C16: Intro to Diastolic Function

Question 1

define diastole

Answer 1

• phase of the cardiac cycle where the chambers relax and fill w/ blood.
• interval from AV closure to MV closure

Question 2

define relaxation

Answer 2

relaxation of the ventricles including IVRT and early filling

Question 3

define compliance

Answer 3

change in volume/change in pressure (Dv/Dp) in the LV during diastole….

e.g. how elastic are the fibers

Question 4

compliance is inverse to _____?

Answer 4

stiffness

Question 5

how does the fitness level of the heart effect relaxation time

Answer 5

-more fit= faster to relax

Question 6

is a thickened ventricle muscle more or less compliant

Answer 6

less

Question 7

define stiffness

Answer 7

change in pressure/change in volume in the LV during diastole….

Question 8

are filling pressures high or low w/ a compliant ventricle

Answer 8

low

Question 9

filling pressures include 2 pressure values?

Answer 9

includes LV end-diastolic press and mean LA press over the diastolic period

Question 10

what is LVEDP

Answer 10

LV end-diastolic press… reflects the LV press after filling is completed (after the MV doppler A wave)

Question 11

what is mean LAP

Answer 11

avg press during the LV filling period

Question 12

define diastolic function

Answer 12

ability of the ventricles to fill to a proper volume at end-diastole to ensure theres enough blood volume ejecting during systole

Question 13

what does norm diastolic function mean

Answer 13

the LV can fill to a normal volume w/ low filling press in the LV and LA during rest or exercise because the myocardium is compliant

Question 14

what does diastolic dysfunction mean

Answer 14

the LV can fill to a normal volume but only when the filling press increases to abnormal levels in the LA and LV because the LV is stiff

Question 15

is there and change in blood volume during IVRT

Answer 15

no

Question 16

what does a larger press difference b/w the LA and LV indicate about the velocity of blood and filling volumes of the LV

Answer 16

-means there will be increase velocity and increased volume moved from LA to LV

Question 17

which phase of the heart shortens the most with increased HR

Answer 17

diastasis

Question 18

on a PW of MV inflow, where would we measure the IVRT

Answer 18

from the closing click of the AV to the opening of the MV

Question 19

the LA and LV should fill properly under what amount of pressure to be considered normal

Answer 19

< 12 mmHg… >15 is elevated

Question 20

elevated filling pressures are the consequence of what type of heart dysfunction

Answer 20

diastolic dysfunction

Question 21

what happens to the stiffness and pressure of the LV when it loses its ability to relax

Answer 21

-both stiffness and pressure increase

Question 22

what are the 5 factors effecting filling

Answer 22

1. compliance
2. hypertrophy/infiltrative disease
3. extrinsic factors (pericardial stiffness)
4. LV muscle remodeling
5. Normal changes w/ aging… fibrotic changes in the LV increases the LV stiffness as you age

Question 23

how will diastolic dysfunction effect the spectral tracing of the MV PW?

Answer 23

• prolonged IVRT and DT

- reduced E wave (due to smaller press gradient b/w LA and LV) and increase A wave

Question 24

what specifically factors effect early diastolic filling

Answer 24

1. preload
2. hyper/hypovolemia
3. excessive MV regurg (will increase volume of blood moving past the MV)

Question 25

what specifically factors effect late diastolic filling

Answer 25

• cardiac rhythm (a fib/a flutter)/HR
• atrial contractile function
• increased LVEDP
• ventricular diastolic function

Question 26

is SOB and symptom of diastolic dysfunction?

Answer 26

yes

Question 27

are short TDI waves concerning

Answer 27

yes… means the ventricle is stiff

Question 28

the lateral and medial TDI valves can be as high as _____?

Answer 28

30 cm/s

Question 29

is a larger E/e prime ratio good or bad?

Answer 29

higher ratio is abnormal and means theres higher filling press

Question 30

if the LV diastolic dysfunction of abnormal for a period of time the increased filling press will lead to and increase pressure in which other area?
why?

Answer 30

lungs

-due to backwards transmission of pressure

Question 31

how can an increase in press in the lungs be measured?

Answer 31

via the RVSP method

Question 32

higher levels of diastolic dysfunction are associate w/ which 2 abnormal values?

Answer 32

TR jet velocity of > 2.7
Or
RVSP > 40mmHg

Question 33

what 2 changes in the LV and the LA are commonly seen w/ diastolic dysfunction

Answer 33

• LV wall thickening

- LA enlargement

Question 34

what is one of the biggest causes of diastolic dysfunction and why?

Answer 34

• hypertension…. b/c its a high after load condition that leads to increase LV muscle mass and thickness which makes it less compliant… which leads to increased filling press
• will also increase the size of the LA

Question 35

if the E/e prime value is 12, what can we assume?

Answer 35

there is some level of diastolic dysfunction but the LV is still filling under normal pressures.

Question 36

what value E/e prime value is considered elevated

Answer 36

> /= 15

Question 37

what is a normal E/e prime value?

Answer 37

= 8

Question 38

What might lead to a small E wave and a large A wave

Answer 38

A stiff ventricle… the LV cant relax as quickly which decreases the pressure gradient b/w the LV and LA…. less pressure means slower velocity and less volume entering the ventricle

Question 39

What does it mean if you have a small e prime and a large E wave?

How will this effect E/e prime ratio?

Answer 39

It means that the ventricle is stiff BUT the LV is still filling to adequate volumes due to a increase in L heart pressure

E/e prime ratio will be larger (< 8)