CVT Echocardiography Techniques 3 — Questions and Answers
Question 1: In the modified Simpson's biplane method for ejection fraction calculation, images from which two views are required?
- Parasternal long-axis and short-axis
- Apical four-chamber and apical two-chamber (Correct answer)
- Subcostal and suprasternal
- Parasternal long-axis and apical four-chamber
Correct answer: Apical four-chamber and apical two-chamber
Simpson's biplane method requires tracing the left ventricular cavity in both the apical four-chamber and apical two-chamber views.
Question 2: Which echocardiographic finding is most characteristic of cardiac tamponade on two-dimensional imaging?
- Left atrial dilation
- Right ventricular diastolic collapse (Correct answer)
- Mitral valve prolapse
- Aortic root dilation
Correct answer: Right ventricular diastolic collapse
Right ventricular diastolic collapse occurs when pericardial pressure exceeds right ventricular diastolic pressure, indicating hemodynamically significant tamponade.
Question 3: The proximal isovelocity surface area (PISA) method estimates regurgitant volume by analyzing which flow phenomenon?
- Turbulent distal jet
- Hemispheric flow convergence proximal to the regurgitant orifice (Correct answer)
- Downstream vena contracta width
- Pressure half-time of the regurgitant signal
Correct answer: Hemispheric flow convergence proximal to the regurgitant orifice
PISA measures the radius of the hemispheric flow convergence zone proximal to the regurgitant orifice to calculate effective regurgitant orifice area.
Question 4: Which transesophageal echocardiographic (TEE) view is optimal for evaluating the left atrial appendage for thrombus?
- Mid-esophageal four-chamber view at 0°
- Mid-esophageal two-chamber view at 60–90° (Correct answer)
- Transgastric short-axis view at 0°
- Upper esophageal aortic arch view
Correct answer: Mid-esophageal two-chamber view at 60–90°
The mid-esophageal two-chamber view at 60–90° provides the best visualization of the left atrial appendage due to its proximity to the esophagus.
Question 5: Which Doppler pattern of mitral inflow indicates Grade III (reversible restrictive) diastolic dysfunction?
- E/A ratio < 0.8 with normal deceleration time
- E/A ratio 0.8–2 with E/e' > 14
- E/A ratio > 2 with deceleration time < 160 ms that normalizes with Valsalva (Correct answer)
- E/A ratio > 2 with deceleration time < 160 ms that does not change with Valsalva
Correct answer: E/A ratio > 2 with deceleration time < 160 ms that normalizes with Valsalva
Grade III reversible restrictive filling shows E/A > 2 with shortened deceleration time that reverts to a lower E/A ratio during Valsalva maneuver.
Question 6: What does the term 'aliasing' refer to in pulsed-wave Doppler echocardiography?
- Signal dropout due to poor acoustic windows
- Underestimation of velocity when it exceeds the Nyquist limit (Correct answer)
- Overestimation of velocity due to beam angulation
- Ghost images from side lobe artifacts
Correct answer: Underestimation of velocity when it exceeds the Nyquist limit
Aliasing occurs when blood velocity exceeds the Nyquist limit (half the pulse repetition frequency), causing the signal to wrap around and appear in the opposite direction.
Question 7: Strain rate echocardiography using speckle tracking primarily measures which mechanical property of the myocardium?
- Myocardial perfusion reserve
- Rate of myocardial deformation per unit time (Correct answer)
- Wall motion score index
- Intracavitary pressure gradients
Correct answer: Rate of myocardial deformation per unit time
Strain rate reflects how quickly the myocardium deforms (shortens or lengthens) and is calculated as the spatial gradient of myocardial velocity.
CVT Echocardiography Techniques 3
In the modified Simpson's biplane method for ejection fraction calculation, images from which two views are required?