Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Echo 2 > Module 3 : Diastolic Function > Flashcards

Module 3 : Diastolic Function Flashcards

1
Q

definition of diastole

A
  • chambers relax and fill with blood under low pressure

- interval from AV closure to MV closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

definition of relaxation

A
  • includes IVRT and early phase ventricular filling (IVRT E wave)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

definition of compliance

A
  • change in volume / change in pressure (Dv/Dp)

- inverse to stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

definition of stiffness

A
  • change in pressure / change in volume (Dp/Dv)

- stiffness inverse to compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what two pressures are included in filling pressures

A
  • LV EDP

- mean LA pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is LVEDP

A
  • left ventricle end diastolic pressure

- reflects ventricular pressure after filling is complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is mean LA pressure

A
  • average pressure during the filling person in the left atrium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the 4 phases of diastole

A
  • IVRT
  • early phase
  • diastasis
  • late phase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is IVRT

A
  • isovolumic relaxation time

- no change in ventricular volume but pressure is ventricle is falling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is early phase of diastole

A
  • rapid filling of the LV

- caused by suction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is diastasis

A
  • pressures equalize between LV and LA

- small amount of blood may flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is late phase

A
  • atria contract and push the rest through
  • atrial kick
  • contributes to 20-30% of normal filling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what three things is IVRT influenced by

A
  • conduction abnormalities or conduction mechanics
  • loading conditions (preload LAP)
  • age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

normal IVRT

A

50-100ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the deceleration time

A
  • LA and LV pressure gradient begins to fall leading to a slow down of blood entering the LV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

4 things that influence rapid filling phase

A
  • rate of LV relaxation
  • elastic recoil of ventricle
  • chamber compliance
  • LAP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how much of total volume does early filling contribute

A

70-80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

normal length of early filling

A

150-200ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what determines the length of diastasis

A
  • HR
  • slow = long diastasis
  • fast = short or absent diastasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what phase of diastole might be absent with afib

A
  • atrial contraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what two things are included in LV filling properties

A
  • LV compliance/stiffness

- myocardial relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

compliant ventricles and pressure

A
  • able to increase its volume without increasing its pressure significantly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

stiff ventricles and pressure

A
  • disproportionate increase in pressure for a relatively small increase in volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

LV mass 2D changes with DD

A
  • Increase age, body weight, blood pressure increases LV mass
  • first walls become thicker than dilates
  • LV mass will increase with either increase wall thickness or with increase in chamber dimension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

LA volume 2D changes with DD

A
  • heart becomes less compliant filling pressures increase
  • increased LAEDP and LAP will dilate the LA
  • LA is only 2-3mm thick and dilates easy
  • > 34ml/m^2 abnormal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

4 causes of DD

A
  • primary myocardial disease
  • secondary hypertrophy
  • coronary artery disease
  • extrinsic factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

3 examples of primary myocardial disease

A
  • dilated CMO (cardiomyopathy) (NUMBER ONE)
  • infiltrative myocardial disease
  • hypertrophic CMO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

3 examples fo secondary hypertrophy

A
  • HTN (hypertension)
  • aortic stenosis
  • severe mitral regurgitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

2 examples of CAD

A
  • ischemia

- infarct

30
Q

2 examples of extrinsic factors

A
  • pericardial tamponade

- pericardial constriction

31
Q

7 factors effecting all diastolic measurements

A
  • HR (IVRT shortens, E/A fuse)
  • rhythm (AF/PVC)
  • preload (artificially increases E wave height)
  • LV systolic function (abnormal contraction = abs relaxation)
  • respiration
  • age
  • PR interval
32
Q

grade 1 DD

A
  • impaired relaxation

- mild diastolic dysfunction

33
Q

grade 2 DD

A
  • pseudo-normal

- moderate DD

34
Q

grade 3 DD

A
  • restrictive filling

- severe DD

35
Q

4 parameters for grading DD

A
  • MV inflow (E/A ratio)
  • averaged E/e prime ratio
  • left atrial volume index
  • TR jet velocity (RVSP)

** 2/3 criteria must be positive to determine grade 2 or 3 DD

36
Q

normal filling

A
  • LV fills at low pressure because the myocardium is compliant
37
Q

normal E/A ratio

A

0.8-2

38
Q

normal DT

A

150-200ms

39
Q

normal MV E wave

A
  1. 6-1.3m/s

- reverses near 6th decade of life

40
Q

definition of DD

A
  • delayed or slowed myocardial relaxation with normal filling pressures
  • prolongs iVRT and DT
41
Q

