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Echocardiography > Hemodynamics > Flashcards

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

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1
Q

Regurgitant volume

A

Difference in RV stroke volume - LV stroke volume

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2
Q

AS DVI

A

Lvot vti/ Ao vti

< 25 severe

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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

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4
Q

Technical difficulties with est LV filling- tachy

A

Pr fused e/a

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5
Q

L wave

A

E L A

Suggests stiff LV

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6
Q

Ski slope PI

A

Indicates elevated PA pressure

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7
Q

Short DT

A

Increased volume load,decreased compliance

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8
Q

Annulular velocity constriction

A

L>s except constriction s> l

Annulus inversion

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9
Q

MV tilt direction

A

Major oriface to free wall (posterior) to decrease turbulence

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10
Q

DVI

A

Nl > 0.3
Indeterm 0.29-0.25
Severe < 0.25

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11
Q

Acceleration time AT aov

A

> 100 msec stenotic

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12
Q

Prosthetic valve mismatch

A

Nl > 0.85

Severe ieoa< 0.65

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13
Q

p1/2 MV

A

Decl time P1/2= DT x 0.29

MVA = 220/pht

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14
Q

Tricuspid stenosis

A

> 5 mmhg

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15
Q

Discrete sub aortic stenosis

A

M mode flutter

Av closure premature

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16
Q

Pressure recovery

A

Aortic
Mod as with small asd Ao
Ao < 3.0

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17
Q

Acute severe AI affect MV

A

Diastolic MR

Premature closure MV

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18
Q

Aorta marfan’s

A

5.0 cm

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19
Q

Aortic insuff vena contracts

A

Mild < 0.3 cm, severe > 0.6 cm

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20
Q

AS < 70, > 70

A

< 70 bicuspid

> 70 degenerative

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21
Q

2D MR jet

A

< 20% mild
20-40 mod
> 40% severe

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22
Q

MR vena contracta

A

< 0.3 mild

> 0.7 severe

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23
Q

Mitral reg volume

A

MV stroke volume- lvot stroke volume

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24
Q

MR Rv, rf, ero

A

Rv < 30% mild, > 60 % severe
Rf 30 mild, 50% severe
Ero .2 mild, > 4 severe

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25
Q

MV p1/2

A

220/ mva

750/DT

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26
Q

Mitral inflow measurement

A

Leaflet tips

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27
Q

TAPSE

A

Tricuspid annular plane excursion
Nl > 1.6
Dil cardiomyopathy < 1.0 mortal 45%/yr

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28
Q

Peak to peak vs instantaneous gradient

A

70% max instantaneous gradient

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29
Q

LA pressure

A

= E/e’ + 4

Inaccurate with Mac,ms,prosthetic MV, mr, depressed ef

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30
Q

TDI settings

A

Wall filter off

Gain down

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31
Q

Spectral vs color tdi

A

Color lower velocities

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32
Q

S1component

A

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
Q

LV stiffens,what happens to MV inflow velocity

A

Decel time shortens

E velocity height depends on la pressure- affected later

34
Q

Findings suggesting vol overload - Doppler/ MV

A

High transmitral E, short decel
Low s/d ratio
High E/e ratio

35
Q

Pisa radius severity

A

Mild if < 0.4

Severe if > 1.0

36
Q

AR mild / severe

MR mild/ severe

A

Rv 60 cc severe

37
Q

Annulus inversion

A

Constriction limits lateral annulus making it paradoxically less than medial annular velocities

38
Q

Dobut low output AS

A

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
Q

Pulmonary vascular resistance

A 
PVR (woods units)=
10 x (vel TR jet/ VTI rvot)
40
Q

Septal flattening

A

Elevated RV pressure- flatten systole and diastole

Volume flatten most in diastole

41
Q

TR vena contracta

A

> 7 mm severe TR

42
Q

Hepatic flow reversal

A

If not in sinus may have even when regurg not severe

43
Q

Doppler signal: obstructive CM v mitral regurg?

