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MIDS 197 > Ch 10 Apical CD > Flashcards

Ch 10 Apical CD Flashcards

1
Q

From a physics perspective, any area of flow disruption results in what?

A

Turbulence

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2
Q

Are small amounts of aliasing normal in certain scenarios?

A

Yes, due to the inherent nature of hemodynamics

(valves cause small areas of turbulence + aliasing which is normal)

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3
Q

Is off axis imaging allowed when evaluating pathology as the primary goal?

A

Yes b/c we are trying to visualize the entirety of the anomaly

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4
Q

Where should we put our CD box when imaging the AP4 MV?

A

-Place over entire LA + at least half of the LV
-MV in center of box

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5
Q

What color is flow in AP4?

A

Red - b/c it is going towards the probe during diastole

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6
Q

Is RV + LV inflow biphasic?

A

Yes:
-early diastolic wave (80%)
-late diastolic wave (20%)

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7
Q

What would regurgitation + stenosis look like with CD in AP4?

A

Regurg: blue/mosaic flow into atria during systole

Stenosis: red/mosaic flow into ventricles during diastole

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8
Q

What 3 things other than regurg + stenosis should we watch for within the CD box while in AP4?

A

-IAS (ASD/PFO)
-IVS (VSD)
-Abnormal pulmonary vein flow (from LA)

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9
Q

What pathology could cause pulmonary vein reversal?

A

MV regurgitation

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10
Q

If we had seen a VSD in PLAX or PSAX, what additional image should we take in AP4? How would it be affected by angulation?

A

-Expand our CD box over the IVS in AP4
-Must make IVS parallel to flow by angling out heart over more in order to best assess the VSD

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11
Q

How can we achieve the AP4 pulmonary vein view with CD?

A

-Increase depth + set box over LA + beyond
-Slight angulation of probe to help bring in PV
-Manipulate CD gains + lower scale to visualize PV blood flow
-RUPV m/c assessed

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12
Q

How would the CD flow look with AP4 pulmonary vein?

A

Red antegrade flow

(abnormal if large amount of blue flow or mosaic colors)

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13
Q

Which pulmonary vein is m/c assessed in AP4?

A

Right upper pulmonary vein (RUPV)

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14
Q

Where should we put our CD box when imaging the AP4 TV?

A

-Place over entire RA + at least half of RV
-TV in middle of box

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15
Q

Why would we change our CD scale + shift the baseline to have a different value on the top + bottom of scale?

A

To show aliasing + regurgitation better when evaluating pathology

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16
Q

Where do we put our CD box in AP5?

A

-Over the SoV to encompass the AoV, LVOT + as much LV as possible
-SoV is m/c in bottom left corner of box

17
Q

What color is flow in AP5?

A

Retrograde blue flow + some aliasing near the AoV

18
Q

List 3 reasons why some aliasing occurs in AP5?

A

-Caused by higher velocities
-Mostly parallel angle
-Presence of the AoV

(remember small amounts are normal)

19
Q

List pathology that can be seen within the LVOT in AP5?

A

-AoV regurg is visible in LVOT
-Aliasing above the AoV, into the LVOT + LV itself can indicate obstructive pathophysiology

-2D can show a thick IVS near LVOT, a membrane, or the AMVL obstructing the area of aliasing in CD

20
Q

What would it look like in color if a thrombus was seen in the LV apex?

A

-May see aliasing + reversal of flow
-Will see filling defect (no color filling around thrombus)

21
Q

How would regurg + stenosis of the AoV appear on CD in AP5?

A

Regurg: red/mosaic flow into LV during diastole

Stenosis: blue/mosaic flow through AoV during systole

22
Q

What 4 things other than AoV regurg + stenosis should we watch for within the CD box while in AP5?

A

-Ao dissection
-IAS (ASD/PFO)
-IVS (VSD, m/c perimembranous)
-MV regurg

23
Q

Where should be put our box when in AP2?

A

-Place over entire LA + at least half of LV
-MV in middle of box

24
Q

What color is flow in AP2?

A

Red

25
Q

If we already evaluated the MV with color in AP4, why are we checking it again in AP2?

A

B/c we are very parallel to flow in AP2, stuff can jump out here + ensures we do not miss anything

26
Q

How would regurg + stenosis look in AP2?

A

Regurg: blue/mosaic flow into LA during systole

Stenosis: red/mosaic flow into LV during diastole

27
Q

Where should we place CD box in AP3 focusing on MV?

A

-Place box over entire LA + at least half of LV
-MV in middle of box

28
Q

What color is flow in AP3 when box is over MV?

A

Red

29
Q

How would regurg + stenosis look in AP3 when box is over MV?

A

Regurg: blue/mosaic flow into LA during systole

Stenosis: red/mosaic flow into LV during diastole

30
Q

Where should we place CD box in AP3 focusing on AoV?

A

-Place over SoV to encompass the AoV, LVOT + as much LV as possible
-SoV m/c in bottom right corner of box

31
Q

What color is flow in AP3 when box is over AoV?

A

Blue, some aliasing may occur close to AoV

(small amount of aliasing due to higher velocities, mostly parallel angle + presence of AoV)

32
Q

Why is AP3 potentially an excellent view for assessing AS/AR/MS/MR/LVOTO?

A

B/c we are parallel to flow in this view

33
Q

What color would AoV regurg + stenosis be in AP3?

A

Regurg: red/mosaic flow into LV during diastole

Stenosis: blue/mosaic flow through AoV during systole

34
Q

What 4 things other than AoV regurg + stenosis should we watch for within the CD box while in AP3?

A

-LVOTO (LVOT obstructions)
-Ao dissection
-IVS (VSD)
-MV regurg

35
Q

What is the most important factor when using CD to ensure accuracy of measurements?

A

Our alignment of the u/s beam to blood flow

36
Q

How can we help align our u/s beam for CD?

A

-By tilting + rotating
-Trying multiple views, including off axis imaging

37
Q

If we see something, should we alter our protocol to investigate further?

A

Yes! Bigger CD boxes often allow us to “catch” pathology we weren’t targeting

MIDS 197 (15 decks)

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