Week 15 Diastology

Question 1

What is diastole

Answer 1

A complex process including ventricular relaxation, diastolic suction, and atrial comtribution

Question 2

What is normal diastolic filling

Answer 2

The ability of the ventricles to accept blood without an abnormal increase in pressure

Question 3

What are the 2 main pressures of the left heart

Answer 3

1) LV end diastolic Pressure: the pressure immediately following atrial systole.
2) mean LA pressure

Question 4

NL values for lvedp and lap

Answer 4

• LVEDP=<15mmhg
• LAP=<10mmhg

Question 5

What measurements are required to assess diastolic fxn

Answer 5

1) PW Doppler MV
2) PW TDI of septal and lateral MV annulus
3) PW Doppler RUPV
4) LA volumes
5) CW Doppler of peak TR

Question 6

What is diastolic dysfunction

Answer 6

• Overtime, the atrial and ventricular pressures can increase resulting in diastolic dysfunction
• when there is systolic dysfunction, there is always Diastolic dysfunction

Question 7

LA ESV values for male and female

Answer 7

Male: 16-34, 35-41, 42-48, >48
Female: 16-34, 35-41, 42-48, >48

Question 8

Grading of DF severity

Question 9

How can echo estimate DD and severity?

Answer 9

• Doppler measurements of waveforms
• 2D measurement of LA volume

Question 10

What creates ivrt on diastolic waveforms

Answer 10

A rapid change in ventricular volume/pressure

Question 11

What creates peak e prime velocity on diastolic waveforms

Answer 11

Occurs due to the early relaxation of the LV

Question 12

What creates peak a prime velocity on diastolic waveforms

Answer 12

Occurs due to atrial contraction

Question 13

What does e prime velocity reflect?

Answer 13

Early relaxation of the LV

Question 14

Normal values for septal and lateral e prime measurement

Answer 14

• septal e prime = > 7cm/sec
• lateral e prime = > 10 cm/sec

Question 15

What is the E/e prime ratio

Answer 15

The mitral valve E wave velocity/the lateral and septal e prime velocity averaged

Question 16

What values suggest normal and elevated LAP

Answer 16

• E/e < 8 is normal LAP
• E/e > 14 is elevated LAP

Question 17

What do we measure on pulmonary vein flow

Answer 17

Measure S and D wave. S > D

Question 18

TR reflects what

Answer 18

-RVSP/pasp
- pasp will be elevated if LA pressure is elevated

Question 19

What is normal TR velocity

Answer 19

< 2.8 m/sec

Question 20

What do You measure first when assessing for DD

Answer 20

1) tdi lateral and sept, then MV velocity for E/e ratio
2) determine tdi lateral and septal velocities
3) TR velocity
4) LA volume

Question 21

Out of the 4 standard measurements. What determines what in terms of DD

Answer 21

<.5% positive. = NL DD
.5% positive = indeterminate
> .5% positive = DD

Question 22

Normal value for E/A ratio

Answer 22

> .8 and < 2.0

Question 23

What criteria are evaluated on mitral inflow if 50% or > are determined from initial assessment

Answer 23

1) AVG E/e ratio > 14
2) TR velocity > 2.8 m/sec
3) LA Vol index > 34ml/m^2

Question 24

If only 2 criteria are available in MV inflow assessment. What are the determinants

Answer 24

• 2 negative = NL LAP; grade 1 DD
• 1 pos 1 neg = cannot determine LAP and DD grade
• 2 positive = LAP elevated, grade 2 DD

Question 25

What are the Doppler and 2D values confirming elevated LAP and abnormal relaxation

Answer 25

• Avg E/e ratio > 14
• septal TDI e velocity < 7cm/sec
• lateral TDI e velocity <10cm/sec
• TR velocity > 2.8 m/sec
• LA Vol index > 34 ML/m2