ECHO

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Author:
liukuf
ID:
94598
Filename:
ECHO
Updated:
2011-07-19 22:06:52
Tags:
Diastology hemodynamics
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Description:
echo review
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  1. Mitral Inflow normal
    • E 0.7-1.2 m/sec
    • A 0.42-0.7 m/sec
    • E/A 1.0-2.0
    • Decel time 150-240 msec
  2. Mitral Inflow Delay Relax
    • E <0.7
    • A >0.7
    • E/A <1.0
    • Decel time >240msec
  3. Mitral Inflow Restrictive
    • E >1.2 m/sec
    • A <2.2
    • E/A >2.2
    • Decel time <150 msec
  4. Expected Mitral inflow 10-30 yr old
    • Rapid Filling
    • E >> A
  5. Expected mitral inflow 30-50 yr old
    E>A
  6. Normal PV flow
    • S/D Ratio 0.86 +/-0.28
    • a reversal 0.17 +/-0.03
  7. Delay relax PV pattern
    • S/D ratio 1.63 +/-0.41
    • a reversal 0.21 m/sec +/-0.03
  8. Restrictive PV pattern
    • S/D ratio 0.40 +/-0.18
    • a reversal >0.35 msec
  9. Normal E/e' ratio in patient with restrictive MV inflow pattern suggests
    Constriction
  10. Normal E/e'
    • Septal: 8 or less
    • Lateral: 12 or less
  11. Normal LAP
    <12 mmHg
  12. Normal RA pressure
    0-5 mmHg
  13. Normal PAP
    20-30 mmHg
  14. PAWP calc by echo (Vp)
    • PAWP = 4.6 + 5.27 x E/Vp
    • Normal Vp(prop vel) =
    • > 55 cm/ sec ( young)
    • > 45 cm/ sec middle age+
  15. PVR calc by ECHO
    PVR = (mean PAP - mean LAP) / Qp
  16. LVEDP calc using ARedv
    LVEDP=DBP - 4 x (ARedv)2
  17. LAP calc with MR velocity
    • LAP = SBP - 4 x (Vmr)2
    • Valid only if no sig AS/lvot grad
  18. Estimated LA pressure with E/e'
    4 + E/e'
  19. LV SBP
    4 x (Vmr)2 + LAP
  20. Calc RVSP
    TR
    VSD
    PDA
    • TR + RA
    • SBP - VSD
    • SBP - PDA
  21. Calc PA edp
    EDpa + RA
  22. Mean PA pressure
    PR
    PA accel
    4*(peak Vpr)2

    • RVOT Acceleration time
    • 79 - (0.45 x Accel t)
    • 80 - (0.50 x accel t)
    • HR must be between 60-80.
    • Not valid with asd or vsd

    peak diastolic PR gradient
  23. RVedp by VSD
    LVedp - EDvsd
  24. Calc LAP with MS without MR
    LAP=Mean mitral gradient in diastole+Early LV diastolic pressure
  25. Usually PASP = RVSP, but in PS RVSP > PASP. Calc PASP.
    PASP = RVSP - PV peak grad
  26. e' < 5 cm/sec indicates
    Severe diastolic dysfxn
  27. Septal e' >8 indicates
    Lateral e' >10
    LAVI <34
    normal EF
    Normal diastolic fxn
  28. PVR woods units
    Qp calc
    TR velocity
    • PVR= MPP−LAP / Qp(l/min)
    • MPP={[2*PADP+PASP]/3}/ Qp

    PVR = 10(V tr / VTI rvot)
  29. Normal PVR (woods unit)
    Precludes closure ASD
    • 1-2 woods unit
    • >9 woods units
  30. SVR normal (woods unit)
    13 (11-16) woods unit
  31. E/e' indices indicating Increased LA Filling pressure in normal EF
    • Septal E/e' >15
    • Lateral E/e' >12
    • Average E/e' >13
  32. E/e' <8 indicates
    Normal LA filling pressure
  33. E/A >2, DT<150 in depressed EF Indicates
    Increased LAP
  34. E/A <1 and E <0.5 in depressed EF indicates
    Normal LAP
  35. Indeterminant mitral E/A with depressed EF.
    Normal LAP findings:
    E/e
    E/Vp
    S/D
    Ar-A
    Val E/A
    PAP
    IVRT/Te
    • E/e'<8
    • E/Vp<1.4
    • S/D>1
    • Ar-A<0
    • Val E/A<0.5
    • PAP<30
    • IVRT/Te>2
  36. Findings for Increased LAP with depressed EF and indeterminant E/e'
    E/e'
    E/Vp
    S/D
    Ar-A
    Val E/A
    PAP
    IVRT/Te
    • E/e'>15
    • E/Vp>2.5
    • S/D<1
    • Ar-A>30
    • Val E/A>0.5
    • PAP>35
    • IVRT/Te<2
  37. Calculate mean PAP pressures
    mean PAP = (PAP Systolic + 2*PAP Diastolic)/3
  38. Calculate MAP pressures
    mean SAP = (SAP Systolic + 2*SAP Diastolic)/3
  39. Calculate SVR continuity
    SVR = (meanSAP-meanRAP)*80/CardiacOutput
  40. Calculate PVR continuity
    PVR = (meanPAP - Wedge Pressure)*80/CardiacOutput
  41. Expected mitral inflow >50 years old
    • E>A
    • Grade1
  42. Calculate PAD by PDA
    DBP-4*(EDVpda)2
  43. What is PA systolic pressure of patient with peak TR velocity of 4m/s with estimated RA pressure 10 mmHg and pulmonic stenosis with PV gradient 3m/s.
    38 mmHg
  44. RAP Estimation Using IVC Collapse Index and Hepatic Venous Flow

    Mean RAP
    *IVC% Collapse
    *Hepatic Veins
    • 0–5 mm Hg
    • ≥50%
    • Vs > VD

    • 5–10 mm Hg
    • ≥50%
    • Vs = VD

    • 10–15 mm Hg
    • <50%
    • Vs < VD

    • ≥20 mm Hg
    • <50%
    • Flow only with VD
  45. JVP 15cm H2O correlates RA pressure of ?
    jugular venous pressure of 15 cm water corresponds to 15 × 0.7 or 10–11 mm Hg, since 1 cm water corresponds to 0.7 mm Hg
  46. Estimate of PVR noninvasively by doppler
    • * PVR = 10(V tr / VTI rvot)
    • estimated noninvasively by using the ratio between peak velocity of TR jet (as a surrogate of PA pressure), and time velocity integral of RVOT systolic flow (as a surrogate of cardiac output)

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