BY RESHMA MASCARENHAS

DOPPLER CARDIOGRAPHY This technique depends on the fundamental principle that sound waves reflected from moving objects, such as intra cardiac red blood cells , undergo a frequency shift. The speed and the direction of movement of red cells and thus of blood, can be detected in the heart chambers and great vessels. The greater the frequency shift, the faster the blood is moving. The derived information can be presented either as a plot of blood velocity against time for a particular point in the heart or as a colour overlay on a true dimensional real time echo picture (colour flow Doppler). Doppler cardiograph is a valuable in decting abnormal direction of blood flow, eg; aortic or mitral reflex, and in estimating pressure gradients, for eg the gradient across a stenosed aortic valve. Normal velocities are in the order of 1m/sec but in the presence of stenosis flow velocity is increased (for e.g., the greater in sever aortic stenosis the peak aortic velocity may be increased to 5m/sec). An estimate of the pressure gradient across a valve or lesion given by Bernoulli equation: Pressure gradient=4*(velocity) 2

DOPPLER TESTING AND VESSEL MAPPING

Different Doppler Tests: A duplex Doppler test makes a picture of a blood and organ around the blood vessels. A computer changes the sound into a graph that tells the doctor about the speed and direction of the blood flows through veins and arteries. A colour Doppler makes a picture of the blood vessel. A computer changes the sound into colour that is laid over the picture of the blood vessels. The colours show the speed and

direction of the blood flows through veins and arteries. The picture on the bottom of the centre column is a colour Doppler picture modified for this brochure.

HOW TO PREPARE: Nicotine causes blood vessel to narrow. A doctor may ask that cigarette, chewing tobacco or nicotine gum not be used from 30 minute to an hour before the test. If you smoke or chew tobacco, ask if you need to stop before the test is done. HOW THE TEST IS DONE: Remove all jewellery. For an arm scan, the arm is turned outward. Gel is put on the skin to help carry the sound waves. The transducer is moved along the arm and sounds from the blood flowing in the vessel may be heard.

HOW TO TEST FEELS: There is normally no pain or discomfort with the test. The gel may feel cold when applied, unless it is warmed by a warmer. If blood pressure is taken during the test, will feel pressure when the cuff inflates.

CHECKING ARTERIESAND VEINS IN THE ARMS: This test is often performed on both the arms for comparison. Blood pressure may be taken from several different places from the arms. Usually blood pressure is taken from the lower arm and then the upper arm. Changes in blood flow are noted in response to breathing patterns.

DOPPLER UNTRASOUND: Doppler ultrasound can be used to evaluate arterial and peripheral venous patency as well as valerian competence. Surface Doppler ultra sound has become almost the standard method of assessment of arterial patency. Doppler surface monitoring is used for few skins and muscle flaps, and reimplanted digits. Use of Doppler surface monitoring ha s some limitations though. The Arial artery must be located superficially and sometimes various obstruction still produce an arterial him. If venous obstruction is suspected compression of the flap will produces a louder hum implanted Doppler probes are also available are in use in some centers.

NURSING AND PATIENT CARE CONSIFERATION: 1. Inform patient that the test is noninvasive. 2. The test takes about 5-10 minutes, and no special preparation is needed. 3. Explain that a cuff applied to patients leg will be inflated and deflated in a manner similar to that of blood pressure measurement and that the purpose of the test is detected arteries patency. ECHOCARDIOGRAPHY: A diagnosis procedure that uses ultrasound at a frequency of 2.5-10MHz to prier image of the heart. The principle is that the interface between tissues of different acoustical impendence causes the ultrasound to be reflected to the transducer which spends a fraction of each second receiving those echoes. An ultrasound image of the heart is generated on a video monitor image is generated by moving the ultrasound beam mechanically or electrically repeatedly through an arc. The transducer is usually

applied to the arteriole chest to a coupling gel devoid of air. This procedure is referred to as transthoracic echocardiography. Small transducers can also be attached to probes placed in the esophagus behind the heart a procedure known as transesophageal echocardiography. The closer the transducers are to the heart, the higher the resolution of the resulting image. The complete echocardiography examination also includes sensitive sampling along certain radians in the arched true-dimensional image and displaying of the movement the structures crossed by the radian over time in an analog fashion this formal is time motion echocardiography or m-mode echocardiography. It is adjunctive to true dimensional and colour flow Doppler echocardiography for answering specific questions about heart structural dimension and functions.

GENERAL INFORMATION: Where its done Doctors office, testing late or outpatient department Who does it Technician, nurse or doctor trained in ultrasound. How long it takes 30-60 minutes discomfort none

Result ready when Immediately to several days

Special equipment Ultrasound transducer monitor with oscilloscope screen, video and/or strip. Chart recorders and ECG mechanic

Risks/complications None

OTHER NAMES Cardiac ultragraphy, ultrasound and dopplerstudy. Purpose: To evaluate various congenital and acquired heart defects. To measure size of the heart and its chambers. To evaluate the function of the heart muscle and heart valves and to detect excessive fluid in the pericardium, the membrane that surrounds the heart.

How TO Work: High frequency sound waves are directed through the body to create an image of the heart and other internal structure. As technician passes an ultrasound transducer over the heart the echoed sound creates an Image that can be viewed on a monitor and also recorded on paper.

Preparation: Remove clients clothing and jewellery above the waist and recline on an exam table. Gel is applied on clients chest to help conduct the sound waves. Test Procedure: As the client on the examining table, the tester guides the transducer pewter, should a pencil and microphone, over specific area of clench chest. Slight pressure is applied between the skin and transducer.

From time to time client may be asked to assume a different position. As the transducer passes the skin, it emits high frequency, inaudible sound waves are used to create images of internal organs and indicate the flow of blood various part of the heart.

Variations: Doppler ultrasound in which a special microphone is used to measure the blood flow in different parts of the heart. Exercise echocardiogram in which the echocardiogram is done during exercise. This provides a better picture of the state of the coronary arteries the echocardiogram done during rest. If the client is unable to exercise, a drug cam is to increase the blood flow mimicking what happened during exercise. Factors Affecting Results: Other disease, such as emphysema. Cheats valve abnormalities, including unusual thickness, which may distort the sound waves. Faulty use of transducer. Exercise movement.