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Mitral Inflow normal
 E 0.71.2 m/sec
 A 0.420.7 m/sec
 E/A 1.02.0
 Decel time 150240 msec

Mitral Inflow Delay Relax
 E <0.7
 A >0.7
 E/A <1.0
 Decel time >240msec

Mitral Inflow Restrictive
 E >1.2 m/sec
 A <2.2
 E/A >2.2
 Decel time <150 msec

Expected Mitral inflow 1030 yr old

Expected mitral inflow 3050 yr old
E>A

Normal PV flow
 S/D Ratio 0.86 +/0.28
 a reversal 0.17 +/0.03

Delay relax PV pattern
 S/D ratio 1.63 +/0.41
 a reversal 0.21 m/sec +/0.03

Restrictive PV pattern
 S/D ratio 0.40 +/0.18
 a reversal >0.35 msec

Normal E/e' ratio in patient with restrictive MV inflow pattern suggests
Constriction

Normal E/e'
 Septal: 8 or less
 Lateral: 12 or less


Normal RA pressure
05 mmHg


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+

PVR calc by ECHO
PVR = (mean PAP  mean LAP) / Qp

LVEDP calc using ARedv
LVEDP=DBP  4 x (ARedv)2

LAP calc with MR velocity
 LAP = SBP  4 x (Vmr)2
 Valid only if no sig AS/lvot grad

Estimated LA pressure with E/e'
4 + E/e'


Calc RVSP
TR
VSD
PDA
 TR + RA
 SBP  VSD
 SBP  PDA


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 6080.
 Not valid with asd or vsd
peak diastolic PR gradient

RVedp by VSD
LVedp  EDvsd

Calc LAP with MS without MR
LAP=Mean mitral gradient in diastole+Early LV diastolic pressure

Usually PASP = RVSP, but in PS RVSP > PASP. Calc PASP.
PASP = RVSP  PV peak grad

e' < 5 cm/sec indicates
Severe diastolic dysfxn

Septal e' >8 indicates
Lateral e' >10
LAVI <34
normal EF
Normal diastolic fxn

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)

Normal PVR (woods unit)
Precludes closure ASD
 12 woods unit
 >9 woods units

SVR normal (woods unit)
13 (1116) woods unit

E/e' indices indicating Increased LA Filling pressure in normal EF
 Septal E/e' >15
 Lateral E/e' >12
 Average E/e' >13

E/e' <8 indicates
Normal LA filling pressure

E/A >2, DT<150 in depressed EF Indicates
Increased LAP

E/A <1 and E <0.5 in depressed EF indicates
Normal LAP

Indeterminant mitral E/A with depressed EF.
Normal LAP findings:
E/e
E/Vp
S/D
ArA
Val E/A
PAP
IVRT/Te
 E/e'<8
 E/Vp<1.4
 S/D>1
 ArA<0
 Val E/A<0.5
 PAP<30
 IVRT/Te>2

Findings for Increased LAP with depressed EF and indeterminant E/e'
E/e'
E/Vp
S/D
ArA
Val E/A
PAP
IVRT/Te
 E/e'>15
 E/Vp>2.5
 S/D<1
 ArA>30
 Val E/A>0.5
 PAP>35
 IVRT/Te<2

Calculate mean PAP pressures
mean PAP = (PAP Systolic + 2*PAP Diastolic)/3

Calculate MAP pressures
mean SAP = (SAP Systolic + 2*SAP Diastolic)/3

Calculate SVR continuity
SVR = (meanSAPmeanRAP)*80/CardiacOutput

Calculate PVR continuity
PVR = (meanPAP  Wedge Pressure)*80/CardiacOutput

Expected mitral inflow >50 years old

Calculate PAD by PDA
DBP4*(EDVpda)2

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

RAP Estimation Using IVC Collapse Index and Hepatic Venous Flow
Mean RAP
*IVC% Collapse
*Hepatic Veins
 ≥20 mm Hg
 <50%
 Flow only with VD

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

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)

