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AI flashcard > AI Flashcards 2 > Flashcards

AI Flashcards 2

1
Q

What are the two states that the left ventricle cycles between?

A

A compliant chamber in diastole and a stiff chamber in systole

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2
Q

What are the two alternating functions of the ventricle?

A

Systolic ejection and diastolic filling

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3
Q

What is the theoretically optimal LV pressure curve?

A

Rectangular, with an instantaneous rise to peak and an instantaneous fall to low diastolic pressures

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4
Q

When are filling pressures considered elevated?

A

When the mean pulmonary capillary wedge pressure (PCWP) is greater than or equal to 12 mm Hg or when the left ventricular end-diastolic pressure (LVEDP) is greater than or equal to 16 mm Hg

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5
Q

What is relaxation?

A

The process whereby the myocardium returns after contraction to its unstressed length and force

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6
Q

What factors can delay myocardial relaxation?

A

Increased afterload or late systolic load, especially when combined with elevated preload

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7
Q

What is the rate of global LV myocardial relaxation reflected by?

A

The monoexponential course of LV pressure fall

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8
Q

What is LV filling determined by?

A

The interplay between LV filling pressures and filling properties

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9
Q

What is chamber stiffness?

A

The LV diastolic pressure-volume relationship

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10
Q

What is a distinct aspect of diastolic function?

A

Longitudinal function and torsion

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11
Q

What is LV hypertrophy?

A

An important reason for diastolic dysfunction

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12
Q

What type of hypertrophy is usually present in patients with depressed EFs?

A

Eccentric LV hypertrophy

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13
Q

What is diastasis?

A

Definition

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14
Q

How is left ventricular wall thickness measured?

A

Using 2-dimensional echocardiography

Guidelines of the American Society of Echocardiography

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15
Q

What should be measured to evaluate left ventricular diastolic function and filling pressures?

A

At least left ventricular wall thickness

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16
Q

What does the presence of predominant early filling in patients with pathologically hypertrophied myocardium favor?

A

Increased filling pressures

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17
Q

What is the significance of measuring left atrial volume?

A

There is a significant relation between left atrial remodeling and echocardiographic indices of diastolic function

18
Q

What is the independent predictor of death, heart failure, atrial fibrillation, and ischemic stroke?

A

Left atrial volume index >34 mL/m2

Observational studies including 6,657 patients without baseline histories of atrial fibrillation and significant valvular heart disease

19
Q

What are the three functions of the atrium in ventricular filling?

A
  • Reservoir * Conduit * Pump
20
Q

What happens to the left atrial contribution to left ventricular filling with impaired left ventricular relaxation?

A

It decreases

21
Q

How can left atrial systolic function be assessed?

A

Using a combination of 2D and Doppler measurements

22
Q

What is used to derive pulmonary artery systolic pressure?

A

Peak velocity of the tricuspid regurgitation jet by continuous-wave Doppler and systolic right atrial pressure

23
Q

What is used to derive pulmonary artery diastolic pressure?

A

End-diastolic velocity of the pulmonary regurgitation jet

24
Q

What is the limitation to the estimation of pulmonary artery diastolic pressure?

A

Lower feasibility rates of adequate pulmonary regurgitation signals, particularly in intensive care units and without intravenous contrast agents

25
Q

What is used to calculate mitral inflow velocities?

A

Pulsed-wave Doppler in the apical 4-chamber view

26
Q

What are the primary measurements of mitral inflow?

A

Peak early filling (E-wave) and late diastolic filling (A-wave) velocities, E/A ratio, deceleration time (DT) of early filling velocity, and IVRT

Secondary measurements include mitral A-wave duration, diastolic filling time, A-wave velocity-time integral, and total mitral inflow velocity-time integral

27
Q

What are the normal values for mitral inflow velocities and time intervals?

A

Mitral E velocity and E/A ratio decrease with increasing age, while DT and A velocity increase. Normal values are provided in Table 1

Other variables such as heart rate, rhythm, PR interval, cardiac output, mitral annular size, and LA function can also affect mitral inflow

28
Q

What are the different mitral inflow patterns?

A

Normal, impaired LV relaxation, pseudo-normal LV filling (PNF), and restrictive LV filling

Less typical patterns such as triphasic mitral flow velocity pattern can also be observed

29
Q

What does the mitral E-wave velocity primarily reflect?

A

The LA-LV pressure gradient during early diastole

Affected by preload and alterations in LV relaxation

30
Q

What does the mitral A-wave velocity reflect?

A

The LA-LV pressure gradient during late diastole

Affected by LV compliance and LA contractile function

31
Q

What influences the E-wave DT?

A

LV relaxation, LV diastolic pressures following mitral valve opening, and LV compliance

Relationship between LV pressure and volume

32
Q

What factors affect mitral inflow velocities and time intervals?

A

Alterations in LV end-systolic and/or end-diastolic volumes, LV elastic recoil, and/or LV diastolic pressures

Directly affect the mitral inflow velocities (E wave) and time intervals (DT and IVRT)

33
Q

What do PW Doppler mitral flow velocity variables and filling patterns correlate with in dilated cardiomyopathies?

A

Cardiac filling pressures, functional class, and prognosis

Correlation is better than LV EF

34
Q

What is a restrictive filling pattern associated with?

A

A poor prognosis, especially if it persists after preload reduction

Indicates increased risk for heart failure, unfavorable LV remodeling, and increased cardiovascular mortality

35
Q

What are the limitations of LV filling patterns?

A

They have a U-shaped relation with LV diastolic function, with similar values seen in healthy normal subjects and patients with cardiac disease

Recognition of PNF can be a problem

36
Q

What is the purpose of PW Doppler in the apical 4-chamber view?

A

To obtain mitral inflow velocities to assess LV filling.

A 1-mm to 3-mm sample volume is placed between the mitral leaflet tips during diastole to record a crisp velocity profile.

37
Q

What are the primary measurements obtained from PW Doppler?

A
  • Peak E and A velocities
  • E/A ratio
  • DT
  • IVRT.

These measurements help assess LV filling and diastolic function.

38
Q

What are the different mitral inflow patterns?

A
  • Normal
  • Impaired LV relaxation
  • PNF
  • Restrictive LV filling.

These patterns can provide information about filling pressures, functional class, and prognosis.

39
Q

What is the purpose of the Valsalva maneuver?

A

To observe changes in mitral inflow and distinguish between normal and PNF patterns.

The Valsalva maneuver involves forceful expiration against a closed nose and mouth, reducing LV preload during the strain phase.

40
Q

What changes occur in mitral inflow during the Valsalva maneuver?

A

In pseudonormal mitral inflow, E velocity decreases with a prolongation of DT, while A velocity is unchanged or increases, resulting in a decrease in the E/A ratio. In normal mitral inflow, both E and A velocities decrease proportionately.

The absolute A velocity should be used when computing the E/A ratio with Valsalva.

41
Q

What are the limitations of the Valsalva maneuver?

A

Not everyone can perform the maneuver adequately, and it is not standardized. Its clinical value has diminished with the introduction of tissue Doppler recordings.

The Valsalva maneuver can be reserved for cases where diastolic function assessment is unclear after other measurements.

AI flashcard (2 decks)

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