacement can be either holosystolic or mid-to-late systolic. The
prolapsing leaflet shoukd extend more than 2 to 3 mm below the C-D points.
✔✔What is the definition of MVP, as documented by 2D echo? - ✔✔MVP is defined as
systolic displacement of one or both mitral leaflets into the LA in the parasternal or
apical long-axis.
,✔✔Why should you refrain from diagnosing MVP in th presence of a large pericardial
effusion? - ✔✔Diagnosing MVP in patients with a large pericardial effusion is more of a
problem with M-mode than 2D echo. During late systole, when the entire heart moves in
a posterior direction within the effusion, posterior movement of the mitral valve may be
falsely interpreted as prolapse.
✔✔Why should you refrain from diagnosing MVP from the AP4CH viewpoint? -
✔✔Because the mitral annulus is saddle-shaped, even normal mitral leaflets appear to
prolapse into the left atrium when seen from the AP4CH
✔✔Will rupture of a few mitral chordae tendineae cause any serious clinical problems? -
✔✔Rupture of a few chordae tendineae rarely results in loss of leaflet support, so
significant MR does not ususally occur. Chordal rupture is typically seen in patients with
CAD or bacterial endocarditis.
✔✔In what clinical setting is chordal rupture a pitential source of diagnostic confusion? -
✔✔In patients being evaluated for endocarditis, ruptured chordae tendineae may be
difficult to distinguish from a vegetative valvular mass. It available, a previous echo is
helpful for comparison.
✔✔Will a flail mitral leaflet cause significant hemodynamic problems?
What symptoms will a patient with this condition probably present? - ✔✔A flail mitral
leaflet results in severe, acute MR. Because the LA does not have time to adapt to the
increased hemodynamic volume, the LAP rises sharply, and patients often present with
pulmonary edema.
Symptoms of acute pulmonary edema include sudden breathlessness; cough up if pink,
frothy liquid; and chest pain if the edena is caused by a myocardial infarction.
✔✔Which of the 2 mitral papillary muscles has a higher incidence of rupture? Why? -
✔✔The posterimedial papillary muscle has a higher rate if rupture than the anterolateral
one. Whereas the postermedial pap muscle recieves its blood supply from a single
coronary artery-RCA-, the anterolateral pap muscle recieves a dual blood supply, from
both the CX and the LAD arteries.
✔✔Patients with calcification or fibrosis of the mitral valve annulus commonly have MR.
If the anatomy of the MV is normal, what causes this regurgitation? - ✔✔The MR is
probably caused by the fact that the annulus is now "fixed" and is therefore unable to
adapt to LV/LA changes. Normally, the mitral annulus is a flexible, fibrous ring, whoses
shape changes to reflect alterations in the LV geometry throughout the cardiac cycle.
✔✔In MS, a classic M-mode finding is flattening of the E-F slope. What causes this
flattening? - ✔✔The E-F slope of the anterior mitral leaflet represents the rate of early
diastolic filling of the LV. Normally, the LA empties rapidly. In MS, however, the filling
time is prolonged, and this slow filling is reflected by the descent of the anterior leaflet.
, Attempts to quantity the slope have not proved sensitive of specific. The slope is
affected by the severity of leaflet fibrous, as well as LV compliance, the heart rate, and
the motion of the mitral annulus during diastole.
✔✔Does MR affect the P1/2t method of calculating the MVA? - ✔✔Mild-to- moderate
MR does not affect the P1/2t method of calculating the MVA. Whereas the peak mitral
flow velocity may increase, the relationship between the peak and the slope remains
constant. Severe MR, with large increases in peak mitral flow velocity, may invalidate
the P1/2t method.
✔✔What is the normal aortic valve area? - ✔✔2.5-3.5 cm2
✔✔What is the best noninvasive method for quantifying Aortic stenosis? - ✔✔Continuity
of flow equation to calculate the area of the Aortic valve.
✔✔How does the aortic valve area correlate with the degree of stenosis? - ✔✔Mild= 1.5
to 2.5 cm².
Mod = 0.7 to 1.5 cm².
