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Echo 3 Final > Diastolic Dysfunction > Flashcards

Diastolic Dysfunction Flashcards

1
Q

diastolic suction

A

A ventricular negative pressure when the ventricle is
allowed to relax completely in the absence of filling. It has not been
extensively studied in the human heart in vivo.

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2
Q

Loading factors

A

By plotting ventricular load as tension time index
against stroke volume, one obtains a valid pump function curve for one beat which is insensitive to changes in heart rate but remains sensitive to changes in end-diastolic volume and contractility

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3
Q

phases of diastolic function

A
  1. IVRT: LV relaxes after AV closes
  2. rapid filling: E wave
  3. atrial contraction: A wave
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4
Q

what is normal diastolic function

A

-the ability of the left ventricle to fill in a competent fashion
• This implies that the filling of the LV will not cause a significant increase in LV pressure

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5
Q

what is diastolic dysfunction

A
  • impaired LV relaxation and increased LV chamber stiffness, which increase cardiac filling pressures
  • LV pressure will increase rapidly
  • ecreased compliance, decreased relaxation or both
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6
Q

assessing for diastolic function

A
  1. mitral inflow
  2. tissue doppler
  3. color m mode
  4. pulmonary inflow
  5. left atrial volume index
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7
Q

what 2 places do you perform tissue doppler

A

mitral annulus on the lateral and septal walls

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8
Q

what measurements do you get at the PW of the mitral inflow

A
  1. E and A filling peaks
  2. deceleration time
  3. IVRT
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9
Q

mitral inflow PW normal findings E & A

A

biphasic, separate E & A peaks;
E > A; E/A ratio between 0.8 and 2.0
E/A > 1 for children and adults < age 50 E increases and A decreases with age

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10
Q

normal deceleration time

A

160-240 msec

increases with age

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11
Q

normal IVRT

A

60-100 msec
reflects the rate of the relaxation of the myocardium
values age sensitive

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12
Q

IVRT is longer in patients with…

A

imparied relaxation

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13
Q

ivrt is shorter in patients with

A

restrictive filling

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14
Q

what is IVRT

A

the time interval between aortic valve closure and mitral valve opening

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15
Q

IVRT is also prolonged in patients with…

A

CAD, advanced age, hypertrophy due to relaxation abnormalities

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16
Q

pitfalls of measuring diastolic function

A
  1. cardiac arrhythmias: changes inflow patterns
  2. tachycardia: fuses E and A together
  3. A fib : produces no A wave
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17
Q

normal TD medial E prime velocity

A

11.5 cm/s

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18
Q

normal lateral E prime velocity

A

13.3 cm/s

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19
Q

TDI velocities less than 8 cm/s indicates what?

A

diastolic dysfunction and relaxation

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20
Q

what is the annular velocity associated with restrictive filling

A

5 cm/s

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21
Q

this indicates normal LV diastolic pressure

A

E/E’ < 8

22
Q

this value indicates increased LV pressure

A

E/E’ ratio > 15

23
Q

TDI is not reliable in patients with…

A

basel ischemia, mitral valve disease, constrictive pericarditis

24
Q

color m mode velocity represents

A

the velocity of blood flow from the mitral leaflets to the apex of the ventricle in early diastole
greater than 50 cm/s is normal

25
Q

how to obtain color m mode

A
  • In AP4 decrease the depth until the sector only shows the full mitral annulus and the LV only
  • Place a color box over the entire LV and MV. Shift the color baseline upward until the top number is about 45 cm/s.
  • Place the cursor through the middle of LV apex and select M-mode
  • Show trace of M-mode with color and measure Vp with a slope
26
Q

normal pulmonary inflow over 50 yrs old

A

higher systolic flow, lower diastolic flow

27
Q

normal pulmonary inflow under age 40

A

higher diastolic velocity

28
Q

LA volume index greater than 34 predicts

A

death, heart failure, A fib, and stroke

29
Q

left atrial volume is measured in …

A

end systole

AP4 and AP2

30
Q

stage 1 diastolic dysfunction

A

early diastolic dysfunction, mild diastolic dysfunction, impaired relaxation, abnormal relaxation

