Ventricular Diastolic Filling & Function Flashcards
What is the equation for ventricular compliance (C) ?
change in volume /change in pressure
Compliance is the reciprocal of what?
Stiffness - change in P/V
Causes of decreased compliance? (increased pressure at a given volume)
- Pressure overload that results in hypertrophy (may be due to stenosis)
- Hypertrophic cardiomyopathy
- Restrictive Cardiomyopathies
- Impaired Relaxation
What happens to end diastolic volume with decreased compliance?
Lower end-diastolic volume
What happens to end diastolic volume with increased compliance?
Higher end-diastolic volume
Causes of decreased compliance? (increased pressure at a given volume)
- Systolic dysfunction (ex: dilated cardiomyopathies)
- Chronic volume overload (ex: regurgitation)
What comes first, diastolic or systolic dysfunction?
Diastolic
What does the E’ represent on spectral doppler?
Early/rapid diastolic filling
What ends IVR?
Opening of the MV
Filling rate and time of LA –> LV is dependent on what factors?
- Pressure
- Ventricular relaxation
- Compliance
In what phase does atrial kick occur?
Late diastolic filling
What does the duration of the diastasis period depend on?
Heart rate - longer duration with a slower heart rate and ABSENT with a fast heart rate
When does ventricular relaxation occur?
IVR and early rapid diastolic filling
Abnormal relaxation will do what to the IVRT?
Prolong it
Abnormal relaxation of the ventricle causes what to occur? (3)
- prolonged IVRT
- Slower rate of decline in ventricular pressure
- Smaller E’ wave and taller A’ wave due to a stronger atrial kick
Ventricular Diastolic Pressures are inclusive of what two things?
- LV end-diastolic pressure
- Mean LA pressure
If you see an increase in LV end-diastolic pressure, are we looking at an increase or decrease in compliance?
DECREASE - stiffer ventricle
What does the small a-wave represent in a spectral doppler? (hint: not atrial kick)
A small amount of flow reversal due to atrial kick
What does the small v-wave represent in spectral doppler?
A small amount of flow reversal due to end-systole/ventricular contraction
In which pulmonary vein is spectral doppler used?
Right Superior
Is the diastolic filling period longer in MV or TV outflow into ventricles?
TV
What does the E’ measure at the TV annulus?
Longitudinal myocardial lengthening in early diastole
What will happen to the IVRT in impaired relaxation of the ventricle?
It will prolong the IVRT
What will happen to the IVRT with a less compliant, stiff ventricle with increased pressure?
A shorter IVRT
What will happen to the diastasis period with a slower heart rate compared to a faster one?
With a slower HR, the diastasis period is longer, which will show a clear separation of the E and A wave in LV inflow
In A-fib, are the E or A waves missing in LV inflow?
A waves are missing
How does a longer P-R interval affect A velocity?
The A velocity or atrial kick occurs sooner so it would superimpose with the E velocity during diastole
What happens to the S and D waves during pulmonary artery flow into the LA with age?
The S wave becomes larger than the D wave
What happens to the E and A velocities during LV inflow with a higher preload?
E velocity will be higher and A velocity will be lower due to the increased pressure in the LA
What is the normal TDI value for lateral and septal e’ velocity?
Lateral >10cm/s
Septal >7cm/s
Is S or D velocity higher in normal PV inflow?
S>D
Is S1 or S2 velocity greater in a normal patient?
S2
What is the approximate S/D ratio?
1
What is the normal IVRT in ms?
50-100 ms
How does impaired relaxation affect IVRT?
Prolongs it
How does a decreased compliance and increased filling pressures affect IVRT?
Shortens it
How do you measure the IVRT? (hint: what view and what doppler measurement)
Ap 5 doppler LVOT with PW
How does a fast heart rate affect diastasis?
Decreases the period of diastasis
