Diastology Flashcards
What is the quick way to assess diastologic function using one test?
e’ > 10 cm/s = Improved mortality compared to <10
e’ <10 cm = Worse mortality!
What are the 4 phases of diastole?
- Isovolumetric Relaxation
- Early Filling (E)
- Diastasis
- Late Filling (A) - Atrial Contraction
How much LV filling occurs during atrial contraction (E) part of diastole?
20%
How much LV filling occurs during (A) part of diastole?
What is the deceleration time?
Time it takes to go from Peak E velocity to the baseline.
What happens to the isovolumetric relaxation time in impaired relaxation?
Prolonged
“Decreased suck takes more time to pop open that mitral valve”
What happens to the Peak E Velocity in impaired relaxation?
Decreased
What happens to the Deceleration time in impaired relaxation?
Prolonged
What do you see in decreased LV compliance with:
IVRT?
Decreased
What do you see in decreased LV compliance with:
DT?
Decreased
How do you distinguish normal MV inflow velocity tracing vs. pseudonormal?
Elevated LAP
What is the x descent correlated with on the PV velocity profile?
x descent = S2 wave
How do the pulmonary vein velocities change with increased LAP?
s wave decreases
D wave inceases
A wave becomes more negative
What are the limitations of transmitral and pulmonary venous inflow profiles?
Loading Conditions
Nitroglycerine
Valsalva
Anesthesia
MR and MS
Arrythmias
Heart Rate
What are the pulmonary venous velocities with severe MR?
Systolic Flow Reversal
As HR increases, how does this affect the E/A ratio?
E/A ratio decreases
What is a normal Color M-Mode Flow Propagation V (Vp)?
is M > 45-50 cm/sec = Norrmal
What view to get Color M-Mode Flow Propagation V (Vp)?
4 chamber
Where is your spectal doppler profile aligned using Color M-Mode Flow Propagation V (Vp)?
MV annulus to LV Apex
Where do you have to measure from the annulus into the LV cavity when performing Color M-Mode Flow Propagation V (Vp)?
4 cm into the LV cavity
How can the E/Vp ratio predict PCWP?
Is their a caveat?
E/Vp > 2.5 then PCWP >15
Caveat = Only if LVEF is <55%
What is the amplitude of Tissue Doppler?
High Amplitude
What is the velocity of Tissue Doppler?
Low velocity
What are the waves of tissue doppler?
Systolic (S’)
Early (e’)
Late (a’)
What should you keep your angle at when performing Tissue Doppler?
<20 degrees
When performing tissue doppler, what should you average them over?
3 cardiac cycles
Is tissue doppler septal and lateral velocities load dependent or load independent?
Load independent
The sicker they are, the better the measurement
What is an abnormal E’ wave?
<8 cm/sec
What is an normal E’ wave?
e’ > 10 = Good
What Tissue Dopple e’/a’ ratio is concerning?
e’/a’ <1 = Bad
Why is e’/a’ measurement valuable?
Independent of angle
What is the e’ <8-10?
Then you need to further evaluate (See algorithm) to determine diastolic function
How does preload affect the M-Mode flow propagation velocity (Vp)?
Vp increases with increases in preload in all patients
Is Mitral annular tissue velicty load dependent or load independent?
(Explain)
Load independent ONLY in patients with diastolic dysfunction
What is the reliability of E/e’?
Unreliable in normal patients
What is the TE’?
TE’ is from the onset of the R wave to when the E’ wave happens in TDI.
What is the TE interval?
Prolonged with Impaired relaxation and is strongly dependent on tau = The time constant of LV relaxation
What is the Lateral Mitral Annular Tissue Doppler in Cardiac Tamponade?
Normal
What is the Lateral Mitral Annular Tissue Doppler in Constrictive pericarditis?
Normal