31
Q

diastolic dysfunction stage 2

A

pseudo normal moderate

32
Q

stage 3 diastolic dysfunction

A

restrictive filling

severe

33
Q

Stage I: Early Diastolic Dysfunction

A

most common filling abnormality associated with coronary artery disease and hypertension
associated with an increase in LVEDP. During the rapid filling phase of diastole, the increase in LV filling pressures results in a decrease in the amount of blood moving from LA to LV.
reduced E wave, increased DT and a higher
A wave.

34
Q

Stage I: Early Diastolic Dysfunction is associated with

A

Associated with several diseases, such as coronary artery disease
(CAD), cardiomyopathy, hypertension, left ventricular hypertrophy (LVH) and pulmonary hypertension

35
Q

Stage I: Early Diastolic Dysfunction mitral inflow

A
  • Decreased E velocity
  • Increased A velocity
  • Increased DT
  • Increased IVRT
36
Q

Stage I: Early Diastolic Dysfunction tissue doppler

A

E’ is reduced (< 8) because of abnormal
compliance and relaxation
• E/E’ ratio is < 15, no significant increase

37
Q

Stage I: Early Diastolic Dysfunction pulmonary veins

A

normal ratio > 1

38
Q

Stage II: Pseudonormal

mitral inflow

A

PW Doppler pattern seems normal. An increase

in LA pressure may mask the relaxation abnormality and normalize the trans-mitral flow

39
Q

Stage II: Pseudonormal

tissue doppler

A

a lower E’ than A’
• E’ is decreased because of decreased LV
compliance and abnormal relaxation
• E/E’ ratio > 15

40
Q

Stage II: Pseudonormal

pulmonary vein inflow

A

will have little or no systolic flow (S-wave) and high diastolic flow (D-wave)
• S/D ratio < 1

41
Q

how to identify pseudonormal patterns

A
  1. valsalva maneuver

2. TDI: an E/E’ greater than 12 shows increased LA pressure

42
Q

stage 3: restrictive

A
  • early pressure gradient is high due to the high LA pressure resulting in increased E velocity. The pressure gradient between the LA and LV equalizes quickly, due to the rapid rise in LV diastolic pressure, resulting in decreased DT.
  • A velocity is low, resulting in an increased E/A ratio
  • In the case of increased LA pressure, the S/D ratio will be reversed—or there will be no systolic flow at all.
43
Q

stage 3 restrictive MV inflow

A
  • Very high E velocity
  • Much lower A velocity
  • Increased E/A ratio: > 2
  • Decreased DT: < 140 msec
  • Decreased IVRT
44
Q

stage 3 restrictive tissue doppler

A

• Significantly decreased E’ velocity because LV
cannot relax normally
• E/E’ ratio is > 15

45
Q

stage 3 restrictive pulmonary vein inflow

A

• Tall D wave
• Significant reduction in S/D ratio (almost no S-
wave)

46
Q

ventricular relaxation and dP/dt

A
  • occurs when the LV pressure declines during IVRT after aortic valve closure and is represented by the rate and duration of the decrease in LV pressure after systolic contraction.
  • assessed by measuring the early slope of the CW Doppler of the mitral regurgitation jet. This indirect measurement is the dP/dt.
47
Q

major determinant os LV filling are

A

ventricular relaxation and passive diastolic properties

48
Q

normal dP/dt values

A

greater than 1200 mmHg

49
Q

as LV compliance decreases…

A

increase in filling pressures is required to maintain normal cardiac filling, volume and output.
seen with LV hypertrophy, ischemia and increasing LV volume

50
Q

LVEDP greater than 16 mmHg is considered

A

increased filling pressures

51
Q

Systolic Function Severe dysfunction

A

dP/dt < 800 and t > 40 msec

52
Q

normal systolic function

A

dP/dt > 1200 mmHg and t < 27 msec

Echo 3 Final (3 decks)

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