DCM, Transplant, CRT

Question 1

in a patient w/ DCM, if LV wall thickness is normal, is there “increased LV mass?”

Answer 1

yes!

Question 2

is this the correct way to measure LVOT Diamter and TVI?

Answer 2

yes

Question 3

what is a normal e’ velocity (i.e. nl filling pressure)?

Answer 3

> .08 m/s

Question 4

in LV dysfxn , what E/ velocity will you see?

Answer 4

< .07 m/s

Question 5

what E/e’ is normal and what is c/w elevated filling pressures?

Answer 5

normal E/e’ < 8, abnormal E/e’ > 15 (e’ of medial annulus, careful with septal infarct)

Question 6

eq’n for Index of Myocardial Performance

Answer 6

IMP = (MVCO - AVET) / AVET, [MVCO = MV Closure to Opening TIME, AVET = AV Ejection Time}

Question 7

Index of Myocardial Performance, normal and abnormal values

Answer 7

Nl < 0.4, abnl > 1.0

Question 8

is Index of Myocardial Pefformance a systolic or diastolic index? is it dependent on MR severity?

Answer 8

neither, no

Question 9

is higher or lower Index of Myocardial Performance worse?

Answer 9

higher

Question 10

name the 3 steps needed to measure dP/dT (a measure of contractility)

Answer 10

1) optimize mR signal 2) dec velocity scale to 4 m/s 3) measure time (dT) from 1s to 3s.

Question 11

which of these is nl and which is poor LV fxn? Calculate dP/dT for both.

Answer 11

Question 12

the higher/lower dP/dt, the better the LV fxn? name normal and abnormal dP/dT values.

Answer 12

higher (more pressure change in less time). Nl > 1200, abn < 1000

Question 13

what 3 measurements are needed to calculate LV mass?

Answer 13

LVEDD, posterior wall thickness (diastole), septal thickness (diastole)

Question 14

review the RWT 4 x 4 table

Answer 14

Question 15

gender differences aside, what is a grossly normal and abnormal LV mass index (significant LVH)?

Answer 15

nl < 100, abn > 150 (significant LVH)

Question 16

can you use LV mass equations for distorted ventricles?- this has been a board question)

Answer 16

no (DCM lecture)

Question 17

In DCM, does a DT > 115ms or < 115ms have a poorer prognosis?

Answer 17

<115 (short decel time = stiffer ventricles)

Question 18

Diagnosis and Prognosis

Answer 18

Pulsus Alternans, poor

Question 19

diagnosis?

Answer 19

OHT (look for LA suture line/ridge)

Question 20

can you decide on offering CRT to a pt based on doppler dyssynchrony?

Answer 20

no

Question 21

what is the difference b/w these 2 strain patterns?

Answer 21

left = synchronous, right = dyssynchrony

Question 22

what M-mode septal to posterior wall delay suggests dyssynchrony?

Answer 22

> 130ms (do not make decision for CRT based on this)

Question 23

eq’n and explanation for Ritter Method to find best AV delay to program CRT

Answer 23

AVopt = AVlong - (a-b) = AVlong - (short-long). allows you to program optimal AV delay for CRT.

Question 24

when putting in an LVAD, which valve lesion needs to be addressed?

Answer 24

TR (it will worsen as more preload comes in from LVAD to RV).

Question 25

if pt gets LVAD and has a PFO, which way will the shunt be?

Answer 25

R–> L (b/c of LV unloading and dec’d pressures on left side)