ARDMS Echo Doppler Echocardiography 2 ā Questions and Answers
Question 1: What is the significance of a diastolic flow reversal in the pulmonary veins on Doppler echocardiography?
- Normal finding in young patients
- Indicates elevated left atrial pressure or severe MR (Correct answer)
- Indicates pulmonary hypertension
- Reflects tricuspid stenosis
Correct answer: Indicates elevated left atrial pressure or severe MR
Diastolic flow reversal in pulmonary veins suggests elevated left atrial pressure or severe mitral regurgitation causing retrograde flow.
Question 2: On pulsed-wave Doppler, the sample volume should be placed where to measure mitral inflow velocities?
- At the mitral annulus
- At the tips of the mitral leaflets (Correct answer)
- In the mid left atrium
- In the LVOT
Correct answer: At the tips of the mitral leaflets
The sample volume is placed at the tips of the mitral leaflets (leaflet tips) to record the highest E and A wave velocities.
Question 3: Which Doppler parameter is used to estimate pulmonary vascular resistance (PVR)?
- TR velocity / RVOT VTI (Correct answer)
- TR velocity Ć RVSP
- RVOT velocity time integral alone
- Mitral E/A ratio
Correct answer: TR velocity / RVOT VTI
PVR ā 10 Ć (TR velocity / RVOT VTI); a ratio >0.2 suggests elevated PVR.
Question 4: The PISA (proximal isovelocity surface area) method is used to quantify:
- LV systolic function
- Severity of valvular regurgitation or stenosis (Correct answer)
- Cardiac output
- Pericardial effusion size
Correct answer: Severity of valvular regurgitation or stenosis
The PISA method uses flow convergence proximal to a regurgitant orifice to calculate the effective regurgitant orifice area (EROA) and regurgitant volume.
Question 5: In continuous-wave Doppler, the modified Bernoulli equation (ĪP = 4VĀ²) is used to calculate:
- Valve area
- Pressure gradient across an obstruction (Correct answer)
- Stroke volume
- Pulmonary venous pressure
Correct answer: Pressure gradient across an obstruction
The simplified Bernoulli equation converts peak Doppler velocity to pressure gradient: ĪP = 4VĀ², ignoring the proximal velocity when it is <1.5 m/s.
Question 6: What finding on CW Doppler of the aortic valve suggests dynamic LVOT obstruction (HOCM)?
- Early peaking, symmetric signal
- Dagger-shaped (late-peaking) signal with mid-systolic notch (Correct answer)
- Holodiastolic flow reversal
- Blunted S wave
Correct answer: Dagger-shaped (late-peaking) signal with mid-systolic notch
Dynamic LVOT obstruction produces a late-peaking, dagger-shaped CW Doppler signal due to progressive systolic narrowing of the outflow tract.
ARDMS Echo Doppler Echocardiography 2
What is the significance of a diastolic flow reversal in the pulmonary veins on Doppler echocardiography?