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Echo 2nd Semester > Exam 2: L+R Systolic Function > Flashcards

Exam 2: L+R Systolic Function Flashcards

To Rock this Shiz!

1
Q

Define Systole by Echo

A

(Begins with) Closure of the Mitral Valve > IVCT > (and ends with) Closure of the Aortic Valve.

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2
Q

Define Systole by EKG

A

Systole begins at the End of the PR Interval/Beginning of QRS and Ends at the end of the T Wave (IVRT)

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3
Q

Define Systole by Pressure

A

Begins with IVCT, through ejection time and ends with Ao closure and beginning of IVRT Pressure Gradients Drive Flow

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4
Q

What is LVEDV?

A

Left Ventricular End Diastolic Volume

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5
Q

What is LVESV?

A

Left Ventricular End Systolic Volume

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6
Q

What are the factors of Systolic Function? What does it depend on?

A

1) Contractility of the Myocardium 2) LV Shape and Size 3) Preload 4) After Load

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7
Q

How does Contractility affect Systolic Function?

A

Contractility is directly related to the ventricles ability to eject its volume. Various disease processes interact with and affect myocardial contractility.

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8
Q

How does LV Shape and Size affect Systolic Function?

A

Size and geometry interact with the hearts ability to fill and pump.

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9
Q

What is Preload and how does Preload affect Systolic Function?

A

Preload is the End Diastolic Volume, so reduced or increased Preload will interact with the hearts ejection of systemic blood.

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10
Q

What is After Load and how does it affect Systolic Function?

A

After load is systemic vascular resistance and disease states or physiologic conditions will cause the heart to work harder overcome increased resistance or become hypokinetic when reduced vascular resistance results.

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11
Q

What is Stroke Volume? (SV)

A

Stroke volume is the amount of blood in cc’s ejected per beat. SV = LVEDV - LVESV per beat/mL

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12
Q

How do the Myocardial Fibers contract?

A

They contract circumferentially and longitudinally. They shorten and thicken upon contraction and they lengthen and thin upon relaxation.

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13
Q

What factors affect Contractility?

A

Disease, Infarction, Valvular Disease and Dysfunction, Medication, Intercardiac Pressures, Loading Conditions, Heart Rate/Metabolic rate.

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14
Q

What Factors can affect Preload?

A

AV Valve disfunction/disease, Ventricular shape and Size, Afterload, Ao Valve Disease and disfunction, Volume overload.

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15
Q

What factors can affect After Load?

A

Systemic Vascular Resistance, either high or low, Ao valvular disease, Arterial disease such as Arteriosclerosis and atherosclerosis.

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16
Q

What is the calculation for LV Volume?

A

LVEDV and LVESV, Calculated with the method of disks in biplane (Apical 4 Chamber and the Apical 2 Chamber - Simpsons) These measures are averaged and used to calculate ejection fractions as well as diastolic and systolic volumes.

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17
Q

What is the calculation for Stroke Volume?

A

LVEDV - LVESV = SV mL/beat

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18
Q

What is the Calculation for Cardiac Output?

A

SV x HR = CO L/min

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19
Q

What are the imaging views for 2D Evaluation of the LV?

A

1) PSLX
2) PSSAX (Base to Apex)
3) Apical 4, 5, 2, 3 and Modified 4
4) Subcostal

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20
Q

In 2D Imaging, What are we looking for in evaluating the LV Regional and LV Global performance?

A

1) Size and Shape 2) Wall Motion 3) Wall Thickness 4) Overall Function 5) Myocardial Health (Bright Echoes indicate dead tissue) 6) Kinesia : norm, hypo, hyper, dyskinetic

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21
Q

The posterior wall thickness is 1.7cm and the LVID is 4cm, what is the Relative Wall Thickness?

A

Relative Wall Thickness = 2PWT/LVID 2(1.7)/4 = 0.85cm

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22
Q

What is the equation for Relative Wall Thickness?

