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DMST 253 Adult Echocardiography 1 > Apical Doppler: Part 1 > Flashcards

Apical Doppler: Part 1 Flashcards

1
Q

What is the order of images for Apical Doppler images? 3

A
  1. 2D
  2. Color
  3. Spectral
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2
Q

Several Doppler measurements are used to assess what?

A

Diastolic function

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3
Q

Diastolic function assess what?

A

How well the heart rests and fills

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4
Q

What are MV inflow parameters for doppler images that pertain to diastolic function? 5

A
  1. E wave
  2. A wave
  3. E/A ratio
  4. Deceleration time (DT)
  5. IVRT
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5
Q

What are MV annulus parameter TDI images that pertain to color doppler?2

A
  1. E prime
  2. E/e
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6
Q

What are PV apical parameters that pertain to diastolic function?3

A
  1. S wave
  2. D wave
  3. A wave reversal
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7
Q

What are other measurements we can use for diastolic assessment?2

A
  1. LA volume index
  2. TR max velocity
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8
Q

What are some things to note about the MV colour inflow images?3

A
  1. Column of blood entering the LV is red and yellow between leaflet tips
  2. Inflow jet angles slightly laterally
  3. Minimal aliasing
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9
Q

What are some things to remember when we get a Colour MV inflow image?3

A
  1. Make sure the color box is long, and slightly wider than the MV annulus
  2. Sweep and assess MV
  3. Show MR is present
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10
Q

When will we see mitral regurgitation during a Color doppler clip of the MV?

A

During Systole

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11
Q

When will we see Mitral stenosis during a color doppler MV clip?

A

Aliasing during diastole

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12
Q

What is mitral stenosis?

A
  1. Leaflets not opening properly - reduced leaflet mobility
    color aliasing with LV (inflow) during diastole
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13
Q

MV inflow and what else can be used interchangeably?

A

LV inflow

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14
Q

When we are getting a pulsed wave of the MV inflow what is the process? 2

A
  1. Place the sample volume (SV) at the tips of the MV when open in the middle of the red column of blood.
  2. This may be out laterally a bit, rather than mid LV
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15
Q

Where should we put the SV in when getting a MV inflow PW?

A

SV in the center of the red inflow at MV leaflet tips

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16
Q

What should the baseline be when we get a MV inflow PW?

A

1/4 - 1/3 from bottom

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17
Q

What should the wall filter be for MV inflow PW?

A

Low wall filter

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18
Q

What do we need to measure during MV inflow PW? 3

A
  1. E
  2. A
  3. Deceleration time
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19
Q

What are the normal values of E, E/A, and DT for MV inflow PW?

A

E: 0.6 - 1.3 m/s
E/A: 0.8 - 2.0
DT: 160 - 220 ms

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20
Q

How would you label the image? What should we remember about this?

A
  1. E is the tall peak
  2. A is the second peak
  3. The measurement is the DT
    **E after T, A after P
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21
Q

What is the early filling phase of the MV inflow phase? What is this relate to?

A
  1. E wave
  2. After IVRT, LV starts to expand, creating suction from LA to LV and opening the MV
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22
Q

The height of the E wave is influenced by what?

A

Amount of blood entering the LV

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23
Q

MV inflow of the e wave is what?

A

Preload dependent

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24
Q

What is the diastasis part of the MV inflow phase? What happens during this phase?