Severe = <0.7 cm²
✔✔What is the continuity of flow equation for aortic valve area? - ✔✔The aortic valve
area equals the area of the LVOT times the velocity in the LVOT divided by the peak
aortic velocity.
A2 = A1 x V1/V2
✔✔2D echo of a 58 year old man with a systolic cardiac murmur reveals the following
findings:
- Concentric left ventricular hypertrophy
- Mild-to-moderate thickening of the aortic leaflets, with decreased valvular opening
- Systolic doming of the aortic leaflets on the parasternal long-axis view
What is the most likely diagnosis? - ✔✔The most likely diagnosis is stenosis of a
congenital bicuspid aortic valve. Thickened leaflets and concentric hypertrophy many
also be seen in patients with degenerative aortic valve stenosis, by systolic doming in
the parasternal long-axis view is typical of a bicuspid aortic valve.
✔✔aortic sclerosis - ✔✔Aortic valve sclerosis denotes hardening and fibrosis of the
aortic leaflets. This condition does not produce a significant gradient, but it may cause a
systolic murmur or some degree of regeneration.
✔✔aortic valve stenosis - ✔✔Aortic valve stenosis denotes narrowing of the aortic
leaflets or outflow tract. This condition is different from sclerosis, in that sclerosis implies
the presence of hemodynamic gradient.
✔✔what is Takayasu's arteritis? - ✔✔Also called aortic arch syndrome this disease
occurs more in young women from Asia. There is fibrosis of the arch and descending
QUESTIONS SET A+
✔✔What is the easiest method of calculating the MVA? - ✔✔- Doppler P1/2t.
✔✔2D echo of a 55 year old woman with an opening mitral snap and a diastolic murmur
reveals LAE and thickening and tethering of the MV leaflets. What is the most likely
diagnosis? What other noninvasive test should be performed to further clarify the
diagnosis? - ✔✔- Rheumatic MS. Although she has no history of rheumatic fever, she is
too young to have degenerative mitral disease. Also her 2D echo exhibits classic
findings that indicate rheumatic MS.
- To determine the severity of her MS, this patient should undergo a Doppler
examination, and the P1/2t equation should be used to calculate her MVA.
✔✔What is the normal MVA? - ✔✔4-6 cm squared
✔✔What valve areas are associated with mild, moderate, and severe MS? - ✔✔- Mild=
>1.5 cm²
- Moderate= 1.0-1.5 cm²
- Severe= <1 cm²
✔✔VCS = - ✔✔SVC
✔✔VCI = - ✔✔IVC
✔✔What is the definition of MVP, as documented by M-mode echocardiography? -
✔✔In M-mode, MVP is defined as posterior displacement of the mitral leaflets during
systole. This displacement can be either holosystolic or mid-to-late systolic. The
prolapsing leaflet shoukd extend more than 2 to 3 mm below the C-D points.
✔✔What is the definition of MVP, as documented by 2D echo? - ✔✔MVP is defined as
systolic displacement of one or both mitral leaflets into the LA in the parasternal or
apical long-axis.
,✔✔Why should you refrain from diagnosing MVP in th presence of a large pericardial
effusion? - ✔✔Diagnosing MVP in patients with a large pericardial effusion is more of a
problem with M-mode than 2D echo. During late systole, when the entire heart moves in
a posterior direction within the effusion, posterior movement of the mitral valve may be
falsely interpreted as prolapse.
✔✔Why should you refrain from diagnosing MVP from the AP4CH viewpoint? -
✔✔Because the mitral annulus is saddle-shaped, even normal mitral leaflets appear to
prolapse into the left atrium when seen from the AP4CH
✔✔Will rupture of a few mitral chordae tendineae cause any serious clinical problems? -
✔✔Rupture of a few chordae tendineae rarely results in loss of leaflet support, so
significant MR does not ususally occur. Chordal rupture is typically seen in patients with
CAD or bacterial endocarditis.
✔✔In what clinical setting is chordal rupture a pitential source of diagnostic confusion? -
✔✔In patients being evaluated for endocarditis, ruptured chordae tendineae may be
difficult to distinguish from a vegetative valvular mass. It available, a previous echo is
helpful for comparison.
