Diastolic Dysfunction

Question 1

Mitral valve PW Doppler should be measured over how many cycles and at what point in respiration?

Answer 1

Over 3 cycles at end expiration.

Question 2

An E/A ratio of what indicates Grade I, Normal, Grade II and Grade III diastolic dysfunction?

Answer 2

Grade I; E/A <1 | Normal & Grade II; E/A 1-2 | Grade III; E/A >2.

Question 3

A deceleration time of what indicates Grade I, Normal, Grade II and Grade III diastolic dysfunction?

Answer 3

Grade I; >230ms | Normal & Grade II; 130-230ms | Grade III; <130ms.

Question 4

What is useful when distinguishing Grade II from normal diastolic function?

Answer 4

A Valsalva.

Question 5

What indicates a good Valsalva technique?

Answer 5

A decrease in 20cm/s in E wave velocity.

Question 6

A decrease in mitral E/A ratio of what upon Valsalva is highly specific of raised LV filling pressures?

Answer 6

≥50%

Question 7

When obtaining pulmonary vein flow patterns, PW Doppler sample volume should be placed how far into the pulmonary vein?

Answer 7

> 0.5cm.

Question 8

Pulmonary vein PW Doppler should be measured over how many cycles and at what point in respiration?

Answer 8

Over 3 cycles at end expiration.

Question 9

If there are two systolic peaks (S1 and S2), which should be used to compute the S/D ratio?

Answer 9

S2.

Question 10

An S/D>1 could indicate what?

Answer 10

Normal or mild diastolic dysfunction.

Question 11

An S/D<1 could indicate what?

Answer 11

Grade II or Grade III diastolic dysfunction.

Question 12

An a dur - A dur of what indicates raised LV filling pressure?

Answer 12

> 30ms.

Question 13

In the calculation a dur - A dur, which is taken away from which (with regards to mitral or pulmonary).

Answer 13

Pulmonary - mitral.

Question 14

When are e’ measurements unreliable?

Answer 14

In the presence of mitral annular calcification, mitral prosthetic valves and annuloplasty rings and severe mitral valve disease.

Question 15

e’ velocities should be measured over how many cycles and at what point in respiration?

Answer 15

Over 3 cycles at end expiration.

Question 16

True or false; e’ will be reduced in all grades of diastolic dysfunction.

Answer 16

True.

Question 17

Mitral E/VP ratio can be used to predict LA pressure. E/VP of greater than what indicates elevated LA pressures?

Answer 17

> 2.5

Question 18

Raised PA pressure may indicate diastolic dysfunction in the absence of what?

Answer 18

Any lung or mitral valve disease.

Question 19

True or false; LA size can be normal in Grade I diastolic dysfunction.

Answer 19

True.

Question 20

In the setting of E/A fusion, what is still considered useful when assessing diastolic dysfunction?

Answer 20

E/e’

Question 21

In the setting of Atrial Fibrillation, what is still considered useful when assessing diastolic dysfunction?

Answer 21

DT and E/e’ (averaged over 5-10 cardiac cycles; recorded from cycle lengths equivalent to a heart rate between 60-80 beats/minute).

Question 22

What can present with heart failure symptoms and restrictive filling pattern (Grade III) in the absence of diastolic dysfunction?

Answer 22

Constrictive pericarditis.

Question 23

What can distinguish constrictive pericarditis from true Grade III diastolic dysfunction?

Answer 23

Normal or increased e’ velocities.

Question 24

Mitral E Vmax and PVs are affected by what?

Answer 24

Significant mitral regurgitation.

Question 25

What is the strongest predictor of LV filling pressure in mitral valve disease?

Answer 25

a dur - A dur