Module 15 : Intro to Systolic Function Flashcards
what are the apical views for assessing wall motion
- PLAX
- PSAX LV base
- Apical 2 chamber
- apical 4 chamber
quantitative assessment of LV systolic function
- MEASURING
- SV/EF/CO
- simpsons
qualitative assessment of LV systolic function
- visual/descriptive
- visual EF
- segmental wall motion analysis
wall motion can be describes as
- hyperkinetic
- normal
- hypokinetic
- akinetic
- dyskinetic
segmental VS global approach **
- you can describe visual wall motion as segmental or global
+ global= entire heart effected
+ segmental = just one region of heart effected
hyperkinesis
- excessive wall motion
- high preload
- severe regurgitation
- fever
- trauma
hypokinesis
- motion/wall thickening is reduced
- not normal but not akinetic
factors leading to hypokinesis
- CAD = coronary artery disease
- CMO = cardiomyopathy
- long standing valve disease
akinetic
- no thickening
- may have motion if tethered to a moving segment adjacent to it
- look for thickening
factors causing akinesis
- MI = myocardial infarction
- viral CMO = viral cardiomyopathy
dyskinetic
- wall or segment is moving the OPPOSITE DIRECTION as normal segments in systole
factors causing dyskinesis
- increased right heart pressure
- pacemaker
- BBB = bundle branch block
- longstanding scarred segment
ways to assess LV EF - least to most accurate
- Teicholz (parasternal - EF) or LINEAR \+ FS (LVIDd) - dimension \+ CO (SV x HR) - Simpsons Biplane EF \+ recommended - 3D trace (3D EF) \+ only most accurate when performed by well experienced staff
volumetric assessment of LV function (quantification)
- Simpsons Biplane \+ end diastolic trace \+ end systole volume - then get STROKE VOLUME and EF - then combine SV with HR to get CARDIAC OUTPUT
images needed to calculate LV stroke volume DOPPLER METHOD
- LVOT diameter (PLAX)
- LVOT VTI (apical 5 PW of LVOT)
3 ways to determine end diastole in 2D scanning
1) onset of QRS complex
2) FRAME AFTER MV CLOSURE (both valves closed)
3) Frame where LV dimension if largest
3 ways to determine end systole in 2D scanning
1) THE FRAM PRECEDING MV OPENING (both valves closed)
2) when the LV is at its smallest
3) near the end of the T wave
triplane EF
- uses 3D
- gives real time volume info
- volume changes over time
- uses 3D echo probe
ASE recommendations for EF
- use modified simpsons EF with biplane apical approach for the measurement of EF
+ felt to be quite accurate and most studied
+ more universal than 3D
+ 3D more accurate when done well
systolic dysfunction
- inability to contract
+ usually due to CAD (coronary arterial disease)
decrease in systolic function causes what to happen
- decrease in SV/EF
- due to inadequate contraction to meet the demands of the body
decrease in SV/EF due to systolic dysfunction can lead to what
- congestive heart failure
congestive heart failure
- chambers state to dilate when there is a back up of blood behind the chamber due to its inability to contract and move forward
qualitative assessment of RV systolic function
- eyeball
quantitative assessment of RV systolic function
- FAC = fractional area change
- TAPSE = tricuspid annular plane systolic excursion
- S prime = doppler TDI (tissue doppler imaging)
eyeball method - RV grades
- normal
- mildly reduced
- moderately reduced
- severely reduced
what will a hypokinetic RV look like
- it will be dilated
fractional area change FAC
- comparison of area change between systole and diastole
+ not a volumetric change like simpsons
calculating FAC
- trace endocardial border surface in apical 4 chamber in
+ END DIASTOLIC AREA
+ END SYSTOLIC AREA - trace along IVS from base to apex then along RV free wall to annulus then back to beginning
FAC formula
FAC=[(EDA-ESA) / EDA] x 100
normal FAC value
> 35%
3D images with contrast used when
- used when regular 2D imaging is poor but need an EF
Thethering
A normal LV segment dragging a nearby akinetic segment making it look normal
