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Echo 2 > C2: Ventricular Systolic Function > Flashcards

C2: Ventricular Systolic Function Flashcards

1
Q

briefly describe/review IVCT, sysole, IVRT and distole

A

see notes from last semester

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2
Q

what are the systolic and diastolic pressures in the LV

A

S: 120 mmHg
D: 10 mmHg

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3
Q

what are the systolic and diastolic pressures in the RV

A

S: 25 mmHg
D: 4 mmHg

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4
Q

Mean LA pressure

A

10 mmgH

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5
Q

Mean RA pressure

A

4 mmHg

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6
Q

review ECG timing for IVCT, sysole, IVRT and distole and AP

A

see notes from last semester

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7
Q

w/ a compliant ventricle, can it accommodate an increase in volume w/o much change in pressure

A

yes

review pressure-volume loop in notes

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8
Q

what shaped pressure-volume loop does the LV have

A

rectangular

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9
Q

what shaped pressure-volume loop does the RV have

why is it different than the LV

A

triangular

lower pressures in the RH and lower impedance of the pulmonary vascular bed

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10
Q

does flow continue to enter the PA from the RV even after peak pressure is reached

A

yes

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11
Q

what 3 things determine stroke volume

A

preload
afterload
contractility/inotropy

Changing any one of these variables will effect the others

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12
Q

describe how preload effects stroke volume

A

changes in preload alter end-diastolic volume which will change the amount of starlings principle and effect SV

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13
Q

what are the 2 ways that we use to estimate preload

A

LVEDV

PVEDP or LA pressure

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14
Q

describe how afterload effects stroke volume

A

more resistance to the ventricle emptying will lead to less blood being ejected

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15
Q

in the RV or LV more sensitive to afterload

A

RV (because its less muscular so it will dilate rather than hypertrophy)

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16
Q

what are some quantitative systolic measurements

A 
FS (N: >25%)
EF (Simpsons: M: 52-72, W: 54-74, Teicholz: >/= 55%)
SV
Delta P/ Delta T
TDI
Strain
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17
Q

what are some qualitative systolic measurements

A

visual EF

segmental wall analysis (normal, hypo, akinetic, dysk.)

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18
Q

why is Teicholz less accurate than Simpsons

A

only looking at motion of 2 segments instead of 17

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19
Q

what is fractional shortening

A

% change in the minor axis dimension

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20
Q

2 methods for estimating LV volume

A

Simpsons

Area length

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21
Q

difference b/w simpsons and area length method

A

S: uses the average of the endocardial tracings in A4CH and A2CH
A: trace the LV chamber in PSAX @ the pap lvl and measure the LV length on A4CH from Mv annulus to apex

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22
Q

if you dont see 2 adjacent segments, should you do EF

A

no

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23
Q

the length of the ventricles in A2 and A4 in simpsons shouldnt differ by more than what value

A

0.5cm or 10%

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24
Q

when would you use the area/lengh method for LV volume

A

if endocardial definition is suboptimal from apical images but parasternal views are good

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25
Q

value for severely reduced Fractional Shortening for M and W

A 
M: = 14 %
W: = 16 %
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26
Q

value for severely reduced parasternal/teicholtz EF for M and W

A

Both: =30 %

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27
Q

value for severe dilation of LVIDd for M and W

A

M: >/= 69 mm
W: >/= 62 mm

28
Q

preferred SV formula/method

A

SV = pie(r^2) x VTI

29
Q

assumptions for SV calculation

A
  • accurate LVOT measurement
  • LVOT is circular
  • laminar flow
  • parallel insonation when doing PW of the LVOT to get the VTI
  • PW and LVOT measurement were made at the same place
30
Q

what does delta pressure/delta time (Dp/Dt) measure

A

measures how much time it takes for the LV pressure to rise by 32 mmHg if the LV were contracting for 1 full second….uses the MR jet

Dp will always be 32 mmHg (t in seconds) or 32000 (t in ms)

31
Q

when is Dp/Dt measured

A

pre-ejection phase (IVCT)

