Case Analysis & Practical Application Flashcards

A patient with known hypertension has concentric LV hypertrophy (relative wall thickness 0.52) with normal cavity size and an EF of 65%. Diastolic assessment shows E/e' ratio of 16 and LAVi of 38 mL/m². What grade of diastolic dysfunction is present?

Answer: Grade II (pseudonormal)

E/e' >14 combined with enlarged LAVi in a patient with LVH and normal EF meets criteria for Grade II (pseudonormal/moderate) diastolic dysfunction.

During examination of a premature infant, you identify a continuous 'machinery' murmur and echo demonstrates a tubular connection between the descending aorta and the pulmonary artery with left-to-right shunting. What structure has failed to close?

Answer: Patent ductus arteriosus

Persistence of the ductus arteriosus after birth creates the classic continuous murmur and aorta-to-pulmonary artery shunt seen in PDA.

A patient with systemic lupus erythematosus has small, irregular, non-mobile vegetations on both surfaces of the mitral and aortic valves. Cultures are negative. Which condition should be suspected?

Answer: Libman-Sacks endocarditis

Libman-Sacks endocarditis is the non-bacterial thrombotic endocarditis associated with SLE, characterized by small verrucous lesions on both valve surfaces.

On 2D echo, a patient with chest pain has an aortic root measuring 5.2 cm at the sinuses of Valsalva with a Type A dissection flap visible on TEE extending into the ascending aorta. The aortic valve shows moderate AR. Which is the most critical immediate finding to report?

Answer: Dissection flap in the ascending aorta (Type A)

Type A aortic dissection involving the ascending aorta is a surgical emergency requiring immediate reporting as it carries high mortality without intervention.

A 55-year-old with progressive dyspnea shows echo findings of right heart enlargement, RV pressure overload pattern (D-shaped septum in systole), tricuspid regurgitation with peak velocity 4.5 m/s, and no left-sided disease. What condition should be the primary consideration?

Answer: Pulmonary arterial hypertension

TR jet velocity of 4.5 m/s yields an estimated RVSP of >80 mmHg, and the septal flattening with RV enlargement without left-sided cause points to pulmonary arterial hypertension.

A patient post-cardiac surgery presents with hypotension, elevated JVP, and muffled heart sounds. Echo shows a moderate circumferential pericardial effusion with right atrial collapse lasting more than one-third of systole and right ventricular diastolic collapse. What hemodynamic state is present?

Answer: Cardiac tamponade

RA collapse >1/3 systole and RV diastolic collapse with circumferential effusion and clinical signs indicate cardiac tamponade physiology.

Spectral Doppler across a bioprosthetic mitral valve shows mean gradient of 8 mmHg and PHT of 230 ms. Effective orifice area by PHT is 0.96 cm². How should this prosthetic valve be assessed?

Answer: Possible prosthetic mitral stenosis warranting further evaluation

PHT >200 ms and elevated mean gradient for a bioprosthetic mitral valve suggest possible prosthetic stenosis and warrant correlation with clinical findings and prior studies.