Diastolic Function/dysfunction

Front 1

Ventricular function and preload relationship

Back 1

If ventricular filling is impaired, this will lead to decrease in stroke volume

Front 2

The changes in ventricular diastolic properties that have an adverse effect on stroke volume

Back 2

Diastolic dysfunction

Front 3

Diastolic function refers mainly to what chamber?

Back 3

LV

Front 4

What are the normal phases of diastole?

Back 4

•Isovolumic relaxation time

•Rapid filling

•Diastasis

•Late filling (atrial contraction)

Front 5

Both MV and AV are closed, no blood flowing

Back 5

Isovolumic relaxation time

Front 6

How is isovolumic relaxation time measured?

Back 6

•The time period measured from AV closure to MV opening

•Measured in milliseconds

Front 7

The initial amount of blood the ventricle receives from the atria when they are acting as a conduit

Back 7

Rapid filling

Front 8

Rapid filling represents what percentage of ventricular filling?

Back 8

70 - 80%

Front 9

Rapid filling is represented by which wave on the Doppler wave form

Back 9

"E" wave

Front 10

The time during ventricular filling when very little blood is flowing because of the equalization of pressures between the atria and ventricle

Back 10

Diastasis

Front 11

The additional 20 - 30% of ventricular filling due to atria acting as a pump

Back 11

Late filling (atrial contraction)

Front 12

Late filling (atrial contraction) is represented by which wave on the Doppler wave form?

Back 12

"A" wave

Front 13

Normal diastolic function of the heart depends on what?

Back 13

A LV that is compliant and quick to relax

Front 14

The diagnosis of diastolic heart failure is best made with...

Back 14

Doppler echocardiography and multiple sites need to be sampled

Front 15

Basic measurements performed for diastolic dysfunction

Back 15

•Deceleration time on "E" wave of MV inflows

•Pulmonary vein flow

•Color m-mode

•TDI

•IVRT

•E/A ratio

•E/Em ratio

Front 16

Normal diastolic function "E" wave velocity

Back 16

0.7 - 1.2 m/sec

Front 17

Normal diastolic function "A" wave velocity

Back 17

.42 - 0.7 m/sec

Front 18

Normal diastolic function deceleration time range

Back 18

150 - 240 msec

Front 19

Normal diastolic function E/A ratio range

Back 19

1.0 - 2.2

Front 20

Normal diastolic function pulmonary vein

Back 20

S larger than D with small R wave less than 25 cm/sec (unless younger than 30)

Front 21

Normal diastolic function color m-mode

Back 21

Straight up and down

Measures greater than 55 cm/sec

Front 22

Normal diastolic function TDI

Back 22

E greater than A

Front 23

Normal diastolic function IVRT

Back 23

63 - 90 msec

Front 24

Normal diastolic function E/Em ratio

Back 24

Predicts increase LVEDP regardless of LV systolic function or mitral inflow profile by determining the LA pressures

Front 25

The inability of the heart to relax properly after systole in order to fill properly with blood from the atria

Back 25

Diastolic dysfunction

Front 26

How does systolic failure cause diastolic dysfunction

Back 26

Impaired relaxation increases myocardial stiffness and causes the LV to fill against elevated pressures

Front 27

Etiologies of diastolic dysfunction

Back 27

•Aging

•CHF

•Ischemic heart disease

•Cardiomyopathies (tamponade, restrictive)

•Systemic heart disease

•Hypertension

•Valvular heart disease

•Many more...

Front 28

Signs and symptoms of diastolic dysfunction

Back 28

The common signs and symptoms are similar to those patients with systolic heart failure

