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Diastolic function
Lecture # 8 2nd semester
47
Other
Not Applicable
05/03/2008

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Cards

Term

The atria is acting like a pump during which phase of normal diastole?

Definition

Late filling / atrial contraction

Term

Diastasis is the time during ventrical filling when very little blood is flowing because of what?

Definition

The pressure equalization between the atria and the ventricle.

Term

The atria are acting as a conduit during what phase of diastole?

Definition

Rapid filling

Term

IVRT is measured in __________ and normally is between ____ and ____ .

Definition

milliseconds

63 and 90 msec

Term

Normal Deceleration Time is?

Definition

150 - 240 msec

Term

In evaluating CMM, the normal shape is ___________ and measures ______.

Definition

straight up and down/vertically straight

> 55 cm/sec

 

Term

Normal E/A ratio is _______.

Definition

1.0 - 2.2

Term

Normal diastolic E wave velocity is ______ to _____ m/sec, while normal A wave velocity is _____ to ____ m/sec.

Definition

normal E wave .7 - 1.2 m/sec

normal A wave .42 - .7 m/sec

 

Term

There are many causes of diastolic dysfunction; see if you can name at least 5.

Definition

Aging

CHF (Chronic Heart Failure)

Ischemic Heart Disease

Cardiomyopathies

Systemic Heart Disease

HTN

Valvular Heart Disease

Term

The common signs and symptoms of diastolic dysfunction are similar to systolic heart failure.  Name several.

Definition

CHF

DOE

Exertional chest pain

Palpitations

SVT

Term

Tissue doppler uses ______ frequency and ______ amplitude to create a doppler image of the myo-cardium in motion.

Definition

low frequency

high amplitude

Term

A 70 yr. old diabetic pt. with HTN and DOE is found to have a DT of 210 msec, an E/A ratio of 1.6, a D greater than S on the pulmonic vein flow and CMM shows the velocity to be 43 cm/sec.  Pt. was asked to sit up and no changes occured.  Stage this pt.

Definition

Stage 2 Pseudonormal relaxation

Term

A 29 yr. old male has findings of E/A ratio greater than 1, DT of 222, R wave of 24 cm/sec, pulmonary vein flow of D greater than S and IVRT at 79 msec.  Stage this pt.

Definition

Normal young adult

Term

A 52 yr. old female pt. has an E wave velocity of .7 and an A wave velocity of .7 msec.  DT is 217 msec, pulmonary vein S is approx. half of D with an R wave of 37 cm/sec.  CMM displays a slight angle < 45 cm/sec.  IVRT is 85 msec.  Stage this pt accurately.

Definition

Have pt perform a maneuver to look for changes/reversal on Doppler.  If changes occur this indicates Stage 1 Dysfunction.  No changes indicates Stage 2 Diastolic Dysfunction.

Term

An 81 yr. old pt with CAD, palpitations and tamponade has a pulmonary vein flow where S is shorter than D.  TDI  shows lower velocity on E than on the A wave.  E waves seen on PW doppler are very tall and the A waves are quite short.  With this information stage the pt accurately.

Definition

Have pt perform a valsalva maneuver/sit up to see if changes occur on doppler which would indicate Stage 3 Restrictive.  If there are no changes; Stage 4 Restrictive Nonreversible.

Term

Ventricular function is highly dependent upon ______ as demonstrated by ________ ______ ___.

Definition

preload

Frank-Starling Law

Term

What are the 7 basic measurements that can be preformed to assess one's diastolic dysfunction?

Definition

Deceleration Time on the E wave of the MV inflows

Pulmonary Vein Flow

Color M-Mode

Tissue Doppler Imagining

Isovolumic Relaxation Time

E/A ratio

E/Em ratio (E/E prime ratio)

Term

The time period measured from aortic valve closure to mitral valve opening when both valves are closed and no blood is flowing is called what?

Definition

IVRT - Isovloumic Relaxation Time

(measured in msec.)

Term

70 - 80% of blood enters the ventricle when the atria are acting as a _________ and this is referred to as ________ ________.

