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Echo 1 > C12&13: Apical Colour And Spectral Doppler > Flashcards

C12&13: Apical Colour And Spectral Doppler Flashcards

1
Q

What’s a normal LA volume index?

A

<34 ml/m2

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2
Q

What should the colour scale be set to for MV colour Doppler

A

50-70 cm/s

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3
Q

How does MV stenosis effect LA pressure and dilation

A

Increases LA pressure and size of LA

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4
Q

What does MV inflow depend on

A

Preload dependant… height of E wave is influences by the amount of blood entering the LV

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5
Q

What is the e-point, DT and the A point

A

E-point: peak velocity in early filling

DT (deceleration time): time it takes to go from E point to baseline

A point: peak velocity in late filling

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6
Q

whats the norm velocity for E-point/early filling

A

0.6-1.3 m/s

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7
Q

whats the norm velocity for DT

how will a slower HR effect this

A

160-220 m/s

….slower HR will increase this time

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8
Q

is there a norm velocity for A-point/late filling?

A

no

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9
Q

whats the norm E/A ratio

how do you find it

A

0.8-2.0….

ration reverses @ age 60 and more filling occurs during late filling that early (70-30 for late filling)

Divide E velocity by A velocity

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10
Q

is it norm for some young healthy people to have E/A ratios >2

A

yes

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11
Q

where do you place the SV when measuring the IVRT duration?

whats the norm duration of IVRT?

A

more medial than the MV inflow tracing (where leaflets intersect)

50-100ms

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12
Q

why might the IVRT duration be prolonged?

A

its taking the LV too long to relax/relaxation impairment… can be norm is >60 yrs old

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13
Q

what is PW tissue doppler (TDI or TVI) measuring?

A

velocity of the movement of the MV/TV annulus in the longitudinal plane towards and away from the apex

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14
Q

how does the LV change shape during diastole

A
  • radially
  • circumferentially
  • longitudinally
  • by twisting (torsion)
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15
Q

are PW tissue doppler velocities more or less dependant on preload than MV inflow

A

Less dependant

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16
Q

what do the TDI colours represent?

how should the colour scale be set?

A 
red= systole (shortening)
blue= diastole (expanding)

lower than for colour doppler

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17
Q

where do you place the SV for TDI of the MV?

how should the spectral tracing appear?

A

on the medial or lateral annulus of the MV

-looks like inverted MV inflow… contains E prime, A prime and an S wave (E and A ratios should be the same as MV inflow)

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18
Q

what are the norm values for TDI for the medial MV annulus and the lateral MV annulus?

A

medial: >/= 8 cm/s
lateral: >/= 10 cm/s

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19
Q

during what phases do the pulm veins fill the LA?

A
  • ventricular systole
  • early diastole (IVRT)
  • diastasis
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20
Q

in which pulm vein do we usually do PW

A

RUPV

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21
Q

how should the spectral tracing appear for the PW of the PV?

describe each one and what causes them?

A

includes….

-S wave: systolic wave
+ should be larger than D wave velocity (S > D)
+ divided into S1 and S2 which are sometimes discernible

-D wave: Diastolic wave
+ smaller than S wave

-A wave: Reversal
+ caused by atrial contraction… blood flows from LA back to PV since theres no valve b/w them

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22
Q

what part of the ECG corresponds to the S wave in the PW of the PV

A

after the QRS complex

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23
Q

where do we place the SV for the PW of the PV

A

1 cm into the PV

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24
Q

whats the norm E/e prime ratio?

A

= less than or equal to 8 (the septal and lateral average)

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25
Q

whats the effect of MV stenosis on Mv inflow?

A

-MV opening is smaller which causes the leaflet to thicken… this speeds up the velocity of the blood flow through the MV… increases the height of E and A waves and prolongs DT

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26
Q

what do we used to measure the MV inflow is the value is Stenotic. What about if not stenotic?

A

CW is stenotic because of fast velocity

PW if normal

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27
Q

how are velocity of blood flow and reduction of valve area related?

A

velocity is proportional to the reduction of area when open… e.g. the less the valve opens the faster the velocity

28
Q

why is the DT increased when the valve is stenotic

A

it takes longer for blood to move through the valve b/c the opening is smaller

29
Q

how can you tell the difference b/w physiological and pathological MV regurg?

what is a common velocity of pathological MV regurg?

A

patho will last throughout systole and both isovolumic periods while physi will only last for a few seconds during systole

  • 5-7 m/s
30
Q

in what order do we assess LV outflow

A
  1. LVOT/AV/AO colour
  2. LVOT- PW
  3. AV- CW
  4. AV- CW for regurg ONLY if present (not done if norm)
31
Q

what must you see when doing colour of the AV in the 5 CH view

A

leaflets must open all the way and must show some ascending AO

32
Q

where do you place the SV when doing PW of the LVOT?

how should the spectral tracing appear? what do we measure on this tracing?

