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Echo: LV and RV Systolic Function > The Left Ventricle > Flashcards

The Left Ventricle Flashcards

1
Q

Define: Pump Performance

A

The ability of the ventricle to deliver a stroke volume

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2
Q

Define: Ventricular Function

A

LV performance relative to the end diastolic fiber length at end diastole

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3
Q

Define: Myocardial Contractility

A

Property of the myocardial tissue in its active state / its ability to contract

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4
Q

Define: Contractile Function

A

Ventricular performance affected by load, fiber length, inotropic state

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5
Q

What are the indirect M-mode markers for LV function?

A
  • AO root motion
  • Mitral Valve D to E excursion
  • Septal and Posterior Wall motion
  • B bump
  • LAE
  • Dilated LV
  • Pulmonary Hypertension
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6
Q

What does decreased AO root motion affect?

A

The propagation of stroke volume

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7
Q

What does a decreased mitral valve excursion mean?

A

There is a poor stroke volume.

Decreased flow = Decreased pressure = Decreased valve excursion

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8
Q

What does a B bump in a mitral valve M-mode mean?

A

It indicates an increased LVEDP (LV End Diastolic Pressure).

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9
Q

What is a B bump?

A

A notch in between the A point and C point on a mitral Valve M-mode

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10
Q

How is pulmonary hypertension indicated on an M-mode?

A

On a Pulmonic Valve M-mode, the valve closes mid-systole due to abnormal pressures causing a “Flying W”

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11
Q

Myocardial Fibers contract _______ and _______ .

A

circumfrentially and longitudinally

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12
Q

Systolic ventricular function depends on:

A
  • LV function
  • Compliance of the myocardium
  • Preload and Afterload
  • LV shape and size
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13
Q

LV contractility is caused by the ________ fibers _______ and _________ .

A

Myocardial
Elongating
Shortening

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14
Q

LV contractility is affected by:

A
  • MI
  • Loading conditions
  • pressures
  • Heart rate
  • blood pressure
  • blood viscosity
  • stress
  • metabolic disorders
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15
Q

Define: Preload

A

What is let tin the ventricle at end diastole

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16
Q

What lesions affect preload?

A

Aortic insufficiency

Left Ventricular Hypertrophy

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17
Q

Define: Afterload

A

Systemic vascular resistance / What the LV has to pump against

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18
Q

LV volumes consist of:

A

LVED

LVES

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19
Q

What is the equation for Stroke Volume?

A

SV = LVED - LVES

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20
Q

What is the equation for Cardiac Output?

A

CO = SV x HR

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21
Q

What are the imaging views for the LV?

A
  • Apical 4,5,2,3
  • LV apex from Apical 4
  • Short axis at LV
  • Modified Apical 4
  • Subcostal
22
Q

What are the parameters for LV Systolic Evaluation?

A
  1. LV Volumes (LVED, LVES)
  2. Simpsons Method, Biplane EF%, Single 4 chamber EF%
  3. LV Mass
  4. Relative Wall Thickness
  5. LV Wall Stress
  6. dp / dt
23
Q

What is the equation for LV mass?

A

LV MASS (ASE) = 1.04 [ (LVED) + IVSD + LVP)^3 - (LVED)^3 x .8 + .6 grams

24
Q

What are the normal limits for LV MASS for women, men & both?

A

Women: 66 - 150 g
Men: 96 - 200 g
Both: 50 - 70 g

25
Q

What is the equation for Relative Wall Thickness?

A

LVIT

26
Q

What are the parameters for LV wall stress?

A
  1. Longitudinal
  2. Meridial
  3. Circumfrential
  4. Radial
27
Q

What are the causes of LV remodeling?

A
  • Changes in pressure

- increased stress in the LV

28
Q

What are the consequences of LV remodeling?

A
  1. increased systolic wall tension & stress
  2. increased MVO2
  3. Reduced myocyte shortening (contractility)
  4. reduced subendocardial perfusion
  5. dysynchronous depolarization / contraction
  6. conduction delay / dyskinetic myocardium
  7. mitral regurge
  8. ventricular arrhythmias (VFIB)
29
Q

What does dp / dt measure?

A

the rate of change in LV pressure at systole / LV systolic performance

30
Q

What does a longer dp / dt mean?

A

poor LV function, low pressures, low EF%

31
Q

What are the normal, borderline and abnormal limits for dp / dt?

A

Normal: > 1200 mmHG/sec or < 27 msec
Borderline: 1,000 - 1,200 mmHG/sec
Abnormal: < 1,000 mmHG/sec or > 32 msec

32
Q

What is VTI?

A

Velocity Time Integral

33
Q

Define: Velocity Time Integral

A

The distance that a volume of blood travels at systole / the stroke index for 1 beat.

34
Q

What is the equation for VTI based on?

A

The volume of a cylinder: base x height

35
Q

What is the equation for VTI?

A

VTI = Velocity x Time

36
Q

What are the units for VTI?

A

cm

37
Q

What are the normal limits for RWT for men and women?

A

Men: .22 - .42
Women: .24 - .4

38
Q

What are the factors that affect wall stress?

A
  1. LV dilation
  2. LV Hypertorphy
  3. Increase in overall pressure
  4. Lesions: AS, MS, etc…
39
Q

What effect does LV dilation have on LV wall stress?

A

the myocardium stretches and wall stress increases

40
Q

What effect does LV hypertrophy have on LV wall stress?

A

the myocardium thickens and wall stress increases

41
Q

Can wall stress be measured?

A

No

42
Q

LV wall stress can affect a ______ or the _______ LV wall

A

portion

entire

43
Q

How do you measure the LVOT diameter (cross sectional area)?

A
  1. Measure the LVOT just at the AO valve (@ systole) in PLAX view
  2. Put that measurement in the CSA equation
    CSA = .785 x d^2
44
Q

What are the two things you need to do a doppler exam of the LV systolic function?

A
  1. CSA of the LVOT

2. VTI

45
Q

What are 4 things a good SV calculation depends on?

A
  1. Accurate caliper placement
  2. Valve must be open
  3. Where you place the sample volume / Caliper must be 1 cm away from the valve in center of flow
  4. Good window / clean up TGCs
46
Q

How do you measure dp / dt?

A
  1. adjust sweep speed to 100 mm/sec
  2. place caliper at MR jet to obtain a doppler reading
  3. measure the point at which the velocity jet reaches 1 m/sec and another caliper at 3 m/sec
    (this represents the time it takes for the pressure change of 32 mmHG to occur)
  4. plug that number into the dp/dt formula:
    dp/dt = 32000
    ———-
    time
47
Q

What are the criteria for using Simpson’s rule / The disk method?

A
  1. Ventricle is symmetrically contracting
  2. apical 4 or 2 chamber
  3. transducer must be at the true apex
  4. the beam must go through the center of the left ventricle
48
Q

What will happen if the criteria for the Disk Method aren’t met?

A

There is an underestimation of LV volume

49
Q

How do you calculate LAP?

A

LAP = E (doppler of MV) / E’ (tissue doppler of MV annulus) x 1.25 + 1.9

50
Q

What factors do you need in order to calculate LAP?

A
  1. Tissue doppler
  2. E/A Ratio
  3. MV flow pattern and decel. time
51
Q

In the LAP equation, what does E represent

A

doppler of the Mitral Valve

52
Q

In the LAP equation, what does E’ represent

A

tissue doppler of the Mitral Valve annulus

Echo: LV and RV Systolic Function (7 decks)

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