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MIDS 197 > Ch 15 Abnormal Doppler Patterns > Flashcards

Ch 15 Abnormal Doppler Patterns Flashcards

1
Q

What is physiologic regurgitation?

A

It is trivial regurg - meaning it is a normal amount we expect to see in a normal healthy adult

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2
Q

Define valvular regurg?

A

Flow moving backwards through a valve, instead of forwards

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3
Q

Define valvular stenosis?

A

Flow being restricted from moving freely forward through a valve

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4
Q

Define intracardiac shunts?

A

Abnormal connections b/w areas of the heart that should NOT have communication b/w them

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5
Q

What 5 factors is it important to look at in terms of inspecting spectral doppler flow patterns?

A

-Speed
-Timing
-Intensity
-Shape
-Direction of blood flow

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6
Q

Why is speed important to look at when inspecting spectral doppler flow patterns: list 2 reasons why the normal values for valves should be memorized?

A

-Allows for recognition of one waveform vs another
-Allows for recognition of accelerated velocities

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7
Q

What can help determine the level of severity of regurgitation or stenosis?

A

Velocities - helps differentiate b/w mild, moderate + severe

(ex RVOT is smaller waveform compared to LVOT)

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8
Q

Do we need to know what mild, moderate + severe regurg or stenosis looks like right now in class?

A

No, just know the difference b/w trivial + very severe forms

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9
Q

Why is timing important to look at when inspecting spectral doppler flow patterns?

A

B/c we must understand exactly when each type of flow occurs during the cardiac cycle in order to make them recognizable

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10
Q

AR + MS both occur during diastole or systole?

A

Diastole

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11
Q

Does AR + MS both occur above or below the baseline?

A

Above

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12
Q

What is isovolumic relaxation time (IVRT)?

A

Time interval b/w AoV closure + MV opening

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13
Q

What is isovolumic contraction time (IVCT)?

A

Time interval b/w MV closure + AoV opening

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14
Q

Why is intensity important to look at when inspecting spectral doppler flow patterns?

A

B/c the more filled in + complete a doppler waveform is (higher amplitude), the more intense the level of flow is

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15
Q

Do doppler envelopes indicate a higher or lower intensity?

A

Higher - they are brighter + have more filling which indicates a higher level of severity

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16
Q

The more RBCs that get pushed through a valve, the higher or lower the amplitude of the signal?

A

Higher

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17
Q

Why is shape important to look at when inspecting spectral doppler flow patterns? List 2 reasons.

A

-B/c the normal contour of doppler waveforms of valves should be memorized, so when they differ they can be recognized
-Also assists in recognizing what type of flow is being visualized

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18
Q

AS + MR both occur during diastole or systole?

A

Systole

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19
Q

Does AS + MR both occur above or below the baseline?

A

Below

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20
Q

What is the normal velocity for the Ao?

A

1 m/s

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21
Q

Are AS jets usually more round or pointy?

A

Pointy

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22
Q

Do AS jets usually extend into the IVRT?

A

No, unlike the MR jet

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23
Q

Why is direction important to look at when inspecting spectral doppler flow patterns?

A

B/c normal directions for valves should be memorized, so when abnormal flow is visualized it is recognized

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24
Q

What is valvular regurg/insufficiency caused by?

A

-Congenital or acquired abnormalities of the valve leaflets
-Valve is not able to coapt (close) properly

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25
Q

Give an example of how abnormalities of associated supporting structures can cause regurg of an otherwise normal valve?

A

Ex: An enlarged Ao can cause a wide annulus, which then pulls the AoV apart + causes it to not be able to close as well anymore, resulting in Ao regurg

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26
Q

Is regurg always detectable via stethoscope?

A

No, echo is needed to find the origin of the murmur

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27
Q

How many imaging planes are needed to assess severity of regurg + stenosis?

A

Multiple

(stenosis - especially in the face of eccentric jets)

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28
Q

Is off-axis imaging allowed when trying to get a regurg or stenotic jet parallel to the u/s beam?