Definition

conduit

Rapid Filling

Term

In order for the heart to achieve normal diastolic function, the _____ ______ must be _________ and _______ to _______.

Definition

In order for the heart to achieve normal diastolic function, the Left Ventricle must be compliant and quick to relax

Term

What type of amplitude is produced by the walls of the heart in TDI?

Definition

Heart walls produce large amplitude echoes.

Term

Ordinarily PW and Color Doppler filter out low frequency, high amplitude echoes caused by wall motion.  What modality makes use of these echoes?

Definition

TDI

Term

TDI has limitations such as:

Definition

RV volume overload (D-sign)

ASD

Severe TR

Hyperdynamic function

 

(Sideways systolic motion of the heart interferes with quantification of velocity)

 

 

Term

Wall motion abnormalities are easier to identify when using TDI because __________ is improved.

Definition

sensitivity

Term

What is the gold standard for determining diastolic function?

Definition

Cardiac cath

Term

Define diastolic function.

Definition

Diastolic function refers to the pressures that the Left Ventricle must fill against.

Term

What is the "R" or "A" wave?

Definition

It is a small reversal of blood after atrial contraction.

Term

The movement of blood measured from the annulus to the apex in velocity and time is called?

Definition

Color M-Mode

Term

The rate of filling (velocity) of the ventricle during Rapid Filling Phase is referred to as what?  Also give the unit of measurement.

Definition

Flow propagation velocity measured in units of cm/sec

Term

Why is TDI considered more accurate?

Definition

It is less dependent on preload.

Term

The #1 cause of diastolic dysfunction is?

Definition

Age

Term

In Stage III Restrictive, why are the E waves so tall and the A waves so little?

Definition

Because all filling occurs early to make tall E, then cannot get atrial contraction to fill much creating shortened A.

Term

Valsalva maneuvers change what?

Definition

venous return/preload

Term

Where should we place our sample volume for TDI and what size would be used?

Definition

On annulus just above leaflets of septal and lateral walls using a sample gate of 5.

Term

A pt has a dilated LA, an E wave velocity of .6 m/sec and an A wave velocity of .9 m/sec.  DT is 253 msec and on the pulmonary vein flow the S is taller than the D with the R wave measuring 24 cm/sec.  Stage this pt.

Definition

Stage I Abnormal or Prolonged Relaxation

Term

When a pt has a shortened IVRT, what is specifically is the reason?

Definition

The IVRT shortens because of increased LA pressures causing the Mitral valve to open early.

Term

Define diastolic dysfunction.

Definition

Changes in ventricular diastole that have an adverse effect on stroke volume. 

Term

When are the atrias acting as a pump and how much of a contribution does this phase produce?

Definition

Late filling is atrial contraction and there is an additional 20 - 30% of blood added to the ventricle.

Term

The E/Em ratio makes a prediction of what?

Definition

The E/Em ratio predicts increase in LVEDP regardless of LV systolic function or mitral inflow profile by determining the LA pressures.

Term

Impaired relaxation causes the myocardium to become what?

Definition

Stiff which causes the LV to fill against elevated pressures.

Term

In which heart disease is diastolic wall motion affected early on?

Definition

Ischemic heart disease

Term

Simply list the 4 stages of diastole.

Definition

1.  isovolumic relaxation

2.  early rapid filling

3.  diastasis

4.  late filling

Term

The D wave of the pulmonic flow represents the diastolic phase when the atria are acting as what?

Definition

A conduit for flow from the systemic venous return to the RV.

Term

CMM measures flow propagation during what?

Definition

rapid filling

Term

What DT would be expected if a pt was in Stage II Pseudonormal Relaxation?

Definition

A DT greater than 200 msec.

Term

What DT would we find if the pt was suspected of Stage I Abnormal or Prolonged Relaxation?

Definition

A DT of greater than 240 msec.

Term

If the E and A velocities appear normal or about equal in size, what would our next step be?

Definition

Have pt valsalva to see if there is any reverse which would take stage 2 back to stage 1.

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