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Cardiac 2 > Ventricular Diastolic Filling & Function > Flashcards

Ventricular Diastolic Filling & Function Flashcards

1
Q

What is the equation for ventricular compliance (C) ?

A

change in volume /change in pressure

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2
Q

Compliance is the reciprocal of what?

A

Stiffness - change in P/V

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3
Q

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

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

What happens to end diastolic volume with decreased compliance?

A

Lower end-diastolic volume

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5
Q

What happens to end diastolic volume with increased compliance?

A

Higher end-diastolic volume

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6
Q

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

A
  1. Systolic dysfunction (ex: dilated cardiomyopathies)
  2. Chronic volume overload (ex: regurgitation)
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7
Q

What comes first, diastolic or systolic dysfunction?

A

Diastolic

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8
Q

What does the E’ represent on spectral doppler?

A

Early/rapid diastolic filling

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9
Q

What ends IVR?

A

Opening of the MV

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10
Q

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

A
  1. Pressure
  2. Ventricular relaxation
  3. Compliance
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11
Q

In what phase does atrial kick occur?

A

Late diastolic filling

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12
Q

What does the duration of the diastasis period depend on?

A

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

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13
Q

When does ventricular relaxation occur?

A

IVR and early rapid diastolic filling

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14
Q

Abnormal relaxation will do what to the IVRT?

A

Prolong it

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15
Q

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

A
  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
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16
Q

Ventricular Diastolic Pressures are inclusive of what two things?

A
  1. LV end-diastolic pressure
  2. Mean LA pressure
17
Q

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

A

DECREASE - stiffer ventricle

18
Q

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

A

A small amount of flow reversal due to atrial kick

19
Q

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

A

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

20
Q

In which pulmonary vein is spectral doppler used?

A

Right Superior

21
Q

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

A

TV

22
Q

What does the E’ measure at the TV annulus?

A

Longitudinal myocardial lengthening in early diastole

23
Q

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

A

It will prolong the IVRT

24
Q

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

A

A shorter IVRT

25
Q

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

A

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

26
Q

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

A

A waves are missing

27
Q

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

A

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

28
Q

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

A

The S wave becomes larger than the D wave

29
Q

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

A

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

30
Q

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

A

Lateral >10cm/s

Septal >7cm/s

31
Q

Is S or D velocity higher in normal PV inflow?

A

S>D

32
Q

Is S1 or S2 velocity greater in a normal patient?

A

S2

33
Q

What is the approximate S/D ratio?

A

1

34
Q

What is the normal IVRT in ms?

A

50-100 ms

35
Q

How does impaired relaxation affect IVRT?

A

Prolongs it

36
Q

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

A

Shortens it

37
Q

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

A

Ap 5 doppler LVOT with PW

38
Q

How does a fast heart rate affect diastasis?

A

Decreases the period of diastasis

Cardiac 2 (6 decks)

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