Hemodyndamics

Front 1

what are 3 ways to calculate SV?

Back 1

-M-mode-EDV-ESV
-2D-simpsons and 2D measurement
-Cardiac doppler-CSAxVTI

Front 2

what is normal LVOT diameter?

Back 2

1.8-2.2cm

Front 3

What does VTI represent?

Back 3

-the distance in centimeterns that blood travels w/ each stroke .

Front 4

what is the formula for CI?what is the normal range?

Back 4

CO/BSA
normal range=2.4-4.2min/m2

Front 5

what are the normal measurements for LVIDd, LVIDs, LVOT, LVOT VTI, HR, BSA

Back 5

LVIDd-5.5
LVIDs-4.0cm
LVOT-2cm
LVOT VTI-20cm
HR-70bpm
BSA-2.0m2

Front 6

what happens to the EF slope with mitral stenosis?

Back 6

IT is prolonged due to a prolongation of LA empty
-normal EF slope=>80mm/sec

Front 7

Mitral valve planimetry

Back 7

-done in shorta axis view at the level of the mitral tips
-trace the inner wall diameter

Front 8

how are MVA and PHT calculated? what is the advantage of PHT?

Back 8

MVA=220/PHT
PHT=decel timex.29-independant of cardiac output or MR

Front 9

what does the PHT measure?

Back 9

-the rate of decline of the pressure difference btw LA and LV

Front 10

what does elevation of LVED because of AI cause?

Back 10

-overestimation of area

Front 11

what do the heart cath and doppler measure

Back 11

heart cath-peak to peak
doppler-instantaneous

Front 12

MACS

Back 12

maximum aortic cusp separation:
-most vertical distance btw the RCC and the NCC of the aortic valve measured during systole.
-reduced flow results in a reduction of MACS

Front 13

what is the continuity equation? what are the measurements used for it?

Back 13

AVA=LVOT area x LVOT(VTI)/(AV(VTI)
MEASUREMENTS:
-PSLX-LVOT diameter
-AP-5-LVOT VTI(PW)
-AP-5-AV VTI(CW)

Front 14

what does the waveform in severe MR look like?

Back 14

-asymmetrical because of increased LA pressure(Sawtooth waveform)
-the more significant the regurgitation, the stronger the intensity of the jet.

Front 15

what are the steps to calculate PISA

Back 15

-apical 4-color MV
-zoom MV
-move baseline to 20-40
-freeze-measure radius from leaflet tips to where red meets blue
-CW doppler through MR and trace
-calculate

Front 16

when can you not determine the ERO for MR?

Back 16

-if you have mild AI or if the MR jet is exentric

Front 17

what is the size of the vena contracta and PISA w/ severe MR?

Back 17

-vena contracta=6mm
-PISA>1cm

Front 18

what is the pisa diameter for the different grades of MR?

Back 18

-1-<4mm
2-5-7mm
3-8-10mm
4->10mm(severe MR)

Front 19

what is the formula to calculate RVSP?

Back 19

RVSP=4(V)2 + RAP

Front 20

HOW is RAP determined? what is normal RVSP?, and when do we have PHT?

Back 20

normal RAP=5-10mmHg=>50% IVC collapse
-High RAP=15-20mmHg-IVC enlarged and doesn not collapse 50% on inspiration
NORMAL RVSP=25mmHg
PHT=>30mmHG

Front 21

DP/DT

Back 21

-meausres the rate of rise of ventricular pressure during IVCT
-time it takes for the LV to generate 32mmHg
-measures the time btw 2 arbitrary points on the MR
-use bernoulli equation to convert velocity to pressure
-measured from MR(CW doppler)

Front 22

what is the normal, mild-mod, ad severe MR jet time?

Back 22

normal-<27ms
mild-mod-27-40ms
severe-40ms

Front 23

explain why diastolic dysfunction occurs before systolic dysfunction?

