LV Diastolic Function Flashcards
S (stands for/ECG)
systole
QRS -> end of T
D (stands for/ECG)
diastole
end T -> QRS
E (stands for/ECG)
early filling
E after T
A (stands for/ECG)
atrial kick
A after P
diastole is from ___ closure to ____ closure
AV
MV
ventricle is relaxing during ___ and ___
IVRT
early filling
IVRT is after
AV closure
compliance is inverse to
stiffness
compliance is change in ___ over change in ___
volume
pressure
Dv/Dp
a compliant ventricle is able to increase its volume without increasing its _____ significantly
pressure
stiffness is change in ___ over change in ____
pressure
volume
Dp/Dv
LVEDP meaning
LV end diastolic pressure
LVEDP reflects LV pressure when (and when on MV doppler)
after filling is complete (after MV doppler A wave)
Mean LAP
average pressure during the LV filling period
filling pressure includes ____ and _____
LVEDP
LAP
normal vs abnormal diastolic function
can fill to adequate volume at low filling pressures
vs
can fill to adequate volume only when filling pressures increase
DDFxn/DD
diastolic dysfunction
6 DDFxn causes
aging
HTN
Muscle remodling
pericardial stiffness
DM
renal dysfunction
HTN = ___ afterload = may lead to____ = ____ compliance
increased
LVH (hypertrophy)
decreased
muscle remodling can happen after (2)
scarring after MI
infiltrative disease
DM
diabetes mellitus
DM and ____ go together a lot
renal dysfunction
what is one of the biggest causes of DDFxn
hypertension
what is the only treatment which directly alters diastolic function
exercise
T/F DDfxn and increased filling pressures are the same
no
elevated filling pressure is a consequence of DDFxn
3 factors affecting early diastolic filling
LV compliance
LAP (increase = more velocity into LV as bigger pressure difference)
volume (preload) ex. excessive MR
increase preload = ____ early diastolic filling
increase
increase LAP = _____ early diastolic filling
increase
increase LV compliance = _____ early diastolic filling
increase
5 things affecting late diastolic filling
cardiac rhythm
atrial function
increased LVEDP
HR
LV compliance
ex of cardiac rhythm affecting late filling
A fib
no A wave = no late diastolic filling
increased LVEDP = ____ A
decreased
increased HR = _____ A
decreased
as we age the LV muscle gets ___ compliant during diastole
less
less compliant = _____ velocity E wave and relatively ____ velocity A wave
lower
higher
diastasis = pressures between LV and LA are
=
what causes IVRT to increase
increase LVP
what causes IVRT to decrease
increase LAP
IVRT mechanical timing
AV just closed
IVRT LV Pressure
decreasing
normal IVRT
50-100ms
early/rapid filling mechanical timing
right after MV opens (T wave ends)
early/rapid filling LV pressure
LV < LA
early/rapid filling LV volume
increasing
normal DT
160-220ms
diastasi mechanical timing
between end of T -> P (between E and A)
diastasis has what valve open
MV
Diastasis LV Pressure
increasing
diastasis LV volume
increasing
Diastasis length determined by
HR
slow= long
fast - short/absent
late filling/A contraction mechanical timing
MV open (A after P)
late filling/A contraction LV pressure
increasing
late filling/A contraction LV volume
increasing
what phase will be absent with A fib
late filling/A contraction
late filling/A contraction is absent with ____
A fib
normal E
0.6-1.3m/s
normal DT
160-220ms
normal E/A
0.8-2.0
most of LA from the PVs occur during ___
systole
TDI med normal
> or euqal to 7cm/s
TDI lat normal
> or equal to 10cm/s
a healthy TDi resembles a mirror image of the ____
MV inflow
normal E/e’
< or equal to 14
pulm veins S ___ D
>
grade 1/mild DDFxn AKA
impaired relaxation
grade 1/mild DDFxn/impaired relaxation (LV pressure/E wave velocity/ E/A /DT/TDI/IVRT)
LVP = increase
E wave velocity = decreased (<50cm/s)
E/A = reduced (<0.8)
DT = increased (>220ms)
TDI = could be lower
IVRT = increase (>100ms)
what level of dysfunction can be normal >60years
grade 1/mild DDFxn/impaired relaxation
grade 1/mild DDFxn/impaired relaxation :
LV filling is now more dependent on ___ than ____ because
atrial kick
early filling
because it depends on LAP/LVP PG
do grade 1/mild DDFxn/impaired relaxation normally present with symptoms
no
possible symptoms of grade 1/mild DDFxn/impaired relaxation
possible SOB on exertion
SOBOE
shortness of breath on exertion
grade II/moderate DDFxn AKA
pseudonormalization
grade II/moderate DDFxn AKA/pseudonormalization (LVP, LAP, E wave, LA/LV PG, TDI, IVRT, S__D, RVSP, TR jet, LA vol index)
LVP = increased
LAP = gradually increased
E wave = increased
LA/LV PG = increased
TDI = abnormal
IVRT = decreased (<50ms)
S<D (abnormal)
RVSP = increased (≥ 35mmHg)
TR jet >2.8m/s
LA vol index = dilates (>34mL/m^2)
with grade II/moderate DDFxn AKA/pseudonormalization MV inflow appears how
almost identical to normal physiology
how to reveal grade II/moderate DDFxn AKA/pseudonormalization
do valsalva for 10s
peak E vel should reduced >50% if pseudonormalization
grade II/moderate DDFxn AKA/pseudonormalization LA pressure increase may cause flow across the MV during _____, called the __ wave
diastasis
L
symptom of grade II/moderate DDFxn AKA/pseudonormalization
SOB at lower levels of activity compared to grade I
Grade III/severe dysfunction (LVP, LAP, RVP, E/A, DT, LAVI, TR peak vel, pulm P, TDI)
LVP =increased lots
LAP = increased lots
RVP = increased
E/A = fast/sharp E wave (>2.0)
DT = Short (<160ms)
LAVI = increased
TR peak vel = increased
pulm P = increased
TDI = drastically decreased
3 symptoms of grade III DD
dyspnea with minimal exertion
reduced exercise tolerance
pedal or abdominal edema
grade III/severe DD AKA
restrictive filling
5 things we look at to analyze DDFxn
E/A ratio (MV inflow PW)
e’ (TDI)
E/e’ (avg)
LAVI
TR max vel (RVSP) - if present
DDfxn analysis amount positive for normal LV EF:
0-1 =_____
2 = ____
3-4 = ____
normal
intermediate
DD
if E/A ratio >2 =
automatically in DDfxn
DDFxn is assumed if LV EF is ____
reduced
tachycardia = E/A __
fuse
mitral regurg = artificially ___ E wave heigh
increased
AI jets often blow across AMVL = __
impossible to asses MV inflow waveform
