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DMST 253 Adult Echocardiography 1 > Apical Doppler: Part 1 > Flashcards

Apical Doppler: Part 1 Flashcards

1
Q

What is the order of images for Apical Doppler images? 3

A
  1. 2D
  2. Color
  3. Spectral
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2
Q

Several Doppler measurements are used to assess what?

A

Diastolic function

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3
Q

Diastolic function assess what?

A

How well the heart rests and fills

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4
Q

What are MV inflow parameters for doppler images that pertain to diastolic function? 5

A
  1. E wave
  2. A wave
  3. E/A ratio
  4. Deceleration time (DT)
  5. IVRT
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5
Q

What are MV annulus parameter TDI images that pertain to color doppler?2

A
  1. E prime
  2. E/e
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6
Q

What are PV apical parameters that pertain to diastolic function?3

A
  1. S wave
  2. D wave
  3. A wave reversal
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7
Q

What are other measurements we can use for diastolic assessment?2

A
  1. LA volume index
  2. TR max velocity
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8
Q

What are some things to note about the MV colour inflow images?3

A
  1. Column of blood entering the LV is red and yellow between leaflet tips
  2. Inflow jet angles slightly laterally
  3. Minimal aliasing
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9
Q

What are some things to remember when we get a Colour MV inflow image?3

A
  1. Make sure the color box is long, and slightly wider than the MV annulus
  2. Sweep and assess MV
  3. Show MR is present
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10
Q

When will we see mitral regurgitation during a Color doppler clip of the MV?

A

During Systole

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11
Q

When will we see Mitral stenosis during a color doppler MV clip?

A

Aliasing during diastole

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12
Q

What is mitral stenosis?

A
  1. Leaflets not opening properly - reduced leaflet mobility
    color aliasing with LV (inflow) during diastole
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13
Q

MV inflow and what else can be used interchangeably?

A

LV inflow

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14
Q

When we are getting a pulsed wave of the MV inflow what is the process? 2

A
  1. Place the sample volume (SV) at the tips of the MV when open in the middle of the red column of blood.
  2. This may be out laterally a bit, rather than mid LV
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15
Q

Where should we put the SV in when getting a MV inflow PW?

A

SV in the center of the red inflow at MV leaflet tips

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16
Q

What should the baseline be when we get a MV inflow PW?

A

1/4 - 1/3 from bottom

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17
Q

What should the wall filter be for MV inflow PW?

A

Low wall filter

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18
Q

What do we need to measure during MV inflow PW? 3

A
  1. E
  2. A
  3. Deceleration time
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19
Q

What are the normal values of E, E/A, and DT for MV inflow PW?

A

E: 0.6 - 1.3 m/s
E/A: 0.8 - 2.0
DT: 160 - 220 ms

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20
Q

How would you label the image? What should we remember about this?

A
  1. E is the tall peak
  2. A is the second peak
  3. The measurement is the DT
    **E after T, A after P
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21
Q

What is the early filling phase of the MV inflow phase? What is this relate to?

A
  1. E wave
  2. After IVRT, LV starts to expand, creating suction from LA to LV and opening the MV
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22
Q

The height of the E wave is influenced by what?

A

Amount of blood entering the LV

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23
Q

MV inflow of the e wave is what?

A

Preload dependent

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24
Q

What is the diastasis part of the MV inflow phase? What happens during this phase?

A
  1. Gap between end of E wave and start of A wave
  2. Very little flow or no flow seen on spectral doppler
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25
Q

What is the Late filling stage of the MV inflow phase? What is this usually called as well? How does it compare to the other phase in terms of size?

A
  1. A wave
  2. The result of atrial contraction ā€œatrial kickā€
  3. Normally the smaller wave of the two
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26
Q

What is the Mitral valve E/A ratio?

A
  1. Routine measurement - machine calculates
  2. Ratio of peak E wave to Peak A wave
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27
Q

What is the normal E/A ratio?

A

0.8 - 2.0

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28
Q

E/A reversal can be normal in what population?

A

Older patients

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29
Q

Besides older patients who might have E/A ratios > 2.0

A

Many fit young people

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30
Q

What is IVRT?

A

The time between AV closure and MV opening

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31
Q

During IVRT what is pressure in the LV?

A

It is falling

32
Q

Where should we place the sample volume during IVRT?

A

Between the MV inflow and LVOT

33
Q

If IVRT is prolonged, what does this mean?

A

If IVRT is prolonged it is taking too long for the LV to relax (impaired relaxation)

34
Q

IVRT may be normal for what population?