A

5mm inferior to the AV cusps

  • should have a hollow envelope, must show the closing click
  • LVOT V max and LVOT VTI by tracing the outflow
33
Q

what do we measure on the PW spectral waveform of the MV inflow?

A
  • e wave with a caliper
  • DT… trace from E wave to basline
  • A wave with a caliper
34
Q

what do we measure on the TDI waveform of the MV medial/septal and lateral annulus?

A

-measure e prime with a caliper

35
Q

how does the PW waveform of LVOT regurg appear?

A

above the baseline…. wave has a downward slop (decrescendo) which shows the pressure gradient dropping

36
Q

how should you place the cursor when doing CW of the AV?

A

through and apex and middle of the AV

37
Q

why is the peak velocity higher for the AV then the LVOT

A

blood picks up velocity the going through the valve

38
Q

what do we measure on the AV CW tracing?

A

-AV max, AV VTI and AV mean and peak gradient… get the values from tracing

39
Q

what is the mean gradient of the AV CW?

A

avg of all the individual points from the tracing of the outflow

40
Q

what are the 3 items we need to calculate the are of the AV?

A
  • LVOT diameter
  • LVOT VTI
  • AV VTI
41
Q

whats the formula for AV area?

what units should these be in?

A

AV Area= Pie x (radius of LVOT^2) x VIT of LVOT / VTI of AV

cm

42
Q

formula for cross sectional area of LVOT

A

CSA = pie (radius of LVOT^2)

will give you cm^2

43
Q

norm value for LVOT velocity and LVOT diameter?

A

LVOT velocity: <1.5 m/s

LVOT diameter: 18mm-22mm (avg 20mm)

44
Q

norm value for AV velocity and AV VTI

A

AV velocity: <2 m/s

AV VTI: 180-250 mm

45
Q

norm AV Area value?

A

250-450 mm^2

46
Q

norm AV peak gradient and mean gradient values?

A

peak: <10 mmHg
mean: <5 mmHg

47
Q

which values of the AV are most important to determine if the valve is stenotic

A

AV velocity
Av peak gradient
Av mean gradient

48
Q

where is the insertion of the Tv annulus compared to the Mv annulus?

A

more inferior, and anterior

49
Q

Is the pulmonary valve commonly seen from the apical view?

A

No, its too anterior

50
Q

Is Tv stenosis common?

Which valve closes first? The TV or MV?

A

No

MV closes first

51
Q

What % of people have tricuspid regurgitation

A

80%

52
Q

Which demographic has the highest amount of physiological TV regurgitation and why?

A

Athletes… due to physiological adaptation to increased cardiac output w/ exercise…. they have slight TV annular expansion

53
Q

What should the colour scale be set at for Tv colour.

A

50-70 m/s

54
Q

Can you see all 3 TV leaflets of the TV with a TEE?

Which other type of US can you see the 3 leaflets?

A

Yes

3D

55
Q

Can you get both regurg and inflow of the TV on the CW spectral waveform of TV?

What does the PW of the TV look like

A
  • CW can get both inflow and regurgitation on the same tracing
  • inflow velocity will be small (E and A waves)…. same as MV inflow
56
Q

What do we measure in the CW TV tracing?

A
  • peak Velocity and find the RVSP

- DO NOT measure E and A waves

57
Q

What’s the equation for RVSP

A

RVSP 4(TRv^2)+ RAP

58
Q

When will the RVAP = PASP

A

When there’s no RV outflow obstruction

59
Q

Where does outflow and regurgitation appear on the CW TV tracing?

A

Outflow: below baseline
Inflow: above baseline

60
Q

How does the waveform of the PW of the Tv appear?

Do we take measurements here?

A

Should look the same as the PW of the MV with the same E/A ratio and IVRT

No

61
Q

What will Tv stenosis do to the Tv PW spectral waveform?

A

There will be an increase in velocity and a loss of defined E and A waves…. they will look like one big wave

62
Q

What’s the norm value for the S prime wave when doing TDI of the RV annulus

A

> 9.5 cm/s

63
Q

What are the routine images we take in A2CH view?

A
  • A2C 2D cine
  • A2C Colour MV
  • Another cine for simpsons tracing

We don’t do any spectral doppler in this view

64
Q

If you’ve done PW and CW on the LVOT and the AV in A5CH, should you do it again in A3CH?

A

No

65
Q

Which colour images do we take in A3CH view?

A
  • MV

- AV

68
Q

LA and LV should filling normally under what filling pressure?
What would be considered elevated?

A

< 12 mmHg

> 15 is elevated

69
Q

What’s the norm value for the E wave of the TV?

A

<0.7 m/s

Echo 1 (17 decks)

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