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LV Diastolic Function > LV Diastolic Function > Flashcards

LV Diastolic Function Flashcards

1
Q

What is Diastolic Function?

A

Period of relaxation when the heart is filling

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2
Q

Is LV Diastolic Dysfunction independent of LV Systolic Function?

A

Yes. Can lead to heart failure independent of LV systolic function

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3
Q

What does normal diastolic function allow for?

A

Ventricles to fill at rest & exercise w/o an abnormal increase in diastolic pressures

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4
Q

What does normal diastolic function pay

attention to?

A

LA size & volume, E/A ratio, IVRT, Pulmonary vein inflow, TDI

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5
Q

How do we find LA size and volume?

A

Estimate volume by trace

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6
Q

LAE(Left atrial enlargement) suggests what?

A

Increased LAP (Left atrial pressure)

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7
Q

Normal Volume indicates?

A

C/W less significant diastolic dysfx

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8
Q

LA volume/BSA

A

estimate 22ml+/- mL/msquared

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9
Q

How is diastolic function assessed?

A

Mitral Valve Inflow Doppler Pattern, IVRT, Pulmonary vein inflow pattern, Hepatic vein flow pattern, Color M-Mode, Tissue Doppler Imaging(TDI), Strain & Strain rate

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10
Q

How is the Mitral Valve inflow doppler

pattern used to assess Diastolic Function?

A

By PW Doppler, E/A ratio, Mdt, MV adur

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11
Q

How is diastolic function assessed by IVRT?

A

PW or CW Doppler

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12
Q

How is diastolic function assessed by

Pulmonary vein inflow pattern?

A

PW Doppler, Inflow pattern, pulm vein adur

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13
Q

Where do you measure E/A ratio?

A

Between leaflet tips of MV when they are open,

early diastole, sample size 1-2mm

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14
Q

relationship of E and A

A

E should be larger than A in a normal wave form

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15
Q

E to a A reversal: E smaller than A

A

A pathology present

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16
Q

Does E/A sample volume/gate placement matter?

A

yes, could make it look as if a patholoy present or wrong Mdt times

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17
Q

what is normal E/A ratio?

A

1.0-1.5:1

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18
Q

What affects does age have on E/A ratio?

A

Ratio decreases, E velocity approaches the A velocity because of decreased early diastolic filling time and a longer deceleration time

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19
Q

Mdt

A

Mitral deceleration time-rate pressure declining on E of the MV

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20
Q

What is the normal range for Mdt?

A

160-240msec

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21
Q

How do you measure Mdt?

A

Mark peak E point of MV inflow, draw line to

the baseline, if 2 slopes w/in E/F slope use initial slope, system calculates time from peak to baseline for you

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22
Q

MV adur

A

MV A-wave duration-measurement of oneset of

A wave to end of A wave

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23
Q

MV adur > pulmonary adur

A

yes

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24
Q

IVRT

A

Isovolumic relaxation time - all four valves closed, volume constant in ventricles, pressure in ventricles drops in prep for diastole

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25
Q

Where do you measure IVRT?

A

Apical 5 Chamber from closing click of AOV to onset of MV flow

26
Q

What is normal range for IVRT?

A

Less than 100 msec regardless of age

27
Q

Rapid early filling and diastasis correspond with what on the MV Doppler waveform?

A

E wave

28
Q

Atrial contraction corresponds with what on the MV Doppler waveform?

A

A wave

29
Q

What do you use to measure IVRT?

A

PW doppler or CW doppler

30
Q

Common errors in IVRT measurements?

A

Mistaking doppler artifacts for AOV closing click, improper placement of sample gate, mistaking MV opening click for onset of MV flow, doppler gain set too high/low, it should make sense with the other indicators

31
Q

Pulmonary Venous flow is measured how?

A

PW Doppler and large sample gate 2-6mm, approx. 1cm into the right upper pulmonary vein located near the interatrial septum

32
Q

Normal PVadur?

A

< 25cm/sec

33
Q

PVs wave greater than PVd wave?

A

true PVs wave, but could be lower in younger patients

34
Q

What are some tricks to finding a Pulonary Vein?

A

Held expiration, slightly higher interspace, increasing sample gate size slightly

35
Q

How do you know you have Pulmonary Venous flow?

