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Echo 1 > C15: Into to Systolic Function > Flashcards

C15: Into to Systolic Function Flashcards

1
Q

systolic function is effect most by what pathology?

A

ischemia

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2
Q

which views are commonly used to asses wall motion

A

PLAX
PSAX LV
A2CH
A4CH

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3
Q

what measurements do we use to quantify LV systolic function

A
  • SV
  • Simpsons EF
  • CO
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4
Q

what visuals/descriptions do we use to qualify LV systolic function

A
  • visual EF

- segmental wall motion analysis

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5
Q

what are the 5 ways we can describe the motion of the 17 LV wall segments and what do each of them mean

A
  1. hyperkinetic
    + excessive wall motion, often the heart will be tachycardic as well
  2. Normal
  3. Hypokinesis
    + motion/wall thickening is reduced…. not norm but not akinetic
  4. Akinetic
    + no thickening of the walls… can have motion if tethered to an adjacent segment thats moving
  5. Dyskinetic
    + wall or segment is moving in the opposite direction or normal
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6
Q

when would you use segmental vs global wall analysis?

A

-you would use global if you cant see the walls/segments very well… otherwise use segmental

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7
Q

what are the causes of hyperkinesis

is hyperkinesis usually segmental or global?

A
  • high preload
  • severe regurg
  • fever
  • trauma

+ global

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8
Q

what are the causes of hypokinesis

A
  • CAD
  • CMO (Cardiomyophathy)
  • chronic valvular disease which causes the valves to fail and then the walls to become hypokinestic
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9
Q

can you have norm movement but no wall thickening?

A

yes

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10
Q

what are the causes of akinesis

A
  • MI

- Viral CMO

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11
Q

what are the causes of dyskinesis

A
  • increased R heart pressure
  • pacemaker
  • BBB
  • chronic scarred segment
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12
Q

which will have a higher EF: an akinetic or dyskinetic wall?

A

akinetic because its staying in the same place… dyskinetic moves in the opposite direction which will decrease EF

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13
Q

how does increased R heartpressure lead to hypokinetic walls

A

increased R heart pressure will push on and compress the IVS which makes it unable to move

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14
Q

does RV muscle hypertrophy in response to increased pressure

A

no, it just stretches out to accommodate the volume

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15
Q

what is the crista terminalis

A

a norm structure in the RA

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16
Q

list the assessment used to calculate EF (volumetric assessment).
which are the most accurate

A

From least to most accurate:

  1. Teicholz EF
    +not very accurate b/c we’re only measuring 2 or the 17 segments
  2. Simpsons biplane EF
    + gold standard for echo
    + assesses 13 segments
    + used to find SV, EJ
  3. 3D Trace/3D EF
    + only most accurate when performed by an experienced tech
    + assesses all segments
17
Q

which measurement in Simpsons may not be accurate w/ MV regurg?

A

ESV because some volume is leaking back into the LV

18
Q

how do we do a flow assessment of the LV?

A

use SV doppler method:

Pie(r^2) x VTI…. using the LVOT radius and LVOT VTI

19
Q

which is more accurate, Simpsons or SV Doppler method for LV systolic function?

A

SV doppler method

20
Q

why is any error of measurement of the LVOT concerning

A

it will result in false measurements that will be magnify by 4 X they real value

21
Q

when doing an PW of the LVOT where should you place the SV

A

where you measured the LVOT diameter

22
Q

what does EF calculate

A

amount of volume ejected from the LV during systole

23
Q

define FS, whats the norm value?

how is it related to EF

A

% of change in the minor axis of the LV
norm: >25%

-directly related to EF

24
Q

why is the simpsons most often used to measure EF

A
  • most studied
  • accurate
  • more universal than 3D
25
Q

why does LV systolic dysfunction often occur and what can it lead to

A

-due to CAD

-causes decreased SV and EF which can lead to:
+ CHF

26
Q

describe what happens in CHF

A

chambers start to enlarge due to back up of blood behind the chamber b/c it cant contract properly to move blood forward

27
Q

how do we use to quantify and qualify RV systolic function

A

qualitative: eyeball

quantitative:
- fractional area change (FAC) (instead of Simpsons)
- TAPSE
- S prime TDI

28
Q

how do we grade RV systolic function when eyeballing

A

norm
mildly reduced
moderately reduced
severely reduce

or hyperkinetic

29
Q

what usually happens to the Rv chamber if the walls are hypokinetic

A

it will be dilated

30
Q

what is a fractional area change (FAC) and how to we measure it.

whats the formula?

A

-comparison of area change b/w systole and diastole… NOT a volume change

+ trace endocardial border surface in A4CH view in end systole and end diastole

FAC= (EDA-ESA/EDA) x 100

31
Q

whats a norm fractional area change (FAC) value

A

> 35%

32
Q

if your TAPSE value is low, which other value will likely be low as well

A

s prime in TDI… s prime is a measure of velocity

33
Q

what part of the ECG corresponds with s prime?

A

ST segment

34
Q

norm S prime value

A

> 9.5 cm/s

35
Q

when would you use 3D imaging with contrast

A

when 2D image quality is poor/you cant see the segments and you need to find the EF

36
Q

When assessing the wall motion qualitatively, we are assessing movement of the ventricle in which plane?

A

Radial

Echo 1 (17 decks)

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