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Echo 2 > Ventricular Systolic Function > Flashcards

Ventricular Systolic Function Flashcards

1
Q

LV systolic function

A

Ventricles pump blood into systemic and pulmonary circulation
Ensure adequate perfusion to the body

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2
Q

What is systolic dysfunction

A

Inability to contract

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3
Q

In systolic dysfunction what happens

A

Decreases in SV/EF
Increase in preload (LVEDP)
?CHF

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4
Q

Diastole is

A

Ventricular distension/ relaxation

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5
Q

What is starling’s law

A

As filling occurs, stretch in muscle develops tension/strength for contraction, generate negative pressure gradient to ensure venous return, coronary arteries fill during this time

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6
Q

Ventricular systole is produced by and what is it followed by

A

Depolarization of the ventricles

Followed by mechanical contraction

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7
Q

What produces increased pressure within LV and RV

A

Ventricular myocardium contraction

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8
Q

What are the phases of systole

A

Isovolumic contraction

Ventricular ejection

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9
Q

What is isovolumic contraction

A

All valves closed, ventricular pressure is building up

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10
Q

What happens in the ventricular ejection phase

A

Atrio-ventricular valves closed
Semilunar valves open caused by pressure gradient between LV and aorta
Ejection occurs until ventricular pressure equalizes within the great vessels

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11
Q

What is the sequence of systole

A

Myocardial depolarization —>contraction—>ejection
Electrical stimulation of the heart that results in a contraction of the myocardium
Pressure increases, causing a reduction of the internal volume of the chamber

