Abnormal Cardiac Doppler Flow Patterns

Question 1

What is the least common type of regurgitation to see in a normal patient?

Answer 1

Aortic

Question 2

In what part of the cardiac cycle does TV and MV regurgitation occur?

Answer 2

Systole

Question 3

In what part of the cardiac cycle do PulmV and AoV regurgitation occur?

Answer 3

Diastole

Question 4

2-D imaging features of valvular regurgitation

Answer 4

1. Dilated chambers
2. Calcific valves
3. Prolapse

Question 5

Is a more gradual slope of regurgitation indicative of mild or severe regurgitation?

Answer 5

Mild - more gradual slope means a slower change in pressure and not as significant

Question 6

What cardiac abnormality may be caused by rheumatic fever?

Answer 6

Valve stenosis

Question 7

T or F? Valve stenosis decreases afterload

Answer 7

FALSE: A stenotic valve creates more work of the ventricle to open and push blood flow which would create a HIGHER afterload as the ventricle must work harder

Question 8

T or F? Valve stenosis creates a larger pressure gradient from one side of the valve to the other

Answer 8

True

Question 9

What is an eccentric jet?

Answer 9

Jets going off in different directions

Question 10

What abnormality should be suspected with the lack of E’ and A’ wave during m-mode?

Answer 10

MV stenosis

Question 11

“Hockey stick” appearance of the MV is due to what?

Answer 11

Rheumatic fever

Question 12

2-D imaging features of valve stenosis

Answer 12

1. Hyperechoic, thick valves
2. Hypertrophy of ventricles due to increased afterload and ventricle having to work harder - more muscle needed
3. Reduced valve excursion - No clear E’ or A’ wave
4. Potenital atrial dilation

Question 13

What valve annulus is most commonly used in the continuity rule equation?

Answer 13

Aortic valve

Question 14

What is V1?

Answer 14

LVOT VTI

Question 15

What is V2?

Answer 15

Peak AV VTI

Question 16

As flow energy increases, what happens to pressure energy?

Answer 16

Decreases

Question 17

The increase in pressure drop occurs due to? (hint: bernoulli equation)

Answer 17

Increasing velocity

Question 18

Is highest velocity flow proximal, at, or distal to stenosis?

Answer 18

AT stenosis

Question 19

Solving for bernoulli’s equation gives what?

Answer 19

The pressure difference between two chambers at a specific point in time

Question 20

What does RVSP stand for?

Answer 20

Right Ventricular Systolic Pressure

Question 21

Velocity in bernoulli’s equation is generated from what?

Answer 21

Vmax in tricuspid regurgitation peak velocity

Question 22

How is the RAP assigned?

Answer 22

The visualized level of collapse of the IVC and it’s widest diameter

Question 23

When there is pan diastolic flow reversal seen in the abdominal aorta, what is that an indication of?

Answer 23

Severe AoV Regurgitation

Question 24

Is normal flow in the abdominal aorta seen above or below the baseline?

Answer 24

Above

Question 25

Is normal hepatic vein flow above or below the baseline?

Answer 25

Below as blood is carried from HV to IVC which is away from the transducer

Question 26

How many waveforms are seen in normal hepatic vein flow on PW doppler?

Answer 26

4

Question 27

What abnormality indicates systolic flow reversal with no systolic forward flow in the hepatic vein?

Answer 27

Severe tricuspid regurgitation

Question 28

What severity of regurgitation is when it is restricted to the area immediately adjacent to valve closure?

Answer 28

Mild/trivial/physiological

Question 29

Higher than normal velocities and larger pressure gradients will be visible on spectral doppler with that abnormality?

Answer 29

Valve stenosis

Question 30

In what abnormality will you lose diastasis?

Answer 30

MV stenosis - lose the E' and A' wave

Question 31

Fluttering of the anterior MV leaflet's E/A excursion in diastole seen in M-mode can indicate what?

Answer 31

Aortic regurgitation