Echocardiogram Cardiac Pathology and Disease Recognition 2 — Questions and Answers
Question 1: Which echocardiographic feature best differentiates constrictive pericarditis from restrictive cardiomyopathy?
- Mitral E/A ratio greater than 2
- Septal bounce and respiratory variation in mitral inflow >25% (Correct answer)
- Biatrial enlargement
- Reduced tissue Doppler e' velocity
Correct answer: Septal bounce and respiratory variation in mitral inflow >25%
Septal bounce and >25% respiratory variation in mitral inflow velocities are hallmarks of constrictive pericarditis, reflecting interventricular dependence.
Question 2: A vegetation on the aortic valve with associated aortic regurgitation is most consistent with which diagnosis?
- Rheumatic aortic stenosis
- Bicuspid aortic valve
- Infective endocarditis (Correct answer)
- Aortic dissection flap
Correct answer: Infective endocarditis
Valvular vegetations with associated regurgitation are the classic echocardiographic hallmarks of infective endocarditis.
Question 3: On echocardiography, which finding is pathognomonic for cardiac tamponade physiology?
- Large pericardial effusion alone
- Right ventricular diastolic collapse with respiratory variation in tricuspid inflow (Correct answer)
- Mitral valve prolapse with effusion
- Dilated inferior vena cava only
Correct answer: Right ventricular diastolic collapse with respiratory variation in tricuspid inflow
RV diastolic collapse combined with respiratory variation >40% in tricuspid inflow is pathognomonic for cardiac tamponade physiology.
Question 4: Ebstein's anomaly is best characterized echocardiographically by which finding?
- Apical displacement of the tricuspid valve leaflets into the RV (Correct answer)
- Supravalvular aortic stenosis
- Mitral valve cleft with primum ASD
- Pulmonary valve atresia
Correct answer: Apical displacement of the tricuspid valve leaflets into the RV
Ebstein's anomaly is defined by apical displacement of the septal and posterior tricuspid leaflets, effectively 'atrialized' the inlet portion of the RV.
Question 5: Which echocardiographic feature best identifies a rheumatic mitral stenosis?
- Mitral valve prolapse with posterior leaflet billowing
- Diastolic doming (hockey-stick deformity) of the anterior mitral leaflet with restricted posterior leaflet (Correct answer)
- Flail anterior mitral leaflet
- Mitral annular calcification only
Correct answer: Diastolic doming (hockey-stick deformity) of the anterior mitral leaflet with restricted posterior leaflet
Rheumatic mitral stenosis classically shows diastolic doming (hockey-stick) of the anterior leaflet with restricted posterior leaflet motion due to commissural fusion.
Question 6: An intracardiac mass attached to the interatrial septum that is mobile and pedunculated most likely represents which condition?
- Left atrial thrombus
- Cardiac lipoma
- Atrial myxoma (Correct answer)
- Papillary fibroelastoma
Correct answer: Atrial myxoma
Atrial myxoma is the most common primary cardiac tumor, typically appearing as a pedunculated, mobile mass attached to the fossa ovalis of the interatrial septum.
Echocardiogram Cardiac Pathology and Disease Recognition 2
Which echocardiographic feature best differentiates constrictive pericarditis from restrictive cardiomyopathy?