A

Relative Wall Thickness = 2PWT/LVID

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23
Q

What are NL of PWT for Women and Men, respectively?

A

Women: 0.22 - 0.42 Men: 0.24 - 0.40

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24
Q

What is the definition of LV Mass?

A

This is the weight of the Left Ventricle in Grams.

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25
Q

What is the equation for LV Mass

A

(ASE): 1.04 [( LVID + IVSD + LVPW )3 - LVID3] x 0.8 + 0.6g

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26
Q

The LVID is 6cm, the IVSD is 1cm and the LVPW is 1.3cm. What is the LV Mass?

A

1.04 [( 6 + 1 + 1.3 )cubed] - 6 cubed ] x 0.8 + 0.6g =1.04 [572 - 216] x 0.8 + 0.6g =1.04 [356] x 0.8 + 0.6g =296.8 grams 1.04 [( LVID + IVSD + LVPW )cubed - LVIDcubed] x 0.8 + 0.6g

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27
Q

What are NL of LV Mass for Women and Men, respectively?

A

Women: 66 - 150 grams Men: 96 - 200 grams

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28
Q

What does Relative Wall Thickness evaluation accomplish?

A

It compares the LV Wall Thickness to the LV Chamber size and establishes an index.

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29
Q

What is LV dP/dT?

A

dP/dT is a measurement to evaluate LV systolic function using the MR Jet.

30
Q

How is an MR Jet useful in evaluating LV Systolic Function?

A

The MR Jet represents a continuous pressure difference between the LA and the LV. The acceleration of the jet can be used as an indicator of LV Function. There is a normal acceleration time and as the LV begins to fail, the time needed to accelerate increases. Specifically: the time interval needed to accelerate blood from 1 m/s to 3 m/s.

31
Q

What is the simplified calculation for dP/dT?

A

(3200/ Time Interval from 1 m/s to 3 m/s) dP/dT: 3200/dT =mmHg/sec

32
Q

What are the ranges for dP/dT?

A
  • NL: > 1200 mmHg/sec OR < 27 ms
  • Borderline > 1000 - 1200 mmHg/sec
  • Abnormal : < 1000 mmHg/sec OR = or > 32 ms
33
Q

How can you calculate the SV from a doppler signal?

A

SV= CSA x VTI

34
Q

How do you calculate the RAP?

A

Right Atrial Pressure is estimated by the size and collapse of the IVC added to the Pressure Gradient derived from the peak velocity of the TR jet obtained by CW doppler.

35
Q

How do you calculate the LAP?

A

Left Atrial Pressure is calculated by dividing Mitral E velocity by TDI e’ velocity x 1.25 + 1.9 = mmHg

36
Q

How do you Calculate the PA Pressure?

A

Did we cover this? I don’t think we did…

37
Q

How do you Calculate the RV Pressure?

A

RV Pressure at end diastole is the same as RAP. RV = RAP

38
Q

How do you calculate CSA when determining SV with the CSA x VTI method?

A

CSA = .785 x d2

39
Q

SV Calculations depend on what variables?

A
  1. Accurate cross sectional area
  2. Laminar Flow
  3. Good Caliper palcement
  4. Good Signal
40
Q

SV can be measured in various areas of the heart. What are they?

A

LVOT: LV stroke volume RVOT: RV stroke volume MV: LA stroke volume (?) TV: RA stroke volume (?)

41
Q

What is normal LAP?

A

9-15mmHg

42
Q

What is normal RVEDP?

A

2-8mmHg

43
Q

What is RV/PA SP?

A

15-30mmHg

44
Q

What is MPAP

A

9-18mmHg

45
Q

What is PAEDP?

A

4-12mmHg

46
Q

What is LAP

A

9-15mmHg

47
Q

What is MEAN LAP?

A

2-12mmHg

48
Q

What is LVEDP

A

Mean 3-12mmHG

49
Q

What is LVSP?