A

> 60 years

35
Q

What does the purple arrow point to?

A

IVRT.

36
Q

Where does IVRT lie?

A

Between Aortic outflow and mitral inflow

37
Q

Is IVRT a routine image?

A

No

38
Q

Is MV CW a routine image?

A

No

39
Q

In Mitral stenosis, the MV opening is what?

A

Smaller

40
Q

In MV stenosis hemodynamics what is blood flow velocity like?

A

It increases

41
Q

In Mitral stenosis what happens if the MV has a higher velocity?

A

It is aliased

42
Q

In Mitral stenosis, as the valve gets smaller what happens?

A

The flow gets faster

43
Q

CW of Mitral regurgitation last throughout what periods?

A

Systole and isovolumic periods

44
Q

How fast is the CW of mitral regurgitation?

A

Near 5-7 m/s very fast

45
Q

During tissue doppler of the MV annulus, as the LV expands in diastole what happens to the base?

A

It lengthens from base to apex

46
Q

What are a couple ways the LV changes it shape during tissue doppler of MV annulus? 4

A
  1. Radially
  2. Circumferentially
  3. Longitudinally
  4. Torsion (twisting and untwisting)
46
Q

What are a couple ways the LV changes it shape during tissue doppler of MV annulus? 4

A
  1. Radially
  2. Circumferentially
  3. Longitudinally
  4. Torsion (twisting and untwisting)
47
Q

When we take a TDI color what can we measure?

A
  1. How quickly the tissue expands or contracts using PW doppler
  2. Just as we can measure the velocity of blood flow
48
Q

The velocities of TDI color are more or less dependent on preload?

A

Less dependent

49
Q

What does the circles indicate?

A

The sample volume placement area of TDI color

50
Q

Where should we place the SV for the MV annulus TDI image?

A

within the medial MV annulus

51
Q

What is the length of the SV gate for the MV annulus?

A

5-10 mm

52
Q

What doe we need to remember about the SV when getting a MV annulus image?

A

Make sure the SV stays within the annulus throughout the cardiac cycle

53
Q

How should we adjust the scale for the MV annulus TDI image? What about gain?

A

Adjust scale for signal seen, and WATCH GAIN HERE

54
Q

What do we measure during a MV annulus TDI image?

A

E prime

55
Q

What are TDI normal values

A
56
Q

What is the E/eā€™ ratio?

A

The MV PW E divided by the average TDI eā€™

57
Q

For TDI lateral MV annulus has what type of movement?

A

More free

58
Q

When does the pulmonary veins fill the LA? 3

A
  1. Ventricular systole
  2. Early diastole
  3. Diastasis
59
Q

Flow is reversed in the Pulmonary veins during what?

A

Atrial systole (after P wave)

60
Q

How often do we use PW in the RUPV?

A

Normally

61
Q

When getting the pulmonary vein color images what must we remember? 3

A
  1. Make sure you have an elongated A4C
  2. Scale set low
  3. Increased color gain
62
Q

Where should we put the cursor during Pulmonary Vein PW images?

A

Cursor in RUPV (medial red flow below IAS)

63
Q

Where should we set the scale for the pulmonary vein in PW?

A

low (30-40)

64
Q

What may we need to do for a pulmonary vein PW? 2

A
  1. May need to decrease reject
  2. Increase sweep speed
65
Q

What do we measure during Pulmonary vein PW?

A
  1. S wave
  2. D wave
  3. Note A- reversal
66
Q

What is the S wave? 4

A
  1. Systolic wave
  2. Normally greater than D wave velocity
  3. Divided into S1 and S2 waves
  4. Occasionally S1 and S2 are discernable
67
Q

What is the D wave?

A
  1. Diastolic wave
  2. Normally less than the S wave
68
Q

What is the A wave reversal?

A
  1. Blood temporarily flows back into the PV from the LA due to lack of a valve
  2. Also occurs during diastole
69
Q

What are the normal values for MV inflow E point (peak)?

A

0.6 - 1.3 m/s

70
Q

What is the normal E/A ratio?

A

0.8 - 2.0

71
Q

What is the IVRT normal value?

A

50-100 ms

72
Q

What is the E prime medial normal values?

A

> 7 cm/s

73
Q

What is the E prime lateral normal value

A

> 10 CM/s

74
Q

What is the E/e prime ratio normal values?

A

<8

75
Q

What is the normal value for pulmonary veins?

A

S>D

DMST 253 Adult Echocardiography 1 (27 decks)

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