Module 13 : Apical Color and Spectral Part 1 Flashcards
order of images
- 2D
- Color (right to left or left to right)
- spectral (right then left)
MV inflow assess
- E wave
- A wave
- E/A ratio
- deceleration time
- IVRT
pulmonary veins asses
- S wave
- D wave
- A wave reversal
tissue doppler at MV annuls asses
- e prime (medial and lateral)
- calculate E/e prime ration
2D assess
- LA volume index
- normal <34 ml/m^2
color doppler LV inflow (MV)
- column of blood entering the LV is red with yellow between leaflet tips
- should have minimal aliasing
- long color box
color scale for LV inflow
- 50-70cm/sec
color doppler MV regurge - leaks
- occurs in systole
- lots of aliasing toward LA
color doppler MV stenosis
- occurs in diastole
- aliasing toward LV
MV regurge causes
- one cause is malcoaptation of MV leaflets
- mitral valve prolaps
- ischemic hear = makes ventricle expand widening annulus
mitral stenosis
- reduced leaflet mobility
- calcified
- thickened
- LA pressure increases
- LA dilates
pulsed wave MV inflow/ LV inflwo
- place sample volume at tips of MV when open in middle of red column of blood
- SV size 3mm
- assess diastolic function
3 inflow phases
- early filling
- diastasis
- late filling
early filling
- after isovolumic relaxation LV starts to expand creating suction from LA to LV opening MV
- E wave
diastasis
- gap between end of E wave and beginning of A wave
- very little flow or no flow seen on spectral doppler
- higher heart rate less diastasis
late filling
- A wave
- result of atrial contraction
- smaller wave of the two
MV inflow is dependant on what
preload
- height of E wave I influenced by amount of blood entering LV
E point
- peak velocity in early filling
DT (deceleration time)
- the downslope after the E point all the way to the baseline
A point
- peak V of late filling phase
E wave normal value
- 6 - 1.3 m/s
- age dependent
deceleration time normal value
160 - 220 ms
A wave normal value
no specified normal
E/A ration normal
- 8 - 2.0 (all age groups)
- E should be larger than A
* E/A ratio does reverse around 6th decade of life
calculate E/A ration
E wave / A wave
isovolumic relaxation time
- covers time between AV closure and MV opening
- pressure is falling from that of the aorta to below pressure in the LA
IVRT - sampling
- place sample volume slightly more medial than would for MV inflow tracing
IVRT normal duration
50-100 ms
IVRT prolonged
- it is taking to long for LV to relax (impaired relaxation)
- may be normal if over 60 years old
tissue doppler of MV annulus
- as LV expands in diastole it lengths from base to apex
- velocity of expansion or contraction of the tissue can be measured using pulsed wave doppler
- LESS DEPENDENT ON PRELOAD
ways that LV changes shaoe
- radially = moving out and in
- circumferentially - circle
- these two are in fractional shortening
- longitudinally (apical 4 assessment)
- torsion (twisting and untwisting)
longitudinal TVI
- tissue velocity imaging
- also called TDI (tissue doppler imaging)
doing TDI of MV
- scan apical 4 focused on LV
- color scale lower than for color doppler
- blue = diastole
- red = system
- place a sample volume within medial and lateral annulus
- make sure SV stays within annulus throughout cardiac cycle
TVI medial MV annulus normal value
> /= 8 cm/s
TVI lateral MV annulus normal valve
> /= 10 cm/s
pulmonary venous flow - when do they fill LA
- ventricular systole
- early diastole
- diastasis
flow is reversed in pulmonary veins when
- atrial systole (after P wave)
-
what pulmonary vein do we usually do PW
right upper pulmonary vein
- RUPV
pulmonary vein waves
- S wave (systolic wave)
- D wave (diastolic wave)
- A wave reversal (caused by atrial contraction)
S wave
- normally greater than D wave velocity
- divided into S1 and S2 wave
- occasionally S1 and S2 are discernible
D wave
- normally smaller than S wave
A wave reversal
- blood temporarily flows back into the PV from the LA due to lack of a valve
normal E/e prime ratio
= 8
pulmonary veins normal value
S > D
mitral stenosis effect on MV inflow
- MV thickened leaflets tethered together = MV opening smaller = speeds of flow
- color moving through the open MV will be of higher velocity = aliased
- measure speed with CW (no aliasing)
- INCREASED IN BLOOD FLOW VELOCITY IS PROPORTIONAL TO REDUCTION IN MV AREA WHEN OPEN
normlal mitral reugure
- trivial or trace of physiologic MR
CW of severe MR
- flow lasts throughout systole and both isovolumic periods
- 5/7 m/s
LV outflow doppler assessment order
- LVOT/AV/aorta color dopple r
- LVOT = PW
- AV - CW outflow
- AV - CW for regurge if present
LVOT assessment view
- done in apical 5 chamber need to see valves of aorta
Sample volume placement of LVOT
- place in middle of LVOT
- 5 mm inferior to AV cusps
- size of sample volume is 3-5 mm
- wan tto see closing click and hollow envelope
LVOT PW doppler assess
- LVOT max velocity
- LVOT VTI
aortic regurge
- assessed with CW
- pressure gradient lowers as ventricle fillis and ventricle pressure increases
CW cursor placement
- should not go through IVS
- slightly higher in valve than LVOT
CW doppler assessmentif AO
- AV max velocity
- AV VTI
- AV peak and mean gradient
peak gradient
4(PV)^2
mean gradient
- average of all sample points in trace
calculating AV area
- need 3 things
+ LVOT diameter
+ LVOT VTI
+ AV VTI
formula to calculate AV area
AVA (cm^2) = 0.785 x LVOTd^2 x VTI(LVOT)
/ VTI (AOV)
stoke volume / VTI AOV
AV velocity normal value
< 2.0 m/s
AV VTI normal value
18 - 25 cm
LVOT diamater normal value
1.6 - 2.3 cm
calculated AVA normal value
2.5 - 4.5 cm ^2
AV peak gradient normal value
< 10 mmHg
AV mean gradient normal value
< 5 mmHg
