Questões função diastólica ASE - 10

A 72 year old woman with chronic hypertension presents with progressive dyspnea. An echocardiogram shows concentric LVH with an ejection fraction of 70%, and a left atrial volume of 100 ml (BSA = 2.0m2). Doppler study shows an E/A ratio of 1.0 and a lateral E/e’ of 18. Patient has mild TR and a TR velocity recorded in the parasternal short axis view has a peak velocity of 2 m/s. Mean RA pressure is estimated at 5 mmHg. How would you interpret these findings?
a) The patient has impaired LV relaxation with elevated mean LA pressure but with normal PA systolic pressure.
b) The patient has impaired LV relaxation with elevated mean LA pressure. Cannot estimate PA systolic pressure since the TR recording may be inadequate due to either an incomplete signal or the parasternal sampling location.
c) The patient has normal diastolic function and PA pressure.
d) The patient has impaired LV relaxation with normal mean LA pressure and PA systolic pressure.

Questões função diastólica ASE - 9

A retrograde A -wave in the pulmonary vein velocity lasting > 50 ms longer than the A- wave in the mitral annulus velocity is indicative of:
a) Normal pulmonary artery pressure
b) Elevated mean LA pressure
c) Elevated LV end-diastolic pressure
d) Normal mean LA pressure

Questões função diastólica ASE - 8

An echocardiogram performed in a 55 year old African American man with chronic hypertension shows moderate concentric LVH and mild LA enlargement.
a) LV relaxation is impaired
b) LV relaxation is normal
c) LV relaxation cannot be established
d) More data are needed to determine LV relaxation

Questões função diastólica ASE - 7

A 72 year old woman presents with dyspnea at rest. An echocardiogram shows a dilated LV with an EF of 25% and enlarged left atrium. Transmitral E velocity = 100cm/s; A velocity = 40cm/s; Lateral e’ = 11cm/s, and TR peak velocity = 3.5m/s. These findings are indicative of:
a) Normal LV relaxation and mean LA pressure. Patient has pulmonary hypertension.
b) Impaired LV relaxation and mean LA pressure. Patient has pulmonary hypertension.
c) Normal mean LA pressure and pulmonary pressures. Patient has pulmonary valve stenosis.
d) Impaired LV relaxation, elevated mean LA pressure and pulmonary hypertension.

Questões função diastólica ASE - 6

When evaluating for the presence of impaired relaxation, the following statement is correct: 

a) The annular velocity, e’ should be considered the “gold standard” for accurate detection 

b) The E/A ratio should be considered the “gold standard” for accurate detection 

c) LA volume should be considered the “gold standard” for accurate detection 

d) Presence of LV regional or global dysfunction, and/or concentric LVH are superior to e’ in establishing the presence of impaired relaxation

Questões função diastólica ASE - 5

When LV relaxation is normal,
a) Pulmonary pressures are always normal
b) LA volume is always less than 34ml/m2
c) LV filling pressures are usually normal
d) Lateral e’ is always greater than 12cm/s

Questões função diastólica ASE - 4

The following clinical scenarios are associated with impaired LV relaxation except: 

a) Constrictive pericarditis 

b) Hypertrophic cardiomyopathy 

c) Ischemic heart disease 

d) Dilated cardiomyopathy

Questões função diastólica ASE - 3

Left atrial volume:
a) Is increased in all patients with diastolic dysfunction
b) Is a sensitive marker of diastolic dysfunction in the absence of primary mitral valve disease, atrial fibrillation, high cardiac output states or athletic physical training
c) Has no value in the evaluation of diastolic function
d) Is in the normal range in most patients with heart failure

Questões função diastólica ASE - 2

The transmitral E/A ratio 

a) Is an excellent indicator of LV relaxation 

b) Is an excellent indicator of LV filling pressures 

c) Can be used to assess diastolic function and filling pressures but only in conjunction with other clinical and echocardiographic findings 

d) Has no value in the evaluation of diastolic function

Questões função diastólica ASE - 1

Questões sobre função diastólica do ASE, cedidas gentilmente pelo colega Dr. Issam.
São 10 questões. Vou publicá-las separadamente, para permitir a discussão individual.
Participem!

1. The main determinants of diastolic function are:
a) The relaxation properties of the left ventricle and the stiffness of the chamber
b) The ejection fraction
c) Systolic blood pressure
d) Coronary blood flow