Lecture 2 - Assessing for Diastolic Dysfunction with Doppler Echocardiography

Question 1

Diastolic Dysfunction leads to an increase in… ?

Answer 1

LV and LA diastolic pressures

Question 2

What are 4 causes of Diastolic Dysfunction?

Answer 2

• Primary myocardial disease (dilated cardiomyopathy)
• Secondary hypertrophy (hypertension)
• Coronary artery disease (Ischemia)
• Extrinsic constraint (Pericardial tamponade)

Question 3

In diastolic heart failure with preserved EF, what does the LV look like?

Answer 3

thick walled, small ventricle

Question 4

What is integral to the evaluation of diastolic function?

Answer 4

Measuring LA size/volume

Question 5

What pathophysiologic variables that affect LV diastolic filling?

Answer 5

Reduced LV systolic function

Question 6

What is the Mitral Deceleration Time?

Answer 6

Less than or equal to 160ms

Question 7

What is the ideal Isovolumetric relaxation time?

Answer 7

Less than or equal to 65 ms

Question 8

In LV diastolic function, what is the ideal E/E’ ratio?

Answer 8

Greater than or equal to 11

Question 9

What are Doppler Parameters indicating LV filling pressures? (4)

Answer 9

E/E’ > 14
S < D
E/A ratio > 2
Deceleration time less than 140 ms

Question 10

What are normal velocities for Lateral E’?

Answer 10

> -10cm/s

Question 11

What are normal velocities for Medial E’?

Answer 11

> -7 cm/s

Question 12

What is the S/D ratio?

Answer 12

~ 1

Question 13

What reduces preload and LA pressure?

Answer 13

Valsalva Maneuver

Question 14

How do you unmask the abnormal relaxation pattern seen in pseudonormal transmitral flow profiles?

Answer 14

Valsalva Maneuver!