Echocardiography
Miscellaneous
Coronary artery disease
It's electrical
Pericardium
100
What pathology does this M-mode show?
What is LVOT obstruction in the setting of hypertrophic cardiomyopathy?
Explanation: This Figure depicts M-mode through the aortic valve (AoV) and displays premature closure of the AoV leaflets due to left ventricular outflow tract obstruction in the setting of hypertrophic cardiomyopathy.
100
A 35 year old man presents for follow up. He was diagnosed with HCM 1 year ago. He is asymptomatic. Based on the ACC/AHA 2020 HCM guidelines, surveillance monitoring with TTE is recommended in this patient every ___ years (Class 1 recommendation)
1-2 years
100
A 40-year-old man presents to the emergency department with severe substernal chest pain that awakened him from sleep. He smokes one pack of cigarettes per day. On examination his blood pressure is 136/84 mm Hg, heart rate is 98 bpm, and his cardiac examination is otherwise unremarkable. His electrocardiogram shows ST segment elevation in leads V1-V3. His high sensitivity troponin T is 220 ng/L. Coronary angiography is notable for the following images (Figure 1; initial and after intracoronary nitroglycerin). His urine toxicology is negative for illicit substances.
What's the diagnosis?
What is Coronary vasospasm (printzmetal angina) ?
This patient's coronary angiography confirms diffuse severe narrowing that is relieved with intracoronary nitroglycerin. Stenting is not necessary in the absence of significant atherosclerotic narrowing.
100
Autosomal dominant inheritance pattern and the ECG finding below are characteristic of this condition
Arrhythmogenic Cardiomyopathy
Epsilon wave
100
Respiratory variation of the mitral inflow velocity measured by Doppler that varies by more than this percentage is supportive of a diagnosis of cardiac tamponade
What is 25%?
200
During routine assessment of a patient with known valvular disease, the sonographer measures a mitral inflow deceleration time of 758 ms. What is a reasonable estimate of the mitral valve area?
Calculate MVA
1.0cm2
This question refers to mitral valve area calculation based on the pressure half-time. The relationship between pressure half-time and deceleration time is constant:
Pressure half-time = 0.29 × deceleration time.
Furthermore, the mitral valve area is estimated according to the formula:
MVA = 220/ pressure half-time.
Using the numbers provided, MVA is 220/(0.29 × 758 ms) = 1.0 cm2
200
This diagnosis is represented by this ECG...
What is limb lead reversal?
200
Based on DEFINE-FLAIR study, a value at or below this number is considered significant for iFR (instantaneous wave-free ratio)
0.89
200
During sinus rhythm, the electrical impulses originate in the right atrium and move to the left atrium predominantly across this to maintain synchrony....
What is Bachmann bundle?
200
This is the diagnosis represented by this ECG....
What is Acute pericarditis?
300
A patient with a right ventricular pacemaker lead infection undergoes lead removal. Following the procedure, a TEE is performed (Figure 21.3). What is the structure in the right atrium given the clinical context?
Your options:
A. A residual vegetation
B. A "ghost"
C. A thrombus
D. A benign cardiac tumor
B: A "ghost"
Explanation:
A “ghost” is a tubular, mobile mass in the path of an intracardiac lead following lead extraction. It seldom occurs following lead extraction for a noninfective reason. It is believed to consist of fibrous sheaths mixed with vegetations in most cases. Ghosts have been reported in 8% to 19% of all patients following lead removal. The incidence rises to 16% in the setting of cardiac device–related IE, but only 5% if there is only local device pocket infection. Cardiac device–related IE and positive lead cultures, but not positive blood cultures, have been reported to be associated with the presence of a ghost after lead removal. Prospective data suggest an independent association between the presence of ghosts and mortality following lead removal.
300
Length of time for which ACEI must be discontinued prior to initiating sacubitril/valsartan
36 hours
300
This is diagnosis represented by this ECG...
What is acute posterior (or inferolateral) MI?
300
This is the diagnosis represented by this ECG...
What is RVH?
- Right axis deviation of +110° or more.
- Dominant R wave in V1 (> 7mm tall or R/S ratio > 1).
- Dominant S wave in V5 or V6 (> 7mm deep or R/S ratio < 1).
- QRS duration < 120ms (i.e. changes not due to RBBB).
300
This structure forms the lower boundary of the transverse pericardial sinus
What is Left atrium
400
How will the pulmonary venous Doppler flow pattern immediately change in the case of left atrial stunning (eg, after cardioversion for persistent atrial fibrillation)?
This figure shows normal interrogation of PVs
A blunted S wave, mainly due to loss of S1 and absence of AR velocity.
Explanation:
There are two systolic velocities (S1 and S2), mostly noticeable when there is a prolonged PR interval since S1 is related to atrial relaxation. S2 should be used to compute the ratio of peak systolic to peak diastolic velocity. S1 velocity is primarily influenced by changes in left atrial pressure and left atrial relaxation or contraction, whereas S2 is related to stroke volume and pulse wave propagation in the pulmonary arterial tree. The diastolic velocity D is influenced by changes in LV filling and compliance and changes in parallel with mitral E velocity. Pulmonary venous atrial flow reversal (AR) velocity and duration are influenced by LV late diastolic pressures, atrial preload, and left atrial contractility. Atrial fibrillation or atrial stunning will result in a blunted S wave, mainly due to a loss of S1 with a decreased systolic fraction and absence of AR velocity
400
What is Isovolumic Contraction
400
IV Cangrelor is being infused in a patient with STEMI. To ensure absorption, only this oral FDA-approved antiplatelet can be given while Cangrelor is being infused.
What is ticagrelor?
400
The electrolyte that may be directly related to the mechanism of this unique arrhythmia...
Calcium
This ECG is an example of bidirectional VT
Also can be seen in calcium overloaded states such as CPVT and digitalis toxicity
400
This carcinogen is the cause of a rare malignancy that is the most common primary pericardial tumor
What is Asbestos?
Mesothelioma is the most common primary pericardial tumor
500
An echocardiogram is obtained on a 3-month-old infant with a loud cardiac murmur. The parasternal short-axis scan in Figure 32.2 is obtained. Which of the following BEST describes the cardiac defect?
A: large membranous VSD
B: large muscular VSD
C: Severe valvular pulmonic stenosis
D: Severe Aortic Regurgitation
Answer: A membranous VSD
The parasternal short-axis image in Figure is a classic demonstration of a membranous VSD adjacent to the tricuspid valve. Color Doppler demonstrates a high-velocity mosaic jet from the left ventricle to the right ventricle.
500
This patient does not have Constriction. This condition can result in rapid "y" descent in RA.
What is severe TR?
- Other causes also severe RV failure
500
This P2Y12 ADP receptor antagonist should NOT be used prior to diagnostic angiogram in patients with NSTEMI/Unstable Angina
What is Prasugrel?
500
If a patient with the ECG below has palpitations associated with AV re-entry, the ablation catheter should be placed in this location in the heart...
Mitral Annulus
Arruda Criteria
500
The pattern of RV pressure seen in the tracing below suggests this diagnosis
What is Constrictive pericarditis?
- square root sign
It indicates rapid early diastolic filling of the ventricle, followed by a sudden halt in filling as the stiff pericardium restricts further expansion.