Echo LV function Assessment

Echo LV function Assessment

Echo LV function Assessment Alfred Mureko UCT 23/03/12 LV function 1.Systolic function 2.Diastolic function Multiple

parameters LV systolic function Major prognostic factor in cardiac disease Systematic study through Mmode,2D and doppler flow Investigation

Allows assessment of global and regional LV systolic function Change in LV geometry between systole and diastole LV systolic function Parameters in systolic function

Change in diameter Change in area Change

in volume Change in diameter Fraction shortening-FS M-mode analysis or 2D LVEDD: 3.5-5.6 cm LVESD: 2-4 cm FS=(LVEDD-LVESD)/LVEDD

*100 Normal:26-45% Fraction shortening(FS) Limitations LV must contract uniformally to reflect global LV functioning Caution

in conditions that can change cardiac geometry : segmentally diseased LV dilated RV LBBB Change in Fractional Area 2D

echo measurement, EDA,ESA EDA-ESA/EDA *100 Normal: greater than 45% Also affected by conditions affecting cardiac geometry Change in volume-EF EF:

well accepted useful index of LVF Interaction: preload,afterload and contractility in determining LV fx Not a measure of contractility but crude indicator of systolic fx EF=EDV-ESV/EDV *100 Normal EF:50-80%

Methods of EF calculation Area-length method Simpsons Rule eye ball SV:SV=Flow velocity integral *AVA

Normal:70-140ml/beat EF in AS Severity:PG,AVA,flow velocities PG is a reliable indicator of AS severity only with good LV function PG will fall as the LV fx deteriorates in end-stage disease

AVA is less flow dependant than PG Dobutamine stress echo Truly severe AS vs Aortic pseudostenosis EF in MR LVEF EF is always overestimated

more than 60% is normal LVID(FS) is a better indicator of LV function Systolic function

Regional wall motion LV segmental analysis Apical/mid/basal Hypokinesis,akinesis,dyskinesis,n ormal WMSI as powerful as EF in prognosticating patients after MI. Systolic function Tissue doppler assessment

Tissue velocity and not blood velocity Systolic velocity from MV annulus Good index of global LV function Velocity>8cm/s: good EF Velocity<3cm/s: poor EF Other Parameters in systolic fx LV

wall thickness:6-12mm >12mm-LVH,independant prognostic indicator in CVS disease Amplitude of IVS indicator of LV fx

Diastolic function Ability LV of the LV to accommodate blood wall relaxation, filling, compliance Normal

LV-EF in CCF should spark suspicion about possible diastolic failure Generally worsens with age: reversed E:A Parameters in Diastolic function Trans-mitral velocities

PWD Pulmonary veins Tissue Doppler Investigation Trans-mitral velocities Transmitral velocities E:A ratio: 0.75-1.5 DT: 140-220ms Diastolic dysfunction: reversal of E:A ratio, pseudonormalisation

short/prolonged DT DT:shortened by high LVEDP prolonged by impaired LV relaxation Trans-mitral velocities Pulmonary vein PWD Pulmonary veins PWD S-wave: antegrade LA inflow

blunted in poor LV relaxation D-wave: antegrade LA inflow Ar-wave: retrograde flow into PV augmented in poor LV compliance Grading of diastolic dysfx Normal

diastolic fx(normal e:a) Impaired relaxation(e:a reversal) Pseudonormalisation(e:a appears

normal) Restrictive filling(e:a more than 2) Hallmark of diastolic dysfx Reversal of E:A Prolonged DT Augmented Ar-wave on PV PWD

THE END... I miss the days when apples and blackberries were just fruits...

Recently Viewed Presentations

  • Expand Your Reach with Open Access: Authors&#x27; Rights DalSpace

    Expand Your Reach with Open Access: Authors' Rights DalSpace

    Expand Your Reach with Open Access Authors' Rights DalSpace Michelle Paon Biology Librarian Sept. 1, 2011 Dal Libraries UnZipped Dal Libraries UnZipped "Notwithstanding any terms in the Publication Agreement to the contrary, AUTHOR and PUBLISHER agree as follows: Author's Retention...
  • Snímek 1 - Evvoluce

    Snímek 1 - Evvoluce

    Později se ke skupině připojil kytarista Andy Summers. Skupina dosáhla největší popularity v polovině osmdesátých let, kdy vydala album s názvem Synchronicity. Následně se na dvacet let skupina odmlčela. Ke koncertování se The Police vrátili v roce 2007. The Police
  • Balancing Oxidation-Reduction Reactions - AP Chemistry

    Balancing Oxidation-Reduction Reactions - AP Chemistry

    Balancing Oxidation-Reduction Reactions Any reaction involving the transfer of electrons is an oxidation-reduction (or redox) reaction Definitions: Oxidation is the loss of electrons. Reduction is the gain of electrons. Oxidation cannot take place without reduction. During a redox reaction, the...
  • Food Service Unit 2: Safety Safety  Safety is

    Food Service Unit 2: Safety Safety Safety is

    Accidents can easily occur because of the amount of activity and potentially dangerous tools and equipment in the kitchen. Accidents just don't happen, they are caused. Accidents can be prevented by identifying possible hazards and minimizing the potential for an...
  • Handling Funerals I. Introduction Every death that takes

    Handling Funerals I. Introduction Every death that takes

    1. Committal for the Unsaved Inasmuch as it has pleased God in His infinite wisdom and providence to remove from this world the soul of _____, we commit his (her) body to the ground, earth to earth, dust to dust,...
  • Writing a Personal Essay

    Writing a Personal Essay

    Evaluate your own sketch Researching, gathering more info., drafting, & revising Features of a Personal Essay First person Subject commonplace Narrative form Sources of information: memory and observation Reflective of dialectical process Writing a Personal Essay CH.4 Personal Essay Places...
  • JNDI - University of Technology Sydney

    JNDI - University of Technology Sydney

    Advanced Java Programming JNDI v2 Chris Wong [email protected] based on notes by Wayne Brookes JNDI - Introduction JNDI = Java Naming and Directory Interface JNDI provides a standard way for Java applications to interface with a variety of naming and...
  • Amateur Radio: A Bright Spot During Power Loss

    Amateur Radio: A Bright Spot During Power Loss

    Amateur Radio: A Bright Spot During Power Loss . The Role of Ham Radio in the 2003 Northeast Blackout. Haritha Pula