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Cardiac 1 > Normal Spectral Doppler Flow > Flashcards

Normal Spectral Doppler Flow Flashcards

1
Q

Highest pressure gradient calculated uses what formula?

A

4(v)^2 - bernoullie’s principle

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2
Q

What does VTI stand for?

A

Velocity - Time - Integral

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3
Q

VTI can be though of as what ?

A

“Stroke distance” - the distance a column of blood travels with each heart beat

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4
Q

What measurement would be used to encompass measurements of changing velocities over a period of flow?

A

VTI

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5
Q

How is Vmax calculated?

A

Placing a caliper at the highest velocity of a waveform

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6
Q

What three things are seen when measure VTI? (slide 4)

A
  1. Vmax
  2. Max pressure gradient
  3. Mean pressure gradient
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7
Q

Where is the SV box placed when measuring flow from LA –> LV in AP4

A

SV box placed in just past the leaflet tips of the MV a few cm into the LV in the CENTER of the valve

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8
Q

In LV inflow through the MV, what does the ‘E’ and ‘A’ represent on the ECG (what wave)?

A

‘E’ = early diastolic filling - just after T-wave

‘A’ = late diastolic filling - just after P-wave

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9
Q

What is the E/A slope known as?

A

Deceleration Time (DT)

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10
Q

What should the E/A ratio be in a normal, healthy adult?

A

> 1

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11
Q

What happens to the LV as we age?

A

Becomes less compliant, more stiff, and harder to fill

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12
Q

What happens to the ‘A’ wave with age?

A

Since the ventricles become more stiff and less compliant, there needs to be a stronger atrial kick, which produces a larger ‘A’ wave

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13
Q

Changes to MV inflow with aging?

A
  1. Reduced ‘E’ velocity
  2. Prolonged early diastolic deceleration
  3. Increased ‘A’ velocity
  4. E/A ratio <1
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14
Q

A larger sample volume will lead to what artifact?

A

Spectral broadening

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15
Q

What can occur to the E/A wave in a high heart rate? How can it be fixed by sonographer?

A

E/A wave can fuse

Increase sweep speed in a higher heart rate to spread out waveforms

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16
Q

In TDI - what shows above and below the baseline?

A

Above = systolic motion
Below = diastolic motion

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17
Q

What is usually measured on TDI?

A
  1. Vmax E’ medial/septal
  2. Vmax E’ lateral - is higher in a normal patient than medial/septal
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18
Q

What does TDI evaluate for?

A

Diastolic dysfunction

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19
Q

What does the E/E’ ratio compare?

A
  1. E wave from MV inflow
  2. E’ wave from TDI
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20
Q

In TDI, what Vmax is usually greater? Medial/septal OR lateral? What are the measurements?

A

Lateral = 6.0-22.0 cm/s

Septal = 5.0-17.0 cm/s

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21
Q

How far into the RUPV is the sample box placed?

A

0.5 to 1 cm in

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22
Q

What is the systolic flow due to in PV flow? Where is it occurring on ECG?

A

Due to the LA relaxing

At the T-wave

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23
Q

What is diastolic forward flow due to in PV flow? Where is it occurring on ECG?

A

Due to open conduit of LA, PV, and open MV during diastole

Occurs after T-wave

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24
Q

Atrial reversal in PV occurs due to what? Where is it occurring on ECG?

A

Due to atrial kick

Occurs after P-wave

25
What measurements are done in PW of pulmonary veins?
1. Vmax S 2. Vmax D 3. Vmax AR 4. S/D ratio
26
What is routinely measured in AP5 LVOT?
VTI trace
27
What are the normal ranges of LVOT for VTI and Vmax?
VTI = 18-22 cm Vmax = 0.8-1.2 m/s
28
What information is obtained when the VTI trace has been done for LVOT?
1. Vmax 2. VTI 3. LVOT max pressure gradient 4. LVOT mean pressure gradient
29
What two VTI measurements should be close to one another in a normal patient?
LVOT and AO
30
What is known as V1?
LVOT
31
What is known as V2?
AoV
32
What is routinely measured in AO CW in AP5?
VTI trace Measurements obtained from trace: 1. AoV Vmax 2. AoV Max pressure gradient 3. AoV Mean pressure gradient 4. AoV VTI
33
How do you trim the beard on your waveforms?
Decrease doppler gains so you trace the "chin" and NOT the beard
34
Where is the PW SVB placed in descending Ao from SSN view?
1 cm below left subclavian artery
35
What is the AoV VTI and Vmax measurements?
Vmax = 1.0 - 1.7 m/s VTI = 18-26cm
36
What is the normal Vmax for descending Ao in SSN?
Vmax = <1.5 m/s
37
Typical flow seen in descending Ao in SSN?
1. Systolic retrograde flow 2. Small amount of diastolic reversal
38
Flow pattern of proximal Ao
Systolic forward flow Brief early diastolic flow reversal Slight antegrade flow in mid-systole
39
Will the RV inflow have higher or lower velocities than the LV inflow?
Lower due to it being the lower pressure side of the heart
40
Are RV inflow measurements usually performed in a standard routine echo?
NO
41
Will inspiration cause an increase or decrease in velocity in RV inflow?
Increased velocity
42
What is measure in TDI of the Lateral TV annulus?
Vmax of E' lateral (>10cm/s)
43
What is the Vmax E' lateral of lateral TV annulus TDI used with to determine RV systolic function?
TAPSE
44
What is routinely measured in RVOT?
VTI trace Obtained following measurement: 1. RVOT VTI 2. RVOT Vmax 3. RVOT max pressure gradient 4. RVOT mean pressure gradient
45
What is the normal Vmax and VTI for RVOT?
Vmax= 0.7-1.0 m/s VTI = 14-16 cm
46
What is routinely measured in PV?
VTI trace Obtained from the trace: 1. PV VTI 2. PV Vmax 3. PV max pressure gradient 4. PV mean pressure gradient
47
Normal Vmax for pulmonic valve?
0.7-1.4 m/s
48
Where should PW sample box be placed within HV?
1-2cm in HV
49
How many phases in RA filling (HV)
4 1. Systolic forward flow 2. Ventricular flow reversal 3. Diastolic forward flow 4. Atrial flow reversal
50
Will velocities in S and D flow be higher or lower during inspiration?
Higher velocities seen with inspiration
51
Will velocities in AR and VR be higher or lower during inspiration?
Lower velocities seen in inspiration
52
Describe RA filling (HV) with what is happening along with phases of cardiac cycle
1. Systolic forward flow - due to atria relaxing as TV annulus moves toward RV apex in systole 2. Ventricular reversal - Retrograde flow into hepatic vein in late systole 3. Diastolic forward flow - due to open conduit between hepatic vein, RA, TV, and RV 4. Atrial flow reversal - retrograde flow from atrial kick
53
Describe velocities of S, D, AR, and VR in atrial filling (HV)
Elevated S and D velocity with inspiration Elevated AR and VR velocity with expiration
54
In presence of A-fib, how many times do you need to measure each doppler waveform?
3
55
What should you do to avoid measuring arrhythmic waveforms?
Measure a normal waveform one to two beats away
56
Most commonly, what velocities are measured in septal and lateral TDI to assess LV diastolic function?
E' velocity (p. 113)
57
The most common measurement performed from tricuspid annular TDI is?
Peak 'S' velocity to assess RV systolic function (p.125)
58
What side of the heart's measurements are more prone to respiratory variation?
Right

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