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PTE Masters + A Practical Approach to Transesophageal Echocardiography > Diastology > Flashcards

Diastology Flashcards

1
Q

What is the quick way to assess diastologic function using one test?

A

e’ > 10 cm/s = Improved mortality compared to <10

e’ <10 cm = Worse mortality!

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2
Q

What are the 4 phases of diastole?

A
  1. Isovolumetric Relaxation
  2. Early Filling (E)
  3. Diastasis
  4. Late Filling (A) - Atrial Contraction
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3
Q

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

A

20%

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4
Q

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

A
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5
Q

What is the deceleration time?

A

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

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6
Q

What happens to the isovolumetric relaxation time in impaired relaxation?

A

Prolonged

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

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7
Q

What happens to the Peak E Velocity in impaired relaxation?

A

Decreased

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8
Q

What happens to the Deceleration time in impaired relaxation?

A

Prolonged

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9
Q

What do you see in decreased LV compliance with:

IVRT?

A

Decreased

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10
Q

What do you see in decreased LV compliance with:

DT?

A

Decreased

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11
Q

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

A

Elevated LAP

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12
Q

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

A

x descent = S2 wave

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13
Q

How do the pulmonary vein velocities change with increased LAP?

A

s wave decreases

D wave inceases

A wave becomes more negative

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14
Q

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

A

Loading Conditions

Nitroglycerine

Valsalva

Anesthesia

MR and MS

Arrythmias

Heart Rate

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15
Q

What are the pulmonary venous velocities with severe MR?

A

Systolic Flow Reversal

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16
Q

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

A

E/A ratio decreases

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17
Q

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

A

is M > 45-50 cm/sec = Norrmal

18
Q

What view to get Color M-Mode Flow Propagation V (Vp)?

A

4 chamber

19
Q

Where is your spectal doppler profile aligned using Color M-Mode Flow Propagation V (Vp)?

A

MV annulus to LV Apex

20
Q

Where do you have to measure from the annulus into the LV cavity when performing Color M-Mode Flow Propagation V (Vp)?

A

4 cm into the LV cavity

21
Q

How can the E/Vp ratio predict PCWP?

Is their a caveat?

A

E/Vp > 2.5 then PCWP >15

Caveat = Only if LVEF is <55%

22
Q

What is the amplitude of Tissue Doppler?

A

High Amplitude

23
Q

What is the velocity of Tissue Doppler?

A

Low velocity

24
Q

What are the waves of tissue doppler?

A

Systolic (S’)

Early (e’)

Late (a’)

25
Q

What should you keep your angle at when performing Tissue Doppler?

A

<20 degrees

26
Q

When performing tissue doppler, what should you average them over?

A

3 cardiac cycles

27
Q

Is tissue doppler septal and lateral velocities load dependent or load independent?

A

Load independent

The sicker they are, the better the measurement

28
Q

What is an abnormal E’ wave?

A

<8 cm/sec

29
Q

What is an normal E’ wave?

A

e’ > 10 = Good

30
Q

What Tissue Dopple e’/a’ ratio is concerning?

A

e’/a’ <1 = Bad

31
Q

Why is e’/a’ measurement valuable?

A

Independent of angle

32
Q

What is the e’ <8-10?

A

Then you need to further evaluate (See algorithm) to determine diastolic function

33
Q

How does preload affect the M-Mode flow propagation velocity (Vp)?

A

Vp increases with increases in preload in all patients

34
Q

Is Mitral annular tissue velicty load dependent or load independent?

(Explain)

A

Load independent ONLY in patients with diastolic dysfunction

35
Q

What is the reliability of E/e’?

A

Unreliable in normal patients

36
Q

What is the TE’?

A

TE’ is from the onset of the R wave to when the E’ wave happens in TDI.

37
Q

What is the TE interval?

A

Prolonged with Impaired relaxation and is strongly dependent on tau = The time constant of LV relaxation

38
Q

What is the Lateral Mitral Annular Tissue Doppler in Cardiac Tamponade?

A

Normal

39
Q

What is the Lateral Mitral Annular Tissue Doppler in Constrictive pericarditis?

A

Normal

40
Q
A

PTE Masters + A Practical Approach to Transesophageal Echocardiography (55 decks)

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