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Systolic Function Questions

Name: ____brianna carden__________

Date:

____1/27/16_______
GENERAL PRINCIPLES
1. Why should assessment of systolic function be a part of all echo exams?
Because it plays a crucial role in the selection of medical therapy,
and is instrumental in determining the timing of surgery for
valvular heart disease
LINEAR MEASUREMENTS
2. When does a linear measurement provide adequate assessment of ventricular
function?
In the presence of normal ventricular geometry and symmetric
function
3. Why has measurements derived from 2D echo (linear or area based) taken the
place of M-mode measurements in most labs today?
2D imaging allows correction for off axis interrogation and also
for determination of the spatial heterogeneity of function
4. What are the 2 limitations of linear measurements of the left ventricle for
determining ventricular performance?
1) Many forms of acquired heart disease, especially coronary
artery disease, result in regional variation in ventricular shape
and function.
2) Underestimates the severity of dysfunction if only a normal
region is interrogated or overestimate the abnormality if the Mmode beam exclusively transmits the wall motion abnormality
INDIRECT M-MODE MARKERS OF LV FUNCTION
5. What are the 2 indirect signs of LV systolic dysfunction given in your book on
page 125?
Increased E-point to septal separation
Gradual closure of the aortic valve during systole
6. What is a normal EPSS measurement?
Within 6 mm of the left side of the ventricular septum
7. What happens to the distance between the left side of the ventricular septum
and the mitral valve E point when there is a decreased ejection fraction? Use
Figure 6.4 to visualize this dysfunction
The distance is increased.
8. What causes the aortic valve to gradually close in late systole with systolic
dysfunction and how will this change appear on an M-mode tracing of the aortic
valve?
The gradual closure is due to a decreased stroke volume from the
left ventricle resulting in a gradual reduction in forward flow in
late systole.

On M-mode, the aortic valve has a rounded appearance rather

than a squared appearance.

TWO-DIMENSIONAL MEASUREMENTS
9. What is the most common method utilized for determining ventricular volume?
Simpson Ruleaka the rule of disks
10. What views are required to utilize the Simpson technique to calculate
ventricular volumes?
In the posterior atrioventricular groove
11. What is required of the images utilized in the Simpson techniques to ensure
the calculation is accurate?
PSAX, Apical, and subcostal views
12. Name two clues that help the sonographer to determine if the transducer is
at the true apex.
This is caused by the heart moving freely within the pericardial
space and the location from beat to beat.
PHYSIOLOGIC VERSUS PATHOLOGIC HYPERTROPHY
13. List the 4 ways left ventricular hypertrophy can be characterized. Page 132
Left ventricular hypertrophy can be characterized as the special
physiologic hypertrophy (seen in highly trained athletes),
concentric, eccentric and physiologic.
14. Left ventricular hypertrophy characterization is due to what 2 things?
The calculation of the left ventricular mass is a determination of
the mass on the left ventricular muscle and may not relate to
overall cardiac enlargement. Increases in left ventricular mass
can occur with chamber enlargement and relatively normal wall
thickness, as seen in resurgent valvular lesions, or secondary to
predominant increase in wall thickness with normal chamber
sizes as seen in the pressure overload of systemic hypertension.
It is important to characterize LVH as being due to either
chamber enlargement or increased wall thickness.
REGIONAL LEFT VENTRICLE FUNCTION
15. What is the most common form of acquired heart disease in modern
medicine?
CAD (Coronary Artery Disease)
16. Describe normal ventricular contraction?
Myocardial fibers are oriented in a spiral fashion around the left
ventricle. Contraction results in myocardial thickening and
excursion of the endocardium toward the center of the ventricle.
Simultaneous with this motion toward the center and cavity
shrinkage is a twisting motion of the left ventricle.
17. What is the common cause of abnormal regional wall motion?
CAD
18. Define the following types of regional wall motion abnormalities: hypokinetic,
akinetic, and dyskinetic.
Hypokinetic: Abnormal diminished muscular function or mobility.

19.

Akinetic: Absence or loss of muscular function and mobility.

Dyskinetic: Wall moves away from the center of the ventricle.
What is the significance of the location of wall motion abnormality?
This is significant because the location is predicitive of the
location of the coronary culprit lesion in myocardial ischemia or
infarction.

NONISCHEMIC WALL MOTION ABNORMALITIES page 135

20. Define tardokinesis:
The delayed contraction of a segment of the left ventricle,
typically occurring in the final 50 to 100 ms of mechanical systole
21. Define early relaxation:
The segment relaxes or moves outward before the rest of the
chamber.
22. Describe the sonographic feature of a left bundle branch block (LBBB):
Early systolic downward motion of the ventricular septum on Mmode
Increased during dobutamine stress test
Paradoxical motion of the IVS
23.

Define paradoxical motion (NOT IN BOOK):

The IVS moves away from the left ventricular free wall during
systole. Normally, it would move towards the wall.

PREMATURE VENTRICULAR CONTRACTIONS

24. What does a premature ventricular contraction (PVC) result in?
Segmental wall motion abnormality for the beat in which the left
ventricle is activated by the PVC.
25. Define bigeminy and trigeminy:
Bigeminy: A cardiac arrhythmia in which each normal beat is
followed by abnormal one
Trigeminy: A cardiac arrhythmia, in which the beats are grouped
in trios, usually composed of a sinus beat followed by two
extrasystoles. One ventricular premature complex followed by
two normal beats.
26. True/False: The wall motion of the beat, following the compensator pause will
then be hyperdynamic.
True
POSTOP CARDIAC MOTION
27. What must have been opened for postop cardiac motion to occur?
The pericardium must have been opened for postop cardiac
motion to occur.
28. Describe postop cardiac motion.
Postop cardiac motion can be described as a global phenomenon
involving exaggerated anterior motion of the entire heart within

the thorax. This occurs after the pericardium has been opened
with the intent for any type of cardiac surgery.
DOPPLER EVALUATION OF GLOBAL LEFT VENTRICULAR FUNCTION
29. What images & Doppler are used to calculate the stroke volume and cardiac
output?
Apical images are used to calculate the stroke volume. Stroke
volume is calculated as the difference between the diastolic and
systolic ventricular volumes. The magnitude of the opening of the
mitral valve, as reflected by E-wave height, correlates with the
volume of transmitral flow and, in the absence of significant
mitral regurgitation, with LV stroke volume. Because cardiac
output is equal to the heart rate times the stroke volume, the
apical images are also useful to calculate this parameter.