Hemodynamics Review

Question 1

Stroke volume

Answer 1

LVOT area * LVOT VTI

Question 2

Stroke volume index

Answer 2

SV / BSA

Question 3

AVA using continuity

Answer 3

LVOT VTI * LVOT area / AV VTI

Question 4

MR flow / instantaneous flow rate

Answer 4

area x aliasing velocity

for area, use 2pir2

Question 5

ERO for MR

Answer 5

ERO = MR flow / MR velocity

Question 6

Quick ERO using PISA

Answer 6

Aliasing velocity 40
Assume MR velocity 500
ERO = PISA radias^2 / 2

Question 7

RV for MR

Answer 7

ERO * MR VTI

Question 8

MS by PHT

Answer 8

MVA = 220 / PHT

Question 9

PHT

Answer 9

DT * 0.29

Question 10

Pitfalls of PHT for MS

Answer 10

Bad with high LV pressures or impaired relaxation

Don’t use after balloon valvuloplasty

Question 11

MS by continuity

Answer 11

MVA = LVOT area * LVOT VTI / MV VTI

Question 12

Pitfalls of continuity for MS

Answer 12

AR increases LVOT VTI

MR increases MV VTI

Question 13

PISA for MS

Answer 13

MVA = 2 * PI * r^2 * aliasing velocity / peak velocity * angle / 180

Question 14

CO in aortic regurgitation

Answer 14

Must use MV SV, don’t use LVOT SV

Question 15

AR RV

Answer 15

LVOT SV - Mitral SV

Question 16

AR RF

Answer 16

RV / LVOT SV

Question 17

AR EROA

Answer 17

RV / AR VTI

Question 18

Severe AR RV

Answer 18

> 60

Question 19

Severe AR RF

Answer 19

> 50

Question 20

Severe AR ERO

Answer 20

> 0.3

Question 21

Severe AR PHT

Answer 21

<250

>500 argues strongly against

Question 22

Severe AR vena contracta

Answer 22

> 0.6

Question 23

Severe AR abdominal aorta

Answer 23

holodiastolic reversal

Question 24

HCM LVOT gradient

Answer 24

4 (LVOT velocity)^2

Question 25

HCM LVOT gradient using MR velocity

Answer 25

Assume LA pressure = 15 LV - LA = 4 MR velocity^2 Gradient = LV - SBP

Question 26

MR and MVP

Answer 26

Use PISA for ERO / RV | RV better

Question 27

MR ERO correction for wall constraint

Answer 27

Divide angle by 180 degrees and multiple by incorrect ROA

Question 28

Posterior MR jet

Answer 28

Posterior leaflet restriction | Anterior leaflet pathology

Question 29

Anterior MR jet

Answer 29

Posterior leaflet perforation or other pathology

Question 30

Cutoff for large aortic atheroma

Answer 30

>= 4mm into lumen

Question 31

PAWP formula

Answer 31

4.6 + 5.27 * E velocity / flow propagation velocity

Question 32

Normal propagation velocity young

Answer 32

>55 cm/s

Question 33

Normal propagation velocity middle aged - old

Answer 33

>45 cm/s

Question 34

LAP estimate

Answer 34

LAP = 4 + E/e'

Question 35

LVEDP equation

Answer 35

LVEDP = DBP - 4 x end-diastolic velocity AR^2

Question 36

LVSP equation

Answer 36

LVSP = 4v^2 + LAP

Question 37

Peak to Peak aortic gradient of AS equation

Answer 37

P2P = LVSP - SBP

Question 38

Calculating gradients / pressure across chambers

Answer 38

Receiving chamber pressure = originating chamber pressure + gradient

Question 39

PVR equation

Answer 39

Change in pressure / Qp | Change in pressure across Pulm circulation = MPP - LAP

Question 40

Mean pulmonary artery pressure equation

Answer 40

MPP = PADP + 1/3 (PASP-PADP)

Question 41

RVSP in VSD

Answer 41

RVSP = SBP - peak systolic VSD gradient

Question 42

PASP equation in PS

Answer 42

PASP = RVSP - peak PS gradient

Question 43

LV dp/dt

Answer 43

``` dP/dt = dP / relative time interval dP = (4v2^2 - 4v1^2) RTI = time at V2 - time at V1 ```

Question 44

Mean LAP equation in MS

Answer 44

LAP = mean mitral gradient in diastole + early LV diastolic pressure

Question 45

AVA by modified continuity equation

Answer 45

LVOT area * V LVOT / V AV | or LVOT area x DI

Question 46

AV dimensionless index

Answer 46

DI = V LVOT / V AV

Question 47

Mean AV gradient calculation

Answer 47

0.6 * peak gradient

Question 48

PV atrial reversal wave cut-off velocity for elevated LVEDP

Answer 48

>= 35cm/s

Question 49

PV atrial reversal wave cut-off duration for elevated LVEDP

Answer 49

>= 30 ms more than duration of mitral inflow A wave

Question 50

Rapid deceleration of TR jet

Answer 50

Very severe TR

Question 51

Regurgitant fraction equation

Answer 51

RF = RF / (forward SV + RF)

Question 52

Mitral inflow in cor triatriatum

Answer 52

Forward flow in systole and diastole with 3 phases

Question 53

LA volume calculation

Answer 53

= 0.85 * (Area 1 * Area 2) / Length

Question 54

Typical mean LA pressure grade 1 DD

Answer 54

8-14mmHg

Question 55

Typical mean LA pressure grade 2 DD

Answer 55

15-22mmHg

Question 56

Typical mean LA pressure grade 3 DD

Answer 56

>22mmHg