3 M-Mode & Echo Doppler

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28 Terms

1
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m-mode echocardiography

fast (1800 frames/sec)

ID moving structures (valves)

accurate & reproducible

may skew measurement bc nonperpendicular orientation

  • timing of rapid cardiac motion (valves)

  • precise measurements (chambers)

  • prove what is seen on 2D

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m-mode echo ex.

measure distance [dots] / time

<p>measure distance [dots] / time</p>
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AV & LA

PLAX

<p>PLAX</p>
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MV

PLAX or PSAX

<p>PLAX or PSAX</p>
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SV

stroke volume

SV=EDV-ESV

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echo doppler

uses hemodynamics (blood moving thru vessels)

  • SV

  • CO

  • intracardiac P

  • P gradient

  • vascular resistance

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doppler equation

determine V based on doppler shift

doppler angle MUST be parallel to flow

c: propagation speed

<p>determine V based on doppler shift</p><p>doppler angle <u>MUST</u> be parallel to flow</p><p></p><p><strong>c</strong>: propagation speed</p>
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bernoulli equation

in stenosis…↑V & ↓P

<p>in stenosis…<span>↑V &amp; ↓P</span></p>
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invert??

do NOT invert color doppler

do NOT invert baseline

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PW doppler

single crystal sent & received

  • time gating device (sample volume) selects depth where returning signal originated

    • sample volume is parallel to direction of flow

<p>single crystal sent &amp; received</p><ul><li><p>time gating device (sample volume) selects <strong>depth</strong> where returning signal originated</p><ul><li><p>sample volume is parallel to direction of flow</p></li></ul></li></ul><p></p>
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CW doppler

two crystals…1 emits & 1 receives

  • allows for max V measurement

  • NO depth; records all shifts along beam

<p>two crystals…1 emits &amp; 1 receives</p><ul><li><p>allows for max V measurement</p></li><li><p><strong>NO</strong> depth; records all shifts along beam</p></li></ul><p></p>
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audio signals & spectral doppler

best doppler when beam is parallel to flow

V of flow determines pitch/frequency of audio

  • ↑V=↑ pitch (hiss/whistle)

  • ↓V=↓ pitch

normal flow:

  • narrow V range & smooth, even audio

disturbed flow (distal to stenosis):

  • harsh tone

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V scale

range of V displayed

maximize waveform w/out aliasing

<p><strong>range of V displayed</strong></p><p>maximize waveform w/out aliasing</p>
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sweep speed

# of cardiac cycles shown

(100mm/sec)

<p><strong># of cardiac cycles shown</strong></p><p>(100mm/sec)</p>
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sample volume size

width of sample volume (gate width)

receive adequate signals & reduce noise

<p><strong>width of sample volume (gate width)</strong></p><p>receive adequate signals &amp; reduce noise</p>
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wall filter

eliminate low V signals near baseline

remove unwanted noise w/out erasing flow info

<p><strong>eliminate low V signals near baseline</strong></p><p>remove unwanted noise w/out erasing flow info</p>
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spectral doppler gain

amplifies doppler signals

to help measure accurately

<p><strong>amplifies doppler signals</strong></p><p>to help measure accurately</p>
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baseline

show as large as possible

eliminate aliasing

NO invert

<p><strong>show as large as possible</strong></p><p>eliminate aliasing</p><p>NO invert</p>
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peak V & P gradient

  • caliper to measure peak V

  • P gradient using peak V (△P=4V2)

<ul><li><p>caliper to measure peak V</p></li><li><p>P gradient<span style="font-size: 13.3333px"> </span>using peak V (△P=4V<span><sup>2</sup></span>)</p></li></ul><p></p>
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velocity time integral (VTI)

distance traveled by blood cells in one cardiac cycle

used to calculate SV, CO, AO valve area

  • trace flow profile

    • VTI, peak V, mean V, peak P gradient, mean P gradient

<p>distance traveled by blood cells in one cardiac cycle</p><p>used to calculate SV, CO, AO valve area</p><ul><li><p>trace flow profile</p><ul><li><p>VTI, peak V, mean V, peak P gradient, mean P gradient</p></li></ul></li></ul><p></p>
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acceleration time

time from flow onset to peak V

<p>time from flow onset to peak V</p>
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deceleration time

time from flow peak to end of flow

<p>time from flow peak to end of flow</p>
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pressure half time

time it takes for peak P to drop to half og P

  • stenosis or regurgitation

<p>time it takes for peak P to drop to half og P</p><ul><li><p>stenosis or regurgitation</p></li></ul><p></p>
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TDI

time doppler imaging

to measure V of moving tissue (myocardium)

  • color doppler

  • color M-mode

  • PW spectral doppler

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spectral TDI

place sample box anywhere on myocardium

shows phases of cardiac cycle & tissue V

E: LV rapid filling

A: “atrial kick” late filling

E’ or A’ (prime): mirror image of LV inflow

<p>place sample box anywhere on myocardium</p><p>shows phases of cardiac cycle &amp; tissue V</p><p><u>E:</u> LV rapid filling</p><p><u>A:</u> “atrial kick” late filling</p><p><u>E’ or A’ (prime):</u> mirror image of LV inflow</p>
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color TDI

ensures all wall segments are moving in correct location & at same V

  • may identify wall motion abnormalities

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m-mode TDI

shows differences in:

  • wall movement direction

  • thickening

  • V

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TDI application & limitations

application: diastolic dysfunction

  • PW TDI to asses LV diastolic function

limitations: myocardial tethering

  • unable to tell btwn myocardial contraction & passive myocardial motion from near structures

& angle dependent

  • must be parallel to myocardial motion direction