Doppler Principles

Question 1

Mitral Flow

Answer 1

0.6-1.3/1.5 m/s

Question 2

Tricuspid Flow

Answer 2

0.3-0.7 m/s

Question 3

Pulmonary Artery Flow

Answer 3

0.6-0.9 m/s

Question 4

LVOT Flow

Answer 4

0.7-1.1 m/s

Question 5

Aortic Flow

Answer 5

1.0-1.7/1.9 m/s

Question 6

Normal Flow Patterns: MV

Answer 6

-Mitral valve flow obtained from A4C
-Positive deflection
-Biphasic flow

Question 7

Normal Flow Patterns: TV

Answer 7

-Tricuspid valve flow obtained from A4C, RV Inflow, PSAX;AOV
-Positive deflection
-Biphasic flow

Question 8

Normal Flow Patterns: AOV

Answer 8

-Aortic Flow (Ascending Aorta) is obtained from the A5C view and Subcostal
-Negative deflection
-Early peak (acceleration time)
-Right Parasternal & Suprasternal view (ascending AO) is a POSITIVE deflection
-DESCENDING AO is Negative!

Question 9

Normal Flow Patterns: PV

Answer 9

-Pulmonic valve flow obtained Inflow, PSAX @ AoV views & pulmonary artery outflow tract view & subcostal SAX view @ PA Level
-Negative deflection
-Early peak flow in systole

Question 10

Normal Flow Patterns: LVOT

Answer 10

-Left ventricular outflow tract (V1)
-Pre-aortic Valve
-A5C view

Question 11

Systolic Ejection Time

Answer 11

Systolic flow velocity duration ejected from LV

Question 12

Time to Peak

Answer 12

Start of flow to the maximum peak of flow

Question 13

Peak Acceleration Time

Answer 13

Time to the upstroke & maximum acceleration of flow expressed in cm/sec

Question 14

Flow Velocity Integral

Answer 14

Velocity of flow over the distance of time

Question 15

Normal AOV

Answer 15

Peaks early, laminar flow profile, reaches about 2 m/s, early acceleration time. Audio signal is not harsh but crisp.

Question 16

AS

Answer 16

Turbulent flow is seen through out with spectral broadening, peaks 50% after start of flow, measures 4m/s.
Audio signal strong harsh.

Question 17

To accurately assess AS…

Answer 17

-Obtain at least 3 different projections:
Apical, Right Parasternal, Suprasternal, Subcostal
-Choose the highest with the most reproducible profile, consistent, and with smooth borders.

Question 18

Mitral Regurgitation

Answer 18

-Apical projection, open up A5C view & use CFM to guide CW probe
-Occurs 40-80 ms after the QRS
-Occurs as the MV opens & as soon as the MV closes
-Reaches as high as 6 m/s due to pressure difference between LV & LA
-Occurs during the isovolumic phases

Question 19

Aortic Stenosis…

Answer 19

-Apical projection, open up A5C view & use CFM to guide CW probe
-AS occurs 80 to 100 msec after the QRS
-Only occurs when the AOV opens
-Rarely approaches 5.5-6 m/s

Question 20

In Aortic Stenosis,never measure post…

Answer 20

…PVC,PJC,PAC; measure the jet due to overestimating (an increased)

Question 21

A-fib in Aortic Stenosis measure

Answer 21

the longest diastolic which will give you the longest systole ejection time (5-10)

Question 22

ECHO vs CATH (4)

Answer 22

-Cath measures peak to peak gradients between LV & AO
-Echo measures peak instantaneous gradient
-CATH & ECHO will not match; Echo will be higher
-ECHO MEAN gradient will match Cath Peak to Peak

Question 23

Which form of Conventional Doppler is used to detect AS & LVOT velocity?

Answer 23

Continuous Wave Doppler

Question 24

Bernoulli Equation

Answer 24

4 (V2² - V1²) = Change in pressure (mmHg)
∆P= 4(V2)²

Question 25

Continuity Equation

Answer 25

Area1 X Velocity 1 = Area 2 X Velocity 2

Area 2 = Area 1 X Velocity 1
Velocity 2

Question 26

What is the Continuity Equation?

Answer 26

Determines valve area
•Based on conservation of mass
•“What goes in must go out”
•Flow area 1 = Flow area 2

Question 27

How do we measure the continuity equation?

Answer 27

-2D – LVOT measured in systole at the level of the AOV cusps insertion
-PW Doppler- TVI of LVOT in A5C
-CW Doppler- TVI of AOV from highest wave
profile

Question 28

Normal Mitral Wave Profile…(3)

Answer 28

…Has a rapid Pressure half-time, peak flow (even though it is biphasic) does not exceed 1.3-1.5 m/s, & during diastasis the flow returns to the baseline.

Question 29

Mitral Stenosis velocities…(4)

Answer 29

…Exceed 1.5 m/s, spectral broadening is noted, during diastasis – a persistent gradient exist & a slow Pressure half-time is present.

Question 30

What does the Bernoulli Equation do?

Answer 30

Changes Velocity to Pressure Gradient

Question 31

Spectral Broadening

Answer 31

-