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What is systolic function affected by?
- Preload (LVED pressure)
- Afterload (Resistance heart must pump against)(Force ventricles face when contracting in systole)
- Intrinsic Ventricular Contractility (intensity myocardium in active state)
- Heart Rate
How do you calculate Fractional Shortening and what is the normal range?
What kind of a measurement is it?
LVEDd - LVEDs / LVEDd = 20-42%
How do you calculate Ejection Fraction?
What is the normal range?
What type of measurement is it?
LVEDd3 - LVEDs3 / LVEDd3 = 60-85%
When using Simpson's to evaluate systolic function, what are you really calculating?
What measurements do you use for Simpson's?
- A4 Length & Diameter
- A2 Diameter
Where would you measure for Circumferential Fiber Shortening?
vcf = mean circumferences / second. What is the formula?
M-Mode AO valve (LVET)
vcf = LVEDd - LVEDs / (LVEDd)(LVET)
CO = ?
)(0.785)(TVI)(HR) / 1000 = L/min
- CSA= d2 0.785
- SV = (CSA)(TVI)
TVI = Time Velocity Integral = ?
Stroke distance in cm
How do you calculate cardiac index?
CO / BSA
What is the normal CO?
Measured in what mode?
Normal measurement is?
- E Point Septal Separation
(AO & LA appear flat when decreased CO)
LV Mass = ?
(muscle volume)(density) = 1.04g/ml
Wall Stress is directly related to ventricular systolic pressure & _ _ _ _ _ _.
Wall Stress is indirectly related to wall _ _ _ _ _ _ _ _ _?
Wall Stress =
WS = Force exerted on object / CSA
RWT=2PWT / LVID
Wall STRAIN is the _ _ _ _ _ applied to solid object causing deformation OR applied to liquid object causing flow strain.
What modality would we use to assess this?
Change P / Change T (time interval between 2 arbitrary points)
What do we use this to assess?
What jet do we use to measure this?
What time integral do we use to assess this?
What is a normal measurement?
- Time it takes to generate 32mmHg
- MR of 1-3m/s = ?change T
- 0.027 sec (27ms)
What is the doppler derived index of myocardial performance?
What is the continuity equation for:
2pi r2(LVOTvel) / MV vel OR AO vel
vs aliasing vel / MR vel
To measure global ventricular function we use IMP. What does IMP stand for?
Index Myocardial Performance
IMP = ?
What is a normal IMP=?
A-B / B
- B=Systolic ejection time
Diastolic dysfunction reflects ventricular _________________, not disease specifically
Interval of AV closure to MV closure
What does the E on MV waveform represent?
- Early rapid filling (Active)
- -early diastole
- -rate of myocardium relaxation & elastic recoil (suction)
What does the A represent on MV waveform?
- Passive Force
- late diastole
- chamber compliance & stiffness
What are 3 basic causes of diastolic dysfunction?
- 1. Diseases affecting myocardium
- 2. Extrinsic - Pericardial disease
- 3. CAD (dd with systolic dysfunction)
What comes secondary to diseases affecting the myocardium?
- LVH d/t HTN
- Hypertrophic CMO
- Restrictive CMO
- Ischemic Disease
Name the diastolic parameters. (5)
- Abnormal Relaxation
- Restrictive filling (reversible)
- Restrictive filling (irreversible)
What is the formula for ventricular compliance?
Compliance = change volume / change pressure
Stiffness = change pressure / change volume
What is an advantage of using tissue doppler?
E velocities are relatively unaffected by preload
Normal E/A Ratio?
Restrictive R ?
relax abn IVRT?
Restrictive R ?
Normal decel time?
abnormal relax ?
normal E wave?
Normal A wave?
Restrictive MV "A" wave duration is ____________________ PV "a" duration time
What can the valsalve manouver do when assessing diastolic dysfunction?
When you line up MV to PV, what letters occur at same time?
Normal pht = _______msec
MVA normal = __________?
Severe = ?
With a stiff, noncompliant MV would the pht increase/decrease?
What is the best quantification of MR?
What does vena contracta mean?
Flow convergence zone (<0.3mm)
dP/dT = 32/dT
time period between 1 & 3m/s