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Echo 2 > Module 2 : Ventricular Systolic Function > Flashcards

Module 2 : Ventricular Systolic Function Flashcards

1
Q

LV function - systole

A
  • ventricles pump blood into systemic and pulmonary circulation
  • ensures adequate perfusion to the body
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2
Q

what is systolic dysfunction

A
  • inability to contract
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3
Q

what 3 things does an inability to contract lead to

A
  • decrease in SV/EF
  • increased preload (LVEDP)
  • ? congestive heart failure
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4
Q

LV function - diastole

A
  • ventricular distention/ relaxation

- to be able to fill up to prepare for the next contraction

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5
Q

what is starlings law

A
  • as filling occurs stretch in muscle develops tension/strength for contraction
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6
Q

what type of pressure gradient does diastole create

A
  • negative pressure gradient to ensure venous return
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7
Q

what stage do the coronary arteries fill

A
  • diastole
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8
Q

how is ventricular systole produced

A
  • by depolarization of the ventricles followed by mechanical contraction
  • ventricular myocardium contraction produces increased pressure within LV and RV
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9
Q

2 phases of systole

A
  • isovolumic contraction

- ventricular ejection

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10
Q

what is isovolumic contraction

A
  • all valves closed

- ventricular pressure is building up

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11
Q

what is ventricular ejection

A
  • atrio-ventricular valves closed
  • semilunar valves open caused by pressure gradient between LV and aorta
  • ejection occurs until ventricular pressure equalizes with the great vessels
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12
Q

systole sequence

A
  • myocardial depolarization&raquo_space; contraction» ejection

- as pressure increases&raquo_space; reduction of the internal volume of the chamber

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13
Q

timing of systole

A
  • IVCT = onset of QRS

- ejection = starts when AV opens ends when AV closes

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14
Q

systolic, diastolic, mean pressure in AO

A
  • sys = 120mmHh
  • dia = 70mmHg
  • mean = 85mmHg
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15
Q

systolic, diastolic, mean pressure in PA

A
  • sys = 25mmHg
  • dia = 10mmHg
  • mean = 16mmHg
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16
Q

mean LA pressure

A
  • 10mmHg
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17
Q

systolic and diastolic LV pressure

A
  • sys = 120mmHg

- dia = 10mmHg

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18
Q

systolic and diastolic pressure RV

A
  • sys = 25mmHg

- dia = 4 mmHg

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19
Q

mean RA pressure

A
  • 4mmHg
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20
Q

5 steps of the ventricular pressure - volume relationship

A
  • after depolarization of the ventricular muscle the LV/RV starts to contract
  • contraction increases the intra-cavitary pressure
  • pressure rises until it exceeds aortic/pa pressure which opens the AV/PV and blood is ejeceted
  • after ejection LV/RV pressure falls below that of the aorta and pA which closes the AV PV
  • pressure keeps falling during relaxation until MV and TV openm
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21
Q

what shape is the pressure loop for the LV and the RV and why

A
  • LV = retangular
  • RV = triangular
  • lower right heart pressures
  • lower impedance of the pulmonary vascular bed
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22
Q

three determinants of stroke volume

A
  • preload
  • afterload
  • contractility
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23
Q

what is preload

A
  • muscle length or stretch at end diastole
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24
Q

how do we estimate preload

A
  • LVEDP = left ventricle end diastolic pressure
  • PVEDP = pulmonary vein EDP
  • LA pressure
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25
Q

what is after load

A
  • the tension that the LV must overcome before fibre shortening and contraction
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26
Q

what three things affect after load

A
  • changes in ventricular volume
  • wall thickness
  • vascular resistance
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27
Q

what is after load most often determined by

A
  • SVR = systemic vascular resistance or blood pressure
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28
Q

is the RV or the LV more sensitive to after load

A
  • RV
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29
Q

what is contractility

A
  • aka inotropy

- inherent strength of the cardiac muscle and ability to shorten as contracts

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30
Q

what three factors increase stroke volume

A
  • increase preload
  • decrease afterload
  • increase inotropy
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31
Q

quantitative systolic measurements

A
  • fractional shortening FS

- ejection fraction EF

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32
Q

7 volumetric assessments of systolic measurement

A
  • simpsons EF
  • area length method
  • stroke volume / CO / CI
  • Dp/Dt
  • tissue doppler
  • MPI
  • global strain
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33
Q

2 qualitative assessment of systolic function

A
  • visual kinetic analysis (global EF estimation)

- segmental wall motion analysis

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34
Q

4 types of wall motion

A
  • normal
  • hypokinetic
  • akinetic
  • dyskinetic
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35
Q

teicholz ejection fraction

A
  • LVIDd ^3 - LVIDs^3 / LVID^3 x 100
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36
Q

normal parasternal techolz EF

A

> /= 55%

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37
Q

fractional shortening equation

A

FS = LVIDd - LVIDs / LVIDd x 100

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38
Q

normal FS

A

> 25%

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39
Q

what does teicholz EF need to be accurate

A
  • needs to have symmetrical contractility
40
Q

what is fractional shortening

A
  • % of change in the minor axis dimension

- has a correlation to EF

41
Q

normal simpsons EF for male and female

A 
male = 52-72
female = 54-74
42
Q

3 signs of end diastole

A
  • onset of QRS complex
  • frame after MV closure
  • frame where the LV diameter/dimension is largest
43
Q

3 signs of end systole

A
  • the frame proceeding MV opening
  • when the LV is smallest
  • near the end of the T wave
44
Q

how to measure LVID with abnormal IVS

A
  • when peak downward displacement of the septum is abnormal use the peak upward displacement of the posterior wall for timing
45
Q

