Hemodynamics, Formulas, Prosthetics Flashcards
Valve area using PHT:
MVA = 220 / PHT
TVA = 190 / PHT
Calculate PHT using deceleration time
PHT = 0.29 x DT
What is the formuala for CO?
C0 = SV x HR
Calculate SV and CO
- E wave DT - 910 ms
- Mean diastolic mitral gradient - 17 mmHg
- Diastolic mitral inflow - VTI - 66 cm
- HR - 85 bpm
- SV = CSA (MVA) x VTI
- MVA = 220/PHT
- PHT = 0.29 x DT
- SV = 0.8 cm2 x 66 cm
- CO = 53 mL x 85 b/min = 4.5 L / min
Define ductus arteriosus (PDA)?
Explain the physiology behind a ductus arteriosus
- extracardiac shunt resulting from a communication between the descending thoracic aorta (DTA) and the proximal left pulmonary artery
- in utero, the blood that reaches the pulmonary artery from the RV cannot enter the collapsed (partially functional) lungs; instead it is diverted across the ductus arteriosus into the DTA
- Soon after birth, the pressure in the pulmonary artery falls below the pressure in DTA and blood flow in the ductus arteriosus reverses its direction –> flow from DTA into pulmonary artery
- High O2 content of the ductal blood triggers closure of the ductus arteriosus in most newborns
What is the major difference in flow calculations in pateints with PDA?
- Flow exiting LVOT (normally Qs) = Qp
- Flow exiting RVOT (normally Qp) = Qs
*****Most individuals with PDA, Qp > Qs
What is the formula for shunt flow (SF) in the setting of PDA?
SF = Qp (LVOT) - Qs (RVOT)
What is a complication of (untreated) PDA?
- Eisenmenger physiology
- R-to-L shunting of deoxygenated blood
- cyanotic lower extremities because deoxygenated blood from the PA crosses the PDA and enters the DTA past the origin of the aortic arch vessels, which supply fully oxygenated blood to the head and the arms
Explain the relationship between RAP and RVDP
can be considered equal in the absence of TS
What is the formula for pressure gradient between PADP and RVDP?
- PADP - RVDP = 4V2
- absence of TS, RVDP = RAP
- PADP - RAP = 4V2
- PADP = 4V2 + RAP
- V = Vend diastolic velocity
- RAP
- > / < 2.1 cm
- > / < 50% collapse on sniff test
- 3, 8, 15 mmHg
What are findings consistent with severe MR?
- Grades 3+ and 4+
- EROA - > 0.4 cm2
- RF - > 50%
- RV - > 60 mL
- VC - > 0.7 cm
What is the formula for instantaneous flow rate across the mitral valve?
- Calculated using PISA method
- IFR = 6.28 r2 x aliasing velocity
What is the formula for SV?
SV = 0.785 x d2 x LVOTVTI
What is the formula for regurgitant volume (RV)?
RV = EROA x VTICW
What is the formula for MVA (using PISA)?
MVA = 6.28 x V2 x aliasing velocity / Peak velocityMS x angle correction
What is the formula for LVOT gradient (using MR)?
LVOT gradient = 4VMR2 + LAP - SBP
What is Teicholz formula for LV volume / SV?
SV = (7 x LVEDD3 / 2.4 x LVEDD) x LVEF
What is the formula for projected AVA?
Projected AVA = AVA rest + [(AVApeak - AVArest) / (Qpeak - Qrest)] x (250 - Qrest)
What is the formula to calculate pulmonary artery wedge pressure?
PAWP = 4.6 + 5.27 x E / Vp
- E = mitral inflow peak velocity
- Vp = flow propagation velocity of the mitral inflow (cm/s) obtained by color M-mode
What does flow propagation velocity of mitral inflow (Vp) measure?
- measures the rate at which red blood cells reach the LV apex from the mitral valve level during early diastole
- obtained on color M-mode
- indirect measure of LV relaxation
- lower the Vp, the slower the LV relaxation and higher the LVDP
Explain the findings of mitral E and A wave in the setting of elevated LAP (or PAWP)
- Peak E wave >> A wave
- Patients will have one of two patterns:
- Pseudonormal filling pattern
- E/A between 1 - 2
- E wave deceleration time > 160 ms
- Restrictive filling pattern
- E/A > 2
- E wave deceleration time < 160 ms
- Pseudonormal filling pattern
What will be the mitral E wave to mitral annular tissue Doppler e’ wave (E/e’) be in the setting of elevated LAP and PAWP?
> 15
What is a normal Vp (propagation of mitral inflow velocity)?
- Young individuals = > 55 cm/s
- Middle-aged = > 45 cm/s
What findings are consistent with severe AR?
- Grades 3+ and 4+
- EROA >0.3 cm2
- RF > 50%
- RV > 60 mL
- VC > 0.6 cm


























