A

Yes

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29
Q

Contour of spectral doppler in regurg reflects the pressure difference b/w what?

A

B/w 2 chambers over the regurgitant flow period

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30
Q

In the presence of significant regurg, will the stroke volume across the valve increase or decrease?

A

Increase

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31
Q

Forward stroke volume is a combo of what 2 things?

A

Normal SV + regurgitant volume

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32
Q

In the presence of significant regurg, reversal of flow in the valves corresponds to what?

A

Their “inlets” + may be visualize with CD and spectral doppler

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33
Q

Where flow goes, pressure _____?

A

Follows

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34
Q

Excess flow will lead to increased or decreased pressure?

A

Increased

35
Q

Increased volume + pressure will lead to what over time?

A

Chamber dilation

36
Q

Having extra inflow coming into the heart will cause an increased preload or afterload?

A

Preload - b/c creates a higher volume in the LV

37
Q

Before applying CD + spectral doppler, can we already become suspicious for the presence of regurg or stenosis?

A

Yes! M-mode + 2D imaging can give us signs before we turn on doppler to confirm regurg

38
Q

Give an example of a structural abnormality that can be seen on an m-mode tracing that would make us suspicious of regurg?

A

Ex: AMVL fluttering due to AR

(image in slide shows the coaptation lines far apart in systole, when normally they should be closed with no gap present)

39
Q

List 3 signs in 2D imaging that would make us suspicious of regurg?

A

-Chamber dilation (backflow of blood causes enlargement)

-Calcific changes (valves that can’t open properly m/c can’t close properly either)

-Prolapse (valve bowing/bending backwards causing leaks in valve)

40
Q

What is valve prolapse?

A

A valve that bends further backward than it should, due to anomalous anatomical issues + allows for leaks

41
Q

What 2 things are necessary to confirm the presence of valvular regurg?

A

-Spectral (CW) doppler
-CD

42
Q

What should we automatically think about when we see chamber dilation + crunchy hyperechoic valves?

A

Dilation = regurg
Crunchy Valves = regurg + stenosis

43
Q

MV prolapse is m/c in males or females?

A

Females

44
Q

Is a small degree of regurg normal + common?

A

Yes - no adverse clinical outcomes will occur

45
Q

List 3 ways we can tell if regurg is only a trace amount (physiologic/trivial)?

A

-Restricted to the area immediately adjacent to the valve closure
-Short in duration
-Incomplete spectral envelope

46
Q

What is the least common type of regurg to see in a normal patient?

A

AR

47
Q

Does severe AR, MR + TR have waveforms that look more round or pointy?

A

Pointy

48
Q

Does MV stenosis, AoV stenosis + PV regurg all have waveforms that look the same or different?

A

Same

49
Q

What 3 things is valvular stenosis caused by?

A

-Congenital or acquired abnormalities of the valve leaflets
-Post inflammatory processes (rheumatic fever)
-Age related calcification

(causing valve to be unable to open completely)

50
Q

What 2 things will be visible on spectral doppler if stenosis is present?

A

-Higher than normal velocities
-Larger pressure gradients

51
Q

Will areas immediately before or after a stenotic valve be dilated?

A

After (following the valve)

52
Q

Is preload or afterload increased with stenosis?

A

Afterload

53
Q

What classic shape does a bicuspid AoV have?

A

Football shape

54
Q

Another name for rheumatic fever?

A

Scarlet fever

55
Q

What is m/c associated with rheumatic fever?

A

MV stenosis

(can affect any valve, but m/c MV)

56
Q

Give an example of a structural abnormality that can be seen on an m-mode tracing that would make us suspicious of stenosis?

A

Ex: Lack of E/A peaks on MV tracing

(severe tracings would show no E/A wave)

57
Q

List 4 signs in 2D imaging that would make us suspicious of stenosis?

A

-Hyperechoic or echogenic thick valve (calcific changes)
-Reduced excursion of valve
-Ventricular hypertrophy
-Possibly atrial dilation

58
Q

List 2 things we would expect to see when we use spectral (CW) doppler + CD to confirm presence of stenosis?

