NBE Transthoracic Echocardiography 3 — Questions and Answers
Question 1: Which TTE measurement is used to calculate the continuity equation for aortic valve area (AVA)?
- Mitral valve annulus diameter and transmitral VTI
- LVOT diameter, LVOT VTI, and aortic jet VTI (Correct answer)
- Aortic root diameter and peak aortic velocity
- Left ventricular end-diastolic volume and stroke volume
Correct answer: LVOT diameter, LVOT VTI, and aortic jet VTI
AVA = (LVOT area × LVOT VTI) / Aortic jet VTI; both the LVOT diameter and velocity-time integrals are essential inputs.
Question 2: A tissue Doppler e' velocity of 6 cm/s at the medial mitral annulus combined with an E/e' ratio of 16 suggests:
- Normal left ventricular filling pressures
- Indeterminate left ventricular filling pressures
- Elevated left ventricular filling pressures (Correct answer)
- Reduced preload with normal compliance
Correct answer: Elevated left ventricular filling pressures
An E/e' ratio > 14 using the medial annulus indicates elevated LV filling pressures (estimated mean LAP > 12 mmHg).
Question 3: During assessment of aortic regurgitation severity, a pressure half-time (PHT) < 200 ms on CW Doppler of the aortic regurgitant jet indicates:
- Mild aortic regurgitation
- Moderate aortic regurgitation
- Severe aortic regurgitation (Correct answer)
- Normal aortic valve closure
Correct answer: Severe aortic regurgitation
A short PHT (< 200 ms) indicates rapid equilibration of aortic and LV diastolic pressures, consistent with severe AR and poor diastolic filling.
Question 4: What is the recommended transducer frequency range for standard adult transthoracic echocardiography?
- 1–2 MHz
- 2–4 MHz (Correct answer)
- 5–10 MHz
- 10–15 MHz
Correct answer: 2–4 MHz
Adult TTE typically uses 2–4 MHz phased-array transducers, balancing adequate penetration with acceptable resolution.
Question 5: Which condition is most likely when TTE shows a 'swinging heart' within a large pericardial effusion?
- Constrictive pericarditis
- Cardiac tamponade (Correct answer)
- Dilated cardiomyopathy
- Hypertensive heart disease
Correct answer: Cardiac tamponade
The pendular motion of the heart ('swinging heart') within a large effusion is associated with tamponade and causes electrical alternans on ECG.
Question 6: In evaluating tricuspid regurgitation by TTE, the simplified Bernoulli equation (4v²) applied to the TR jet peak velocity estimates:
- Right ventricular systolic pressure (Correct answer)
- Pulmonary artery diastolic pressure
- Mean pulmonary artery pressure
- Left atrial pressure
Correct answer: Right ventricular systolic pressure
RVSP = 4 × (TR peak velocity)² + estimated RAP; this equals PASP in the absence of pulmonary stenosis or RVOT obstruction.
Question 7: Which parasternal short-axis level is used to assess the mitral valve leaflet tips for planimetry?
- Aortic valve level
- Papillary muscle level
- Mitral valve tip level (Correct answer)
- Apical level
Correct answer: Mitral valve tip level
Planimetry of the mitral valve orifice is performed at the leaflet tip level in the PSAX view to directly trace the valve opening area.
NBE Transthoracic Echocardiography 3
Which TTE measurement is used to calculate the continuity equation for aortic valve area (AVA)?