Diastolic Function Flashcards
Diastole is the interval from what closure to the next?
AV closure to MV closure
Compliance is opposite to what?
Stiffness
What are the 4 phases of diastole?
IVRT, early phase, diastasis, late phase
Explain what IVRT is:
No change in volume, pressure is falling
Explain what early phase is:
Rapid filling of the LV
Explain what diastasis is:
Pressures equalize between LV and LA
Explain what late phase is:
atria contract and push rest of blood through AKA atrial kick
Once LV pressure falls below the LA pressure, what will open?
Mitral valve
IVRT is influenced by what 3 things?
Conduction, loading conditions, age
What is normal IVRT?
50-100 ms
What is the deceleration time during early rapid filling phase?
When the LA-LV pressure gradient begins to fall which results in a slowdown of blood entering the LV
Which phase of diastole contributes to 70-80% of total diastolic filling?
Early rapid filling phase
How long should the early rapid filling phase last?
150-200 ms
Which phase of diastole has the LV and LA pressure almost equal?
Diastasis
The length of diastasis is determined by what?
Heart rate
A slow heart length would mean what length of diastasis?
Long
A fast heart rate would mean what length of diastasis?
Short or absent
Diastolic dysfunction refers to the changes in LV filling properties while elevated filling pressures refers to what?
The consequence of diastolic dysfunction
A higher preload would mean a larger increase or decrease in end-diastolic pressure?
Increase
What is considered abnormal for LA volume?
> 34 ml/m2
What are three examples of primary myocardial disease?
Dilated CMO, infiltrative myocardial disease, hypertrophic CMO
What are three examples of secondary hypertrophy?
Hypertension, aortic stenosis, severe mitral regurgitation
What are two examples of coronary artery disease?
Ischemia and infarct
What are two examples of extrinsic factors?
Pericardial tamponade and pericardial constriction
What is the physiology of Grade 1 diastolic function and its degree of severity?
Impaired relaxation, mild diastolic dysfunction
What is the physiology of Grade 2 diastolic function and its degree of severity?
Pseudo-normal, moderate diastolic dysfunction
What is the physiology of Grade 3 diastolic function and its degree of severity?
Restrictive filling, severe diastolic dysfunction
Why does the LV fill at low pressures?
Myocardium is compliant
Due to vigorous elastic recoil of the LV, 70% of the filling occurs during which phase of diastole?
Early filling
What is the normal value for E wave of mitral inflow?
0.6-1.3 m/s
What is the normal value of deceleration time of mitral inflow?
160-200 ms
What is the normal value for E/A ratio of mitral inflow?
≥0.8
Delayed or slowed myocardial relaxation with normal filling pressures will prolong what?
IVRT and DT
What are two factors that affect filling?
Chamber compliance and extrinsic factors
What does e’ represent with tissue Doppler?
Lengthening of the ventricle during early filling
What does a’ represent with tissue Doppler?
Atrial contraction
What does s’ represent with tissue Doppler?
Systolic contraction (ventricular shortening)
What is a normal measurement for the medial (septal wall) with tissue Doppler?
> 7 cm/s
What is a normal measurement for the lateral wall with tissue Doppler?
> 10 cm/s
What is the normal E/e’ ratio with tissue Doppler?
<8
What things will you see with mild diastolic dysfunction?
- 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
With higher levels of diastolic dysfunction, the TR jet velocity will increase or decrease?
Increase
Why would the TR jet velocity increase with higher level of diastolic dysfunction?
Due to high filling pressures backing up to the right heart
What does SOBOE stand for?
Shortness of Breath on Exertion
During which times do the pulmonary veins fill the LA?
Ventricular systole, early diastole, diastasis
When is flow reversed in the pulmonary veins?
Atrial systole
MV inflow a wave and pulmonary vein a wave are caused by which same event?
Atrial contraction
With DD, the PV atrial reversal wave does what to velocity?
Increases it
With DD, the PV atrial reversal wave does what to duration?
Increases it
Where can atrial reversal be seen?
Just after the P wave
With DD, the MV a wave decreases what?
Duration
What is a normal measurement for PVa-MVa?
<20 ms
What is a severe measurement for PVa-MVa?
≥30 ms
What is a normal measurement for LA volume index?
16-34 ml/m2
What is a severe measurement for LA volume index?
> 48 ml/m2
The TR jet is an accurate reflection of what?
Left heart filling pressures
As the LV becomes less compliant, pressures in in the LV, LA, pulmonary veins, lungs, pulmonary artery, and RV all will do what?
Increase
Grade 2 diastolic dysfunction is also known as what?
Pseudo-normal
What are key hemodynamic characteristics for someone with pseudo-normal DD?
Impaired relaxation and moderate reduction in LV compliance, increased LAP
How can you unmask pseudo-normal?
Perform valsalva maneuver
What will happen if a patient performs valsalva with suspicion of pseudonormal (and actually has Grade II DD)
It should go back to Grade 1 and E wave will reduce by 50%
What is the wave seen during diastasis known as?
L wave
Where is the L wave commonly seen?
With LVH and lower heart rates
If someone who had an L wave’s heart rate increased, what would happen?
L wave would become E
What are the hemodynamic characteristics of someone with Grade 3 DD?
Reduced LV compliance, increased filling pressures, high E wave, short DT, increased LAP
What are some symptoms of Grade 3 DD?
Dyspnea with minimal exertion, reduced exercise tolerance, pedal of abdominal edema
What kind of DT would you see with someone with Grade 3 DD?
Short
In pseudo-normal, the TDI e’ should be less or more than the MV e’?
Less
What are the 3 key differences between RV and LV diastolic dysfunction?
- RV velocities vary with respiration
- RV inflow velocities are lower
- RV diastolic filling time is longer
What does the E/A ratio look like with RV impaired relaxation?
<0.8
