In mitral stenosis, which Doppler-derived velocities increase with severity?

In mitral stenosis, which Doppler-derived velocities increase with severity?

• A. E velocity and A velocity increase
• B. E velocity increases while A velocity decreases
• C. E velocity decreases and A velocity increases
• D. Both velocities decrease

Answer: (A)

As mitral stenosis becomes more severe, the pressure gradient across the mitral valve during diastole increases. That larger gradient makes the blood jet across the narrowed orifice faster, so the early diastolic (E) Doppler velocity rises. At the same time, the left atrium has to work harder to push blood through the narrowed valve, so the atrial contraction (A) Doppler velocity also increases. Put together, both E and A velocities climb with greater stenosis. (Note: in atrial fibrillation, the A wave can be absent, but the general pattern in progressive MS is for both velocities to rise.)

As mitral stenosis becomes more severe, the pressure gradient across the mitral valve during diastole increases. That larger gradient makes the blood jet across the narrowed orifice faster, so the early diastolic (E) Doppler velocity rises. At the same time, the left atrium has to work harder to push blood through the narrowed valve, so the atrial contraction (A) Doppler velocity also increases. Put together, both E and A velocities climb with greater stenosis. (Note: in atrial fibrillation, the A wave can be absent, but the general pattern in progressive MS is for both velocities to rise.)