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Doppler equation
 V=c x (Fs  Ft) /[2 Ft(cos 0)]
 V=1.54 x change freq/angle
 Higher velocity > higher doppler frequency shift assume cos 0=1(beam parallel to flow)

Bernoulli's equation
 4V(2) assumes prox velocity <1.
 When LVOT/ PS
 4[V2(2)  V1(2)]


EF% by volumes
 SV/EDV X 100%
 EDVESV/EDV X 100%

Wall stress
 Pressure(P) x Ventricular Radius(R) / [2 x wall thickness]
 Analogy balloon
 Bigger balloon with more air pressure has thinner wall & increased wall stress

Cardiac Output
SV(ml) x HR(beats/min) / 1000mL/L

dP/dT is Rate of pressure rise over time is a loadindependent measure of LV function.
 dP/dT=32mmHg/ (time from 1to 3 m/s MR CW jet in sec)
 Normal is > 1200
 Abn < 1000


PAP with significant PS
[4(Vtr)^{2} + RAP]  4(VrvVpa)


AVA continuity
.785 x D lvot x VTI lvot/ VTI as

Velocity ratio
 V lvot/ V as
 >0.5 mild
 <0.25 severe

MVA(Mitral stenosis) by P1/2t
220/P1/2t

Aortic Regurgitation volumes
 RVav=tSVavfSVmv
 ROA=RV/VTIav
 RF=RVav/TSVx100%
 Severe Mild
 RV >60 <30
 RF >50 <30
 ROA>0.30 <0.10


AR pressure 1/2 t
 Severe <200ms
 Mod Severe 200350
 Moderate 350500
 Mild >500

Mitral Regurgitation volumes
 RV=tSVmvfSVlvot
 ROA=RVmv/VTImv
 RF=RVmv/SVmv x100%
 Severe Mild
 RV >60 <30
 RF >50% <30%
 ROA >0.4. <0.20

MR jet area
 Severe >40% LA
 Mild <20% LA


MR PISA
 Rflow=6.28 r^{2} x Va
 ERO=RFlow/Vmr
 RV=ERO x VTImr

Aortic dilation with age.
Predicted sinus diamension.
 Age 1840
 0.97 + (1.12 BSA)
 Age >40
 1.92 + (0.75 BSA)

Qp:Qs
D pa^{2} x VTI pa / D lvot^{2} x VTI lvot

What is normal fractional shortening?
2440%

Index of Myocardial Performance (IMP)
LIMP or RIMP
[MR or tr duration  LVOT or rvot duration] / LVOT or rvot duration
 Norm < 0.40
 mild 0.40.5
 Mod 0.60.9
 Sev > 0.9

PA acceleration time
 Estimates mean PA pressure.
 79  (0.45 x Accel t)
 HR must be between 6080.
 Not valid with asd or vsd

Simplified continuity equation.
 [(3.0 x BSA x 1000) / HR] / AVvti = AVA cm2
 Assume nl lvot sv

AVA index c/w severe AS
<= 0.45

Calc AR ERO by vol, what considered severe
 AV regurg vol / VTIar
 (SVav  SVmv) / VTIar
 >0.29 = severe

Calc AR regurg fraction by vol, What is moderate.
 (SVav  SVmv) / SVav
 Moderate = 3050%
 *invalid with significant MR
 *not well validated

Expected AV decel rate for moderate AR.
 2  3.5 m/sec2
 *least reliable

Calc p1/2t AR
What are mild, mod, sev parameters.
 mSec x 0.29
 Mild >500mSec
 Severe <200mSec
*least reliable

AR jet/LVOT diameter ratio for moderate AR.
 2564% mod
 <25% mild
 >64% sev

AR jet/LVOT area ratio for moderate AR
 559% mod
 <5% mild
 >59% sev

EF calculation Quinones
(LVEDd2  LVEDs2) / LVEDd2 x 100%

PVa velocity >0.35 m/sec indicates
Increased LA pressure/LVEDP

PISA calc
Flow rate
ERO
RV
 2 pi r^{2} x Va = flow rate
 6.28 r^{2} x Va / peak Vmr = ERO (cm^{2})
 ERO cm^{2} x VTI mr = RV

Simplified MVA by p1/2 t
759 / decel time

