Hemodynamics Flashcards
0
Q
Effective oriface area: severe
MR v AR
A
MR 0.4 cm2 vs AR 0.3 cm2
Both 60 cc/beat
Diastole longer than systole, so AR lasts longer than MR
1
Q
Regurgitant volume
A
Difference in RV stroke volume - LV stroke volume
2
Q
AS DVI
A
Lvot vti/ Ao vti
< 25 severe
3
Q
PISA eroa
A
2 pie r2 x vel of alias velocity/ vel of regurg
Mild < 20cm2, severe > 40 cm2
Rv is ero x vto
4
Q
Technical difficulties with est LV filling- tachy
A
Pr fused e/a
5
Q
L wave
A
E L A
Suggests stiff LV
6
Q
Ski slope PI
A
Indicates elevated PA pressure
7
Q
Short DT
A
Increased volume load,decreased compliance
8
Q
Annulular velocity constriction
A
L>s except constriction s> l
Annulus inversion
9
Q
MV tilt direction
A
Major oriface to free wall (posterior) to decrease turbulence
10
Q
DVI
A
Nl > 0.3
Indeterm 0.29-0.25
Severe < 0.25
11
Q
Acceleration time AT aov
A
> 100 msec stenotic
12
Q
Prosthetic valve mismatch
A
Nl > 0.85
Severe ieoa< 0.65
13
Q
p1/2 MV
A
Decl time P1/2= DT x 0.29
MVA = 220/pht
14
Q
Tricuspid stenosis
A
> 5 mmhg
15
Q
Discrete sub aortic stenosis
A
M mode flutter
Av closure premature
16
Q
Pressure recovery
A
Aortic
Mod as with small asd Ao
Ao < 3.0
17
Q
Acute severe AI affect MV
A
Diastolic MR
Premature closure MV
18
Q
Aorta marfan’s
A
5.0 cm
19
Q
Aortic insuff vena contracts
A
Mild < 0.3 cm, severe > 0.6 cm
20
Q
AS < 70, > 70
A
< 70 bicuspid
> 70 degenerative
21
Q
2D MR jet
A
< 20% mild
20-40 mod
> 40% severe
22
Q
MR vena contracta
A
< 0.3 mild
> 0.7 severe
23
Q
Mitral reg volume
A
MV stroke volume- lvot stroke volume
24
MR Rv, rf, ero
Rv < 30% mild, > 60 % severe
Rf 30 mild, 50% severe
Ero .2 mild, > 4 severe
25
MV p1/2
220/ mva
| 750/DT
26
Mitral inflow measurement
Leaflet tips
27
TAPSE
Tricuspid annular plane excursion
Nl > 1.6
Dil cardiomyopathy < 1.0 mortal 45%/yr
28
Peak to peak vs instantaneous gradient
70% max instantaneous gradient
29
LA pressure
= E/e' + 4
| Inaccurate with Mac,ms,prosthetic MV, mr, depressed ef
30
TDI settings
Wall filter off
| Gain down
31
Spectral vs color tdi
Color lower velocities
32
S1component
First pul vein wave related to LA relaxation (absent in afib)
S2: affected by Rv
Left atrial pressure- S2 primary effects as does LV shortening, and mitral annular descent
33
LV stiffens,what happens to MV inflow velocity
Decel time shortens
| E velocity height depends on la pressure- affected later
34
Findings suggesting vol overload - Doppler/ MV
High transmitral E, short decel
Low s/d ratio
High E/e ratio
35
Pisa radius severity
Mild if < 0.4
| Severe if > 1.0
36
AR mild / severe
| MR mild/ severe
Rv 60 cc severe
37
Annulus inversion
Constriction limits lateral annulus making it paradoxically less than medial annular velocities
38
Dobut low output AS
SV/EF/AVA/ mean grad
0-20 mcg dobut stress
Severe if: vel >= 4 m/sec or Ava < 1.0 with > 20% increase in SV
If SV or EF fail to increase by 20% then lack of contractile reserve
39
Pulmonary vascular resistance
```
PVR (woods units)=
10 x (vel TR jet/ VTI rvot)
```
40
Septal flattening
Elevated RV pressure- flatten systole and diastole
Volume flatten most in diastole
41
TR vena contracta
> 7 mm severe TR
42
Hepatic flow reversal
If not in sinus may have even when regurg not severe
43
Doppler signal: obstructive CM v mitral regurg?