✔✔Will a flail mitral leaflet cause significant hemodynamic problems?
What symptoms will a patient with this condition probably present? - ✔✔A flail mitral
leaflet results in severe, acute MR. Because the LA does not have time to adapt to the
increased hemodynamic volume, the LAP rises sharply, and patients often present with
pulmonary edema.
Symptoms of acute pulmonary edema include sudden breathlessness; cough up if pink,
frothy liquid; and chest pain if the edena is caused by a myocardial infarction.
✔✔Which of the 2 mitral papillary muscles has a higher incidence of rupture? Why? -
✔✔The posterimedial papillary muscle has a higher rate if rupture than the anterolateral
one. Whereas the postermedial pap muscle recieves its blood supply from a single
coronary artery-RCA-, the anterolateral pap muscle recieves a dual blood supply, from
both the CX and the LAD arteries.
✔✔Patients with calcification or fibrosis of the mitral valve annulus commonly have MR.
If the anatomy of the MV is normal, what causes this regurgitation? - ✔✔The MR is
probably caused by the fact that the annulus is now "fixed" and is therefore unable to
adapt to LV/LA changes. Normally, the mitral annulus is a flexible, fibrous ring, whoses
shape changes to reflect alterations in the LV geometry throughout the cardiac cycle.
✔✔In MS, a classic M-mode finding is flattening of the E-F slope. What causes this
flattening? - ✔✔The E-F slope of the anterior mitral leaflet represents the rate of early
diastolic filling of the LV. Normally, the LA empties rapidly. In MS, however, the filling
time is prolonged, and this slow filling is reflected by the descent of the anterior leaflet.
, Attempts to quantity the slope have not proved sensitive of specific. The slope is
affected by the severity of leaflet fibrous, as well as LV compliance, the heart rate, and
the motion of the mitral annulus during diastole.
✔✔Does MR affect the P1/2t method of calculating the MVA? - ✔✔Mild-to- moderate
MR does not affect the P1/2t method of calculating the MVA. Whereas the peak mitral
flow velocity may increase, the relationship between the peak and the slope remains
constant. Severe MR, with large increases in peak mitral flow velocity, may invalidate
the P1/2t method.
✔✔What is the normal aortic valve area? - ✔✔2.5-3.5 cm2
✔✔What is the best noninvasive method for quantifying Aortic stenosis? - ✔✔Continuity
of flow equation to calculate the area of the Aortic valve.
✔✔How does the aortic valve area correlate with the degree of stenosis? - ✔✔Mild= 1.5
to 2.5 cm².
Mod = 0.7 to 1.5 cm².
Severe = <0.7 cm²
✔✔What is the continuity of flow equation for aortic valve area? - ✔✔The aortic valve
area equals the area of the LVOT times the velocity in the LVOT divided by the peak
aortic velocity.
A2 = A1 x V1/V2
✔✔2D echo of a 58 year old man with a systolic cardiac murmur reveals the following
findings:
- Concentric left ventricular hypertrophy
- Mild-to-moderate thickening of the aortic leaflets, with decreased valvular opening
- Systolic doming of the aortic leaflets on the parasternal long-axis view
What is the most likely diagnosis? - ✔✔The most likely diagnosis is stenosis of a
congenital bicuspid aortic valve. Thickened leaflets and concentric hypertrophy many
also be seen in patients with degenerative aortic valve stenosis, by systolic doming in
the parasternal long-axis view is typical of a bicuspid aortic valve.
✔✔aortic sclerosis - ✔✔Aortic valve sclerosis denotes hardening and fibrosis of the
aortic leaflets. This condition does not produce a significant gradient, but it may cause a
systolic murmur or some degree of regeneration.
✔✔aortic valve stenosis - ✔✔Aortic valve stenosis denotes narrowing of the aortic
leaflets or outflow tract. This condition is different from sclerosis, in that sclerosis implies
the presence of hemodynamic gradient.
✔✔what is Takayasu's arteritis? - ✔✔Also called aortic arch syndrome this disease
occurs more in young women from Asia. There is fibrosis of the arch and descending
