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ECHO 325 > Diastolic Function > Flashcards

Diastolic Function Flashcards

1
Q

Diastole is the interval from what closure to the next?

A

AV closure to MV closure

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2
Q

Compliance is opposite to what?

A

Stiffness

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3
Q

What are the 4 phases of diastole?

A

IVRT, early phase, diastasis, late phase

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4
Q

Explain what IVRT is:

A

No change in volume, pressure is falling

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5
Q

Explain what early phase is:

A

Rapid filling of the LV

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6
Q

Explain what diastasis is:

A

Pressures equalize between LV and LA

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7
Q

Explain what late phase is:

A

atria contract and push rest of blood through AKA atrial kick

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8
Q

Once LV pressure falls below the LA pressure, what will open?

A

Mitral valve

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9
Q

IVRT is influenced by what 3 things?

A

Conduction, loading conditions, age

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10
Q

What is normal IVRT?

A

50-100 ms

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11
Q

What is the deceleration time during early rapid filling phase?

A

When the LA-LV pressure gradient begins to fall which results in a slowdown of blood entering the LV

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12
Q

Which phase of diastole contributes to 70-80% of total diastolic filling?

A

Early rapid filling phase

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13
Q

How long should the early rapid filling phase last?

A

150-200 ms

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14
Q

Which phase of diastole has the LV and LA pressure almost equal?

A

Diastasis

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15
Q

The length of diastasis is determined by what?

A

Heart rate

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16
Q

A slow heart length would mean what length of diastasis?

A

Long

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17
Q

A fast heart rate would mean what length of diastasis?

A

Short or absent

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18
Q

Diastolic dysfunction refers to the changes in LV filling properties while elevated filling pressures refers to what?

A

The consequence of diastolic dysfunction

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19
Q

A higher preload would mean a larger increase or decrease in end-diastolic pressure?

A

Increase

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20
Q

What is considered abnormal for LA volume?

A

> 34 ml/m2

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21
Q

What are three examples of primary myocardial disease?

A

Dilated CMO, infiltrative myocardial disease, hypertrophic CMO

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22
Q

What are three examples of secondary hypertrophy?

A

Hypertension, aortic stenosis, severe mitral regurgitation

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23
Q

What are two examples of coronary artery disease?

A

Ischemia and infarct

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24
Q

What are two examples of extrinsic factors?

A

Pericardial tamponade and pericardial constriction

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25
Q

What is the physiology of Grade 1 diastolic function and its degree of severity?

A

Impaired relaxation, mild diastolic dysfunction

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26
Q

What is the physiology of Grade 2 diastolic function and its degree of severity?

A

Pseudo-normal, moderate diastolic dysfunction

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27
Q

What is the physiology of Grade 3 diastolic function and its degree of severity?

A

Restrictive filling, severe diastolic dysfunction

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28
Q

Why does the LV fill at low pressures?

A

Myocardium is compliant

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29
Q

Due to vigorous elastic recoil of the LV, 70% of the filling occurs during which phase of diastole?

A

Early filling

30
Q

What is the normal value for E wave of mitral inflow?

A

0.6-1.3 m/s

31
Q

What is the normal value of deceleration time of mitral inflow?

A

160-200 ms

32
Q

What is the normal value for E/A ratio of mitral inflow?

A

≥0.8

33
Q

Delayed or slowed myocardial relaxation with normal filling pressures will prolong what?

A

IVRT and DT

34
Q

What are two factors that affect filling?

A

Chamber compliance and extrinsic factors

35
Q

What does e’ represent with tissue Doppler?

A

Lengthening of the ventricle during early filling

36
Q

What does a’ represent with tissue Doppler?

A

Atrial contraction

37
Q

What does s’ represent with tissue Doppler?

A

Systolic contraction (ventricular shortening)

38
Q

What is a normal measurement for the medial (septal wall) with tissue Doppler?

A

> 7 cm/s

39
Q

What is a normal measurement for the lateral wall with tissue Doppler?

A

> 10 cm/s

40
Q

What is the normal E/e’ ratio with tissue Doppler?

A

<8

41
Q

What things will you see with mild diastolic dysfunction?

A
  • Reduced E/A ratio (<0.8)
  • Reduced E velocity
  • Prolonged DT (>200ms)
  • Reduced TDI (IVS <7 cm/s, lat <10 cm/s)
  • E/e’ <14
  • TR velocity jet <2.8 m/s
42
Q

With higher levels of diastolic dysfunction, the TR jet velocity will increase or decrease?

A

Increase

43
Q

Why would the TR jet velocity increase with higher level of diastolic dysfunction?

A

Due to high filling pressures backing up to the right heart

44
Q

What does SOBOE stand for?

A

Shortness of Breath on Exertion

45
Q

During which times do the pulmonary veins fill the LA?

A

Ventricular systole, early diastole, diastasis

46
Q

When is flow reversed in the pulmonary veins?

A

Atrial systole

47
Q

MV inflow a wave and pulmonary vein a wave are caused by which same event?

A

Atrial contraction

48
Q

With DD, the PV atrial reversal wave does what to velocity?

A

Increases it

49
Q

With DD, the PV atrial reversal wave does what to duration?

A

Increases it

50
Q

Where can atrial reversal be seen?

A

Just after the P wave

51
Q

With DD, the MV a wave decreases what?

A

Duration

52
Q

What is a normal measurement for PVa-MVa?

A

<20 ms

53
Q

What is a severe measurement for PVa-MVa?

A

≥30 ms

54
Q

What is a normal measurement for LA volume index?

A

16-34 ml/m2

55
Q

What is a severe measurement for LA volume index?

A

> 48 ml/m2

56
Q

The TR jet is an accurate reflection of what?

A

Left heart filling pressures

57
Q

As the LV becomes less compliant, pressures in in the LV, LA, pulmonary veins, lungs, pulmonary artery, and RV all will do what?

A

Increase

58
Q

Grade 2 diastolic dysfunction is also known as what?

A

Pseudo-normal

59
Q

What are key hemodynamic characteristics for someone with pseudo-normal DD?

A

Impaired relaxation and moderate reduction in LV compliance, increased LAP

60
Q

How can you unmask pseudo-normal?

A

Perform valsalva maneuver

61
Q

What will happen if a patient performs valsalva with suspicion of pseudonormal (and actually has Grade II DD)

A

It should go back to Grade 1 and E wave will reduce by 50%

62
Q

What is the wave seen during diastasis known as?

A

L wave

63
Q

Where is the L wave commonly seen?

A

With LVH and lower heart rates

64
Q

If someone who had an L wave’s heart rate increased, what would happen?

A

L wave would become E

65
Q

What are the hemodynamic characteristics of someone with Grade 3 DD?

A

Reduced LV compliance, increased filling pressures, high E wave, short DT, increased LAP

66
Q

What are some symptoms of Grade 3 DD?

A

Dyspnea with minimal exertion, reduced exercise tolerance, pedal of abdominal edema

67
Q

What kind of DT would you see with someone with Grade 3 DD?

A

Short

68
Q

In pseudo-normal, the TDI e’ should be less or more than the MV e’?

A

Less

69
Q

What are the 3 key differences between RV and LV diastolic dysfunction?

A
  • RV velocities vary with respiration
  • RV inflow velocities are lower
  • RV diastolic filling time is longer
70
Q

What does the E/A ratio look like with RV impaired relaxation?

A

<0.8

ECHO 325 (19 decks)

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