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Echo > Module 13 : Apical Color and Spectral Part 1 > Flashcards

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)
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2
Q

MV inflow assess

A
  • E wave
  • A wave
  • E/A ratio
  • deceleration time
  • IVRT
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3
Q

pulmonary veins asses

A
  • S wave
  • D wave
  • A wave reversal
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4
Q

tissue doppler at MV annuls asses

A
  • e prime (medial and lateral)

- calculate E/e prime ration

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5
Q

2D assess

A
  • LA volume index

- normal <34 ml/m^2

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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
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7
Q

color scale for LV inflow

A
  • 50-70cm/sec
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8
Q

color doppler MV regurge - leaks

A
  • occurs in systole

- lots of aliasing toward LA

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9
Q

color doppler MV stenosis

A
  • occurs in diastole

- aliasing toward LV

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10
Q

MV regurge causes

A
  • one cause is malcoaptation of MV leaflets
  • mitral valve prolaps
  • ischemic hear = makes ventricle expand widening annulus
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11
Q

mitral stenosis

A
  • reduced leaflet mobility
  • calcified
  • thickened
  • LA pressure increases
  • LA dilates
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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
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13
Q

3 inflow phases

A
  • early filling
  • diastasis
  • late filling
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14
Q

early filling

A
  • after isovolumic relaxation LV starts to expand creating suction from LA to LV opening MV
  • E wave
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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
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16
Q

late filling

A
  • A wave
  • result of atrial contraction
  • smaller wave of the two
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17
Q

MV inflow is dependant on what

A

preload

- height of E wave I influenced by amount of blood entering LV

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18
Q

E point

A
  • peak velocity in early filling
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19
Q

DT (deceleration time)

A
  • the downslope after the E point all the way to the baseline
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20
Q

A point

A
  • peak V of late filling phase
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21
Q

E wave normal value

A
  1. 6 - 1.3 m/s

- age dependent

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22
Q

deceleration time normal value

A

160 - 220 ms

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23
Q

A wave normal value

A

no specified normal

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24
Q

E/A ration normal

A
  1. 8 - 2.0 (all age groups)
    - E should be larger than A
    * E/A ratio does reverse around 6th decade of life
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25
Q

calculate E/A ration

A

E wave / A wave

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26
Q

isovolumic relaxation time

A
  • covers time between AV closure and MV opening

- pressure is falling from that of the aorta to below pressure in the LA

27
Q

IVRT - sampling

A
  • place sample volume slightly more medial than would for MV inflow tracing
28
Q

IVRT normal duration

A

50-100 ms

29
Q

IVRT prolonged

A
  • it is taking to long for LV to relax (impaired relaxation)
  • may be normal if over 60 years old
30
Q

tissue doppler of MV annulus

A
  • 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
Q

ways that LV changes shaoe

A
  • radially = moving out and in
  • circumferentially - circle
  • these two are in fractional shortening
  • longitudinally (apical 4 assessment)
  • torsion (twisting and untwisting)
32
Q

longitudinal TVI

A
  • tissue velocity imaging

- also called TDI (tissue doppler imaging)

33
Q

doing TDI of MV

A
  • 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
Q

TVI medial MV annulus normal value

A

> /= 8 cm/s

35
Q

TVI lateral MV annulus normal valve

A

> /= 10 cm/s

36
Q

pulmonary venous flow - when do they fill LA

A
  • ventricular systole
  • early diastole
  • diastasis
37
Q

flow is reversed in pulmonary veins when

A
  • atrial systole (after P wave)

-

38
Q

what pulmonary vein do we usually do PW

A

right upper pulmonary vein

- RUPV

39
Q

pulmonary vein waves

A
  • S wave (systolic wave)
  • D wave (diastolic wave)
  • A wave reversal (caused by atrial contraction)
40
Q

S wave

A
  • normally greater than D wave velocity
  • divided into S1 and S2 wave
  • occasionally S1 and S2 are discernible
41
Q

D wave

A
  • normally smaller than S wave
42
Q

A wave reversal

A
  • blood temporarily flows back into the PV from the LA due to lack of a valve
43
Q

normal E/e prime ratio

A

= 8

44
Q

pulmonary veins normal value

A

S > D

45
Q

mitral stenosis effect on MV inflow

A
  • 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
Q

normlal mitral reugure

A
  • trivial or trace of physiologic MR
47
Q

CW of severe MR

A
  • flow lasts throughout systole and both isovolumic periods

- 5/7 m/s

48
Q

LV outflow doppler assessment order

A
  • LVOT/AV/aorta color dopple r
  • LVOT = PW
  • AV - CW outflow
  • AV - CW for regurge if present
49
Q

LVOT assessment view

A
  • done in apical 5 chamber need to see valves of aorta
50
Q

Sample volume placement of LVOT

A
  • 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
Q

LVOT PW doppler assess

A
  • LVOT max velocity

- LVOT VTI

52
Q

aortic regurge

A
  • assessed with CW

- pressure gradient lowers as ventricle fillis and ventricle pressure increases

53
Q

CW cursor placement

A
  • should not go through IVS

- slightly higher in valve than LVOT

54
Q

CW doppler assessmentif AO

A
  • AV max velocity
  • AV VTI
  • AV peak and mean gradient
55
Q

peak gradient

A

4(PV)^2

56
Q

mean gradient

A
  • average of all sample points in trace
57
Q

calculating AV area

A
  • need 3 things
    + LVOT diameter
    + LVOT VTI
    + AV VTI
58
Q

formula to calculate AV area

A

AVA (cm^2) = 0.785 x LVOTd^2 x VTI(LVOT)
/ VTI (AOV)

stoke volume / VTI AOV

59
Q

AV velocity normal value

A

< 2.0 m/s

60
Q

AV VTI normal value

A

18 - 25 cm

61
Q

LVOT diamater normal value

A

1.6 - 2.3 cm

62
Q

calculated AVA normal value

A

2.5 - 4.5 cm ^2

63
Q

AV peak gradient normal value

A

< 10 mmHg

64
Q

AV mean gradient normal value

A

< 5 mmHg

Echo (19 decks)

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