The atria is acting like a pump during which phase of normal diastole?

Late filling / atrial contraction

Diastasis is the time during ventrical filling when very little blood is flowing because of what?

The pressure equalization between the atria and the ventricle.

The atria are acting as a conduit during what phase of diastole?

Rapid filling

IVRT is measured in __________ and normally is between ____ and ____ .

milliseconds

63 and 90 msec

Normal Deceleration Time is?

150 - 240 msec

In evaluating CMM, the normal shape is ___________ and measures ______.

straight up and down/vertically straight

> 55 cm/sec

Normal E/A ratio is _______.

1.0 - 2.2

Normal diastolic E wave velocity is ______ to _____ m/sec, while normal A wave velocity is _____ to ____ m/sec.

normal E wave .7 - 1.2 m/sec

normal A wave .42 - .7 m/sec

There are many causes of diastolic dysfunction; see if you can name at least 5.

Aging

CHF (Chronic Heart Failure)

Ischemic Heart Disease

Cardiomyopathies

Systemic Heart Disease

HTN

Valvular Heart Disease

The common signs and symptoms of diastolic dysfunction are similar to systolic heart failure.  Name several.

CHF

DOE

Exertional chest pain

Palpitations

SVT

Tissue doppler uses ______ frequency and ______ amplitude to create a doppler image of the myo-cardium in motion.

low frequency

high amplitude

A 70 yr. old diabetic pt. with HTN and DOE is found to have a DT of 210 msec, an E/A ratio of 1.6, a D greater than S on the pulmonic vein flow and CMM shows the velocity to be 43 cm/sec.  Pt. was asked to sit up and no changes occured.  Stage this pt.

Stage 2 Pseudonormal relaxation

A 29 yr. old male has findings of E/A ratio greater than 1, DT of 222, R wave of 24 cm/sec, pulmonary vein flow of D greater than S and IVRT at 79 msec.  Stage this pt.

Normal young adult

A 52 yr. old female pt. has an E wave velocity of .7 and an A wave velocity of .7 msec.  DT is 217 msec, pulmonary vein S is approx. half of D with an R wave of 37 cm/sec.  CMM displays a slight angle < 45 cm/sec.  IVRT is 85 msec.  Stage this pt accurately.

Have pt perform a maneuver to look for changes/reversal on Doppler.  If changes occur this indicates Stage 1 Dysfunction.  No changes indicates Stage 2 Diastolic Dysfunction.

An 81 yr. old pt with CAD, palpitations and tamponade has a pulmonary vein flow where S is shorter than D.  TDI  shows lower velocity on E than on the A wave.  E waves seen on PW doppler are very tall and the A waves are quite short.  With this information stage the pt accurately.

Have pt perform a valsalva maneuver/sit up to see if changes occur on doppler which would indicate Stage 3 Restrictive.  If there are no changes; Stage 4 Restrictive Nonreversible.

Ventricular function is highly dependent upon ______ as demonstrated by ________ ______ ___.

preload

Frank-Starling Law

What are the 7 basic measurements that can be preformed to assess one's diastolic dysfunction?

Deceleration Time on the E wave of the MV inflows

Pulmonary Vein Flow

Color M-Mode

Tissue Doppler Imagining

Isovolumic Relaxation Time

E/A ratio

E/Em ratio (E/E prime ratio)

The time period measured from aortic valve closure to mitral valve opening when both valves are closed and no blood is flowing is called what?

IVRT - Isovloumic Relaxation Time

(measured in msec.)

70 - 80% of blood enters the ventricle when the atria are acting as a _________ and this is referred to as ________ ________.

conduit

Rapid Filling

In order for the heart to achieve normal diastolic function, the _____ ______ must be _________ and _______ to _______.

In order for the heart to achieve normal diastolic function, the Left Ventricle must be compliant and quick to relax. 

What type of amplitude is produced by the walls of the heart in TDI?

Heart walls produce large amplitude echoes.

Ordinarily PW and Color Doppler filter out low frequency, high amplitude echoes caused by wall motion.  What modality makes use of these echoes?

TDI

TDI has limitations such as:

RV volume overload (D-sign)

ASD

Severe TR

Hyperdynamic function

(Sideways systolic motion of the heart interferes with quantification of velocity)

Wall motion abnormalities are easier to identify when using TDI because __________ is improved.

sensitivity

What is the gold standard for determining diastolic function?

Cardiac cath

Define diastolic function.

Diastolic function refers to the pressures that the Left Ventricle must fill against.

What is the "R" or "A" wave?

It is a small reversal of blood after atrial contraction.

The movement of blood measured from the annulus to the apex in velocity and time is called?

Color M-Mode

The rate of filling (velocity) of the ventricle during Rapid Filling Phase is referred to as what?  Also give the unit of measurement.

Flow propagation velocity measured in units of cm/sec

Why is TDI considered more accurate?

It is less dependent on preload.

The #1 cause of diastolic dysfunction is?

Age

In Stage III Restrictive, why are the E waves so tall and the A waves so little?

Because all filling occurs early to make tall E, then cannot get atrial contraction to fill much creating shortened A.

Valsalva maneuvers change what?

venous return/preload

Where should we place our sample volume for TDI and what size would be used?

On annulus just above leaflets of septal and lateral walls using a sample gate of 5.

A pt has a dilated LA, an E wave velocity of .6 m/sec and an A wave velocity of .9 m/sec.  DT is 253 msec and on the pulmonary vein flow the S is taller than the D with the R wave measuring 24 cm/sec.  Stage this pt.

Stage I Abnormal or Prolonged Relaxation

When a pt has a shortened IVRT, what is specifically is the reason?

The IVRT shortens because of increased LA pressures causing the Mitral valve to open early.

Define diastolic dysfunction.

Changes in ventricular diastole that have an adverse effect on stroke volume. 

When are the atrias acting as a pump and how much of a contribution does this phase produce?

Late filling is atrial contraction and there is an additional 20 - 30% of blood added to the ventricle.

The E/Em ratio makes a prediction of what?

The E/Em ratio predicts increase in LVEDP regardless of LV systolic function or mitral inflow profile by determining the LA pressures.

Impaired relaxation causes the myocardium to become what?

Stiff which causes the LV to fill against elevated pressures.

In which heart disease is diastolic wall motion affected early on?

Ischemic heart disease

Simply list the 4 stages of diastole.

1.  isovolumic relaxation

2.  early rapid filling

3.  diastasis

4.  late filling

The D wave of the pulmonic flow represents the diastolic phase when the atria are acting as what?

A conduit for flow from the systemic venous return to the RV.

CMM measures flow propagation during what?

rapid filling

What DT would be expected if a pt was in Stage II Pseudonormal Relaxation?

A DT greater than 200 msec.

What DT would we find if the pt was suspected of Stage I Abnormal or Prolonged Relaxation?

A DT of greater than 240 msec.

If the E and A velocities appear normal or about equal in size, what would our next step be?

Have pt valsalva to see if there is any reverse which would take stage 2 back to stage 1.