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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
Q

The pressure keeps falling during relaxation until what

A

MV and TV open

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26
Q

Filling sees a large change in ___ with only a slight ____ in ______.

A

Volume
Increase
Pressure

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27
Q

The LV has what kind of pressure volume loop

A

Rectangular

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28
Q

The RV has what kind of pressure volume loop

A

Triangular

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29
Q

Why is the RV different from the LV pressure volume loop

A

Lower pressure are on the right side

Lowers impedance of the pulmonary vascular bed

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30
Q

Even after the peak pressure is reached, flow continues to enter where and from where

A

The PA from the RV

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31
Q

Determinates of SV

A

Preload
Afterload
Contractility

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32
Q

Preload is

A

Muscle length or stretch at end-diastole

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33
Q

Since the intact heart cannot be measures we estimate preload by using

A

LVEDV
PVEDP
LA pressure

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34
Q

Changes in preload alter what

A

The end-diastolic volume

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35
Q

Altering the end-diastolic volume caused by the change in preload increases the what

A

Amount of stretch

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36
Q

Afterload is

A

The tension that the LV must overcome before fiber shortening and contraction

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37
Q

What affects afterload

A

Changes in ventricular volume, wall thickness or vascular resistance

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38
Q

Is the LV or the RV more sensitive to afterload

A

RV

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39
Q

What is contractility

A

Inherent strength of the cardiac muscle and ablility to shorten as it contracts

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40
Q

Changing any one the three determinants of stroke volume will do what

A

Affect the other two

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41
Q

What are the factors the increase stroke volume

A

Increased preload
Decreased afterload
Increased inotropy

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42
Q

What are the factors that decrease stroke volume

A

Decrease preload
Increase afterload
Decrease inotropy

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43
Q

Fractional shortening and ejection fraction are what kind of systolic measurement

A

Quantitative

44
Q

What are the volumetric assessments of LV systolic function

A 
Simpson’s EF 
Area length method 
stroke volume -> cardiac output, cardiac index 
Dp/Dt
Tissue doppler 
MPI 
global strain
45
Q

What are the qualitative LV systolic function measurements

A

Visual kinetic analysis (global EF estimation)

Segmental wall motion analysis

46
Q

What are the 4 different types of segmental wall motion analysis

A

Normal
Hypokinetic
Akinetic
Dyskinetic

47
Q

What is the normal value for a parasternal EF

A

55%

48
Q

What is the normal value for fractional shortening

A

> 25%

49
Q

What is the normal Simpson’s EF for males

A

52-72

50
Q

What is the normal Simpson’s EF for females

A

54-74

51
Q

% of change in the minor axis dimension has a correlation to what

A

EF

52
Q

When to measure end diastolic

A

Isovolumic contraction time

  • onset of the QRS complex
  • frame after MV closure
  • frame where LV diameter/dimension is largest
53
Q

When to measure end systole

A

Isovolumic relaxation time

  • the frame preceding MV opening
  • when the LV is the smallest
  • near the end of the T wave
54
Q

When peak downward displacement if the septum is abnormal what should be used for timing

A

The peak upward displacement if the posterior wall

55
Q

Increasing what can help the linear EF with abnormal IVS

A

Frame rate

56
Q

Simpson’s biplane is also called the

A

Method of disks

57
Q

What does the Simpson’s biplane method rely on

A

Endocardium tracing in 2 apical views

58
Q

What are the 2 apical views that the Simpson’s biplane uses

A

A4C

A2C

59
Q

The length of the LV should extend from where to where

A

The middle of the MV annulus to the true LV apex

60
Q

If the true apex cannot be seen well, what should not be done

A

Simpsons

61
Q

Ensure that the LV central axis in diastole or length does not differ between the A4C and A2C views by more than what

A

10%

62
Q

What is derived from the volumetric assessment

A

Stroke volume

Ejection fraction

63
Q

What is the cardiac output equation

A

CO= SV x HR

64
Q

What is the equation for the volumetric assessment

A

SV = EDV-ESV

65
Q

What can be performed when the endocardial definition is suboptimal from the apical images but good from parasternal

