Ventricular Diastolic Function Flashcards
What are the 4 phases of diastole?
Initial isovolumic relaxation
Early rapid LV inflow
Diastasis
Atrial systole.
What is the E/A for impaired relaxation?
What is the IVRT?
E/A < 0.8
IVRT > 110 ms
What is the E/A in a pseudonormal filling pattern?
What will be abnormal?
normal with 0.8
E/e’ > 10-14
What happens to pulmonary venous flow in a restrictive diastolic dysfunction pattern?
Systolic blunting.
How to assess diastolic function in atrial fibrillation?
Average 10 consecutive cycles.
What happens to diastolic assessement in patients with Mitral annular calcification?
E/e’ measurements may be elevated.
E/A and IVRT better correlate
What happens to diastolic assessement in patients with mitral stenosis?
E/e’, etc are unreliable metrics.
What does end systole hepatic flow reversal indicate for right ventricular compliance?
Decreased
In tamponade does RA or RV collapse happen first? To what extent is RA collapsed?
RA collapse is first
Happens in early systole and lasts more than 1/3 of the cardiac cycle.
With further rise of pressures then RV collapses.
What is the L wave in diastology?
In pseudonormal diastolic pattern
What is a normal septal e’?
Normal lateral e’?
Septal = 8 cm/s
Lateral = 12 cm/s
Explain the parts of the pulmonary vein waveform.
S1 - Atrial relaxation
S2 - Descent of ventricular base “sucks” blood into atrium
D: blood passively flows into atrium during ventricular diastole
A: Reversal wave - reflux when atria contracts
What A reversal wave velocity suggests elevated LVEDP?
Velocity > 35 cm/s
What happens to IVRT (Isovolumetric Relaxation Time) in an impaired relaxation, pseudonormal, and Restrictive Diastolic patterns?
Impaired relaxation - IVRT increased
Decreases for other two
What happens to A duration (Atrial kick) for impaired relaxation, pseudonormal, and restrictive diastolic patterns?
Impaired relaxation - Increased A duration
Decreased in other 2
What does an E/Vp >2.5 mean for PCWP?
Vp = propogation velocity
> 15 mmHg in patients with decreased LVEF
How to calculate Myocardial performance Index?
(IVCT + IVRT)/ET
IVCT = Isovolumic contraction time
IVRT = Isovolumic relaxation time
ET = Ejection Time
What is a typical pulmonary venous doppler flow profile?
antegrade systolic velocity which may be monophasic or biphasic ( PVs1, PVs2)
This is followed by an antegrade diastolic flow while mitral valve is open.
Finally a late diastolic flow reversal PVar
What is a normal pulmonary venous diastolic atrial flow reversal duration?
90-115 ms
What happens to the pulmonary venous waveform in a patient with an impaired relaxation pattern?
Reduced PVd velocity and compensatory increase in PVs resulting in a systolic predominance.
What happens to the pulmonary venous waveform in a restrictive filling pattern?
Systolic blunting as well as an increase in duration and velocity of the late diastolic flow reversal PVar