•CHF

•DOE

•Exertional chest pain

•Palpitations

•SVT

Front 29

Stage 1 diastolic dysfunction aka

Back 29

Abnormal or prolonged relaxation

Front 30

Stage 1 diastolic dysfunction "E" wave velocity

Back 30

Less than .7 m/sec

Front 31

Stage 1 diastolic dysfunction "A" wave velocity

Back 31

Greater than 0.7 m/sec

Front 32

Stage 1 diastolic dysfunction deceleration time range

Back 32

Greater than 240 msec

Front 33

Stage 1 diastolic dysfunction E/A ratio

Back 33

Less than 1.0

Front 34

Stage 1 diastolic dysfunction pulmonary vein

Back 34

S taller than D and small R wave less than 25 cm/sec

Front 35

Stage 1 diastolic dysfunction color m-mode

Back 35

Slower propagation velocity in the "E" wave less than 55 cm/sec

Front 36

Stage 1 diastolic dysfunction TDI

Back 36

E less than A

Front 37

Stage 1 diastolic dysfunction IVRT

Back 37

Greater than 90 msec

Front 38

Stage 1 diastolic dysfunction LA

Back 38

Dilated LA with decreased LA contraction

Front 39

Stage 2 diastolic dysfunction aka

Back 39

Pseudonormal relaxation

Front 40

Stage 2 diastolic dysfunction E and A wave velocities

Back 40

Appear normal or equal in size

Have patient valsalva to see if it reverses

Front 41

Stage 2 diastolic dysfunction deceleration time range

Back 41

Greater than 200 msec

Front 42

Stage 2 diastolic dysfunction E/A ratio

Back 42

Greater than 1.5

Front 43

Stage 2 diastolic dysfunction pulmonary veins

Back 43

S wave 50% less than D wave and R wave greater than 35 m/sec

Front 44

Stage 2 diastolic dysfunction color m-mode

Back 44

Shorter propagation on the "E" wave than the "A" wave

Slight angle less than 45 cm/sec

Front 45

Stage 2 diastolic dysfunction TDI

Back 45

Lower velocity on "E" wave than "A" wave less than 8 cm/sec

Front 46

Stage 2 diastolic dysfunction IVRT

Back 46

Shortened less than 90 msec d/t increased LA pressures causing early MV opening

Front 47

Stage 3 diastolic dysfunction aka

Back 47

Restrictive-reversible

Front 48

Stage 3 diastolic dysfunction "E" wave velocity

Back 48

Greater than 1.2 m/sec

Front 49

Stage 3 diastolic dysfunction "A" wave velocity

Back 49

Less than .42 m/sec

Front 50

Stage 3 diastolic dysfunction deceleration time range

Back 50

Less than 150 msec

Front 51

Stage 3 diastolic dysfunction E/A ratio

Back 51

Greater than 2.2

Front 52

Stage 3 diastolic dysfunction pulmonary vein flow

Back 52

S shorter than D with R wave greater than 25 cm/sec but less than 35 cm/sec

Front 53

Stage 3 diastolic dysfunction color m-mode

Back 53

More slanted angle on inflows less than 45 cm/sec (similar to stage 2)

Front 54

Stage 3 diastolic dysfunction TDI

Back 54

Lower velocity with E taller than A

Front 55

Stage 3 diastolic dysfunction IVRT

Back 55

Less than 60 msec

Front 56

Stage 4 diastolic dysfunction aka

Back 56

Restrictive-nonreversible

Front 57

Stage 4 diastolic dysfunction ranges

Back 57

Same as stage 3 except no changes in preload reduction when a maneuver is used

Front 58

What happens when a person valsalvas?

Back 58

Changes in preload occur

Front 59

What is the main difference in echoes between heart walls and blood?

Back 59

Moving blood causes weak or low amplitude echoes in comparison

Front 60

TDI is more sensitive to wall movement than color Doppler is to RBC movement as a result of

Back 60

Higher amplitudes

Front 61

TDI uses low frequencies to create a Doppler image of what?

Back 61

Myocardium in motion

Front 62

TDI most helpful for...

Back 62

Depicting ischemia during treadmill and dobutamine stress test to bring out or enhance subtle wall motion abnormalities

Front 63

TDI may impact electrophysiology studies how?

Back 63

As the wave of depolarization and repolarization spread over the atrial myocardium

Front 64

TDI helps define

Back 64

•Wall motion abnormalities that are extremely subtle

•Diastolic wall motion

Front 65

The ultimate goal of TDI is

Back 65

To quantify myocardial velocity and therefore wall motion

Front 66

Limitations of TDI

Back 66

•Sideways movement of heart as it contracts interferes with the quantification of velocity

•Motion is significant with: RV volume overload; ASD; severe TR

Front 67

The tool of choice to assess wall motion

Back 67

Color m-mode TDI

Front 68

Color m-mode TDI bands of color/different hues represent what?

Back 68

Changes in velocities and direction of motion during systole and diastole