Constriction vs Restriction

Question 1

Cath

Answer 1

RCM - LVEDP>5mm greater than RVEDP (but can be same
CP - RVEDP=LVEDP,
RVSP<50
RVEDP>1/3 RVSP

Question 2

TTE

Answer 2

RCM - inc’d wall thickness
Thickend valves
Granular sparkling

Dec’d RV/LV vel with inspir

CP - Inc’d RVS Vel, dec’s LV Syst vel with inpsir
Expiratory augmentation of hepatic vein diastolic flow reversal

Question 3

Constriction
prior chest radiation
prior CTS
repeated pericaritis

Answer 3

high RAP -> rapid filling of LV - rapid Y-descent
Septal bounce (RV fills so LV can’t simultaneously)
>30% reduction in MV filling with inpsiration
>60% reduction in TV filling with expiration
hepatic vein flow reversal during expiration
enhanced ventricular interdepedence
equalization of end diastolic pressures (RV/LV)
No pulm HTN
Dip and plateau diastolic waveforms
TTE doppler - enhanced TDI septal (annulus reversus)

Question 4

Restriction

Answer 4

Low voltage on ECG despite thick walls on echo
Biatrial enlargement without valvular disease
Equalization of pressures/rapid Y descent/SqRt sign (both constriction and restriction)
Reduced e’ (high e’ with restriction)
Dx with endomyocardial bx