do patients with LVDD uaually have normal ejection fractions?
yes, it's not until end stage heart failure that systolic function will be affected.
what does a BNP blood test assess?
the extent of heart failure
name some potential symptoms of diastolic heart failure
dyspnea chest pain chf palpitations SVT
what is the best way to diagnose LVDD?
there is no one way to diagnose, it is the sum of all its parts. but not all have to be present at once
the e wave of mitral inflow dopple represents which stage of diastasis
early diastolic filling
the A wave of mitral inflow doppler represents which stage of diastasis?
the atrial kick, or last filling stage
when does that rapid rise of pressure in the LV occur?
during the IVCT (btwn MV closure and Ao Opening)
tissue doppler tells us what info about the LV
the amount of blood entering the ventricles
- used in assessing LVDD
what are the normal ,abnormal and restrictive IVRT values?
normal- btwn 70-90 msec
abnormal- above 90msec
restrictive- below 70 msec
what happens to the IVRT when coronary artery disease in present?
it get prolonged
if there are arrhythmias present, is TDI still accurate?
what are the stages of LVDD
-normal with rapid filling for a young and healthy adult -normal, normal filling -abnormal relaxation, but normal for age ( above 50) -abnormal relaxation,disease process - psuedonormal -restrictive relaxation
if a patients MV inflow looks normal, but the pulmonary veins show a reversed pattern, what should be done next?
a valsalva manuver durning pw of the mv inflow, this brings out the true flow pattern
what would be looked at to decide if LAP is elevated in the presence of LVDD
the A reversal wave of the pulmonary vein flow. anything above 20cm/sec will be elevated pressure in the LA
with abnormal relaxation, what happens to the deceration times?
it gets prolonged
what is the relationship of the MV inflow pattern and the pulmonary vein patterns?
inverse. if E wave is higher then the A, then the S wave should be smaller then the D ( with normal function)
which stage mimics restrictive complience? and why?
normal for a young adult with rapid filling, bc they are at high flow states bc thier hearts are in such good condtition. the pulmonary vein flow will be normal
grade the LVDD.
mitral E/A is >2.2, decel time <150msec, and pulm. vein A reversal duration is longer then the mirtal inflow A duration.
restrictive lvdd grade 3
mitral e/a=1.2, decel time is btwn 150.250msec, and e/a reversal with decel propagation prolongation >250msec when valsalva is done.
psuedonormal, lvdd grade 2
what is diastolic dysfunction
the inability of the left ventricle to fill efficiantly with out an undue increase in filling pressure,
mitral e/a <.7 and decel. time >250msec
impaired relaxation lvdd stage 1
when can LVDD be reversed and when can it not?
up until stage 4 , it can be reversed. stage four is irreversable damage