hi i'm tom cook i'm an emergency physician and i work with prisma health in the university of south carolina and this is a short video on the evaluation of the heart for mitral regurgitation this is a very very common valve abnormality particularly in patients who have some element of cardiomegaly due to variety of different pathologic processes and to do this exam we'll go ahead and start with b mode and to look for this particular problem we would like to get a really nice apical 4 chamber view we have a nice one right here and of course for michael riegers we'll focus on the mitral valve we got a really nice view of that right here now this is where we're going to use color doppler some people would call it color flow and you turn on color doppler and you're immediately given a view box this view box needs to be positioned and shaped and it's important to understand that you should try and use the smallest box possible because you're asking the system to do a lot of mathematical calculations and so the smaller you make this box the less work the computer has to do to make the box smaller you tap on the box you're given this little icon in the corner where you get a dot with a couple of arrows and this tells you that you can now grab that and move it in such a way that you can change the height and the width of the box once you get it to a size that you're comfortable with you're going to place that by putting your finger in the middle of the box and dragging that to the area that you're interested in evaluating which of course for us is the mitral valve so to evaluate this patient's mitral regurgitation we're going to go ahead and freeze the image and when we do so we can see that we have this mixed picture of red and blue colors in the left atrium this is an indication of turbulent flow but the way the doppler works color doppler works is that if the blood is moving towards the transducer it is by convention given a red color and if it is moving away from the transducer it is by convention given a blue color if we look at this little tracing here we can see it's predominantly blue now of course we all know that blood should only move from the atria in this case the left atrium into the left ventricle so you should never see blue in this particular chamber when we see blue we know that it must be coming from the left ventricle back into the left atrium and of course this can only occur if you have mitral regurgitation we can also look at different aspects of the actual color doppler image to give us an indication if this is mild moderate or severe disease in this particular situation this would sort of be mild to moderate amount of mitral regurgitation so in summary this is how we use color doppler to identify mitral regurgitation it can be important use in the emergency department or in an office based setting to refer these patients to a cardiologist