Back 23

-in early diastole, there is relaxation of the ventricle, then there is complience or stiffness of the ventricle in mid-late diastole
-therefor relaxation abnormaliities occur first followed by changes in compliance

Front 24

what measurements are used to determine diastolic function of the Lv

Back 24

-MV inflow
-pulmonary venous doppler flow profiles
-tisue doppler MV annulus

Front 25

Explain the phases of diastole

Back 25

IVRT-btw AV closure, and MV opening
Early filling-LV pressure falls below LA pressure
Diastasis-pressures equalizing
atrial filling phase-last kick at the cat

Front 26

explain how pulmonary venous flow corrisponds to the pressure curve

Back 26

-Sytolic forward flow(s-wave) corrisponds to x-descent on the pressure curve
-Distolic forward flow=y descent
-D-wave=MV e-velocity
-atral flow reversal

Front 27

how does the velocity and amplitude of wall motion of tissue doppler compare to blood flow?

Back 27

-velocity of the myocardium is lower than that of blood flow
-amplitude of myocardium is much greater than that of blood flow.

Front 28

why does pseudonormalization occur?

Back 28

-because the increased LA pressure masks diastolic dysfunction

Front 29

what does the valsalva change?

Back 29

causes a reduced preload, and reduced volume

Front 30

what are the symptoms of the beck triad?

Back 30

-increased jugular venous pressure
-hypotension
-diminished heart signs

Front 31

what are the m-mode and 2D features of cardiac tamponade?

Back 31

-early diastolic RV collapse
-late diastolic RA collapse(inversion)
-late LA collapse
-swinging heart
-IVC plethora
-abnormal ventricular septal motion
-respratory right and left ventricular chamber size variation
-clotted blood in pericardiu

Front 32

how does the length of time that the RA is collapse determine severeity of cardiac tamponade?

Back 32

-the longer in diastole that RA is collased, and the longer it persists into systole, the mre useful it is as a sign of tamponade.
-RA inversion that lasts longer than 1/3 of RR interval, is suggestive of hemodynamically significant tamponade.

Front 33

explain the ventricular motion w/ tamponade?

Back 33

-septum moves toward the LV w/ inspiration and towards the RV upon expiration

Front 34

explain doppler for cardiac tamponade?

Back 34

-more sensitive for diagnosing tamponade
-normally, there is a small decrese in LV pressure and intrathoracic pressure w/ inspiration.
-w/ tamponade, intrathoracic pressure will fall more than intrapericardial pressure
-transmitral velocity gradient will diminish substantially during inspiration
-LV diastolic pressure gradient will be decreased
-As the RV and LV are coupled during tamponade(fixed heart volume), there will be a significant increase in transtricuspid gradient during insiration.

Front 35

how do hepatic and tricuspid flow velocities increase w/ inspirations?

Back 35

-there is an increase in hepatic and tricuspid flow velocity.

Front 36

how does the right ventricular wall move w/ cardiac tamponade?

Back 36

-there is posterior motion of the anterior RV wall in diastole

Front 37

where are pericardial effusions first seen?

Back 37

-in the posterior basal ventricle

Front 38

what is seen in pulmonary veins with severe MR?

Back 38

-systolic flow reveresal w/ severe MR

Front 39

how does acure MR affect the MV and Aortic valve?

Back 39

mitral valve closes early and aortic valves opens late.

Front 40

what is the most deadly form of thrombus?

Back 40

pedunculated-less common than mural thrombus

Front 41

what is the normal velocity for PV?

Back 41

<1.5-1.1

Front 42

if there is MS from carcinoid, what is this due to?

Back 42

ASD-only occurs on RT side, so it has to get to the LT somehow

Front 43

starlings law

Back 43

-preload
-stretch

Front 44

if a person has a bicuspid aortic valve, what view should be done, and why?

Back 44

-suprasternal because 50% of patients w/ a bcuspid valve will have a coarctation

Front 45

what are the types of MVP/

Back 45

holosystolic
mid-late systolic

Front 46

How does the M-mode differ w/ MVP and stenosis

Back 46

MVP=bowing-posterior leaflet bows more than the anterior
Stenosis-doming

Front 47

kawasaki's

Back 47

coronary aneurysm in children
-seen in PSSA

Front 48

where(o clock) are the coronary arteries located?

Back 48

LCA-1-2
RCA-10-11

Front 49

what is seen on ECG with a-fib?

Back 49

-no p wave

Front 50

T/F the anterior and posterior leaflet always move together w/ MS

Back 50

-false-the posterior leaflet only moves with the anterior leaflet 90 % of the time.