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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 = 2042%
dimensional

How do you calculate Ejection Fraction?
What is the normal range?
What type of measurement is it?
LVEDd^{3}  LVEDs^{3} / LVEDd^{3} = 6085%
Volumetric measurement

When using Simpson's to evaluate systolic function, what are you really calculating?
What measurements do you use for Simpson's?
Ejection fraction
 A4 Length & Diameter
 A2 Diameter

Where would you measure for Circumferential Fiber Shortening?
vcf = mean circumferences / second. What is the formula?
MMode AO valve (LVET)
vcf = LVEDd  LVEDs / (LVEDd)(LVET)

CO = ?
CO =(d ^{2})(0.785)(TVI)(HR) / 1000 = L/min
 CSA= d^{2 }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?
48L/min

EPSS means?
Measured in what mode?
Normal measurement is?
 E Point Septal Separation
 Mmode
 27mm
(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
 MR of 13m/s = ?change T
 0.027 sec (27ms)

What is the doppler derived index of myocardial performance?
Myocardial Index

What is the continuity equation for:
MVA
AVA
ERO
2pi r^{2}(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=?
AB / B
 A=Holosystolic
 B=Systolic ejection time
IMP=<0.4

Diastolic dysfunction reflects ventricular _________________, not disease specifically
physiology

Define: Diastole
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)
 Normal
 Abnormal Relaxation
 Pseudonormalization
 Restrictive filling (reversible)
 Restrictive filling (irreversible)

What is the formula for ventricular compliance?
Stiffness?
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?
Relax abn?
Restrictive R ?

Normal IVRT?
relax abn IVRT?
Restrictive R ?

Normal decel time?
abnormal relax ?
Restrictive R?

normal E wave?
abnorm relax?
Restrictive R?

Normal A wave?
abnormal relax?
Restrictive R?

Restrictive MV "A" wave duration is ____________________ PV "a" duration time
less than

What can the valsalve manouver do when assessing diastolic dysfunction?
unmask pseudonormalization

When you line up MV to PV, what letters occur at same time?

MVA= _______/_______
220/pht


Normal pht = _______msec
severe ?

MVA normal = __________?
Severe = ?

With a stiff, noncompliant MV would the pht increase/decrease?
decrease

What is the best quantification of MR?
doppler

What does vena contracta mean?
Flow convergence zone (<0.3mm)

Pulmonary Regurgitation
PAEDP =
4V2+RAP

WMSI=
1
2
3
4
5
 normal
 hypokinetic
 akinetic
 dyskinetic
 aneurismal

dP/dT = 32/dT
dT=
time period between 1 & 3m/s

