Module 13 : Apical Color and Spectral Part 1 Flashcards
1
Q
order of images
A
- 2D
- Color (right to left or left to right)
- spectral (right then left)
2
Q
MV inflow assess
A
- E wave
- A wave
- E/A ratio
- deceleration time
- IVRT
3
Q
pulmonary veins asses
A
- S wave
- D wave
- A wave reversal
4
Q
tissue doppler at MV annuls asses
A
- e prime (medial and lateral)
- calculate E/e prime ration
5
Q
2D assess
A
- LA volume index
- normal <34 ml/m^2
6
Q
color doppler LV inflow (MV)
A
- column of blood entering the LV is red with yellow between leaflet tips
- should have minimal aliasing
- long color box
7
Q
color scale for LV inflow
A
- 50-70cm/sec
8
Q
color doppler MV regurge - leaks
A
- occurs in systole
- lots of aliasing toward LA
9
Q
color doppler MV stenosis
A
- occurs in diastole
- aliasing toward LV
10
Q
MV regurge causes
A
- one cause is malcoaptation of MV leaflets
- mitral valve prolaps
- ischemic hear = makes ventricle expand widening annulus
11
Q
mitral stenosis
A
- reduced leaflet mobility
- calcified
- thickened
- LA pressure increases
- LA dilates
12
Q
pulsed wave MV inflow/ LV inflwo
A
- place sample volume at tips of MV when open in middle of red column of blood
- SV size 3mm
- assess diastolic function
13
Q
3 inflow phases
A
- early filling
- diastasis
- late filling
14
Q
early filling
A
- after isovolumic relaxation LV starts to expand creating suction from LA to LV opening MV
- E wave
15
Q
diastasis
A
- gap between end of E wave and beginning of A wave
- very little flow or no flow seen on spectral doppler
- higher heart rate less diastasis
16
Q
late filling
A
- A wave
- result of atrial contraction
- smaller wave of the two
17
Q
MV inflow is dependant on what
A
preload
- height of E wave I influenced by amount of blood entering LV
18
Q
E point
A
- peak velocity in early filling
19
Q
DT (deceleration time)
A
- the downslope after the E point all the way to the baseline
20
Q
A point
A
- peak V of late filling phase
21
Q
E wave normal value
A
- 6 - 1.3 m/s
- age dependent
22
Q
deceleration time normal value
A
160 - 220 ms
23
Q
A wave normal value
A
no specified normal
24
Q
E/A ration normal
A
- 8 - 2.0 (all age groups)
- E should be larger than A
* E/A ratio does reverse around 6th decade of life
25
calculate E/A ration
E wave / A wave
26
isovolumic relaxation time
- covers time between AV closure and MV opening
| - pressure is falling from that of the aorta to below pressure in the LA
27
IVRT - sampling
- place sample volume slightly more medial than would for MV inflow tracing
28
IVRT normal duration
50-100 ms
29
IVRT prolonged
- it is taking to long for LV to relax (impaired relaxation)
- may be normal if over 60 years old
30
tissue doppler of MV annulus
- as LV expands in diastole it lengths from base to apex
- velocity of expansion or contraction of the tissue can be measured using pulsed wave doppler
- LESS DEPENDENT ON PRELOAD
31
ways that LV changes shaoe
- radially = moving out and in
- circumferentially - circle
* these two are in fractional shortening
- longitudinally (apical 4 assessment)
- torsion (twisting and untwisting)
32
longitudinal TVI
- tissue velocity imaging
| - also called TDI (tissue doppler imaging)
33
doing TDI of MV
- scan apical 4 focused on LV
- color scale lower than for color doppler
- blue = diastole
- red = system
- place a sample volume within medial and lateral annulus
- make sure SV stays within annulus throughout cardiac cycle
34
TVI medial MV annulus normal value
>/= 8 cm/s
35
TVI lateral MV annulus normal valve
>/= 10 cm/s
36
pulmonary venous flow - when do they fill LA
- ventricular systole
- early diastole
- diastasis
37
flow is reversed in pulmonary veins when
- atrial systole (after P wave)
| -
38
what pulmonary vein do we usually do PW
right upper pulmonary vein
| - RUPV
39
pulmonary vein waves
- S wave (systolic wave)
- D wave (diastolic wave)
- A wave reversal (caused by atrial contraction)
40
S wave
- normally greater than D wave velocity
- divided into S1 and S2 wave
- occasionally S1 and S2 are discernible
41
D wave
- normally smaller than S wave
42
A wave reversal
- blood temporarily flows back into the PV from the LA due to lack of a valve
43
normal E/e prime ratio
= 8
44
pulmonary veins normal value
S > D
45
mitral stenosis effect on MV inflow
- MV thickened leaflets tethered together = MV opening smaller = speeds of flow
- color moving through the open MV will be of higher velocity = aliased
- measure speed with CW (no aliasing)
- INCREASED IN BLOOD FLOW VELOCITY IS PROPORTIONAL TO REDUCTION IN MV AREA WHEN OPEN
46
normlal mitral reugure
- trivial or trace of physiologic MR
47
CW of severe MR
- flow lasts throughout systole and both isovolumic periods
| - 5/7 m/s
48
LV outflow doppler assessment order
- LVOT/AV/aorta color dopple r
- LVOT = PW
- AV - CW outflow
- AV - CW for regurge if present
49
LVOT assessment view
- done in apical 5 chamber need to see valves of aorta
50
Sample volume placement of LVOT
- place in middle of LVOT
- 5 mm inferior to AV cusps
- size of sample volume is 3-5 mm
- wan tto see closing click and hollow envelope
51
LVOT PW doppler assess
- LVOT max velocity
| - LVOT VTI
52
aortic regurge
- assessed with CW
| - pressure gradient lowers as ventricle fillis and ventricle pressure increases
53
CW cursor placement
- should not go through IVS
| - slightly higher in valve than LVOT
54
CW doppler assessmentif AO
- AV max velocity
- AV VTI
- AV peak and mean gradient
55
peak gradient
4(PV)^2
56
mean gradient
- average of all sample points in trace
57
calculating AV area
- need 3 things
+ LVOT diameter
+ LVOT VTI
+ AV VTI
58
formula to calculate AV area
AVA (cm^2) = 0.785 x LVOTd^2 x VTI(LVOT)
/ VTI (AOV)
stoke volume / VTI AOV
59
AV velocity normal value
< 2.0 m/s
60
AV VTI normal value
18 - 25 cm
61
LVOT diamater normal value
1.6 - 2.3 cm
62
calculated AVA normal value
2.5 - 4.5 cm ^2
63
AV peak gradient normal value
< 10 mmHg
64
AV mean gradient normal value
< 5 mmHg
