C15: Into to Systolic Function Flashcards
systolic function is effect most by what pathology?
ischemia
which views are commonly used to asses wall motion
PLAX
PSAX LV
A2CH
A4CH
what measurements do we use to quantify LV systolic function
- SV
- Simpsons EF
- CO
what visuals/descriptions do we use to qualify LV systolic function
- visual EF
- segmental wall motion analysis
what are the 5 ways we can describe the motion of the 17 LV wall segments and what do each of them mean
- hyperkinetic
+ excessive wall motion, often the heart will be tachycardic as well - Normal
- Hypokinesis
+ motion/wall thickening is reduced…. not norm but not akinetic - Akinetic
+ no thickening of the walls… can have motion if tethered to an adjacent segment thats moving - Dyskinetic
+ wall or segment is moving in the opposite direction or normal
when would you use segmental vs global wall analysis?
-you would use global if you cant see the walls/segments very well… otherwise use segmental
what are the causes of hyperkinesis
is hyperkinesis usually segmental or global?
- high preload
- severe regurg
- fever
- trauma
+ global
what are the causes of hypokinesis
- CAD
- CMO (Cardiomyophathy)
- chronic valvular disease which causes the valves to fail and then the walls to become hypokinestic
can you have norm movement but no wall thickening?
yes
what are the causes of akinesis
- MI
- Viral CMO
what are the causes of dyskinesis
- increased R heart pressure
- pacemaker
- BBB
- chronic scarred segment
which will have a higher EF: an akinetic or dyskinetic wall?
akinetic because its staying in the same place… dyskinetic moves in the opposite direction which will decrease EF
how does increased R heartpressure lead to hypokinetic walls
increased R heart pressure will push on and compress the IVS which makes it unable to move
does RV muscle hypertrophy in response to increased pressure
no, it just stretches out to accommodate the volume
what is the crista terminalis
a norm structure in the RA
list the assessment used to calculate EF (volumetric assessment).
which are the most accurate
From least to most accurate:
- Teicholz EF
+not very accurate b/c we’re only measuring 2 or the 17 segments - Simpsons biplane EF
+ gold standard for echo
+ assesses 13 segments
+ used to find SV, EJ - 3D Trace/3D EF
+ only most accurate when performed by an experienced tech
+ assesses all segments
which measurement in Simpsons may not be accurate w/ MV regurg?
ESV because some volume is leaking back into the LV
how do we do a flow assessment of the LV?
use SV doppler method:
Pie(r^2) x VTI…. using the LVOT radius and LVOT VTI
which is more accurate, Simpsons or SV Doppler method for LV systolic function?
SV doppler method
why is any error of measurement of the LVOT concerning
it will result in false measurements that will be magnify by 4 X they real value
when doing an PW of the LVOT where should you place the SV
where you measured the LVOT diameter
what does EF calculate
amount of volume ejected from the LV during systole
define FS, whats the norm value?
how is it related to EF
% of change in the minor axis of the LV
norm: >25%
-directly related to EF
why is the simpsons most often used to measure EF
- most studied
- accurate
- more universal than 3D
why does LV systolic dysfunction often occur and what can it lead to
-due to CAD
-causes decreased SV and EF which can lead to:
+ CHF
describe what happens in CHF
chambers start to enlarge due to back up of blood behind the chamber b/c it cant contract properly to move blood forward
how do we use to quantify and qualify RV systolic function
qualitative: eyeball
quantitative:
- fractional area change (FAC) (instead of Simpsons)
- TAPSE
- S prime TDI
how do we grade RV systolic function when eyeballing
norm
mildly reduced
moderately reduced
severely reduce
or hyperkinetic
what usually happens to the Rv chamber if the walls are hypokinetic
it will be dilated
what is a fractional area change (FAC) and how to we measure it.
whats the formula?
-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
whats a norm fractional area change (FAC) value
> 35%
if your TAPSE value is low, which other value will likely be low as well
s prime in TDI… s prime is a measure of velocity
what part of the ECG corresponds with s prime?
ST segment
norm S prime value
> 9.5 cm/s
when would you use 3D imaging with contrast
when 2D image quality is poor/you cant see the segments and you need to find the EF
When assessing the wall motion qualitatively, we are assessing movement of the ventricle in which plane?
Radial
