NBE Transthoracic Echocardiography 4 — Questions and Answers
Question 1: Which echocardiographic finding is most specific for constrictive pericarditis compared with restrictive cardiomyopathy?
- Biatrial enlargement
- Respiratory variation in mitral E velocity > 25% (Correct answer)
- Elevated E/e' ratio
- Reduced tissue Doppler e' velocity
Correct answer: Respiratory variation in mitral E velocity > 25%
In constrictive pericarditis, the rigid pericardium causes exaggerated interventricular dependence, resulting in > 25% respiratory variation in mitral inflow E velocity.
Question 2: A patient's TTE shows a bicuspid aortic valve with a doming appearance. Which complication should be most closely monitored?
- Mitral regurgitation
- Aortic root dilation and aneurysm (Correct answer)
- Tricuspid stenosis
- Left ventricular non-compaction
Correct answer: Aortic root dilation and aneurysm
Bicuspid aortic valve is associated with aortopathy including aortic root and ascending aorta dilation, requiring serial imaging surveillance.
Question 3: On a standard TTE, which structure is best seen in the subcostal view that may be difficult to assess from parasternal windows?
- Left atrial appendage
- Atrial septum and right ventricle (Correct answer)
- Aortic arch
- Left coronary artery
Correct answer: Atrial septum and right ventricle
The subcostal view provides an orthogonal perspective ideal for evaluating the atrial septum (including ASD) and the right ventricle.
Question 4: The 'hockey stick' or 'elbow' deformity of the anterior mitral leaflet on 2D TTE is classically associated with:
- Mitral annular calcification
- Rheumatic mitral stenosis (Correct answer)
- Mitral valve prolapse
- Papillary muscle rupture
Correct answer: Rheumatic mitral stenosis
Rheumatic MS causes tip fusion and doming of the anterior mitral leaflet, producing the characteristic hockey-stick appearance on PLAX view.
Question 5: Which formula correctly expresses left ventricular ejection fraction (LVEF) using biplane Simpson's method?
- (EDV − ESV) / EDV × 100% (Correct answer)
- (ESV / EDV) × 100%
- (EDV + ESV) / EDV × 100%
- Stroke volume / heart rate × 100%
Correct answer: (EDV − ESV) / EDV × 100%
LVEF = [(EDV − ESV) / EDV] × 100%; biplane Simpson's method sums disk volumes from apical 4- and 2-chamber views to calculate EDV and ESV.
Question 6: A dilated right ventricle with D-shaped interventricular septum flattening during systole on PSAX view suggests:
- Left ventricular volume overload
- Right ventricular pressure overload (Correct answer)
- Normal septal motion
- Left ventricular pressure overload
Correct answer: Right ventricular pressure overload
Systolic septal flattening (D-sign) indicates RV pressure overload; diastolic flattening indicates volume overload.
Question 7: Which Doppler finding best differentiates severe mitral regurgitation from moderate MR using the vena contracta method?
- Vena contracta width ≥ 7 mm indicates severe MR (Correct answer)
- Vena contracta width ≥ 3 mm indicates severe MR
- Vena contracta width < 3 mm indicates severe MR
- Vena contracta is not useful for grading MR severity
Correct answer: Vena contracta width ≥ 7 mm indicates severe MR
A vena contracta width ≥ 7 mm is a specific marker of severe MR, representing the narrowest portion of the regurgitant jet at the orifice.
NBE Transthoracic Echocardiography 4
Which echocardiographic finding is most specific for constrictive pericarditis compared with restrictive cardiomyopathy?