Echo 2 > Module 3 : Diastolic Function > Flashcards

Module 3 : Diastolic Function Flashcards

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1
Q

definition of diastole

A
  • chambers relax and fill with blood under low pressure

- interval from AV closure to MV closure

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2
Q

definition of relaxation

A
  • includes IVRT and early phase ventricular filling (IVRT E wave)
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3
Q

definition of compliance

A
  • change in volume / change in pressure (Dv/Dp)

- inverse to stiffness

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4
Q

definition of stiffness

A
  • change in pressure / change in volume (Dp/Dv)

- stiffness inverse to compliance

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5
Q

what two pressures are included in filling pressures

A
  • LV EDP

- mean LA pressure

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6
Q

what is LVEDP

A
  • left ventricle end diastolic pressure

- reflects ventricular pressure after filling is complete

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7
Q

what is mean LA pressure

A
  • average pressure during the filling person in the left atrium
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8
Q

what are the 4 phases of diastole

A
  • IVRT
  • early phase
  • diastasis
  • late phase
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9
Q

what is IVRT

A
  • isovolumic relaxation time

- no change in ventricular volume but pressure is ventricle is falling

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10
Q

what is early phase of diastole

A
  • rapid filling of the LV

- caused by suction

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11
Q

what is diastasis

A
  • pressures equalize between LV and LA

- small amount of blood may flow

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12
Q

what is late phase

A
  • atria contract and push the rest through
  • atrial kick
  • contributes to 20-30% of normal filling
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13
Q

what three things is IVRT influenced by

A
  • conduction abnormalities or conduction mechanics
  • loading conditions (preload LAP)
  • age
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14
Q

normal IVRT

A

50-100ms

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15
Q

what is the deceleration time

A
  • LA and LV pressure gradient begins to fall leading to a slow down of blood entering the LV
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16
Q

4 things that influence rapid filling phase

A
  • rate of LV relaxation
  • elastic recoil of ventricle
  • chamber compliance
  • LAP
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17
Q

how much of total volume does early filling contribute

A

70-80%

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18
Q

normal length of early filling

A

150-200ms

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19
Q

what determines the length of diastasis

A
  • HR
  • slow = long diastasis
  • fast = short or absent diastasis
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20
Q

what phase of diastole might be absent with afib

A
  • atrial contraction
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21
Q

what two things are included in LV filling properties

A
  • LV compliance/stiffness

- myocardial relaxation

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22
Q

compliant ventricles and pressure

A
  • able to increase its volume without increasing its pressure significantly
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23
Q

stiff ventricles and pressure

A
  • disproportionate increase in pressure for a relatively small increase in volume
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24
Q