A
  1. Gap between end of E wave and start of A wave
  2. Very little flow or no flow seen on spectral doppler
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25
What is the Late filling stage of the MV inflow phase? What is this usually called as well? How does it compare to the other phase in terms of size?
1. A wave 2. The result of atrial contraction "atrial kick" 3. Normally the smaller wave of the two
26
What is the Mitral valve E/A ratio?
1. Routine measurement - machine calculates 2. Ratio of peak E wave to Peak A wave
27
What is the normal E/A ratio?
0.8 - 2.0
28
E/A reversal can be normal in what population?
Older patients
29
Besides older patients who might have E/A ratios > 2.0
Many fit young people
30
What is IVRT?
The time between AV closure and MV opening
31
During IVRT what is pressure in the LV?
It is falling
32
Where should we place the sample volume during IVRT?
Between the MV inflow and LVOT
33
If IVRT is prolonged, what does this mean?
If IVRT is prolonged it is taking too long for the LV to relax (impaired relaxation)
34
IVRT may be normal for what population?
> 60 years
35
What does the purple arrow point to?
IVRT.
36
Where does IVRT lie?
Between Aortic outflow and mitral inflow
37
Is IVRT a routine image?
No
38
Is MV CW a routine image?
No
39
In Mitral stenosis, the MV opening is what?
Smaller
40
In MV stenosis hemodynamics what is blood flow velocity like?
It increases
41
In Mitral stenosis what happens if the MV has a higher velocity?
It is aliased
42
In Mitral stenosis, as the valve gets smaller what happens?
The flow gets faster
43
CW of Mitral regurgitation last throughout what periods?
Systole and isovolumic periods
44
How fast is the CW of mitral regurgitation?
Near 5-7 m/s very fast
45
During tissue doppler of the MV annulus, as the LV expands in diastole what happens to the base?
It lengthens from base to apex
46
What are a couple ways the LV changes it shape during tissue doppler of MV annulus? 4
1. Radially 2. Circumferentially 3. Longitudinally 4. Torsion (twisting and untwisting)
46
What are a couple ways the LV changes it shape during tissue doppler of MV annulus? 4
1. Radially 2. Circumferentially 3. Longitudinally 4. Torsion (twisting and untwisting)
47
When we take a TDI color what can we measure?
1. How quickly the tissue expands or contracts using PW doppler 2. Just as we can measure the velocity of blood flow
48
The velocities of TDI color are more or less dependent on preload?
Less dependent
49
What does the circles indicate?
The sample volume placement area of TDI color
50
Where should we place the SV for the MV annulus TDI image?
within the medial MV annulus
51
What is the length of the SV gate for the MV annulus?
5-10 mm
52
What doe we need to remember about the SV when getting a MV annulus image?
Make sure the SV stays within the annulus throughout the cardiac cycle
53
How should we adjust the scale for the MV annulus TDI image? What about gain?
Adjust scale for signal seen, and WATCH GAIN HERE
54
What do we measure during a MV annulus TDI image?
E prime
55
What are TDI normal values
56
What is the E/e' ratio?
The MV PW E divided by the average TDI e'
57
For TDI lateral MV annulus has what type of movement?
More free
58
When does the pulmonary veins fill the LA? 3
1. Ventricular systole 2. Early diastole 3. Diastasis
59
Flow is reversed in the Pulmonary veins during what?
Atrial systole (after P wave)
60
How often do we use PW in the RUPV?
Normally
61
When getting the pulmonary vein color images what must we remember? 3
1. Make sure you have an elongated A4C 2. Scale set low 3. Increased color gain
62
Where should we put the cursor during Pulmonary Vein PW images?
Cursor in RUPV (medial red flow below IAS)
63
Where should we set the scale for the pulmonary vein in PW?
low (30-40)
64
What may we need to do for a pulmonary vein PW? 2
1. May need to decrease reject 2. Increase sweep speed
65
What do we measure during Pulmonary vein PW?
1. S wave 2. D wave 3. Note A- reversal
66
What is the S wave? 4
1. Systolic wave 2. Normally greater than D wave velocity 3. Divided into S1 and S2 waves 4. Occasionally S1 and S2 are discernable
67
What is the D wave?
1. Diastolic wave 2. Normally less than the S wave
68
What is the A wave reversal?
1. Blood temporarily flows back into the PV from the LA due to lack of a valve 2. Also occurs during diastole
69
What are the normal values for MV inflow E point (peak)?
0.6 - 1.3 m/s
70
What is the normal E/A ratio?
0.8 - 2.0
71
What is the IVRT normal value?
50-100 ms
72
What is the E prime medial normal values?
>7 cm/s
73
What is the E prime lateral normal value
>10 CM/s
74
What is the E/e prime ratio normal values?
<8
75
What is the normal value for pulmonary veins?
S>D

DMST 253 Adult Echocardiography 1 (27 decks)

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