Download Suzanne "Shine" Tobias Admin Coordinator Tel

Suzanne "Shine" Tobias
Admin Coordinator
[email protected]
Tel: 966-1-4647272 x 32018
Color M-mode flow propagation velocity. Color M-mode propagation velocities in a
patient with normal (left) and abnormal (right) diastolic function. Vp, color M-mode
color flow propagation velocity (normal Vp [cm/s] > 45; diastolic dysfunction < 45).
=====================================================================
Diastolic Function Assessment Algorithm
1. Assess overall LV and RV systolic function from
two-dimensional images. “Yes” answers increase the
likelihood of diastolic dysfunction.
a. Are chamber sizes normal?
i. Is LA enlargement seen?
ii. Is LVH present?
iii. Is LV systolic function abnormal?
b. Standard Doppler interrogation of mitral inflow
and PV flow.
i. If mitral inflow appears normal, integrate the
above information and assess the PV flow
pattern to differentiate from a pseudonormal
pattern.
c. DTI to measure Ea.
d. Color M-mode of mitral inflow with qualitative
assessment of Vp.
e. If further investigation is required, consider:
i. Assessment of mitral filling patterns in
response to alterations in loading conditions
(administration of sublingual nitroglycerin to
decrease preload or passive leg raising to
increase preload).
ii. Response to exercise.
iii. Estimation of LV filling pressures using E/Ea.
iv. Measurement of IVRT.
Dilated cardiomyopathy: Mitral regurgitation. Mitral annular dilatation, lateral
papillary muscle displacement, and apical tethering prevent normal leaflet
coaptation. The result is typically mitral regurgitation (MR) with a centrally directed
jet. Worsening MR heralds a worse prognosis. Color M-mode Doppler across the
mitral valve (apical four-chamber view) during diastole provides a spatio-temporal
display of blood velocities across the vertical interrogation line. This parameter may
be less affected by loading conditions. The slope of this flow signal—flow
propagation velocity (Vp)—is the slope of the first aliasing velocity measured on the
E wave. Normal Vp is > 55 cm/s. Vp < 45cm/s may indicate impaired relaxation .
Mechanism of septal “bounce”/diastolic “checking”/ “shuddering” in constrictive
pericarditis. Signs of ventricular interdependence are manifest in constrictive
pericarditis. During inspiration, right heart filling proceeds at the expense of left
ventricular filling (seen on spectral Doppler pattern)—shifting the interventricular
septum to the left. This is followed by an abrupt cessation of diastolic filling (diastolic
“checking”) corresponding to a third heart sound or pericardial “knock.” During
expiration, increased left heart filling occurs at the expense of the right ventricle with
reciprocal movement in the interventricular septum.
Constrictive pericarditis. Sketch depicting exaggerated patterns of ventricular filling in inspiration and
expiration in constrictive pericarditis. In inspiration, an exaggerated increase in right ventricular (tricuspid
valve [TV]) inflow velocities occurs at the expense of left ventricular (mitral valve [MV]) inflow as manifest
on pulsed Doppler tracings. During expiration, reciprocal changes occur. Similar respirophasic variations
on pulsed Doppler can be seen in pulmonary embolism, right ventricular infarction, and COPD .
A more specific sign of cardiac tamponade is the echocardiographic finding of RV diastolic collapse,
compression, or inversion. These patterns are visualized as persistent posterior or inward motion of the RV free wall
during diastole, representing elevation of intrapericardial pressure above RV diastolic pressure . The
parasternal or subcostal long-axis views are best for visualizing this effect. The sensitivity of this finding is less than
that of right atrial collapse (approx 60–80%), but the specificity is high (between 90 and 100%).