A

Velocity always higher in MR than HCM

44
Q

Pulsus paradoxus

A

Decline of sbp > 20 mmhg with inspiration

45
Q

Pericardial reflection

A 
Oblique sinus ( pul vein orifaces)
Transverse sinus ( great vessels
46
Q

AVA

A

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
Q

Sig AI when calc AS

A

Vena contracta > 3mm

48
Q

Dimensionless ratio

A

Outflow tract: aortic jet vel
Normal 1.0
Mild 0.5
Severe 0.25

49
Q

Continuity MVA

A

SV (transmittal) / VTI of ms jet

SV determined in lvot or across pul valve
Not accurate if sig MR

50
Q

Rheumatic dz

A

Mv first then 35% aov

6 % tricuspid valves

51
Q

Pulm stenosis gradients

A

Mild < 25 mmhg peak
Moderate 25-50 mmhg
Severe > 50 mmhg peak

52
Q

Afib and measuring tricuspid or mitral stenosis

A

Average mean gradient ( more representive of degree of stenosis than peak

53
Q

PISA alias velocity

A

Set to 30-40cm/sec

54
Q

Regurgitant volume

A

Total vol across valve- SV across competent valve

SV= CSA x VTI = 3.14 x dia/2 sq x VTI

55
Q

ROA

A

Regurg SV ( cm3) / VTI of regurg jet ( cm)

56
Q

Vena contracta severity
AI
MR

A

AI < 0.3 CM mild , > 0.6 severe

ME < 0.3 mild, > 0.7 severe

57
Q

ROA MR short cut

A

Alias vel 40cm/sec
Assume MR vel 5 m/ sec

Roa is r sq / 2

58
Q

Root replace size bicuspid aov

A

> 5.0 CM Ao root

> 4.5 if avr done

59
Q

MV anatomy:

2d with aortic valve in view

A

p1 or p2

60
Q

Commisural view, MV

A

p1 lateral, a2, p3

If move right p2 or a2

61
Q

Constriction and restriction share what hemodynamic measurement

A

E short decel time

IVRT short

62
Q

MR vena contracta

A

< 0.3 mild

> 0.7 severe

63
Q

MR regurg volume calculation:

A

Mitral annular VTI x CSA mitral annulus- LVOT stroke volume

64
Q

MR :
Regurg volume
Regurg fraction
ERO

A

60cc
rF < 30, > 50 %
< 0.2, > 0.4

65
Q 
Eoa in prosthetic MV 
Mean 6.1 mmhg
MV vti 43.4
Pht40 msec
SV lovt 64 cc
A

Cannot due p1/2 ( May use serial studies)
Use continuity with SV/ prmv vti
64 cc/ 31.5= 1.94 cm2

66
Q

PPM eoa

A

> 0.85 cm2/ m2 insignificant

Obese pt bmi> 30 may not have effects ppm

67
Q

Ppm aortic valve parameters
Peak gradient
Dvi
Accel time

A

Nl < 3.0 m/ sec peak, mean < 20 mmhg,dvi >0.30. Eoa > 2.1 cm2, accel time < 80 msec

68
Q

DT

A

Pht= 0.29 DT

69
Q

EOA prosthetic MV

A

Do not use dec time or p1/2 due to la compliance and high la pressure
Use SV lvot / MV vti

70
Q

Loeys-dietz dz

A

Auto dominant - sim to marfan’s

71
Q

Transaortic CW velocity 4 m/sec and lovt pw 1.5 m/sec

What is transvalvular gradient ?

A

P= 4 ( V2-V1)

55 mmhg

72
Q

P1/2 affected by asd

A

Will shorten p1/2 and overestimate mva

73
Q

Deceleration time: grades of diastolic dysfunction

A 
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
Q

Pul vein diastolic dysfunction

A

Normal S>D, AR duration < a duration
Grade 1: S>d, AR dur < a dur
Grade 2: s a dur + 30msec

75
Q

Vena contracta
MR
AR

A

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
Q

S wave

A

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
Q

Definition of AS in dobutamine stress echo

A

Ava < 1.0 CM 2
With increase in SV > 20%
Or
AV vel > 4.0 CM/sec at any flow rate

78
Q

Late systolic velocity

A

Think MVP with regurg

79
Q

Fusion of pul vein S and D waves

A

Occurs with pul vein escape route- ie ASD

Echocardiography (14 decks)

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