A

100-140mmHg

50
Q

IVC < 1.7cm and collapses > 50% with inspiration; Estimated RAP?

A

5mmHg

51
Q

IVC < 1.7cm and collapses < 50% with inspiration; Estimated RAP?

A

10mmHg

52
Q

IVC > 1.7cm and collapses < 50% with inspiration; Estimated RAP?

A

15mmHg

53
Q

IVC > 1.7cm with no inspiratory collapse; Estimated RAP?

A

20mmHg

54
Q

What is the Calculation for FAC?

A

RVED area - RVES area / RVED area X 100 Trace the RV in Diastole and in Systole to obtain the areas

55
Q

What are the four ways to evaluate RV Function?

A

1) Visually 2) TAPSE 3) FAC 4) Trace RV - method of disks

56
Q

What is the Calculation to estimate RV/PA pressure?

A

Estimated RAP via IVC collapse + TR Jet velocity converted to mmHg via modified Bernoulli equation 4(v2)=mmHg

57
Q

How do you calculate LAP?

A

LAP = E / e’ x 1.25 + 1.9 =mmHg E = Mitral Valve E velocity e’ = Tissue Doppler e’ velocity (during rapid filling)

58
Q

What parameters are used to evaluate RV function?

A

1) Area of the RV compared to the LV
2) Shape of the RV
3) RV Wall Thickness
4) RV Wall Motion
5) RV Function

59
Q

What is TAPSE?

A

Tricuspid Annular Plane Systolic Excursion A method of Indirect evaluation of RV systolic function and EF%

60
Q

How is the TAPSE Measurement made?

A

Modified 4 Chamber view. M-Mode with vector through the Tricuspid annulus at the lateral wall. Excursion measured from diastole to systole.

61
Q

What are TAPSE Values?

A

> 2cm is normal

2cm = >50% EF

1.5cm = 40% EF (mild)

1cm = 30% EF (moderate)

0.5cm = 20% EF (severe)

62
Q

How do you evaluate RV function visually?

A

RV size is less than LV = Normal RV dilated but still smaller than LV = Mild RV is equal to LV = Moderate RV is greater than LV = Severe (Eisenmengers or possible systemic pressures)

63
Q

What are the RV end-diastolic area values; normal, mild, moderate and severe?

A

all cm2

Normal: 11-28

Mild: 29-32

Moderate: 33-37

Severe: =>38

hint: ( next +3, next +4, next )

64
Q

What are the RV end-systolic area values; normal, mild, moderate and severe?

A

all cm2

Normal: 7.5-16

Mild: 17-19

Moderate: 20-22

Severe: =>23

hint: ( next +2)

65
Q

What are the values for RV FAC?

A

all %

Normal: 32-60

Mild: 25-31

Moderate: 18-24

Severe: =<17

hint: FAC reduces with disease hint: ( next -6 )

66
Q

What are the grades of Pulmonary Artery Pressure (SPAP)?

A

Normal: 18-25mmHg

Mild PHTN: 30-40mmHg

Moderate PHTN: 40-70mmHg

Severe PHTN: =>70mmHg

Eisenmenger’s Physiology: 120mmHg

67
Q

What are the grades of PHTN based on RVOT Acceleration Time?

A

Normal: =>120 ms

Mild PHTN: 80-100 ms

Moderate PHTN: 60-80 ms

Severe PHTN: <60 ms

68
Q

What is the value of total Pulmonary Vascular Resistance?

A

100 to 300 dynes/sec/cm-5

69
Q

What is the value of Pulmaonary Vascular Resistance?

A

20-130 dynes/sec/cm-5

70
Q

What are the indirect markers for LV Function in M-Mode?

A

Decreased AO root motion

Decreased MV D-E excursion

Decreased septal and PW motion

Dilated LV

LAE

B bump

Evidence of PHTN

Echo 2nd Semester (3 decks)

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