← Section I · Physical Principles, Instrumentation, Examination Principles

I.A

Routine Doppler Examination

7 cards

Notes

Normal antegrade Doppler velocities

Site	Normal range (m/s)
Ascending aorta	1.0 – 1.7
LVOT	0.7 – 1.1
Mitral E (early)	0.6 – 1.3
Mitral A (late)	0.2 – 0.7
Pulmonary artery	0.5 – 1.3
RV inflow E	0.3 – 0.7
SVC / hepatic vein (systolic)	0.32 – 0.69
Pulmonary vein (systolic)	0.56 ± 0.13
Pulmonary vein (diastolic)	0.44 ± 0.16
Pulmonary vein (atrial reversal)	0.32 ± 0.07

Sequence for a routine exam

PW at LVOT to derive stroke volume (with CSA_LVOT).
CW across AV, MV, TV, PV for peak velocities and gradients.
PW at mitral inflow (leaflet tips) for E, A, DT.
Tissue Doppler at septal and lateral mitral annulus for e′ (diastolic function).
PW of pulmonary vein (S, D, atrial reversal).
PW of hepatic vein and IVC (RA pressure estimation).
Color Doppler for regurgitant/shunt lesions in every view.

Age-related changes in transmitral inflow

Young adults: E > A, E/A > 1.
Middle age: E/A ≈ 1.
Older adults: E/A < 1 (impaired relaxation is the norm).
With age: E velocity ↓, deceleration time ↑, A velocity ↑.

Cards

basicI.A-001
Normal peak velocity across the LVOT?
→ 0.7 – 1.1 m/s.
basicI.A-002
Normal peak velocity in the ascending aorta?
→ 1.0 – 1.7 m/s.
basicI.A-003
Normal peak mitral E velocity in a young adult?
→ ~1.0 m/s (range 0.6 – 1.3 m/s). Mitral A is 0.2 – 0.7 m/s, giving E/A > 1.
basicI.A-004
How does the mitral E/A ratio typically change with age?
→ Young: E/A > 1. Around age 50–60: ≈ 1. Older: E/A < 1 (impaired relaxation is the norm). E velocity falls, DT prolongs, A velocity rises.
basicI.A-005
What are the three components of a normal pulmonary vein PW Doppler signal?
→ S wave (systolic forward flow), D wave (diastolic forward flow), and A-reversal (atrial contraction-induced retrograde flow into the PV).
basicI.A-006
Where do you place the PW sample volume to measure mitral inflow?
→ At the tips of the mitral leaflets during maximum leaflet opening (early diastole).
basicI.A-007
Which Doppler modality is used to measure e′ at the mitral annulus?
→ Tissue Doppler (PW-TDI) with the sample volume at the septal and lateral mitral annulus.