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

Roteiro inicial do exame pediátrico

Colegas, conforme discutimos recentemente, achei interessante registrar este roteiro do exame pediátrico (e de pacientes adultos com condições congênitas). A rotina de avaliação sugerida é:

1. Análise do situs;
      a. Situs solitus
      b. Situs inversus
      c. Situs ambiguus
              c1. Isomerismo atrial direito
              c2. Isomerismo atrial esquerdo

2. Análise da posição da ponta cardíaca;
      a. Levocardia
      b. Dextrocardia

3. Análise da posição de descida da aorta ascendente (esquerda ou direita);

4. Identificação das válvulas semilunares;

5. Identificação das válvulas atrioventriculares;

6. Identificação da posição dos ventrículos;