Diastology Flashcards
What is normal diastolic filling?
The ability of the ventricles to accept blood without an abnormal increase in pressure
This occurs even during activities such as exercise.
What is the timing of ECG in relation to diastole?
From the end of T wave (closure of the SL valves) to the R wave (closure of the AV valves)
SL valves refer to semilunar valves, while AV valves refer to atrioventricular valves.
What are the four phases of diastole?
- Isovolumic relaxation time (IVRT) - all valves closed
- AV valve open (early rapid filling)
- Diastasis (LA/LV pressures equalize)
- Late filling (after P wave)
LA refers to left atrium and LV refers to left ventricle.
What occurs during isovolumic relaxation time (IVRT)?
All valves are closed
This phase marks the end of ventricular contraction and the beginning of diastole.
What happens during the early rapid filling phase of diastole?
AV valve opens
This phase allows blood to flow rapidly from the atria to the ventricles.
What is diastasis in the context of diastole?
LA/LV pressures equalize
This phase represents a brief period of minimal blood flow into the ventricles.
What occurs during the late filling phase of diastole?
Filling occurs after the P wave
The late filling phase is critical for maximizing ventricular filling before the next contraction.
True or False: The SL valves close at the beginning of diastole.
False
The SL valves close at the end of the T wave, marking the end of systole.
What marks the closure of the AV valves?
R wave
This closure signifies the end of ventricular filling and the onset of isovolumic contraction.
What are the echo measurements required to assess diastolic function
-pw Doppler of MV
-pw Doppler of RUPV
-lateral and septal MV tdi e prime
-LA volume on 2ch and 4ch
Values for LA vol index
16-34 ml/m^2
35-41 mL/m^2
42-48 mL/m^2
> 48
What is the peak s’ velocity related to?
It occurs due to the contraction (coil) of the LV
LV stands for left ventricle.
What do IVRT velocities indicate?
They occur due to a rapid change in ventricular volume/pressure
IVRT stands for Isovolumetric Relaxation Time.
What causes diastasis velocities?
They occur due to the competing, near-equalization of pressure in the LA and LV
LA stands for left atrium.
The peak a velocity occurs due to what?
It occurs due to atrial contraction (always after the ECG P-wave)
The P-wave corresponds to atrial depolarization in an ECG.
What is normal values for septal and lateral e prime
-septal e prime = > 7cm/s
-lateral e prime = > 10 cm/s
What is the first method used to estimate mean LAP?
Peak MV E wave velocity is measured
MV refers to mitral valve.
What is measured to estimate mean LAP alongside Peak MV E wave velocity?
Peak TDI e’ velocities from the septal and lateral annulus are measured (averaged)
TDI stands for tissue Doppler imaging.
How is the E/e’ ratio calculated?
E wave velocity divided by average e’ velocities
This ratio helps assess left atrial pressure.
What E/e’ ratio is highly suggestive of normal LAP?
E/e’ ratio < 8
Indicates normal left atrial pressure.
What E/e’ ratio is suggestive of elevated LAP?
E/e’ ratio > 14
Indicates potential heart dysfunction.
What should be done with E/e’ ratios between 8-14?
Require the use of other diagnostic criteria
This range suggests uncertainty in LAP assessment.
What are the 4 determinants for DD with normal EF
1) Avg E/e prime ratio
2) septal and lateral e prime
3) TR velocity
4) LA vol
Avg E/e prime ratio representing potential dysfunction
> 14
If EF is abnormal what 3 determinants do you look at first
1) E/A < .8 + E velocity < 50cm/s = NL LAP grade 1 DD
2) E/A < .8 + E > 50 cm/s, must also assess Avg E/e prime, TR vel, LA vol
3) E/A > 2 = elev LAP and grade 3 DD
