LV Diastolic Function Flashcards by Kate Grimeau

S (stands for/ECG)

systole
QRS -> end of T

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D (stands for/ECG)

diastole
end T -> QRS

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E (stands for/ECG)

early filling
E after T

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A (stands for/ECG)

atrial kick
A after P

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diastole is from ___ closure to ____ closure

AV
MV

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ventricle is relaxing during ___ and ___

IVRT
early filling

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IVRT is after

AV closure

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compliance is inverse to

stiffness

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compliance is change in ___ over change in ___

volume
pressure
Dv/Dp

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a compliant ventricle is able to increase its volume without increasing its _____ significantly

pressure

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stiffness is change in ___ over change in ____

pressure
volume

Dp/Dv

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LVEDP meaning

LV end diastolic pressure

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LVEDP reflects LV pressure when (and when on MV doppler)

after filling is complete (after MV doppler A wave)

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Mean LAP

average pressure during the LV filling period

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filling pressure includes ____ and _____

LVEDP
LAP

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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

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DDFxn/DD

diastolic dysfunction

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6 DDFxn causes

aging
HTN
Muscle remodling
pericardial stiffness
DM
renal dysfunction

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HTN = ___ afterload = may lead to____ = ____ compliance

increased
LVH (hypertrophy)
decreased

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muscle remodling can happen after (2)

scarring after MI
infiltrative disease

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diabetes mellitus

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DM and ____ go together a lot

renal dysfunction

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what is one of the biggest causes of DDFxn

hypertension

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what is the only treatment which directly alters diastolic function

exercise

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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

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

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) S2.8m/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

Name the 4 parameters we used to grade the severity of diastolic dysfunction and their normal values

E/A ratio: 0.8-2.0 E/e': <14 TR velocity: <2.8m/s LAVI: < 34ml/m2