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Echo > Module 16 : Introduction to Diastolic Function > Flashcards

Module 16 : Introduction to Diastolic Function Flashcards

1
Q

diastole- definition

A
  • phase of heart cycle where the chambers relax and fill with blood
  • interval from AV closure to MV closure
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2
Q

relaxation - definition

A
  • relaxation of the ventricle including IVRT and early phase ventricular filling
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3
Q

compliance - definition

A
  • change in volume / change in pressure
  • in the LV during diastole
  • compliance is inverse to stiffness
  • if compliant then not stiff
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4
Q

stiffness - definition

A
  • change in pressure/ change in volum e
  • in LV during diastole
  • inverse to compliance
  • if stiff not compliant
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5
Q

filling pressure - definition

A
  • includes LV EDP and mean LA pressure
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6
Q

LVEDP- definition

A
  • left ventricular end diastolic pressure
  • reflects left ventricular pressure after filling is complete
    + after MV doppler A wave
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7
Q

mean LAP - definition

A
  • average pressure during LV filling period only during diastole
  • left atria pressure
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8
Q

diastolic function - definition

A
  • ability of ventricle to all to an adequate volume at end diastole to ensure that there is enough forward volume during systole
    + bad diastolic function leads to congestive hear failure
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9
Q

normla diastolic function

A
  • means that LV can fill to an adequate volume with low filling pressures during rest or exercise
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10
Q

diastolic dysfunction

A
  • the LV can fill to ensure a normal forward volume but only when the filling pressure increases to abnormal levels
  • # 1 symptom of diastolic dysfunction is shortness of breath
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11
Q

normal LV filling doppler qualities

A
  • tall E wave
  • smaller A wave
  • steep deceleration time
  • short IVRT
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12
Q

normal E wave value

A
  1. 6 - 1.3 m/s
    - age dependant
    - reverses in 6th decade of life
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13
Q

normal deceleration time value

A

160 - 220 ms

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14
Q

normal A wave value

A

no normal

- less than E wave

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15
Q

normal E/A ratio

A

> /= 0.8 - 2

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16
Q

how to measure IVRT

A
  • find clear A4C view aligned to MV inflow
  • place cursor so pulsed wave sample volume is straddling the red inflow path and blue outflow path
  • press PW
  • optimise signal
  • measure between aortic outflow (closing click) and MV valve opening
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17
Q

Normal IVRT value

A

50-100 ms

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18
Q

LV end diastolic filling pressure

A
  • pressure in the LV just after LA contraction

- should be pretty high

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19
Q

mean LA pressure

A
  • pressure in LA averaged over the LV filling period mLAP

- diastole

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20
Q

normal filling pressure

A
  • both LV and LA normally fill under low pressure

< 12 mmHg

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21
Q

elevated filling pressure

A

> 15 mmHg

22
Q

diastolic dysfunction vs increased filling pressure

A

not the same thing

23
Q

elevated filling pressure - definition

A
  • consequence of diastolic dysfunction (diastolic dysfunction leads to increased filling pressures)
  • when lv loses its ability to real and becomes more stiff then the pressure rise to maintain normal forward flow in systole
24
Q

normal filing

A
  • LV fills at low pressure because myocardium is compliant
  • if LV was stiff the filling pressure would rise above normal forcing the LA pressure to increase to maintain a pressure gradient to sustain forward flow
25
Q

abnormal diastolic filling - factors affecting filling

A

1) chamber compliance
2) hypertrophy / infiltrative disease
3) extrinsic factors
+ pericardial stiffness
4) LV muscle remodelling
+ post MI (scarring)
5) normal change with age
+ fibrotic change in the LV increases LV stiffness with age