A

-Expect turbulent flow
-Expect regurg (b/c valves that can’t open properly also can’t close properly)

59
Q

What classic shape is the AMVL when rheumatic fever is present?

A

Hockey stick shaped (MV stenosis)

60
Q

AoV + PV stenosis waveforms look similar along with TV + MV stenosis waveforms, what is the only difference?

A

Velocities - AoV + MV will have higher velocity waveforms

61
Q

What is the small hyperechoic area in a AS waveform?

A

LVOT

62
Q

Does PV stenosis have waveforms that look more round or pointy with higher velocities?

A

Round

63
Q

Semilunar regurg looks somewhat like what?

A

Atrioventricular stenosis

(know cardiac timing by ECG to keep things clear)

64
Q

Atrioventricular regurg looks somewhat like what?

A

Semilunar stenosis

(know cardiac timing by ECG to keep things clear)

65
Q

Volumetric flow rate must be constant at all 3 locations of a stenosis, what are they?

A

-Proximal to stenosis
-At stenosis
-Distal to stenosis

(continuity rule)

66
Q

Is blood created or destroyed as it flows through a vessel?

A

Neither!

(continuity rule)

67
Q

Average flow speed at a stenosis must be greater or weaker than the prox + distal part of the stenosis?

A

Greater - so that the volumetric flow rate can remain constant through all parts of the vessel

(continuity rule)

68
Q

What principle says “what goes in, must come out”

A

Continuity principle

69
Q

The continuity equation can calculate what?

A

Valve areas of any annulus, but m/c used for AoV

70
Q

List what the variables mean in the continuity equation: A2 = A1 x V1 / V2

A

A2: AVA (aortic valve area)
A1: LVOT diameter
V1: LVOT VTI (time velocity interval)
V2: Peak AoV VTI

(all obtained from PLAX)

71
Q

Explain the bernoulli effect?

A

-Drop in pressure at a stenosis due to high velocities
-The pressure difference allows for fluid to accelerate into the stenosis + decelerate out to maintain energy balance

72
Q

As flow energy increases, pressure energy ____?

A

Decreases

(bernoulli effect)

73
Q

Pressure energy is converted into ____ energy?

A

Flow energy - upon entry of stenosis then convert’s back exiting stenosis

(bernoulli effect)

74
Q

What type of doppler is used to calculate pressure gradients b/w chambers?

A

Spectral doppler - allows quantification of the pressure gradient for areas of narrowing, such as a calcific AoV

(bernoulli effect)

75
Q

List what the variables mean in the simplified bernoulli equation: P = 4v^2

A

P = pressure gradient
V = velocity

76
Q

Solving for the bernoulli equation gives us what?

A

The pressure difference b/w 2 chambers at a specific point in time

77
Q

List 3 things that we estimate the max + mean pressure gradients for?

A

-Aortic + pulmonic stenosis
-LVOT obstruction
-Right ventricular systolic pressure (RVSP)

(these are bernoulli equation applications)

78
Q

List the formula for RVSP?

A

RVSP = 4 (tricuspid regurgitant velocity)^2 + RA pressure

(P = 4V^2 + RAP)

79
Q

RVSP is a routine measurement taken in the echo lab to calculate what?

A

Right sided pressures

80
Q

RVSP is used clinically to determine what?

A

If there is pulmonary hypertension

(a common response to many chronic left sided cardiac diseases)

81
Q

RAP is assigned based on the visualized level of what?

A

Level of collapse of the IVC + its widest diameter

82
Q

“V” in the bernoulli equation is generated by what?

A

By the Vmax of TR peak velocity from CW doppler

83
Q

If there are 2 jets (stenosis or regurg) present, does the severity automatically go up now?

A

Yes, severity goes up a tick b/c there are 2 jets. Must doppler both jets independently

(ex: trivial now becomes mild)

MIDS 197 (15 decks)

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