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Annette Vegas TEE Notes > Ch 6 Global LV Systolic Function > Flashcards

Ch 6 Global LV Systolic Function Flashcards

1
Q

What are the 3 movements the heart contracts in systole?

A
  1. Base to Apex Longitudinal Shortening of Subendocardium (Displacement base toward apex)
  2. Radial Thickening inwards around the long axis of the subepicardium
  3. Circumferential Torsion of the Base Clockwise and Apex Counterclockwise (TORQUE)
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2
Q

How does the LV maintain its circular shape in the cardiac cycle?

A

The interventricular septum functions as part of the LV

  • (Maintains its shape)
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3
Q

The Posterior interventricular artery arises from RCA in what percentage?

A

85%

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4
Q

The Posterior interventricular artery arises from LCx in what percentage?

A

8%

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5
Q

The Posterior interventricular artery arises from both RCA and LCx in what percentage?

A

7%

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6
Q

What supplies the interventricular septum?

A

Inferior IVS = PDA
Anterior 2/3 = LAD

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7
Q

What is the cutoff for normal (No degree of dilatation) for End-Systole diameter and End-Diastole diamater?

A

Normal

ESD 23 mm

EDD 37

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8
Q

What is the cutoff for mild degree of dilatation for End-Systole diameter and End-Diastole diamater?

A

Mild

ESD 37 mm

EDD 51 mm

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9
Q

What is the cutoff for moderate degree of dilatation for End-Systole diameter and End-Diastole diamater?

A

Moderate

ESD 36 mm

EDD 60 mm

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10
Q

What is the cutoff for severe degree of dilatation for End-Systole diameter and End-Diastole diamater?

A

Severe

ESD >50 mm

EDD > 70 mm

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11
Q

When would you measure the LV diameter and wall thickness on echo?

A

Ventricular End Diastole (R wave EKG)

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12
Q

What are the cutoffs for normal:

LV Diameter?

LV Wall thickness?

A

LV Diameter < 5.5 cm

Wall thickness < 1.2 cm

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13
Q

What is Concentric Hypertrophy?

A

LV Thickening without cavity enlargement

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14
Q

What is Eccentric Hypertrophy?

A

LV Thickening and cavity enlargement

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15
Q

How do measurements on Echo differ for Edge components of M-mode vs. 2d Imaging?

A

M-Mode = Leading Edge to leading edge (LE to LE)

-

2D = Trailing edge to Leading edge (TE to LE)

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16
Q

What is the frame rate for M mode?

Frame rate for 2d?

A

M mode = 1800 FR

2D = 300 FR

17
Q

Systolic LV Function can be assesed how?

A

LV volume by measure:

1. Stroke Volume

2. Ejection Fraction

18
Q

What 4 limitations do we have on assessing LV Systolic Function?

A
  1. RWMA
  2. Foreshortening (Underestimates)
  3. Poor endocardial definition
  4. Load Dependent
19
Q

What is the gold standard for assessing LV Function?

A

Cardiac MRI

20
Q

What are the Load Dependent measures of LV Systolic Function?

A
  1. Fractional Shortening
  2. FAC (Fractional Area Change)
  3. EF (Method of Discs)
21
Q

What are the Load Independent measures of LV Systolic Function?

A

Vcf (Circumferential Fiber Shortening)

Wall Stress

TDI (Strain, SR)

22
Q

What is the formula for Stroke Volume?

A

End Diastolic Volume - End Systolic Volume

23
Q

What is the formula for cardiac output?

A

Stroke Volume x Heart Rate

24
Q

What are the two requirements you need for stroke volume via doppler method?

A
  1. Cross Sectional Area
  2. VTI
25
Q

What 4 assumptions have to be made in order to obtain SV from doppler?

A
  1. Circular Geometry
  2. Laminar Flow
  3. Parallel Intercept Angle
  4. Same Anatomic Site
26
Q

What is the average stroke volume?

A

50 - 80 cc

27
Q

What is the preferred sites of CO/SV measurements?

A
  1. LVOT
  2. Aortic Annulus
  3. Pulmonic Annulus
28
Q

When do you measure (in the cardiac cycle) the CO/SV?

A

Mid systole

29
Q

What is a shortcut formula for CSA?

A

CSA = 0.785 * D2

(CSA = 3.14 (D/2)2

30
Q

What are the assumptions we use to calculate LV volumes based on Linear M-mode and 2D images?

A
  1. LV described as prolate ellipse
  2. 2 short axis are equal
  3. Long axis is 2x short axis
  4. LV dimensions approximate the short axis
  5. Uniform wall motion
31
Q

Which gives higher volumes:

Echo vs. Angiography?

A

Angiography > Echo

32
Q

What is a normal EF?

A

55-75%

33
Q

How does a Simpson’s Biplane work?

A

Divides LV into slices of known thickness

The sum of the slices = Represents LV Volume

Length of the LV through apex is indicated

34
Q

How would you obtain Fractional Shortening?

A

Linear measurements (M mode) LV TG SAX

  • [End Diastole - End Systole] / End Diastole
35
Q

What is a normal fractional shortening?

A

26 - 45%

36
Q
A

Annette Vegas TEE Notes (20 decks)

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