26
Q

MV doppler wave - abnormal filling

A
  • reduced E wave
  • prolonged IVRT
  • tall A wave
  • no gap between E and A
  • increased DT
27
Q

factors affecting early diastolic filling

A
  • volume (preload)
  • hyper/hypovolemia
  • excessive mitral regurge
    + increases volume of blood movxngpast MV
    + starlings law
28
Q

factors affecting late diastolic filling

A 
- cardiac rhythm
   \+ organized P waves not in Afib and flutter 
- atrial contractile function 
- increased LVEDP
- HR
- ventricular diastolic function
29
Q

impaired LV filling - physiology

A
  • as we get older LV muscle becomes less compliant during diastole
  • LV does not expand as quickly therefore the LV/LA pressure gradient is reduced which reduced E wave peak velocity
  • leads to lower velocity E wave and relatively higher velocity A wave
30
Q

ways that LV expands in diastole

A
  • radially
  • circumferentially
  • LONGITUDINALLY
  • torsion
31
Q

tissue doppler of MV annulus

A
  • velocity of expansion or contraction can be measured using pulsed wave doppler
  • these velocities are less dependant of preload than MV inflow doppler
32
Q

TDI/TVI

A
  • same thing
  • as ventricles fill during diastole the annulus moves way for the apex and moves outward circumfrenetially
  • velocity of lengthening is measured in longitudinal plane
  • measures the speed of tissue movement not blood movement t
  • should resemble a mirror image of MV velocity profile on a lower scale
  • one upward wave and two downward waves
33
Q

abnomal TDI of MV

A
  • small e’ (e prime)
34
Q

waves of TDI

A 
s prime (s')
e prime (e')
a prime (a')
35
Q

s prime

A
  • systolic motion of the mortal annulus towards the probe in systole
36
Q

e prime

A
  • early diastolic motion of the MV annulus toward the probe in systole
37
Q

a prime

A
  • late diastolic motion of the MV annulus in the late diastole away from the probe
38
Q

normal TDI - medial e prime

A

> /= 8 cm/s

39
Q

normal TDI - lateral e prime

A

> /= 10 cm/s

40
Q

TDI - age related

A
  • the younger and more athletic you are the higher the velocity tissue doppler will be
    + increases rate of expansion enhancing starlings
  • more efficient heart
41
Q

e/ e’ ration

A
  • evelocity divided by e’ velocity
  • need sam units
  • the smaller the ratio the better
  • larger ratio means increased filling pressure
42
Q

normal e/e’ ration

A

< 8

43
Q

abnormal e/e’ with elevated filling pressure

A

> 15

44
Q

pulmonary venous flow

A 
- pulmonary veins fill the LA during 
   \+ ventricular systole 
   \+ early diastole 
    \+ diastasis 
- flow is reversed in the pulmonary veins during 
   \+ atrial systole or late diastole
45
Q

what pulmonary vein do we usually pulse

A

right upper pulmonary vein RUPV

46
Q

pulmonary vein waves

A 
S wave (systolic)
d wave (diastolic)
a wave reversal (atrial kick)
47
Q

S wave

A
  • systolic wave
  • normally greater than d wave velocity
  • divided into s1 and s2 waves
  • occasionally discernable
48
Q

d wave

A
  • diastolic wave

- normally smaller than S wave

49
Q

a wave reversal

A
  • cause by atrial kick

- blood temporarily flows back into the PV form LA die to lack of valve

50
Q

diastolic dysfunction and RVSP

A
  • as LV diastolic function remains abnormal for long period of time the increased filling pressure leads to increased pressure in the lungs due to backward transmission of pressure
  • the increased pressure in the lungs can be measured via RSVP
  • higher levels of diastolic dysfunction are associates with
    + TR jet velocity > 2.8
    + RVSP > 40mmHg
51
Q

LV wall and LA size with diastolic dysfunction

A
  • hypertension is one of the biggest causes of diastolic dysfunction
  • hypertension is a high afterload condition leading to increased LV muscle mass and thickness
  • a thicker LV muscle is stiffer and less compliant muscle
  • this leads to increased filling pressure
  • as filling pressure increases the LA size does too
  • LA muscle is thin and will dilate under these condition

Echo (19 decks)

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