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Jean and Doug, I can't speak for this interesting carotid case, but
generally, in alternating forward -reverse flow, or "to and fro", the
segment that is of the shortest duration is systole.  A simultaneous
palpation of a radial or brachial pulse while observing the waveform
would also clarify systolic vs diastolic direction. I don't feel you need
EKG to determine this.
Rob Daigle

 -----Original Message-----
From: Douglas O'Reilly [SMTP:[log in to unmask]]
Sent: Thursday, August 10, 2000 6:18 AM
To: Robd; UVMFLOWNET
Subject: RE: interesting carotid


Jean,
    That was my question. Too often the assumption is made that the
forward
flow is systolic when in fact the pressure gradient means that the
retrograde flow occurs in systole.
Doug.
 -----Original Message-----
From: Jean Primozich <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Thursday, 10 August 2000 02:17
Subject: Re: interesting carotid


>How did you know if it was systole or diastole? Were you monitoring with
EKG?
>Jean Primozich
>University of Washington
>
>On 8/9/00, UVM Flownet wrote:
>>Systolic
>>
>>-----Original Message-----
>>From: Zwakenberg Terry >[mailto:[log in to unmask]]
>>Sent: Wednesday, August 09, 2000 7:06 AM
>>To: [log in to unmask]
>>Subject: Re: interesting carotid
>>
>>
>>Was the antegrade portion of flow in the ica >systolic or diastolic?
>>
>>Terry J Zwakenberg
>>Program Director
>>Providence Heart Institute
>>School of Cardiovascular Diagnostics
>>e-mail [log in to unmask]
>><mailto:[log in to unmask]>
>>
>>        -----Original Message-----
>>        From:   Waters, MaryAnne >[SMTP:[log in to unmask]]
>>        Sent:   Tuesday, August 08, 2000 4:45 PM
>>        To:     [log in to unmask]
>>        Subject:        interesting carotid
>>
>>        I am looking for input on a carotid study >done in our lab
today.
83
>>y/o
>>        female sent for carotid duplex for R carotid >bruit.  Duplex of
R
>>carotid
>>        reveals stenosis of just about 50% based on >velocity criteria.
>>Otherwise,
>>        unremarkable.  Duplex of L carotid reveals >occluded CCA.  Flow
in
>>ICA
>>        reveals a "to-fro" pattern similar to that >seen in a pre-steal
>>vertebral.
>>        ECA signal was low resistant-similar to ICA.  >Several branches
of
>>ECA were
>>        sampled.   All signals were similar, but >some were antegrade,
some
>>        retrograde.
>>        TCD was performed.  R side WNL-no >abnormalities seen.  L side-
>>terminal ICA
>>        showed similar pattern seen in the >extracranial ICA.  MCA
flows
were
>>        normal????  PCA WNL.  ACA not seen.
>>        I have never seen such a signal in the ICA.  >I would be
interested
>>in any
>>        and all thoughts on this one.
>>        MaryAnne Waters
>>        UVM
>>
>