ECHO LAB AND CARDIOVASCULAR HEAMODYNAMICS. A simple cost effective,non invasive approach which when used appropriately can be boon for physicians and cardiologists in diagnosis and prognostication.

1. Dr. RANJEET PALKAR MD
DNB CARD TRAINEE MMM CHENNAI

3.  M-mode and 2D Echo give indirect evidence of
hemodynamic abnormalities
 Are qualitative at best
 Doppler provides accurate intracardiac
hemodynamic data MORE QUANTITATIVE
 Accuracy validated by simultaneous cath data
by several studies

13.  Flow across a fixed orifice is equal to the
product of the cross sectional area of the
orifice & flow velocity.
 Velocities varies during ejection in a
pulsatile system, individual velocities of the
doppler spectrum need to be summed(TVI
or VTI).
Flow rate = CSA x FLOW VELOCITY
SV = CSA X TVI CO = SV X HR

14.  The CSA of orifices in the heart is usually
assumed to be a circle and it is determined
from measurement of the orifice
diameter(D).
CSA = (D/2) ² X  = D ² X 0.785
SV = D ² X 0.785 X TVI

15. Cardiac Output = SV x HR

16. Error

21. Where Q total is total forward vol across a regurgitant
valve

22.  It is simply the percentage of regurgitant
volume compared to flow across the
regurgitant valve.
REG VOL
Regurgitant fraction =
Q valve flow
X
100

23. MR regurg volume = Mitral inflow - LVOT flow
(D2 x0 .785 x TVI) MV - (D2x0.785xTVI) LVOT
200 ml - 60 ml = 140 ml
Regurg fraction = 140ml/ 200ml x 100% = 70%

27. PISA CALCULATION

28. PISA CALCULATION

29. PISA CALCULATION

30. REGURGITANT ORIFICE AREA
CALCULATION

31. REGURGITANT
ORIFICE AREA
INTEGRATED
VELOCITY
OF MR JET
XRV =

34.  In the presence of intracardiac shunt the flow ratio
between the pulmonary & systemic circulation
usually indicates the magnitude of shunt.
 Pulmonary flow (Qp) is calculated from the RVOT
& systemic flow (Qs) , from the LVOT.

35. RVOT TVI X RVOT CSA
LVOT TVI X LVOT CSA.
Qp/Qs =

37.  Pressure gradient (Δ P) = 4v2
 Blood flow velocity measured by Doppler
is an instantaneous event
 Hence the pressure gradient derived is
instantaneous gradient

40. Automated border detection
CW doppler of AV -peak and mean gradients

42. Cath gradients
Echo doppler

48. Error

55. PHT = 0.29 X DT

56. Where A1 is a known area at a location proximal to the
unknown area

58. Area 1 - Known CSA ; Area 2 - Unknown CSA

61.  LAP = SBP- MR Peak Gdt
 LVEDP = DBP-AREDP
 RVSP = TR Gdt + RA Mean pressure
 PAMAP = PR Peak Gdt
 PAMAP = 79-0.45XPA Acc Time
 PADP = PREDP +RAP
 dP/dt = 32mmhg/time in seconds
(Normal dp/dt > 1200 mmhg/sec)
 PHT = 0.29X DT
 MVA = 220/PHT

62. •Reflects pressure difference
between RV &RA
•TR present in 75% normal
adults
•Normal velocity 2- 2.5m/sec
•Higher velocity –PS or PHT

68. >15

71.  PAP systolic = 18- 25 mmhg
 PAP mean = 9 - 18 mmhg
 PAP dias = 4- 12 mmhg
 LAP = 2 - 12 mmhg
 LVEDP = 3 - 12 mmhg
 RAP = 2 - 8 mmhg

72.  MR velocity represents the systolic
pressure difference between the LV &
the LA.
 In patients without LV outflow
obstruction systolic BP is practically
same as LV systolic pressure.
 LA pressure = SBP – 4 x MRV²

74.  LVEDP & LV diastolic function are closely
related phenomenon.
 Changes in mitral flow velocities in early &
late diastole reflect changes in LVEDP.
 In presence of AR the LVEDP is easily
calculated.
 AR velocity reflects the diastolic pressure
difference between AO & LV.

77. LIKE TISSUE DOPPLER ARE
ALSO HEPFUL

78. E
E’
> 12(lateral);15(septal)
LVEDP > 12 mmHg

79. PCWP = 1.24 E 1.9
E’
X +

81. •Pulse wave doppler
•Sample volume at valve annulus
•Ac T=Time between beginning
of flow & peak velocity
•Normal 120 m Sec or higher
•PHT –Ac T Shortened

82. Fig. 4-43.
Pulmonar
y artery
flow in
three
patients
with dif-
fering
pulmonar
y artery
pres-
sures. The
acceleratio
n time
(AT)
becomes
shorter as
the
pulmonar
y artery
pressure
rises.

83. MAHAN’S regression equation
MPAP = 79 - ( 0.45 X Ac T)