Velocity always higher in MR than HCM
44
Pulsus paradoxus
Decline of sbp > 20 mmhg with inspiration
45
Pericardial reflection
```
Oblique sinus ( pul vein orifaces)
Transverse sinus ( great vessels
```
46
AVA
AVA= cross sectl area of lvot ( 3.14x r squ) x VTI of lvot / VTI as jet
Simplified
AVA = CSA lvot x V lvot / V max
47
Sig AI when calc AS
Vena contracta > 3mm
48
Dimensionless ratio
Outflow tract: aortic jet vel
Normal 1.0
Mild 0.5
Severe 0.25
49
Continuity MVA
SV (transmittal) / VTI of ms jet
SV determined in lvot or across pul valve
Not accurate if sig MR
50
Rheumatic dz
Mv first then 35% aov
| 6 % tricuspid valves
51
Pulm stenosis gradients
Mild < 25 mmhg peak
Moderate 25-50 mmhg
Severe > 50 mmhg peak
52
Afib and measuring tricuspid or mitral stenosis
Average mean gradient ( more representive of degree of stenosis than peak
53
PISA alias velocity
Set to 30-40cm/sec
54
Regurgitant volume
Total vol across valve- SV across competent valve
| SV= CSA x VTI = 3.14 x dia/2 sq x VTI
55
ROA
Regurg SV ( cm3) / VTI of regurg jet ( cm)
56
Vena contracta severity
AI
MR
AI < 0.3 CM mild , > 0.6 severe
| ME < 0.3 mild, > 0.7 severe
57
ROA MR short cut
Alias vel 40cm/sec
Assume MR vel 5 m/ sec
Roa is r sq / 2
58
Root replace size bicuspid aov
> 5.0 CM Ao root
| > 4.5 if avr done
59
MV anatomy:
| 2d with aortic valve in view
p1 or p2
60
Commisural view, MV
p1 lateral, a2, p3
| If move right p2 or a2
61
Constriction and restriction share what hemodynamic measurement
E short decel time
| IVRT short
62
MR vena contracta
< 0.3 mild
| > 0.7 severe
63
MR regurg volume calculation:
Mitral annular VTI x CSA mitral annulus- LVOT stroke volume
64
MR :
Regurg volume
Regurg fraction
ERO
60cc
rF < 30, > 50 %
< 0.2, > 0.4
65
```
Eoa in prosthetic MV
Mean 6.1 mmhg
MV vti 43.4
Pht40 msec
SV lovt 64 cc
```
Cannot due p1/2 ( May use serial studies)
Use continuity with SV/ prmv vti
64 cc/ 31.5= 1.94 cm2
66
PPM eoa
> 0.85 cm2/ m2 insignificant
| Obese pt bmi> 30 may not have effects ppm
67
Ppm aortic valve parameters
Peak gradient
Dvi
Accel time
Nl < 3.0 m/ sec peak, mean < 20 mmhg,dvi >0.30. Eoa > 2.1 cm2, accel time < 80 msec
68
DT
Pht= 0.29 DT
69
EOA prosthetic MV
Do not use dec time or p1/2 due to la compliance and high la pressure
Use SV lvot / MV vti
70
Loeys-dietz dz
Auto dominant - sim to marfan's
71
Transaortic CW velocity 4 m/sec and lovt pw 1.5 m/sec
| What is transvalvular gradient ?
P= 4 ( V2-V1)
| 55 mmhg
72
P1/2 affected by asd
Will shorten p1/2 and overestimate mva
73
Deceleration time: grades of diastolic dysfunction
```
Normal: DT > 160 msec
Grade 1: > 200 msec
Grade 2: 160-200 msec ( pseudo normal)
Grade 3: < 160 msec ( reversible restrictive)
Grade 4: < 160 msec. ( fixed restricted)
```
74
Pul vein diastolic dysfunction
Normal S>D, AR duration < a duration
Grade 1: S>d, AR dur < a dur
Grade 2: s a dur + 30msec
75
Vena contracta
MR
AR
Severe > 0.7 CM MR, Pisa radius > 1, RV > 60cc, roa > 0.4
Mild < 0.3cm, Pisa radius < 30cc
Severe AR: > 0.6cm mild 0.3, Rv < 30 mild, severe > 60
76
S wave
Pul vein: s1 atrial relaxation due to la pressure, contraction, relaxation
S2 from mitral descent due to stroke volume and pulm arterial tree pulse wave propagation
D
A - mitral a <25msec
77
Definition of AS in dobutamine stress echo
Ava < 1.0 CM 2
With increase in SV > 20%
Or
AV vel > 4.0 CM/sec at any flow rate
78
Late systolic velocity
Think MVP with regurg
79
Fusion of pul vein S and D waves
Occurs with pul vein escape route- ie ASD
