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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
Q

What measurements are done in PW of pulmonary veins?

A
  1. Vmax S
  2. Vmax D
  3. Vmax AR
  4. S/D ratio
26
Q

What is routinely measured in AP5 LVOT?

27
Q

What are the normal ranges of LVOT for VTI and Vmax?

A

VTI = 18-22 cm

Vmax = 0.8-1.2 m/s

28
Q

What information is obtained when the VTI trace has been done for LVOT?

A
  1. Vmax
  2. VTI
  3. LVOT max pressure gradient
  4. LVOT mean pressure gradient
29
Q

What two VTI measurements should be close to one another in a normal patient?

A

LVOT and AO

30
Q

What is known as V1?

31
Q

What is known as V2?

32
Q

What is routinely measured in AO CW in AP5?

A

VTI trace

Measurements obtained from trace:
1. AoV Vmax
2. AoV Max pressure gradient
3. AoV Mean pressure gradient
4. AoV VTI

33
Q

How do you trim the beard on your waveforms?

A

Decrease doppler gains so you trace the “chin” and NOT the beard

34
Q

Where is the PW SVB placed in descending Ao from SSN view?

A

1 cm below left subclavian artery

35
Q

What is the AoV VTI and Vmax measurements?

A

Vmax = 1.0 - 1.7 m/s
VTI = 18-26cm

36
Q

What is the normal Vmax for descending Ao in SSN?

A

Vmax = <1.5 m/s

37
Q

Typical flow seen in descending Ao in SSN?

A
  1. Systolic retrograde flow
  2. Small amount of diastolic reversal
38
Q

Flow pattern of proximal Ao

A

Systolic forward flow
Brief early diastolic flow reversal
Slight antegrade flow in mid-systole

39
Q

Will the RV inflow have higher or lower velocities than the LV inflow?

A

Lower due to it being the lower pressure side of the heart

40
Q

Are RV inflow measurements usually performed in a standard routine echo?

41
Q

Will inspiration cause an increase or decrease in velocity in RV inflow?

A

Increased velocity

42
Q

What is measure in TDI of the Lateral TV annulus?

A

Vmax of E’ lateral (>10cm/s)

43
Q

What is the Vmax E’ lateral of lateral TV annulus TDI used with to determine RV systolic function?

44
Q

What is routinely measured in RVOT?

A

VTI trace

Obtained following measurement:
1. RVOT VTI
2. RVOT Vmax
3. RVOT max pressure gradient
4. RVOT mean pressure gradient

45
Q

What is the normal Vmax and VTI for RVOT?

A

Vmax= 0.7-1.0 m/s

VTI = 14-16 cm

46
Q

What is routinely measured in PV?

A

VTI trace

Obtained from the trace:
1. PV VTI
2. PV Vmax
3. PV max pressure gradient
4. PV mean pressure gradient

47
Q

Normal Vmax for pulmonic valve?

A

0.7-1.4 m/s

48
Q

Where should PW sample box be placed within HV?

A

1-2cm in HV

49
Q

How many phases in RA filling (HV)

A

4

  1. Systolic forward flow
  2. Ventricular flow reversal
  3. Diastolic forward flow
  4. Atrial flow reversal
50
Q

Will velocities in S and D flow be higher or lower during inspiration?

A

Higher velocities seen with inspiration

51
Q

Will velocities in AR and VR be higher or lower during inspiration?

A

Lower velocities seen in inspiration

52
Q

Describe RA filling (HV) with what is happening along with phases of cardiac cycle

A
  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
Q

Describe velocities of S, D, AR, and VR in atrial filling (HV)

A

Elevated S and D velocity with inspiration

Elevated AR and VR velocity with expiration

54
Q

In presence of A-fib, how many times do you need to measure each doppler waveform?

55
Q

What should you do to avoid measuring arrhythmic waveforms?

A

Measure a normal waveform one to two beats away

56
Q

Most commonly, what velocities are measured in septal and lateral TDI to assess LV diastolic function?

A

E’ velocity (p. 113)

57
Q

The most common measurement performed from tricuspid annular TDI is?

A

Peak ‘S’ velocity to assess RV systolic function (p.125)

58
Q

What side of the heart’s measurements are more prone to respiratory variation?

Cardiac 1 (9 decks)

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