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12
Q

What is the timing of systole

A

IVCT- onset of QRS complex

Ejection

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13
Q

When does ejection of systole start

A

AV opens

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14
Q

When does systolic ejection end

A

When the AV closes

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15
Q

What are the pressures of the AO

A

Systolic: 120mmHg
Diastolic: 70mmHg
Mean: 85mmHg

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16
Q

What are the pressures in the PA

A

Systolic: 25mmHg
Diastolic: 10mmHg
Mean: 16mmHg

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17
Q

What is the mean pressure of the LA

A

10mmHg

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18
Q

What is the mean pressure of the RA

A

4mmHg

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19
Q

What are the pressures of the RV

A

Systolic: 25mmHg
Diastolic: 4mmHg

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20
Q

What are the pressures of the LV

A

Systolic: 120mmHg
Diastolic: 10mmHg

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21
Q

After depolarization of the ventricular muscle what starts to contract

A

LV/RV

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22
Q

What does contraction increase

A

Intra-cavitary pressure

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23
Q

Pressure rises until it exceeds what

A

AO/PA pressure which opens the AV/PV and blood is ejected

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24
Q

After ejection what happens

A

LV/RV pressure falls below the AO and PA, which closes the AV and PV

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25
The pressure keeps falling during relaxation until what
MV and TV open
26
Filling sees a large change in ___ with only a slight ____ in ______.
Volume Increase Pressure
27
The LV has what kind of pressure volume loop
Rectangular
28
The RV has what kind of pressure volume loop
Triangular
29
Why is the RV different from the LV pressure volume loop
Lower pressure are on the right side | Lowers impedance of the pulmonary vascular bed
30
Even after the peak pressure is reached, flow continues to enter where and from where
The PA from the RV
31
Determinates of SV
Preload Afterload Contractility
32
Preload is
Muscle length or stretch at end-diastole
33
Since the intact heart cannot be measures we estimate preload by using
LVEDV PVEDP LA pressure
34
Changes in preload alter what
The end-diastolic volume
35
Altering the end-diastolic volume caused by the change in preload increases the what
Amount of stretch
36
Afterload is
The tension that the LV must overcome before fiber shortening and contraction
37
What affects afterload
Changes in ventricular volume, wall thickness or vascular resistance
38
Is the LV or the RV more sensitive to afterload
RV
39
What is contractility
Inherent strength of the cardiac muscle and ablility to shorten as it contracts
40
Changing any one the three determinants of stroke volume will do what
Affect the other two
41
What are the factors the increase stroke volume
Increased preload Decreased afterload Increased inotropy
42
What are the factors that decrease stroke volume
Decrease preload Increase afterload Decrease inotropy
43
Fractional shortening and ejection fraction are what kind of systolic measurement
Quantitative
44
What are the volumetric assessments of LV systolic function
``` Simpson’s EF Area length method stroke volume -> cardiac output, cardiac index Dp/Dt Tissue doppler MPI global strain ```
45
What are the qualitative LV systolic function measurements
Visual kinetic analysis (global EF estimation) | Segmental wall motion analysis
46
What are the 4 different types of segmental wall motion analysis
Normal Hypokinetic Akinetic Dyskinetic
47
What is the normal value for a parasternal EF
55%
48
What is the normal value for fractional shortening
>25%
49
What is the normal Simpson’s EF for males
52-72
50
What is the normal Simpson’s EF for females
54-74
51
% of change in the minor axis dimension has a correlation to what
EF
52
When to measure end diastolic
Isovolumic contraction time - onset of the QRS complex - frame after MV closure - frame where LV diameter/dimension is largest
53
When to measure end systole
Isovolumic relaxation time - the frame preceding MV opening - when the LV is the smallest - near the end of the T wave
54
When peak downward displacement if the septum is abnormal what should be used for timing
The peak upward displacement if the posterior wall
55
Increasing what can help the linear EF with abnormal IVS
Frame rate
56
Simpson’s biplane is also called the
Method of disks
57
What does the Simpson’s biplane method rely on
Endocardium tracing in 2 apical views
58
What are the 2 apical views that the Simpson’s biplane uses
A4C | A2C
59
The length of the LV should extend from where to where
The middle of the MV annulus to the true LV apex
60
If the true apex cannot be seen well, what should not be done
Simpsons
61
Ensure that the LV central axis in diastole or length does not differ between the A4C and A2C views by more than what
10%
62
What is derived from the volumetric assessment
Stroke volume | Ejection fraction
63
What is the cardiac output equation
CO= SV x HR
64
What is the equation for the volumetric assessment
SV = EDV-ESV
65
What can be performed when the endocardial definition is suboptimal from the apical images but good from parasternal
Area-length method
66
How is the area-length method performed
Trace the LV chamber at the pap muscle level then measure the LV length in the A4C view from the MV annulus to the apex
67
What does the SV calculation assume about the LVOT
That it is circular
68
What is also assumed in the SV calculation
Laminar flow
69
Most indices of cardiac performance are influenced by
Loading conditions, like SV CO CI
70
When is the Dp/Dt measured
During the pre-ejection phase of the cardiac cycle
71
Dp/Dt is less influenced by what
Loading conditions
72
Dp is the
Change in pressure
73
Dt is the
Change in time it takes to reach that pressure
74
What are the points that are Usually chosen for Dp/Dt
1 m/s and 3m/s
75
Dp/Dt uses which principle
Bernoulli
76
What is the pressure at 1 m/s in the Bernoulli equation
4mmHg
77
What is the pressure at 3 m/s in the Bernoulli equation
36mmHg
78
What is the difference between the two pressures (1 m/s and 3 m/s)
32mmHg
79
Dp/Dt measures how much time it takes for what
The LV pressure to rise by 32mmHg
80
What are the limitations of Dp/Dt
Valve click artifact (from prosthetic valves) Eccentric MR jets (difficult to pick up CW) Poor alignment to the MR jets Non-compliant LA
81
What is the normal value for Dp/Dt
<27 msec
82
Tissue doppler measures the speed that the
LV muscle contracts in the longitudinal plane
83
What is the normal value for tissue doppler
>9.0 cm/s
84
Tissue doppler is a good measurement of
Systolic function
85
Muscle tissues in the LV are arranged
Longitudinally Radially Circumferentially
86
What is the S prime influenced by
Tethering and translational motion of the heart
87
What is tethering
When a hypokinetic or akinetic segment is adjacent to a normal segment and gets dragged along by its motion
88
What velocities progressively decrease form base to apex in the normal heart
S prime
89
S prime will not be accurate when there is varying degrees of
Segmental systolic dysfunction, as it will not include those abnormal segments
90
S prime will be fairly accurate when
Wall motion is normal or globally down
91
S prime measures what
The velocity of the tissue in one of the basal segments from the apical view
92
Therefore what can the s prime only truly reflect
The performance of that segment
93
When is the index of myocardial performance used in cases with
``` Dilated cardiomyopathy Cardiac amyloidosis Pulmonary hypertension RV infarction RV dysplasia ```
94
MPI provides information about both
Systolic and diastolic function
95
IMP is a ratio between
(ICT+IRT)/ET
96
May disease states include some degree of
Systolic and diastolic dysfunction
97
In a diseased heart, what happens to ejection time and isovolumic times
ET shortens, isovolumic times increase
98
What is the normal LV for the MPI conventional doppler method
<0.44
99
What are the normal measurements for the TDI method
LV: <0.6 RV: <0.55
100
The normal RV in the A4C view should be ___ than ___ the size of the LV
Less | 2/3
101
Should the RV or the LV dominate the apex
LV
102
Mild dilation of the RV is when the
RV >2/3 of the LV but RV cavity is still smaller than LV.
103
The RV apex more basal than the LV apex is what
Normal
104
Moderate dilation of the RV
When the RV and the LV are equal size and share the apex
105
Severe dilatation of the RV is when
RV>LV size and RV occupies the apex
106
Walls MUST be seen in how many views to be scored qualitatively
2 or more

Echo 2 (6 decks)

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