2 things needed for simpsons EF

A
  • requires clear endocardial definition

- reduce depth to half way into th atria and sector down if possible

46
Q

when would you never do Simpsons

A
  • suboptimal endocardial definition

- IF YOU CANNOT SEE TWO ADJACENT SEGMENTS

47
Q

how do we quantify left ventricle volumes

A
  • end diastolic trace (A4C and A2C average)

- end systolic trace (A4C and A2C average)

48
Q

stroke volume equation with EDV and ESV

A

SV = EDV - ESV

49
Q

severe abnormal parasternal teichols EF

A

= 30

50
Q

normal LV size women

A

= 5.3

51
Q

severe abnormal LV size women

A

> /= 6.2

52
Q

normal LV size men

A

= 5.9

53
Q

severe abnormal LV size men

A

> /= 6,9

54
Q

normal simpsons EF female

A

54-74

55
Q

severe abnormal simpsons EF female

A

< 30

56
Q

normal simpsons EF male

A

52-72

57
Q

severe abnormal Ef male

A

< 30

58
Q

4 tips/assumptions for SV calc

A
  • accurate LVOT measurement
    + assumes LVOT is circular
  • Laminar flow assumed
    + plate sv in center of LVOT
  • parallel intercept angle between doppler beam and direction of flow
  • velocity and diameter measurements are made at the same anatomic site
59
Q

pressure over time equation

A

Dp/Dt

- Dp will ALWAYS equal 32mmHg

60
Q

when is Dp/Dt measured

A
  • the pre-ejection phase fo the cardiac cycle

- less influenced by loading conditions

61
Q

what is Dp/Dt a measurement of

A
  • rate of LV pressure rise during isovolumic contraction
62
Q

what are the two arbitrary points chosen for Dp/Dt

A

1m/s and 3m/s

63
Q

4 limitations of Dp/Dt

A
  • valve click artifacts (prosthetic valves)
  • eccentric MR jets (difficult to pick up CW)
  • poor alignment to MR jets
  • non compliant LA
64
Q

how to do Dp/Dt

A
  • optimize mitral regurge jet
  • increase sweep speed to 100-200 cm/s
  • draw a line from 1m/s to 3m/s
65
Q

normal Dt

A

< 27 milisec

66
Q

severe abnormal Dt

A

> 40ms

67
Q

normal Dp/Dt values

A

> 1200 mmHg/s

68
Q

severe abnormal Dp/Dt

A

< 800 mmHg/s

69
Q

how are the muscle tissue in the LV arranged

A
  • longitudinally
  • radially
  • circumferentially
70
Q

what does tissue doppler measure

A
  • speed that the LV muscle contracts in the longitudinal plane
  • good measure of systolic function
71
Q

what is normal LV s prime measurement

A

> 9.0cm/s

72
Q

what is normal RV s prime measurement

A

> 9.5cm/s

73
Q

6 s prime limitations

A
  • can only truly reflect the performance of the basal segments in apical view
  • if wall motion normal or globally down s prime will still be accurate
  • if there are varying degrees of segmental systolic dysfunction s prime not as accurate
  • s prime is influenced by tethering and translational motion of heart
  • s prime velocity progressively decrease from base to apex
  • TDI requires the optimal doppler angle
74
Q

LIMP

A
  • left index of myocardial performance
75
Q

RIMP

A
  • right index of myocardial performance
76
Q

5 cases where index of myocardial performance is used

A
  • dilated cardiomyopathy
  • cardiac amyloidosis
  • pulmonary hypertension
  • RV infarction
  • RV dysplasia
77
Q

can MPI provide info on systolic and diastolic function

A
  • yes
78
Q

what is IMP a ration between

A
  • isovolumic contraction time and isovolumic relaxation time divided by ejection time
79
Q

normal LV LIMP doppler method

A

< 0.44

80
Q

TDI MPI method LV normal LIMP

A

< 0.6

81
Q

TDI MPI method RV normal RIMP

A

< 0.55

82
Q

how is the RV size assessed

A

qualitatively

83
Q

normal RV size - qualitative

A
  • RV in A4C view should be less than 2/3 size of LV

- LV should dominate apex

84
Q

Mild dilation of RV size - qualitative

A
  • RV > 2/3 of LV but RV cavity is still smaller than LV

- RV apex more basal than LV apex as normal

85
Q

moderate dilatation of RV - qualitative

A
  • RV and LV share apex
86
Q

severe dilatation of RV - qualitative

A
  • RV > LV size

- RV occupies the apex

87
Q

normal RV basal diameter

A

= 4.1 cm

88
Q

normal mid cavity diameter RV

A

= 3.5cm

89
Q

normal RV length

A

=8.6cm

90
Q

RVOT diameter normal prox

A

= 3.3 cm

91
Q

RVOT diameter normal distal

A

= 2.7cm

92
Q

normal RV fractional area change

A

> /= 35%

93
Q

normal MPI RV doppler method

A

= 0.43

94
Q

TAPSE normal

A

> /= 12mm

95
Q

5 methods to asses RV systolic function

A
  • TASPSE
  • RV s prime wave
  • RV fractional area change
  • RIMP
  • RV stroke volume
96
Q

what 3 things is RV stroke volume dependant on

A
  • preload
  • afterload
  • contractility
97
Q

qualitative LV systolic function assessment

A
  • need to assess wall motion and thickening

- walls must be seen in 2 or more views to be scored

Echo 2 (18 decks)

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