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I am with Steve (and Dr Beach) and I really like your perspective on dealing with them in a practical fashion. In terns of risk of symptoms, I believe highest velopcity is the critical element. Grading a lesion to correspond to an angiographic stenosis is another issue. We often report out ranges if substantially different and will also report "image / Doppler mismatch" if they don't agree. Bill Schroedter, Venice, Fl.

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From: Steve Knight <[log in to unmask]>
Date: Thu, 15 Jan 2009 08:58:35 -0500
To: <[log in to unmask]>
Subject: Re: dysrhythmia

Karen,
Were you measuring flow in a carotid?
I have heard it argued by a respected luminary in the field (Kirk Beach) that, because it is the highest velocity that will produce the lowest  pressure (Bernoulli's principle),  the cap of a hemorrhagic plaque is more likely to get "sucked off" on the strong beat - food for thought.

Dysrhythmia's are a nuisance and come in many flavors (bigeminy, trigeminy, PVC's, Atrial fibrillation).  I try to measure peaks that occur in sinus rhythm (they are similar in height and morphology) but waiting for that to happen spontaneously will lengthen the exam time.  Take your ratios from beats that are similar (ie biggest to biggest or second from biggest to second from biggest).

A lab policy on dysrhythmias will bring consistency to your method (or error - depending on how you look at it).

Steve

On Thu, Jan 15, 2009 at 2:40 AM, K Archer <[log in to unmask]> wrote:
I had a patient the other night who had a dysrhythmia. Irregular timing,
irregular PSV. Some big "catch up" beats.

I had let the machine "High Q" calculate the (avg'd) velocity.

Few days later had conversation (counseling) with co-worker who said, Always
take highest, that's what we were taught.
I think she is harkening back to highest velocity in any segment, not The
catch up beat...

Doesnt quite feel right.

Help?

( I already searched Flownet, but only found discussion specific to BP and
tachy a fib. )

Karen RVT

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--
Steve Knight BSc RVT RDCS
Specialists In Ultrasound, Inc.

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