LV mass 2D changes with DD

A
  • Increase age, body weight, blood pressure increases LV mass
  • first walls become thicker than dilates
  • LV mass will increase with either increase wall thickness or with increase in chamber dimension
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25
LA volume 2D changes with DD
- heart becomes less compliant filling pressures increase - increased LAEDP and LAP will dilate the LA - LA is only 2-3mm thick and dilates easy - > 34ml/m^2 abnormal
26
4 causes of DD
- primary myocardial disease - secondary hypertrophy - coronary artery disease - extrinsic factors
27
3 examples of primary myocardial disease
- dilated CMO (cardiomyopathy) (NUMBER ONE) - infiltrative myocardial disease - hypertrophic CMO
28
3 examples fo secondary hypertrophy
- HTN (hypertension) - aortic stenosis - severe mitral regurgitation
29
2 examples of CAD
- ischemia | - infarct
30
2 examples of extrinsic factors
- pericardial tamponade | - pericardial constriction
31
7 factors effecting all diastolic measurements
- HR (IVRT shortens, E/A fuse) - rhythm (AF/PVC) - preload (artificially increases E wave height) - LV systolic function (abnormal contraction = abs relaxation) - respiration - age - PR interval
32
grade 1 DD
- impaired relaxation | - mild diastolic dysfunction
33
grade 2 DD
- pseudo-normal | - moderate DD
34
grade 3 DD
- restrictive filling | - severe DD
35
4 parameters for grading DD
- MV inflow (E/A ratio) - averaged E/e prime ratio - left atrial volume index - TR jet velocity (RVSP) ** 2/3 criteria must be positive to determine grade 2 or 3 DD
36
normal filling
- LV fills at low pressure because the myocardium is compliant
37
normal E/A ratio
0.8-2
38
normal DT
150-200ms
39
normal MV E wave
0. 6-1.3m/s | - reverses near 6th decade of life
40
definition of DD
- delayed or slowed myocardial relaxation with normal filling pressures - prolongs iVRT and DT
41
2 factors affecting filling
- chamber compliance | - extrinsic factors
42
three tissue doppler waves
- e' = lengthening of ventricle during early filling - a' = atrial contraction - s' = systolic contraction (ventricular shortening)
43
normal medial wall e'
> 7cm/s
44
normal lateral wall e'
> 10cm/s
45
normal E/e' ratio
less than 8 | - 8-12
46
mild DD / impaired relaxation
- reduced E/A ratio (<0.8) - reduced E velocity - prolonged DT (>200ms) - reduced TDI (IVS < 7cm/s, lat <10cm/s) - E/e prime < 14 (not increased) - TR velocity jet < 2.8 (normal)
47
symptoms of mild DD
- mild shortness of breath on exertion SOBOE
48
TR jet with DD
- in absence of significant pulmonary or right heart disease the TR jet is accurate reflection of left heart filling pressure - with DD LV, LA, PV, lungs, PA, RV pressure all increase leading to increase TR jet
49
grade 2 / pseudonormal DD
- imparted relaxation + moderate reduction in LV compliance which results in increased LAP - MV inflow pattern returns to fairly normal profile due to increase LAP
50
grade 2 DD MV inflow characteristics
- E/A ratio (0.8-2) looks normal - DT (150-200) looks normal - IVRT (50-100) looks normal - E/e prime 10-14 (abnormal) - MV inflow A wave duration shortens as LAP increases
51
symptoms grade 2 DD
- SOB at lower levels of activity compared to grade 1 DD
52
how to unmask pseudo normal
- VALSALVA - hold valsalva while pulsing MV - reduces venous return to Rt heart then left Heart - reduces LA pressure - if grade 2 then should changes to grade 1 - e wave will reduce >50% if positive
53
mid-diastolic flow pseudo normal
- sometimes the LV la pressure gradient is maintained well into diastasis - this results in flow across the MV during diastasis
54
what is the wave seen during diastasis in pseudonormal
- L wave - commonly seen along the LVH at lower heart rates - what would you see at higher HR + L would fuse with E
55
grade 3 DD/ severe DD
- reduced LV compliance and increased filling pressure leads to tall E wave and short deceleration time LAP ++
56
symptoms of grade 3 DD
- dyspnea with minimal exertion - reduced exercise tolerance - pedal or abdominal edema
57
grade 3 DD MV inflow characteristics
- increased E velocity - increased E/A ratio >/= 2.0 - short DT < 150-160-ms - low e' < 5cm/s - increased E/e prime ratio >/= 14 indicates High LAP or filling pressure
58
when do pulmonary veins fill the LA during
- ventricular systole - early diastole - diastasis
59
when is the flow reversed in the pulmonary veins
- atrial systole
60
what three things happen with the PV a wave and MV a wave with DD
- PV atrial reversal wave increases velocity - PV atrial reversal wave increases duration - MV a wave decreases duration
61
PVa - MVa normal
< 20ms
62
PVa - MVa mild DD
< 20ms
63
PVa - MVa mod DD
>/= 30ms
64
PVa - MVa sev DD
>/= 30ms
65
treatment for diastolic dysfunction
- besides treating underlying cause of DD EXERCISE is only direct treatment of DD
66
3 key differences between RV and LV diastolic dysfunction
- RV inflow velocities vary with respiration - RV inflow velocities are lower + TV area is larger than MV leads to lower filling velocites - RV diastolic FILling time is longer + the TV opens before and closes after the MV
67
3 stages of RV dysfunction
- impaired relaxation - pseudonormal TV inflow - restrictive filling
68
impaired relaxation RV DD criteria
- E/A <0.8
69
pseudonormal TV INflow RV DD criteria
- E/A 0.8-2.1 | - E/e' > 6 (or HV diastolic flow predominance)
70
restrictive filing RV DD criteria
- E/A > 2.1 | - DT < 120ms
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