LVSF Flashcards
What are the CAUSES of LVSF?
- ischemic cardiac disease
- cardiomyopathies
- valvular heart disease
- congenital heart disease
- hypertension
- renal disease
- diabetes
- thyroid disease
- drug and alcohol abuse
What are the SIGNS of LVSF?
- reduced cardiac output
- pulmonary edema
- volume to periphery
What are the SYMPTOMS of reduced cardiac output?
- DOE
- fatigue
- dizziness
- hypotension
- angina
What are the SYMPTOMS of pulmonary edema?
- dyspnea
- orthopnea/PND
- cough/sputum/rales
What are the SYMPTOMS of peripheral edema?
- JVD
- hepatomegaly
- ascites
What MURMURS are heard?
- soft S1
- S3
- S4
Murmur soft S1 is quiet due to what?
quiet due to AV valves closing less forcefully
Murmur S3 is due to what?
diastolic flow into volume overloaded ventricle
Murmur S4 is due to what?
atrial contraction flow against a stiff non-compliant ventricle
What is the NORMAL range of LVSP?
100-140 mmHg
What is the equation of LVSP with no AS?
LVSF = Systolic BP
What is the equation of LVSP with AS?
What are the steps?
LVSF = Systolic BP + AV PPG
CW - A5 - AV - PPG - SYSTOLE
What is the equation of LVSP with MR?
What are the steps?
LVSP = 4 x MR^2 + LAP
CW - A4 - MV- PEAK VELOCITY - SYSTOLE
CW - AV PSAX - PV - EDV & find PAEDP
What are the 2D FINDINGS?
- reduced global contractility
- reduced regional contractility
- LVE
- premature closure of MV and opening of AV
- fractional shortening
What are the M MODE FINDINGS?
- increased EPSS (mitral)
- “B” bump as sign of elevated LVEDP (mitral)
- decrease motion of aortic root (aortic)
- LVE
- premature closure of MV and opening of AV
- fractional shortening
Define STRAIN
the extent of myocardial deformation as a percentage
What does it mean to “DEFORM”?
myocardial fibers should be lengthened during diastole and shortened during systole
What is the equation for STRAIN?
strain = L - Lo / Lo x 100
L = length after deformation (short)
Lo = original length
Define STRAIN RATE
rate of change in the myocardial length
What is the EQUATION for strain rate?
SR = (V2-V1) /D
difference in tissue Doppler velocities between two locations divided by the distance between them**
What MODALITIES are used for strain rate?
- quantitative TDI
- speckle
What are the NORMS for Longitudinal Strain?
Longitudinal strain ≥ absolute 20%
Longitudinal strain rate ≥ 1 Hz
What is LONGITUDINAL STRAIN?
an average of strain values captured at the segments longitudinally (A4,A3,A2)
What is the NORMAL Stroke Volume for LVSF?
Normal ≥ 70 cc
How do you calculate SV?
SV = .785 x d2 x VTI
What does SV require?
-accurate diameter
-laminar flow
-parallel angle
What is the EQUATION and NORM for CARDIAC OUTPUT?
- you do once you have SV*
CO = SV X HR /100
Normal ≥ 4 L/min
What is the EQUATION and NORM for CARDIAC INDEX?
CI = CO / BSA
Normal ≥ 2.4 L/min/m²
What 3 factors do you need to determine SHAPE OF AORTIC or LVOT Doppler Outflow Curve?
- ejection time (ET)
- Ao acc time (AT)
- Ao decel time (DT)
In what view(s) & modality(s) are you using to find ET/AT/DT?
PW LVOT or
CW A5
What are the NORMS for:
ET?
AT?
DT?
< 325 msec
< 188 msec
< 230 msec
Who would be CANDIDATES for biventricular pacemaker?
- NYHA functional class III or IV
- EF ≤ 35%
- QRS ≥ 120 ms
What is a good indicator of dyssynchrony?
QRS ≥ 120 ms
What are the 3 types of dyssynchrony?
- intraventricular
- interventricular
- atrioventricular
What is INTRAVENTRICULAR?
ill timing between LV segments
What is INTERVENTRICULAR?
ill timing of right to left ventricular contraction
- should contract at same time*
What is ATRIOVENTRICULAR?
ill timing of atria and ventricle contraction
How do you rule OUT ACUTE HEART FAILURE?
normal levels of BNP
What is BNP (brain natriuretic peptide)?
secreted by the ventricles of the heart in response to excessive stretching of heart muscle cells
What is the MARK KARRY METHOD?
shortcut method in which optimal setting tends to be where r wave of ECG aligns with MV closing click
What is the EQUATION of FRACTIONAL SHORTENING and the NORMS?
LVIDd - LVIDs / LVIDd x 100
Normal > 25%
