Ventricular Diastolic Filling & Function (Lecture 1) Flashcards
What are the four phases of Diastole?
Isovolumetric Relaxation
Early Rapid Diastolic Filling
Diastasis
Late Diastolic Filling (Atrial Contraction)
Pick which phase of Diastole this fits for:
- Starts with Ao valve closure, followed by a rapid decline in LV pressure
- LV pressure falls below LA pressure, MV opens ending the IVR period
Isovolumetric Relaxation
Pick which phase of Diastole this fits for:
- Occurs right after MV opening, LVP falls below LAP
- LV volume and LVP increase – contributes to 70-80% of LV filling
- Filling rate and time of LA to LV flow determined by pressure, ventricular relaxation
(elastic recoil of LV), and compliance of the ventricles
Early Rapid Diastolic Filling
Pick which phase of Diastole this fits for:
- Pressures in atria and ventricles equalize during this period of lower ventricular filling
- Equalization due to simultaneous ↓LAP and ↑LVP
- Duration depends on HR, longer at low HR and absent with fast HR
Diastasis
Pick which phase of Diastole this fits for:
- LA pressure exceeds LV pressure with atrial contraction, second pulse of LV filling (atrial
kick) - In normal patients – contributes to 20% of total ventricular filling
Late Diastolic Filling (Atrial Contraction)
What are the parameters of Diastolic Function?
Ventricular Relaxation
Myocardial or Chamber Compliance
Filling Pressures
And additionally: Elastic Recoil of the Ventricle, Pericardial Constraint
When does Ventricular Relaxation occur?
During Isovolumetric Relaxation and Early Diastolic Filling
What are examples of Intrinsic factors that affect IVRT?
Stiff myocardium, infiltrative disease, LVH
What are examples of Extrinsic factors that affect IVRT?
Pericardial constraint (constrictive pericarditis, pericardial tamponade)
A more compliant ventricle will allow less or more blood to fill the ventricle?
It will allow more blood
A less compliant ventricle will allow (ess or more blood to fill the ventricle?
Less blood
Compliance is the ratio of what?
Change in volume to change in pressure (dV/dP)
What is the inverse of compliance?
Stiffness
What is the equation for Stiffness?
The ratio of change in Pressure to change in Volume (dP/dV)
What are six factors that affect late diastolic filling?
- Cardiac rhythm
- Atrial contractile function
- Ventricular end-diastolic pressure
- Heart rate
- The timing of atrial contraction
- Ventricular diastolic function
What are 3 factors that that Affect Peak Early Diastolic
Filling Rate?
- Changes in preload that affect the initial pressure difference between the ventricle and the atrium (e.g., increased with volume loading, decreased with volume depletion)
- A change in transmitral volume flow rate (e.g., increased with coexisting mitral regurgitation)
- A change in atrial pressure (e.g., elevated LV end-diastolic pressure – stiff ventricle)
What are the RA pressures?
0-5mmHg (low)
What is S velocity?
Forward flow into LA
What is the difference between S1 and S2 in LA filling?
S1 occurs in early systole, increased PV flow secondary to LA relaxation
S2 occurs mid-late systole due to increased PV pressure from transpulmonary flow after RV systole
What is the D velocity in LA filling?
Diastolic Pressure Gradient between the Pulmonary Vein and LA, forward flow that mimics transmitral peak E velocity
Atrial flow reversal (AR) is the Pressure Gradience of what?
The PV and LA following atrial contraction, retrograde flow occuring after the P wave on ECG
When looking for the Pulmonary Venous (LA) Filling Doppler Velocity curve, where should the SVB be placed?
1-2 from the orifice, parallel alignment with the right superior pulmonary vein (RSPV)
In Pulmonary Veins, patients over 50 yrs old have prominent ____ velocities? (which letter?)
S velocities
As age increases, what ratio increases for LA fillin?
SD ratio
With ‘No increase with inspiration, PV
intrathoracic, not affected’ - which ventricle and which breathing cycle is this true?
LV, inspiration
With ‘negative intrathoracic pressure
results in an increase in systemic
venous return into the thorax and
thus into the atrium and transient increase in ventricle diastolic filling of up to 20%’ - which ventricle and which breathing cycle is this true?
RV, inspiration
Which ventricle has a higher at end-expiration than during inspiration?
LV
Which ventricle has no increase with expiration?
RV
In the early stages of diastolic function, what happens to early rapid filling and atrial contraction?
Decreased early rapid filling with an increase in atrial contraction to compensate for poor filling 1st phase
Are max velocities higher or lower in RV diastolic filling?
lower (tricuspid annulus is larger)
What ventricle filling doppler has greater normal respiratory variation?
RV
E’ velocity corresponds with which cardiac cycle?
Early rapid filling
A’ velocity corresponds with which cardiac cycle?
Atrial contraction
What are the abnormal cut off values annular E’ velocity for Septal E’?
Less than 7 cm/sec
What are the abnormal cut off values annular E’ velocity for Lateral E’?
< 10 cm/sec
What are the abnormal cut off values for the average E/E’ ratio?
> 14
If you have prolonged IVRT, what is happening to the relaxation?
It is impaired
If you have a short IVRT, what is happening to compliance filling pressures?
Decreased compliance and elevated filling pressures
Diastole is shorter, especially in diastasis, with which heart rate? (higher or slow)
Higher
Which heart rate are E and A velocities much further apart with longer period of diastasis?
Slow HR
Atrial fibrillation shows which waveform?
E velocity curves
A mix of longer and shorter diastolic intervals on the E/A pattern is indicative of which effect?
Heart block or atrial arrhythmia
Higher LA pressure causes an increased __ velocity, reduced ____ and steeper deceleration slope of _____ _______ _______ .
E, IVRT, early diastolic filling