A

Forward Systolic wave, forward Diastolic wave, & Atrial reversal wave

36
Q

If in A-Fib (regards to Pulmonary Vein Inflow)

A

No A wave(PVadur) present and Systole(PVs) wave would be blunted or appear absent

37
Q

How many Grades of Diastolic Dysfunction are there? Look at MV Doppler waveforms for indication of Grade

A

Normal, Grade I, Grade II, Grade III, Grade IV

38
Q

Normal Diastolic Function

A

Good LV relaxation, normal LA/LV filling

pressures, normal Mdt of 160-240ms, normal E/A ratio 1.0-1.5:1, normal IVRT <100ms

39
Q

Grade I Diastolic Dysfunction

A

Impaired relaxation of LV, normal LA/LV filling
pressures, E/A reversal & Mdt greater than 240ms, IVRT>100ms, no symptoms at rest, only mild symptoms with moderate-extreme exertion

40
Q

Grade II Diastolic Dysfunction

A

More impaired relaxation of LV, increased LAP/LV filling pressures, psuedonormalized, increased LAE dimension indication may be psuedonormal, (Mdt, E/A ratio, IVRT all appear normal), DOE

41
Q

What will unmask pseudonormalization?

A

Valsalva maneuver

42
Q

Grade III Diastolic Dysfunction

A

Even more impaired relaxation of LV & more increased LAP/LV filling pressures, very little happening from atrial contraction. PV adur > MV adur, Mdt less than 160ms, E/A ratio equal to or greater than 2:1, IVRT less than 60ms, severely decreased LV compliance & with response to Valsalva - preload reduction=not safe for all patients. LAE, hypocontractile, DOE marked impairment of pt’s funtional status, Reversible-Restrictive

43
Q

Grade IV Diastolic Dysfunction

A

Larger yet impaired relaxation of LV and larger LAP/LV filling pressures. Looks same as Grade III. Fixed-Restrictive, LAE, DOE w/minimal
extertion, hypocontractile, marked functional impairment, end stage, severely decreased LV compliance w/o response to preload reduction(valsalva)

44
Q

Valsalva does what?

A

Decreases venous return = reducing SV, CO, CI, and filling pressures. Not for USA, MI, AS, severe MR, recent CVA/TIA

45
Q

Can you tell Grade level based on looks of Doppler alone?

A

No, need more info

46
Q

What does Tissue Doppler Imaging measure(TDI)?

A

The velocity of the myocardial movement - Doesn’t lie, Truth about velocity vs MV inflow which could have operator error

47
Q

Where do you measure TDI?

A

The E’ peak velocity is measured from the

septal and lateral wall at the annulus mitral valve level

48
Q

The TDI velocity of the Septal annulus wall is

greater than or less than the TDI velocity of the Lateral annulus wall?

A

Less than

49
Q

E/E’ relationship normal

A

8:10

50
Q

Does TDI pseudonormalize like MV inflow?

A

No, It is an important method for detecting diastolic dysfunction

51
Q

Where do you find the Hepatic Vein Doppler signal?

A

Subcostal View

52
Q

How do you find the Hepatic Vein Doppler?

A

PW Doppler - looks like mirror image of

pulmonary vein flow under baseline

53
Q

CMM

A

Color M-Mode

54
Q

Flow propagation velocity(Vp)

A

relies on color and M-mode, how something moves along

55
Q

MV E-wave flow velocity

A

Vp in cm/s

56
Q

What view is used for CMM

A

Apical 4 chamber and align with color inflow, select color M-mode

57
Q

How does flow look on color inflow?

A

If normal=flow vertical and velocity faster into

LV, if abnormal=an angle will occur and flow velocity will be slower into LV

58
Q

Myocardial Strain

A

Longitudinal lengthening and shortening of cardiac muscle unit is %, assesses longitudinal and radial strain

59
Q

What is Strain

A

How an object or tissue deforms

60
Q

What is Strain Rate?

A

The speed of deformation (1/s) used to evaluate systolic and diastolic function, it is a new technique that is still being researched for clinical potential

61
Q

How is Strain Measured?

A

Put samples all around in LV wall looking at how it changes in length and radially. sampling these sites simultaneously.

62
Q

Normal vs Abnormal Strain

A

Lines will be in sync if normal, if abnormal lines will be out of sync, not overlaying each other. muscular function readings.

LV Diastolic Function (1 decks)

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