Chamber / Function / M mode Flashcards
Linear method calculation of LV mass
1.04 x [(IVS + LVID + PWT)^3 - LVID^3] -13.6
Normal LV mass index
Women <= 95 g/m2
Men <= 115 g/m2
Relative wall thickness calc
(2xPWTd) / LVIDd
Normal relative wall thickness
<= 0.42
Concentric Remodeling
Normal LV mass index
Increased RWT
Eccentric hypertrophy
High LV mass index
Normal RWT
Concentric hypertrophy
High LV mass index
High RWT
Fractional Shortening for EF
(LVEDD - LVESD) / LVEDD
Normal FS
>= 18% 2D >= 25% M-mode
Quinones Equation for EF
EF = (LVEDD^2 - LVESD^2) / LVEDD^2 + (Apical factor)
Apical factor
Normal +10% Hypok +5% Akinetic +0% Dyskinetic -5% Aneurysm -10%
Volumetric EF
EF = (EDV - ESV) / EDV
Recommended method
Stroke volume
EDV - ESV
Long axis walls
Anterior septum
Inferior lateral
Two chamber walls
Anterior wall
Inferior wall
Four chamber walls
Inferior septum
Anterior lateral wall
LAD walls
Anterior wall
Anterior septum
Most of apex
RCA walls
Inferior wall
Inferior septum
Lcx walls
+/- Anterior lateral
+/- Inferior lateral
Wall motion score index
1 = Normal 2 = Hypo 3 = Akinetic 4 = Dyskinetic / aneurysmal
SAM septal contact
Duration of sam-septal contact / time from onset of systole to onset of sam-septal contact
Correlates with peak LVOT gradient
MVP M-Mode
Systolic bowing of leaflet tips >= 3mm below C-D line
TV leaflets on 4 chamber view
Septal and anterior
Assumed LV geometry for LV mass and volume calculations
Ellipsoid
Systolic function parameter independent of preload
End-systolic volume
Soft first heart sound
1st degree AVB
Linear dimension measurement method
Tissue-blood interface
LV vol versus angiography
Smaller
Paradoxical septal motion definition
Early systolic rightward motion
Paradoxical septal motion causes
RV volume overload
LBBB / RV pacing
Post-cardiac surgery
Pseudodyskinesis def
Diastolic flattening of the inferior / inferolateral wall
Pseudodyskinesis cause
Abdominal process such as liver disease
LV dimensions measurement level
At or immediately below level of tips of mitral leaflets in parasternal long axis
M mode with early mitral valve closure
Acute severe AR
PW doppler PV mid-systolic notch
Severe pulmonary artery hypertension
M mode of PV in PAH
Absent a wave
Prolongation of preejection period
mid-systolic notching (flying W sign)
B bump
M mode with bump after A wave of MV
LVEDP elevated
M mode sub aortic membrane
Abrupt, very early posterior motion of right cusp of aortic valve
M mode left atrial myxoma
Tumor appears as mass of echoes behind mitral valve during diastole
M-mode LVOT dynamic obstruction
Mid-systolic closure of AV
M-mode PPM
Early downward septal motion
Significant delay
Peak upward motion of posterior wall
M mode rheumatic MS
Reduced E-F slope
Prominent early diastolic dip
Paradoxical anterior motion of septum in systole
M-mode constriction
Septal shudder in early diastole
Flattening of posteiror wall in diastole
M-mode preexcitation
Inward movement of posterior wall prior to septum
Left atrial measurement
End of LV systole
Dedicated LA images
Tracing left atrium exclude
PVs
LAA
Tracing LA AV interface
Mitral annulus plane
Limitation of 3D LA volume
Lack of standardized methodology
RA volume views
4 chamber view by gender, index by BSA
Normal RA volume men
25 +/- 7
Normal RA volume women
20.5 +/- 6
Measuring AV annulus diameter
Calcium protuberances considered part of lumen
Calcium affects accuracy
PLAX view, mid-systole
Approximates minor axis of elliptical aortic annulus
IVC in athletes
May be dilated with normal collapse
Views for RV function
Modified apical 4 RV focused apical 4 Left parasternal long and short Left parasternal RV inflow Subcostal
RV EF metho
Use 3D
RV EF normal
> 45
Limitations for 3D RV EF
Significant TR Post-op state with paradoxical septal motion Very large ventricle Poor windows Irregular rhythm
Normal RV dimension at base
<= 41mm
Normal RV dimension at mid-level
<= 35mm
Normal RV Sā
> = 9.5
Normal TAPSE
> = 17 mm
Fractional shortening of LV not reliable when
Regional wall motion abnormalities
Assessment of contractility
Systolic strain rate
Wall stress proportionate to
Transmural pressure
Chamber size
Wall stress inversely proportionate to
Wall thickness
Quantification of wall motion abnormality
Thickening <50%, excursion <5mm
95% CI for EF
+/- 11%
95% CI for LV mass
+/- 60g
Hemodynamic condition with worse strain
Decreased preload