ARDMS Echo Pericardial Disease 2 — Questions and Answers
Question 1: Which echocardiographic sign of cardiac tamponade typically appears earliest as pericardial pressure rises?
- Right ventricular diastolic collapse
- Right atrial systolic collapse (Correct answer)
- Inferior vena cava plethora
- Left ventricular diastolic collapse
Correct answer: Right atrial systolic collapse
Right atrial systolic collapse is the earliest sign of tamponade because the right atrium has the lowest intracavitary pressure and the thinnest wall, making it most susceptible to external compression.
Question 2: In cardiac tamponade, what degree of respiratory variation in mitral inflow peak E-wave velocity is considered hemodynamically significant?
- > 10% decrease with inspiration
- > 25% decrease with inspiration (Correct answer)
- > 40% decrease with inspiration
- > 50% decrease with inspiration
Correct answer: > 25% decrease with inspiration
A respiratory variation in mitral E-wave velocity exceeding 25% is the Doppler equivalent of clinical pulsus paradoxus and indicates significant tamponade physiology.
Question 3: Which inferior vena cava finding on echocardiography is most consistent with cardiac tamponade?
- IVC diameter < 1.5 cm with normal inspiratory collapse
- Dilated IVC with < 50% inspiratory collapse (Correct answer)
- Normal IVC with exaggerated inspiratory collapse
- IVC cannot be assessed in tamponade
Correct answer: Dilated IVC with < 50% inspiratory collapse
Cardiac tamponade elevates right atrial pressure, resulting in a plethoric (dilated) IVC that fails to collapse normally with inspiration.
Question 4: Which Doppler finding best distinguishes constrictive pericarditis from restrictive cardiomyopathy on tissue Doppler imaging?
- Elevated E/e' ratio > 15
- Prominent mitral E wave
- Medial mitral annulus e' velocity greater than lateral e' velocity (annulus reversus) (Correct answer)
- Decreased mitral deceleration time
Correct answer: Medial mitral annulus e' velocity greater than lateral e' velocity (annulus reversus)
In constrictive pericarditis, the rigid pericardium limits lateral annular expansion while preserving medial longitudinal motion, producing the annulus reversus pattern (medial e' > lateral e').
Question 5: The interventricular septal bounce in constrictive pericarditis is most pronounced during which phase of respiration?
- End expiration
- Early inspiration (Correct answer)
- Peak inspiration
- End inspiration
Correct answer: Early inspiration
The abrupt septal shift (bounce) in constrictive pericarditis occurs at early inspiration when sudden changes in ventricular filling due to ventricular interdependence are greatest.
Question 6: What hepatic vein Doppler pattern is most characteristic of constrictive pericarditis?
- Blunted systolic (S) wave
- Prominent diastolic flow reversal with expiration (Correct answer)
- Absent diastolic (D) wave
- Increased systolic-to-diastolic ratio
Correct answer: Prominent diastolic flow reversal with expiration
Constrictive pericarditis produces prominent hepatic vein diastolic flow reversal during expiration, reflecting the abnormal increase in right ventricular pressure that occurs with expiration due to ventricular interdependence.
Question 7: Which combination of assessments is recommended when cardiac tamponade is suspected echocardiographically?
- Two-dimensional imaging alone
- Combined 2D imaging, M-mode, and Doppler with respiratory variation assessment (Correct answer)
- Three-dimensional echocardiography only
- Stress echocardiography
Correct answer: Combined 2D imaging, M-mode, and Doppler with respiratory variation assessment
A complete tamponade evaluation requires 2D imaging to identify chamber collapse, M-mode for precise timing of collapse relative to the cardiac cycle, and Doppler to quantify respiratory variation in transvalvular flow velocities.
ARDMS Echo Pericardial Disease 2
Which echocardiographic sign of cardiac tamponade typically appears earliest as pericardial pressure rises?