A

Area-length method

66
Q

How is the area-length method performed

A

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
Q

What does the SV calculation assume about the LVOT

A

That it is circular

68
Q

What is also assumed in the SV calculation

A

Laminar flow

69
Q

Most indices of cardiac performance are influenced by

A

Loading conditions, like SV CO CI

70
Q

When is the Dp/Dt measured

A

During the pre-ejection phase of the cardiac cycle

71
Q

Dp/Dt is less influenced by what

A

Loading conditions

72
Q

Dp is the

A

Change in pressure

73
Q

Dt is the

A

Change in time it takes to reach that pressure

74
Q

What are the points that are Usually chosen for Dp/Dt

A

1 m/s and 3m/s

75
Q

Dp/Dt uses which principle

A

Bernoulli

76
Q

What is the pressure at 1 m/s in the Bernoulli equation

A

4mmHg

77
Q

What is the pressure at 3 m/s in the Bernoulli equation

A

36mmHg

78
Q

What is the difference between the two pressures (1 m/s and 3 m/s)

A

32mmHg

79
Q

Dp/Dt measures how much time it takes for what

A

The LV pressure to rise by 32mmHg

80
Q

What are the limitations of Dp/Dt

A

Valve click artifact (from prosthetic valves)
Eccentric MR jets (difficult to pick up CW)
Poor alignment to the MR jets
Non-compliant LA

81
Q

What is the normal value for Dp/Dt

A

<27 msec

82
Q

Tissue doppler measures the speed that the

A

LV muscle contracts in the longitudinal plane

83
Q

What is the normal value for tissue doppler

A

> 9.0 cm/s

84
Q

Tissue doppler is a good measurement of

A

Systolic function

85
Q

Muscle tissues in the LV are arranged

A

Longitudinally
Radially
Circumferentially

86
Q

What is the S prime influenced by

A

Tethering and translational motion of the heart

87
Q

What is tethering

A

When a hypokinetic or akinetic segment is adjacent to a normal segment and gets dragged along by its motion

88
Q

What velocities progressively decrease form base to apex in the normal heart

A

S prime

89
Q

S prime will not be accurate when there is varying degrees of

A

Segmental systolic dysfunction, as it will not include those abnormal segments

90
Q

S prime will be fairly accurate when

A

Wall motion is normal or globally down

91
Q

S prime measures what

A

The velocity of the tissue in one of the basal segments from the apical view

92
Q

Therefore what can the s prime only truly reflect

A

The performance of that segment

93
Q

When is the index of myocardial performance used in cases with

A 
Dilated cardiomyopathy 
Cardiac amyloidosis 
Pulmonary hypertension
RV infarction
RV dysplasia
94
Q

MPI provides information about both

A

Systolic and diastolic function

95
Q

IMP is a ratio between

A

(ICT+IRT)/ET

96
Q

May disease states include some degree of

A

Systolic and diastolic dysfunction

97
Q

In a diseased heart, what happens to ejection time and isovolumic times

A

ET shortens, isovolumic times increase

98
Q

What is the normal LV for the MPI conventional doppler method

A

<0.44

99
Q

What are the normal measurements for the TDI method

A

LV: <0.6
RV: <0.55

100
Q

The normal RV in the A4C view should be ___ than ___ the size of the LV

A

Less

2/3

101
Q

Should the RV or the LV dominate the apex

A

LV

102
Q

Mild dilation of the RV is when the

A

RV >2/3 of the LV but RV cavity is still smaller than LV.

103
Q

The RV apex more basal than the LV apex is what

A

Normal

104
Q

Moderate dilation of the RV

A

When the RV and the LV are equal size and share the apex

105
Q

Severe dilatation of the RV is when

A

RV>LV size and RV occupies the apex

106
Q

Walls MUST be seen in how many views to be scored qualitatively

A

2 or more

Echo 2 (6 decks)

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