2 factors affecting filling

A
  • chamber compliance

- extrinsic factors

42
Q

three tissue doppler waves

A
  • e’ = lengthening of ventricle during early filling
  • a’ = atrial contraction
  • s’ = systolic contraction (ventricular shortening)
43
Q

normal medial wall e’

A

> 7cm/s

44
Q

normal lateral wall e’

A

> 10cm/s

45
Q

normal E/e’ ratio

A

less than 8

- 8-12

46
Q

mild DD / impaired relaxation

A
  • reduced E/A ratio (<0.8)
  • reduced E velocity
  • prolonged DT (>200ms)
  • reduced TDI (IVS < 7cm/s, lat <10cm/s)
  • E/e prime < 14 (not increased)
  • TR velocity jet < 2.8 (normal)
47
Q

symptoms of mild DD

A
  • mild shortness of breath on exertion SOBOE
48
Q

TR jet with DD

A
  • in absence of significant pulmonary or right heart disease the TR jet is accurate reflection of left heart filling pressure
  • with DD LV, LA, PV, lungs, PA, RV pressure all increase leading to increase TR jet
49
Q

grade 2 / pseudonormal DD

A
  • imparted relaxation + moderate reduction in LV compliance which results in increased LAP
  • MV inflow pattern returns to fairly normal profile due to increase LAP
50
Q

grade 2 DD MV inflow characteristics

A
  • E/A ratio (0.8-2) looks normal
  • DT (150-200) looks normal
  • IVRT (50-100) looks normal
  • E/e prime 10-14 (abnormal)
  • MV inflow A wave duration shortens as LAP increases
51
Q

symptoms grade 2 DD

A
  • SOB at lower levels of activity compared to grade 1 DD
52
Q

how to unmask pseudo normal

A
  • VALSALVA
  • hold valsalva while pulsing MV
  • reduces venous return to Rt heart then left Heart
  • reduces LA pressure
  • if grade 2 then should changes to grade 1
  • e wave will reduce >50% if positive
53
Q

mid-diastolic flow pseudo normal

A
  • sometimes the LV la pressure gradient is maintained well into diastasis
  • this results in flow across the MV during diastasis
54
Q

what is the wave seen during diastasis in pseudonormal

A
  • L wave
  • commonly seen along the LVH at lower heart rates
  • what would you see at higher HR
    + L would fuse with E
55
Q

grade 3 DD/ severe DD

A
  • reduced LV compliance and increased filling pressure leads to tall E wave and short deceleration time LAP ++
56
Q

symptoms of grade 3 DD

A
  • dyspnea with minimal exertion
  • reduced exercise tolerance
  • pedal or abdominal edema
57
Q

grade 3 DD MV inflow characteristics

A
  • increased E velocity
  • increased E/A ratio >/= 2.0
  • short DT < 150-160-ms
  • low e’ < 5cm/s
  • increased E/e prime ratio >/= 14 indicates High LAP or filling pressure
58
Q

when do pulmonary veins fill the LA during

A
  • ventricular systole
  • early diastole
  • diastasis
59
Q

when is the flow reversed in the pulmonary veins

A
  • atrial systole
60
Q

what three things happen with the PV a wave and MV a wave with DD

A
  • PV atrial reversal wave increases velocity
  • PV atrial reversal wave increases duration
  • MV a wave decreases duration
61
Q

PVa - MVa normal

A

< 20ms

62
Q

PVa - MVa mild DD

A

< 20ms

63
Q

PVa - MVa mod DD

A

> /= 30ms

64
Q

PVa - MVa sev DD

A

> /= 30ms

65
Q

treatment for diastolic dysfunction

A
  • besides treating underlying cause of DD EXERCISE is only direct treatment of DD
66
Q

3 key differences between RV and LV diastolic dysfunction

A
  • RV inflow velocities vary with respiration
  • RV inflow velocities are lower
    + TV area is larger than MV leads to lower filling velocites
  • RV diastolic FILling time is longer
    + the TV opens before and closes after the MV
67
Q

3 stages of RV dysfunction

A
  • impaired relaxation
  • pseudonormal TV inflow
  • restrictive filling
68
Q

impaired relaxation RV DD criteria

A
  • E/A <0.8
69
Q

pseudonormal TV INflow RV DD criteria

A
  • E/A 0.8-2.1

- E/e’ > 6 (or HV diastolic flow predominance)

70
Q

restrictive filing RV DD criteria

A
  • E/A > 2.1

- DT < 120ms

Echo 2 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions