Case Analysis & Practical Application Flashcards

A 60-year-old with systolic heart failure (EF 30%) has tricuspid regurgitation. The IVC is dilated at 2.4 cm with <50% collapse on sniff. What is the estimated right atrial pressure based on these findings?

Answer: 15 mmHg

IVC >2.1 cm with <50% inspiratory collapse indicates elevated RAP, estimated at 15 mmHg (range 10–20 mmHg) per ASE guidelines.

During evaluation of a chest mass, echo reveals a lobulated, mobile mass attached to the interatrial septum near the fossa ovalis with heterogeneous echogenicity. The patient reports positional dyspnea. What is the most likely diagnosis?

Answer: Left atrial myxoma

Left atrial myxoma typically arises from the fossa ovalis, is mobile, lobulated, and causes positional symptoms due to intermittent obstruction of the mitral orifice.

A patient with known liver disease and ascites has a bubble study showing contrast opacification of the left heart >5 cardiac cycles after right heart opacification without direct RA-to-LA communication. What does this suggest?

Answer: Intrapulmonary arteriovenous shunting (hepatopulmonary syndrome)

Delayed contrast crossing (>3–5 beats) after right heart opacification without a direct intracardiac shunt indicates intrapulmonary AVMs, characteristic of hepatopulmonary syndrome.

A patient with chest trauma has echo showing a hyperechoic space posterior to the left ventricle with compression of the LV cavity. There is no respiratory variation. What finding is most consistent with acute hemopericardium causing tamponade?

Answer: RV free wall diastolic collapse and RA systolic collapse

Cardiac tamponade from hemopericardium classically presents with RV diastolic collapse and RA systolic collapse due to intrapericardial pressure exceeding right-sided chamber pressures.

A patient with carcinoid syndrome has echo showing thickened, retracted, immobile tricuspid valve leaflets with severe tricuspid regurgitation and a fixed open position. The pulmonic valve is also thickened. What explains this pattern of valve involvement?

Answer: Carcinoid plaques depositing serotonin-induced fibrous tissue on right heart valves

Carcinoid heart disease causes fibrous plaque deposition (from serotonin/substance P) on the downstream side of right heart valves, leading to retraction and regurgitation.

A patient with severe aortic regurgitation has a pressure half-time of 180 ms on CW Doppler of the AR jet and holodiastolic flow reversal in the descending aorta. How do these findings influence severity classification?

Answer: PHT <200 ms and holodiastolic reversal both support severe AR

PHT <200 ms indicates rapid equalization of aortic-LV diastolic pressures, and holodiastolic flow reversal in the descending aorta are both supportive criteria for severe aortic regurgitation.

You are scanning a term neonate with cyanosis and the echo shows the aorta arising from the morphologic right ventricle (anterior and rightward) and the pulmonary artery from the morphologic left ventricle (posterior and leftward), with an intact ventricular septum. What is the diagnosis?

Answer: D-Transposition of the great arteries (D-TGA)

D-TGA is characterized by ventriculoarterial discordance with the aorta arising from the RV and the PA from the LV, creating parallel rather than crossing circulations.