Ventricular Diastolic Filling & Function

Question 1

What is the equation for ventricular compliance (C) ?

Answer 1

change in volume /change in pressure

Question 2

Compliance is the reciprocal of what?

Answer 2

Stiffness - change in P/V

Question 3

Causes of decreased compliance? (increased pressure at a given volume)

Answer 3

1. Pressure overload that results in hypertrophy (may be due to stenosis)
2. Hypertrophic cardiomyopathy
3. Restrictive Cardiomyopathies
4. Impaired Relaxation

Question 4

What happens to end diastolic volume with decreased compliance?

Answer 4

Lower end-diastolic volume

Question 5

What happens to end diastolic volume with increased compliance?

Answer 5

Higher end-diastolic volume

Question 6

Causes of decreased compliance? (increased pressure at a given volume)

Answer 6

1. Systolic dysfunction (ex: dilated cardiomyopathies)
2. Chronic volume overload (ex: regurgitation)

Question 7

What comes first, diastolic or systolic dysfunction?

Answer 7

Diastolic

Question 8

What does the E’ represent on spectral doppler?

Answer 8

Early/rapid diastolic filling

Question 9

What ends IVR?

Answer 9

Opening of the MV

Question 10

Filling rate and time of LA –> LV is dependent on what factors?

Answer 10

1. Pressure
2. Ventricular relaxation
3. Compliance

Question 11

In what phase does atrial kick occur?

Answer 11

Late diastolic filling

Question 12

What does the duration of the diastasis period depend on?

Answer 12

Heart rate - longer duration with a slower heart rate and ABSENT with a fast heart rate

Question 13

When does ventricular relaxation occur?

Answer 13

IVR and early rapid diastolic filling

Question 14

Abnormal relaxation will do what to the IVRT?

Answer 14

Prolong it

Question 15

Abnormal relaxation of the ventricle causes what to occur? (3)

Answer 15

1. prolonged IVRT
2. Slower rate of decline in ventricular pressure
3. Smaller E’ wave and taller A’ wave due to a stronger atrial kick

Question 16

Ventricular Diastolic Pressures are inclusive of what two things?

Answer 16

1. LV end-diastolic pressure
2. Mean LA pressure

Question 17

If you see an increase in LV end-diastolic pressure, are we looking at an increase or decrease in compliance?

Answer 17

DECREASE - stiffer ventricle

Question 18

What does the small a-wave represent in a spectral doppler? (hint: not atrial kick)

Answer 18

A small amount of flow reversal due to atrial kick

Question 19

What does the small v-wave represent in spectral doppler?

Answer 19

A small amount of flow reversal due to end-systole/ventricular contraction

Question 20

In which pulmonary vein is spectral doppler used?

Answer 20

Right Superior

Question 21

Is the diastolic filling period longer in MV or TV outflow into ventricles?

Answer 21

TV

Question 22

What does the E’ measure at the TV annulus?

Answer 22

Longitudinal myocardial lengthening in early diastole

Question 23

What will happen to the IVRT in impaired relaxation of the ventricle?

Answer 23

It will prolong the IVRT

Question 24

What will happen to the IVRT with a less compliant, stiff ventricle with increased pressure?

Answer 24

A shorter IVRT

Question 25

What will happen to the diastasis period with a slower heart rate compared to a faster one?

Answer 25

With a slower HR, the diastasis period is longer, which will show a clear separation of the E and A wave in LV inflow

Question 26

In A-fib, are the E or A waves missing in LV inflow?

Answer 26

A waves are missing

Question 27

How does a longer P-R interval affect A velocity?

Answer 27

The A velocity or atrial kick occurs sooner so it would superimpose with the E velocity during diastole

Question 28

What happens to the S and D waves during pulmonary artery flow into the LA with age?

Answer 28

The S wave becomes larger than the D wave

Question 29

What happens to the E and A velocities during LV inflow with a higher preload?

Answer 29

E velocity will be higher and A velocity will be lower due to the increased pressure in the LA

Question 30

What is the normal TDI value for lateral and septal e' velocity?

Answer 30

Lateral >10cm/s Septal >7cm/s

Question 31

Is S or D velocity higher in normal PV inflow?

Answer 31

S>D

Question 32

Is S1 or S2 velocity greater in a normal patient?

Answer 32

S2

Question 33

What is the approximate S/D ratio?

Answer 33

1

Question 34

What is the normal IVRT in ms?

Answer 34

50-100 ms

Question 35

How does impaired relaxation affect IVRT?

Answer 35

Prolongs it

Question 36

How does a decreased compliance and increased filling pressures affect IVRT?

Answer 36

Shortens it

Question 37

How do you measure the IVRT? (hint: what view and what doppler measurement)

Answer 37

Ap 5 doppler LVOT with PW

Question 38

How does a fast heart rate affect diastasis?

Answer 38

Decreases the period of diastasis