32
Q

is Dp/Dt more or less dependent on pre-load than SV, CO and CI
why

A

less, because its measured during the pre-ejection phase

33
Q

Dp/Dt uses which principle

A

bernoulli

34
Q

do severe MR and impaired LV systolic function often occur together

A

yes

35
Q

how can the EF remain normal or above normal with MR

A

the changes in pre-load caused by the MR

36
Q

whats the benefit of Dp/Dt being less effected by preload

A

makes it a good tool to assess the true systolic function of the LV

37
Q

limitations of Dp/Dt that make the calculation less accurate

A

valve click artifact (w/ prosthetic valves)
may not pick up eccentric MR jets
poor alignment to MR jet
non-compliant LA

38
Q

how to do Dp/Dt

A
  • optimize MR jet in CW (early systole is most important)
  • increase sweep speed to 100-200cm/s
  • draw line from 1m/s-3m/s for delta T
39
Q

norm value for delta t

how long should it take for the LV to generate 32 mmgH

A

<27 ms

40
Q

what value is severely abnormal for delta t

A

> 40 ms

41
Q

norm value for Dp/Dt

A

> 1200 (mmHg/s)

42
Q

severely abnorm value for Dp/Dt

A

<800 (mmHg/s)

43
Q

norm value for S prime velocity for LV

A

> 9 cm/s

44
Q

TDI measures the speed of LV contraction in which plane

A

longitudinal

45
Q

if E prime is depressed, how will that effect S prime

A

will also be depressed

46
Q

limitations of S prime

A
  • only reflects movement at base of the heart so wont be accurate if there are abnormal segments
  • influenced by tethering and translational motion of the heart
  • S prime velocities progressively decrease from base to apex in a norm heart
  • need optimal doppler angle
47
Q

what is tethering

A

when a hypo or akinetic segment is adjacent to a norm segment and gets pulled around by its motion

48
Q

what is LIMP and RIMP

when are they used

A

indices of myocardial performance… a ratio b/w IVCT and IVRT/ejection time

dilated cardiomyopathy
cardiac amyloidosis
pulmonary hypertension
RV infarction
RV dysplasia
49
Q

what info does IMP/MPI provide

A

info about systolic and diastolic function

50
Q

formula for MPI

A

(IVCT + IVRT) / ET

51
Q

2 methods for IMP/MPI

A

conventional doppler method (preferred)

TDI method

52
Q

norm LIMP value w/ the doppler method

norm LIMP value w/ the TDI method

A

D: < 0.44

TDI: < 0.6

53
Q

in a diseased heart, what happens to ejection time, IVRT and IVCT

A

ejection time decreases and the others increase

54
Q

if LIMP and RIMP are elevated, what does that say about pressure in the heart

A

means its taking longer for press to rise and fall

55
Q

what 2 doppler waveforms do you need to show in the same tracing for LIMP (doppler method)

what do you need to TDI method

A

LVOT outflow and MV inflow so that you can measure IVCT, IVRT and ET

TDI only tracing

56
Q

norm value for RIMP w/ doppler method

norm value for RIMP w/ TDI method

A

D: = 0.43

TDI: = 0.54

57
Q

why is the TDI method of calculating RIMP and LIMP not preferred

A

it only gives information about the walls sampled

58
Q

in A4Ch, the RV should appear how much smaller than the LV

A

less than 2/3 the size of the LV

59
Q

describe the appearance of mild dilation of the RV

A

Rv >2/3 of the LV but still smaller than LV

60
Q

describe the appearance of moderate dilation of the RV

A

RV and LV share the apex and are equal size

61
Q

describe the appearance of severe dilation of the RV

A

RV > LV size and occupies the apex

62
Q

can the RV dilate due to MR

A

yes

63
Q

norm values for RV basal, mid and length

A 
B: = 41 mm
M: = 35 mm
L: = 86 mm
64
Q

norm values for RVOT diameter prox and distal

A

prox: = 33 mm
dis: = 27 mm

65
Q

norm value for TDI s prim RV

A

> /= 9.5 cm/s

66
Q

norm value for FAC

A

> /= 35%

67
Q

in order to qualitatively assess LV systolic function of individual segments, do you need to see each segment in 2 or more views

A

yes

Echo 2 (15 decks)

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