Ch 15 Abnormal Doppler Patterns Flashcards
What is physiologic regurgitation?
It is trivial regurg - meaning it is a normal amount we expect to see in a normal healthy adult
Define valvular regurg?
Flow moving backwards through a valve, instead of forwards
Define valvular stenosis?
Flow being restricted from moving freely forward through a valve
Define intracardiac shunts?
Abnormal connections b/w areas of the heart that should NOT have communication b/w them
What 5 factors is it important to look at in terms of inspecting spectral doppler flow patterns?
-Speed
-Timing
-Intensity
-Shape
-Direction of blood flow
Why is speed important to look at when inspecting spectral doppler flow patterns: list 2 reasons why the normal values for valves should be memorized?
-Allows for recognition of one waveform vs another
-Allows for recognition of accelerated velocities
What can help determine the level of severity of regurgitation or stenosis?
Velocities - helps differentiate b/w mild, moderate + severe
(ex RVOT is smaller waveform compared to LVOT)
Do we need to know what mild, moderate + severe regurg or stenosis looks like right now in class?
No, just know the difference b/w trivial + very severe forms
Why is timing important to look at when inspecting spectral doppler flow patterns?
B/c we must understand exactly when each type of flow occurs during the cardiac cycle in order to make them recognizable
AR + MS both occur during diastole or systole?
Diastole
Does AR + MS both occur above or below the baseline?
Above
What is isovolumic relaxation time (IVRT)?
Time interval b/w AoV closure + MV opening
What is isovolumic contraction time (IVCT)?
Time interval b/w MV closure + AoV opening
Why is intensity important to look at when inspecting spectral doppler flow patterns?
B/c the more filled in + complete a doppler waveform is (higher amplitude), the more intense the level of flow is
Do doppler envelopes indicate a higher or lower intensity?
Higher - they are brighter + have more filling which indicates a higher level of severity
The more RBCs that get pushed through a valve, the higher or lower the amplitude of the signal?
Higher
Why is shape important to look at when inspecting spectral doppler flow patterns? List 2 reasons.
-B/c the normal contour of doppler waveforms of valves should be memorized, so when they differ they can be recognized
-Also assists in recognizing what type of flow is being visualized
AS + MR both occur during diastole or systole?
Systole
Does AS + MR both occur above or below the baseline?
Below
What is the normal velocity for the Ao?
1 m/s
Are AS jets usually more round or pointy?
Pointy
Do AS jets usually extend into the IVRT?
No, unlike the MR jet
Why is direction important to look at when inspecting spectral doppler flow patterns?
B/c normal directions for valves should be memorized, so when abnormal flow is visualized it is recognized
What is valvular regurg/insufficiency caused by?
-Congenital or acquired abnormalities of the valve leaflets
-Valve is not able to coapt (close) properly
Give an example of how abnormalities of associated supporting structures can cause regurg of an otherwise normal valve?
Ex: An enlarged Ao can cause a wide annulus, which then pulls the AoV apart + causes it to not be able to close as well anymore, resulting in Ao regurg
Is regurg always detectable via stethoscope?
No, echo is needed to find the origin of the murmur
How many imaging planes are needed to assess severity of regurg + stenosis?
Multiple
(stenosis - especially in the face of eccentric jets)
Is off-axis imaging allowed when trying to get a regurg or stenotic jet parallel to the u/s beam?
Yes
Contour of spectral doppler in regurg reflects the pressure difference b/w what?
B/w 2 chambers over the regurgitant flow period
In the presence of significant regurg, will the stroke volume across the valve increase or decrease?
Increase
Forward stroke volume is a combo of what 2 things?
Normal SV + regurgitant volume
In the presence of significant regurg, reversal of flow in the valves corresponds to what?
Their “inlets” + may be visualize with CD and spectral doppler
Where flow goes, pressure _____?
Follows