Case Analysis & Practical Application Flashcards

A 40-year-old marathon runner undergoes echo and shows RV enlargement, increased RV trabeculation, and mildly reduced TAPSE of 18 mm with normal LV function. In the absence of symptoms, what is the most appropriate interpretation?

Answer: Athletic heart with physiologic RV adaptation

Endurance athletes commonly develop physiologic RV remodeling with mild enlargement and increased trabeculation; TAPSE near normal limits and absence of symptoms favor athlete's heart.

A patient with hypertrophic cardiomyopathy has a subaortic peak gradient of 45 mmHg at rest. On echo, the anterior mitral leaflet moves toward the septum during systole. What phenomenon is occurring?

Answer: Systolic anterior motion (SAM) of the mitral valve

SAM of the mitral valve is the dynamic obstruction mechanism in HOCM where the anterior leaflet is drawn into the LVOT during systole, worsening the gradient.

During a TEE for evaluation of a stroke source, you identify a small interatrial communication with bidirectional shunting augmented by Valsalva maneuver and contrast (agitated saline) crossing from right to left atrium within 3 beats of RV opacification. What is the diagnosis?

Answer: Patent foramen ovale (PFO)

Bubble contrast crossing from RA to LA within 3 cardiac cycles with augmentation by Valsalva is the classic TEE finding of a patent foramen ovale.

An elderly patient with rheumatic history shows a mitral valve with diastolic doming, commissural fusion, and subvalvular thickening. Mean gradient is 10 mmHg and MVA by PHT is 1.0 cm². What severity of mitral stenosis is present?

Answer: Severe mitral stenosis (MVA <1.0 cm²)

MVA of 1.0 cm² meets the threshold for severe mitral stenosis (≤1.0 cm²) per ACC/AHA guidelines.

A patient with renal failure on dialysis has echo showing bright echoes along the mitral annulus posteriorly with acoustic shadowing and reverberations. There is mild mitral regurgitation. What is the most likely finding?

Answer: Mitral annular calcification (MAC)

Mitral annular calcification is common in renal failure patients and appears as a dense, echogenic structure along the posterior annulus with posterior shadowing.

A patient with a history of pericarditis presents with dyspnea, elevated JVP, Kussmaul sign, and equalization of diastolic pressures on cath. Echo shows a thickened, bright pericardium with septal bounce and respiratory variation >25% in mitral inflow E velocity. What is the diagnosis?

Answer: Constrictive pericarditis

Septal bounce, exaggerated mitral inflow respiratory variation, and thickened pericardium with Kussmaul sign and equalized diastolic pressures define constrictive pericarditis.

A 28-year-old with Marfan syndrome has aortic root dilation to 4.6 cm at the sinuses of Valsalva and mild aortic regurgitation. LV dimensions are normal. Using current guidelines, at what aortic root diameter should elective surgical repair be considered in Marfan patients?

Answer: 4.5 cm

ACC/AHA guidelines recommend elective aortic root repair in Marfan syndrome when the aortic root reaches 4.5 cm (or at 4.0 cm with rapid growth or family history of dissection).