Diastology Flashcards by Tim Montrief

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!

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What are the 4 phases of diastole?

Isovolumetric Relaxation
Early Filling (E)
Diastasis
Late Filling (A) - Atrial Contraction

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How much LV filling occurs during atrial contraction (E) part of diastole?

20%

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How much LV filling occurs during (A) part of diastole?

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What is the deceleration time?

Time it takes to go from Peak E velocity to the baseline.

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What happens to the isovolumetric relaxation time in impaired relaxation?

Prolonged

“Decreased suck takes more time to pop open that mitral valve”

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What happens to the Peak E Velocity in impaired relaxation?

Decreased

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What happens to the Deceleration time in impaired relaxation?

Prolonged

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What do you see in decreased LV compliance with:

IVRT?

Decreased

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What do you see in decreased LV compliance with:

DT?

Decreased

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How do you distinguish normal MV inflow velocity tracing vs. pseudonormal?

Elevated LAP

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What is the x descent correlated with on the PV velocity profile?

x descent = S2 wave

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How do the pulmonary vein velocities change with increased LAP?

s wave decreases

D wave inceases

A wave becomes more negative

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What are the limitations of transmitral and pulmonary venous inflow profiles?

Loading Conditions

Nitroglycerine

Valsalva

Anesthesia

MR and MS

Arrythmias

Heart Rate

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What are the pulmonary venous velocities with severe MR?

Systolic Flow Reversal

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As HR increases, how does this affect the E/A ratio?

E/A ratio decreases

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What is a normal Color M-Mode Flow Propagation V (V_p)?

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 T_E'?

T_E' is from the onset of the R wave to when the E' wave happens in TDI.

What is the T_E 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