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Applied Cardiovascular > Evaluation of Diastolic Function > Flashcards

Evaluation of Diastolic Function Flashcards

Week 5

1
Q

____ comprises approximately 2/3 of the cardiac cycle.

A

Diastole

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2
Q

What are the four assessments of diastolic function?

A
  • LA size
  • Mitral valve inflow
  • Pulmonary vein flow
  • Tissue Doppler
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3
Q

Diastole can be divided into what four phases related to mechanical events?

A
  • Isovolumic relaxation time (IVRT)
  • Early rapid filling phase (E wave)
  • Diastasis
  • Late filling (A wave)
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4
Q

What are the most clinically relevant parameters of diastolic function?

A
  • Ventricular relaxation
  • Myocardial or chamber compliance - stiffness
  • Filling pressures
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5
Q

Ventricular Compliance is a ____ process that influences all three filling phases of diastole.

A

Passive

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6
Q

Myocardial stiffness and chamber stiffness alter ____ ____.

A

Ventricular compliance

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7
Q

If a ventricle is ____, it will not passively accept the blood from the atrium.

A

Stiff

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8
Q

Diastolic filling pressures include ____ ____ ____-____ ____ and ____ ____ ____ ____.

A

Left ventricular end-diastolic pressure (LVEDP) and mean left atrial pressure (LAP).

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9
Q

____ reflects ventricular pressure after filling is complete.

A

LVEDP

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10
Q

____ ____ ____ (LAP) is the average pressure in the LA during diastole.

A

Left atrial pressure

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11
Q

M-mode is most useful in the ____ evaluation

A

Systolic

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12
Q

What is normal LV wall thickness?

A

6-10mm

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13
Q

LV wall motion ____ may suggest possible CAD or MI.

A

Abnormalities

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14
Q

What are the clinically useful measured diastolic parameters?

A
  • Isovolumic relaxation time (IVRT)
  • Deceleration time (DT)
  • E and A velocities
  • E/A ratio
  • A wave duration
  • Pulmonary vein S, D and AR velocities
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15
Q

What is IVRT (isovolumic relaxation time)?

A

The time between aortic valve closure and mitral valve opening.

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16
Q

What is the normal IVRT range?

A

60-100 msec

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17
Q

An IVRT < ____ msec indicates decreased compliance and increased filling pressures

A

60 msec

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18
Q

An IVRT > ____ msec indicates impaired relaxation

A

100 msec

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19
Q

What is normal mitral inflow DT?

A

150-220 msec

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20
Q

Young, healthy patients often have DT < ____ msec and this is normal.

A

150 msec

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21
Q

Any DT < ____ msec or > ____ msec is abnormal in an older adult

A

150 msec; 240 msec

22
Q

In a normal mitral inflow pattern, the E wave exceeds the A-wave, so the E/A ratio is more than ____.

A

1.0

23
Q

S1 of pulmonary venous flow represents ____ ____.

A

Atrial relaxation

24
Q

The pulmonary vein “D” wave occurs after ____ ____ opening.

A

Mitral valve

25
Q

In a normal pulmonary inflow pattern, S velocity is ____ than D velocity.

A

Higher

26
Q

In a normal pulmonary inflow pattern, AR velocity is less than ____ cm/s

A

35 cm/s

27
Q

In a normal pulmonary inflow pattern, the AR – A duration (Mv-inflow) is less than ____.

A

20

28
Q

With prolonged relaxation the E/A ratio will be less than ____.

A

1.0

29
Q

With impaired pulmonary relaxation, D velocity ____ the transmitral E velocity.

A

Parallels

30
Q

When a pattern of prolonged relaxation (Grade I) occurs in the presence of increased preload, the mitral filling pattern approaches a “normal looking” pattern, termed ____ (Grade II).

A

Pseudonormalization

31
Q

Which diastolic pattern is characterized by E/A ration between 1-1.5?

A

Pseudonormal (Grade II)

32
Q

A pseudonormal diastolic pattern in characterized by a DT of ____ ms.

A

150-220 ms

33
Q

The pulmonary vein pattern and the ____ maneuver will help differentiate pseudonormal from a normal pattern.

A

Valsalva

34
Q

In pseudonormalization, the S velocity will be ____ than the D velocity, and the atrial reversal wave will be prominent.

A

Lower

35
Q

A pseudonormal diastolic pattern in characterized by an AR velocity of ____ ms.

A

> 35 ms

36
Q

With a restrictive (Reversible-Grade III) diastolic pattern, does the pattern reverse with valsalva?

A

Yes

37
Q

A grade III diastolic pattern in characterized by a DT of ____ ms.

A

< 160 ms

38
Q

What is used to record the Doppler velocities within the myocardium itself?

A

TDI

39
Q

TDI measures the ____ of the LV wall movement (E’ and A’).

A

Velocity

40
Q

E/e’ > ____ indicates significant diastolic dysfunction (aka - elevated LV filling pressure).

A

15

41
Q

In color m-mode, reduced flow velocity = reduced ____.

A

Slope

42
Q

In color m-mode, any slope less than ____ cm/sec is indicative of diastolic dysfunction.

A

45 cm/sec

43
Q

In general, the higher the E wave velocity, the higher the ____ ____ pressure

A

Left atrial

44
Q

The shorter the MV Decel time, the greater the reduction in ventricular ____.

A

Compliance

45
Q

According to the new 2016 ASE diastolic dysfunction guidelines: Average E/e’ > ____.

A

14

46
Q

According to the new 2016 ASE diastolic dysfunction guidelines: Septal e’ < ____ cm/s

A

7 cm/s

47
Q

According to the new 2016 ASE diastolic dysfunction guidelines: Lateral e’ < or = to ____ cm/s.

A

10 cm/s

48
Q

According to the new 2016 ASE diastolic dysfunction guidelines: TR vel > m/s

A

2.8 m/s

49
Q

According to the new 2016 ASE diastolic dysfunction guidelines: LA volume index > ____ mL/m2.

A

34 mL/m2

50
Q

According to the new 2016 ASE diastolic dysfunction guidelines, if more than ____ of the parameters are present, then the patient is positive for diastolic dysfunction.

A

Half

Applied Cardiovascular (12 decks)

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