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%
dimensional
How do you calculate Ejection Fraction?
What is the normal range?
What type of measurement is it?
LVEDd^{3} - LVEDs^{3} / LVEDd^{3} = 60-85%
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?
M-Mode 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?
4-8L/min
EPSS means?
Measured in what mode?
Normal measurement is?
E Point Septal Separation
M-mode
2-7mm
(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 _ _ _ _ _ _ _ _ _?
radius
thickness
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?
Force
Tissue Doppler
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 1-3m/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=?
A-B / 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 ?
>1
<1
>2
Normal IVRT?
relax abn IVRT?
Restrictive R ?
70
>110
<60
Normal decel time?
abnormal relax ?
Restrictive R?
200 ms
>240
<150
normal E wave?
abnorm relax?
Restrictive R?
.85 m/s
< .5 m/s
>1.2 m/s
Normal A wave?
abnormal relax?
Restrictive R?
.55 m/s
<.8 m/s
<.3 m/s
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?
E to S
A to A
MVA= _______/_______
220/pht
pht=?
dt (.29)
Normal pht = _______msec
severe ?
30-60
>220msec
MVA normal = __________?
Severe = ?
>2.5cm^{2}
<1.0cm^{2}^{ }
With a stiff, noncompliant MV would the pht increase/decrease?