Spectral Doppler Examination

Question 1

What color is a positive doppler shift and is it above the baseline or below?

Answer 1

Red (toward probe) positive
Above the basline

Question 2

If there is a higher variance of color what do we expect to see?high or low velocities

Answer 2

High velocities

Question 3

What are the 3 types of spectral doppler?

Answer 3

PWD,CWD,Tissue doppler imaging

Question 4

What do bright region on spectral doppler mean?

Answer 4

Strong doppler shift and lots of red blood cells moving

Question 5

How many beats measured and didplayed for sinus rhythm and how many for AF?

Answer 5

Sinus rhythm=2
AF=Measure and Display 3-5

Question 6

Why dont you measure on or after an ectopic beat

Answer 6

The filling time before an ectopic beat is shorter, so it won’t represent an accurate velocity.
The filling time after an ectopic beat is usually longer so won’t reflect an accurate velocity

Question 7

What can we tell from spectral doppler?

Answer 7

-Intensity of the signal
-Time
-Velocity

Question 8

What type of flow is mitral valve

Answer 8

Bi phasic flow

Question 9

What type of flow is the pulmonary vein or hepatic vein?

Answer 9

Tri phasic flow

Question 10

What are 5 features that help interpret flow patterns?

Answer 10

1) timing of flow
2) duration of flow
3) velocity of flow
4) direction of flow
5) typical flow patterns

Question 11

What should standard sweep speed be set at?

Answer 11

100mm/sec for measuring however u may need to alter this for e.g sinus Brady or to demonstrate respiratory variation

Question 12

What is sweep speed?

Answer 12

The rate that the display moves the ultrasound information accross the screen. Therefore high sweep useful for tachycardia, low sweep good for slow bradycardia. Hence, provides appropriate temporal resolution

Question 13

why isnt angle correction used in cardiac

Answer 13

Angle correction in ultrasound refers to the adjustment made to account for the angle between the ultrasound beam and the direction of blood flow. This adjustment is essential for accurately calculating blood flow velocities using Doppler ultrasound.

Angle correction is used primarily in vascular ultrasound to adjust for insonation angle effects. It’s not used in cardiac ultrasound because blood flow is three-dimensional, making direction determination and reproducibility difficult.

Question 14

why should we only take the maximum velocity?

Answer 14

becuase we are not likely to overestimate unless its been over gained.

Question 15

Rather than using angle correct we should:

Answer 15

1.Use multiple angles in multiple views
2.Measure all doppler signals
3.Measure only Maximum velocity

Question 16

what is Isovolumetric contraction in cardiac ultrasound?

Answer 16

Isovolumetric contraction is a phase of the cardiac cycle that occurs in the early part of systole, just after the atrioventricular (AV) valves (mitral and tricuspid valves) have closed and before the semilunar valves (aortic and pulmonary valves) open. During this phase, the ventricles contract, but there is no change in ventricular volume because all the heart valves are closed.

Question 17

What is isovolumetric relaxation?

Answer 17

Isovolumetric relaxation is a phase of the cardiac cycle that occurs immediately after the ejection phase, where the ventricles stop contracting and begin to relax, but all the heart valves (aortic, pulmonary, mitral, and tricuspid) remain closed. This phase results in a rapid decrease in ventricular pressure without a change in ventricular volume.

Question 18

What are the alignments in the E/a cycle of filling?

Answer 18

1. Isovolumetric contraction (aligns with Q)
2. Ejection (Immediately after QRS)
3. Isovolumetric relaxation (Beginning E wave), Time between when aortic valve closes and mitral valve opens.
4. Rapid filling ( E wave, in line with end of E wave)
5. Diastole (between E and A waves)
6. Atrial contraction ( Aligned with A wave)

Question 19

Early rapid filling is responsible for how much of the filling?

Answer 19

80%

Question 20

How to examine the mitral valve with spectral doppler?

Answer 20

-apical 4 chamber
-diastolic flow
-biphasic
-positive doppler shift (above baseline)
- sample volume: 1-3mm/sec
-100mm/sec sweep speed
-capture at end expiration
-sample volume at tips of MV leaflets
- Color doppler is red with yellow at leaflet tips

Question 21

What is measured in the E/a ratio
How many beats is it averaged over
What affects/influences the rate of filling in E wave?

Answer 21

Measure the peak E and A wave velocity, calculate the deceleration time, Average it over 2 beats
Peak E wave - Pressure gradient between the LA and LV during early rapid filling, accounts for 80% of filling, affected by the rate of LV relaxation

Question 22

What is the A wave represent?
What affects this?

Answer 22

The pressure gradient between the LA and LV, during atrial contraction
LV compliance and LA contractile function
Accounts for 20% of filling

Question 23

Mitral inflow pattern

Answer 23

-peak E wave
-Peak A wave
-deceleration time
-Average over 2 beats
-Calculate E/a ratio