Chamber / Function / M mode Flashcards by Harpreet Bhatia

Linear method calculation of LV mass

1.04 x [(IVS + LVID + PWT)^3 - LVID^3] -13.6

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Normal LV mass index

Women <= 95 g/m2

Men <= 115 g/m2

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Relative wall thickness calc

(2xPWTd) / LVIDd

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Normal relative wall thickness

<= 0.42

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Concentric Remodeling

Normal LV mass index

Increased RWT

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Eccentric hypertrophy

High LV mass index

Normal RWT

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Concentric hypertrophy

High LV mass index

High RWT

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Fractional Shortening for EF

(LVEDD - LVESD) / LVEDD

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Normal FS

>= 18% 2D
>= 25% M-mode

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Quinones Equation for EF

EF = (LVEDD^2 - LVESD^2) / LVEDD^2 + (Apical factor)

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Apical factor

Normal +10%
Hypok +5%
Akinetic +0%
Dyskinetic -5%
Aneurysm -10%

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Volumetric EF

EF = (EDV - ESV) / EDV

Recommended method

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Stroke volume

EDV - ESV

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Long axis walls

Anterior septum

Inferior lateral

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Two chamber walls

Anterior wall

Inferior wall

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Four chamber walls

Inferior septum

Anterior lateral wall

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LAD walls

Anterior wall
Anterior septum
Most of apex

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RCA walls

Inferior wall

Inferior septum

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Lcx walls

+/- Anterior lateral

+/- Inferior lateral

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Wall motion score index

1 = Normal
2 = Hypo
3 = Akinetic
4 = Dyskinetic / aneurysmal

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SAM septal contact

Duration of sam-septal contact / time from onset of systole to onset of sam-septal contact

Correlates with peak LVOT gradient

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MVP M-Mode

Systolic bowing of leaflet tips >= 3mm below C-D line

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TV leaflets on 4 chamber view

Septal and anterior

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Assumed LV geometry for LV mass and volume calculations

Ellipsoid

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Systolic function parameter independent of preload

End-systolic volume

Soft first heart sound

1st degree AVB

Linear dimension measurement method

Tissue-blood interface

LV vol versus angiography

Smaller

Paradoxical septal motion definition

Early systolic rightward motion

Paradoxical septal motion causes

RV volume overload LBBB / RV pacing Post-cardiac surgery

Pseudodyskinesis def

Diastolic flattening of the inferior / inferolateral wall

Pseudodyskinesis cause

Abdominal process such as liver disease

LV dimensions measurement level

At or immediately below level of tips of mitral leaflets in parasternal long axis

M mode with early mitral valve closure

Acute severe AR

PW doppler PV mid-systolic notch

Severe pulmonary artery hypertension

M mode of PV in PAH

Absent a wave Prolongation of preejection period mid-systolic notching (flying W sign)

B bump

M mode with bump after A wave of MV | LVEDP elevated

M mode sub aortic membrane

Abrupt, very early posterior motion of right cusp of aortic valve

M mode left atrial myxoma

Tumor appears as mass of echoes behind mitral valve during diastole

M-mode LVOT dynamic obstruction

Mid-systolic closure of AV

M-mode PPM

Early downward septal motion Significant delay Peak upward motion of posterior wall

M mode rheumatic MS

Reduced E-F slope Prominent early diastolic dip Paradoxical anterior motion of septum in systole

M-mode constriction

Septal shudder in early diastole | Flattening of posteiror wall in diastole

M-mode preexcitation

Inward movement of posterior wall prior to septum

Left atrial measurement

End of LV systole | Dedicated LA images

Tracing left atrium exclude

PVs | LAA

Tracing LA AV interface

Mitral annulus plane

Limitation of 3D LA volume

Lack of standardized methodology

RA volume views

4 chamber view by gender, index by BSA

Normal RA volume men

25 +/- 7

Normal RA volume women

20.5 +/- 6

Measuring AV annulus diameter

Calcium protuberances considered part of lumen Calcium affects accuracy PLAX view, mid-systole Approximates minor axis of elliptical aortic annulus

IVC in athletes

May be dilated with normal collapse

Views for RV function

``` Modified apical 4 RV focused apical 4 Left parasternal long and short Left parasternal RV inflow Subcostal ```

RV EF metho

Use 3D

RV EF normal

>45

Limitations for 3D RV EF

``` Significant TR Post-op state with paradoxical septal motion Very large ventricle Poor windows Irregular rhythm ```

Normal RV dimension at base

<= 41mm

Normal RV dimension at mid-level

<= 35mm

Normal RV S'

>= 9.5

Normal TAPSE

>= 17 mm

Fractional shortening of LV not reliable when

Regional wall motion abnormalities

Assessment of contractility

Systolic strain rate

Wall stress proportionate to

Transmural pressure | Chamber size

Wall stress inversely proportionate to

Wall thickness

Quantification of wall motion abnormality

Thickening <50%, excursion <5mm

95% CI for EF

+/- 11%

95% CI for LV mass

+/- 60g

Hemodynamic condition with worse strain

Decreased preload