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PTE Masters + A Practical Approach to Transesophageal Echocardiography > Tissue Doppler > Flashcards

Tissue Doppler Flashcards

1
Q

What angle do you want to keep tissue doppler within?

A

<20 degrees

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2
Q

Tissue doppler should be averaged over how many cardiac cycles?

A

3

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3
Q

What e’ on the lateral mitral annulus work indicate that they have Grade 0 (Normal)?

A

Lateral e’ velocity of > 10 cm/sec

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4
Q

If the e’ (lateral mitral TDI) is <10 cm, what determines Grade 1 impaired relaxation?

A

E/e’ <8

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5
Q

If the e’ (lateral mitral TDI) is <10 cm, what determines Grade 2 pseudonormal?

A

E/e’ = 9-12

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6
Q

If the e’ (lateral mitral TDI) is <10 cm, what determines Grade 3 Restrictive?

A

E/e’ > 13

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7
Q

In the ME 4 chamber, how does the septal annulus move during systole? during diastole

A

Moves down = Systole

Moves up = Diastole (What we measure)

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8
Q

During tissue doppler, what are the main 3 waves we look at?

Draw these waves

A

S’ = Peak velocity during systole

e’ = Peak early velocity diastole

a’ = Peak late velocity diastole

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9
Q

What is the myocardial performance index?

A

IVCT + IVRT / ET

Isovolumetric contraction time

Isovolumetric relaxation time

Ejection TIme

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10
Q

What is a concerning lateral mitral annulus e’ wave?

A

<8 cm/sec = Bad

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11
Q

Which mitral annulus has a greater velocity?

What is the caveat?

A

lateral > septal

Caveat = CP in which lateral e’ < septal e’

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12
Q

What is a non-reassuring e’ velocity?

A

e’ < 8 cm/sec = bad

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13
Q

What is a reassuring a’ velocity?

A

a’ <10 = Good

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14
Q

what is a non-reassuring e’/a’ ratio?

A

<1 = bad

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15
Q

What are the 3 important time intervals needed to know for TDI?

A
  1. Isovolumetric Contraction
  2. Ejection Time
  3. Isovolumetric Relaxation
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16
Q

What is a reassuring s’ velocity?

A

s’ > 8 cm/sec = good

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17
Q

What is a non-reassuring s’ velocity?

A

s’ < 5 cm/sec = bad

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18
Q

What is the Te’?

What is the significance for diastole?

A

Time to e’

Onset of QRS to onset of e’ wave

For diastole = Prolonged Te’ in diastolic dysfunction

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19
Q

What is Te?

A

Time from QRS (R wave) to E wave (Transmitral inflow velocities)

20
Q

What is the significance of substracting Te’ - E

A

Te’ - TE = Prolonged with impaired relaxation and is strongly dependence on tau = Time constant of LV relaxation

21
Q

What is a normal Te’ - TE measurement?

A

0 - 4 msec

22
Q

When is Te’ - TE unreliable?

A

Arrythmias

Variable HR

Atrial Fibrillation

23
Q

How does the s’ in TDI change in ischemia?

24
Q

How does the e’ in TDI change in ischemia?

25
How does the a' in TDI change in ischemia?
Increased
26
How does the e'/a ratio in TDI change in ischemia?
Decrease
27
what are the limitations to tissue doppler limitations?
Mitral annular disease / tethering
28
What is tissue doppler in cardiac tamponade?
Normal
29
What is tissue doppler in constrictive pericarditis?
Normal
30
What is annular reversus?
**Lateral e' \< septal e'** 1.24 - 1.3 = Normal ratio, but in this disease, its \<0.95!
31
What is the lateral e' in RICM?
e' \< 8 cm/sec
32
What is the lateral e' in CP?
e' \>10 cm/sec
33
MPI is a measure of what function: Systolic or Diastolic?
**BOTH!** **Systolic and Diastolic**
34
What is the formula for MCI?
Isovolemic phases / Ejection Time [***_IVCT + IVRT_***] / **ET**
35
What is the value for MPI?
**0.39 +/- 0.05** = Normal "Low number is better" Ex: Dilated CM has 0.59 +/- 0.1
36
What S' for the Tricuspid lateral annulus is **non-reassuring** when assessing right heart function?
***_Right ventricle S'_*** \<10 cm/sec (This would be concerning in young healthy patient)
37
What is the formula for Isovolumetric acceleration?
**Vt** / **Change in time** Vt = Max Isovolumetric Velocity Change in time = Time it takes to get there
38
Is the RV MPI independent or dependent on loading conditions?
RV MPI independent of HR, preload and afterload
39
What is the normal values for IVA?
1.4 +/- 0.5 m/s2
40
Is the RV MPI measure systolic or diastolic function?
Both
41
What is the formula for MPI?
IVCT + IVRT / ET
42
What RV MPI value was found to be predictive of HD instability and mortality after cardiac valvular surgery?
\> 0.5
43
What is the formula for RV strain?
Straing = [**Final Length - Initial Length**] / **Initial length** ## Footnote **L2 - L1**
44
What is a normal RV strain?
Anymore more negative than -20
45
What is the strain rate?
Strain / Change in time (V2-V1) / x

PTE Masters + A Practical Approach to Transesophageal Echocardiography (55 decks)

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