Overview
This lecture covered echocardiography board review questions focusing on cardiac pathologies, anatomical identification, and physiologic responses observed in echocardiography.
Cardiac Defects and Pathologies
- Ventricular septal defect (VSD) after myocardial infarction is seen on echocardiogram.
- Apical hypertrophic cardiomyopathy is differentiated from other cardiomyopathies by echocardiogram.
- Non-compaction cardiomyopathy is visualized using contrast agents like Optison, Definity, or Lumison.
- Perimembranous and supercrystal types of VSD can cause aortic regurgitation; supercrystal VSDs are specifically associated.
- Renal cell carcinoma is the tumor that invades renal veins.
- Angiosarcoma commonly found in the right atrium is noted with echocardiogram.
- Papillary fibroelastoma appears in a non-febrile patient with high white blood cells.
Pericardial and Constrictive Physiology
- Flat posterior wall in diastole signals constrictive pericarditis.
- Large circumferential pericardial effusion can cause tamponade; tricuspid inflow velocity increases during inspiration.
- In tamponade, the ventricular septum moves to the left during inspiration and towards the RV free wall during expiration.
- In constrictive pericarditis, the ventricular septum moves towards the RV free wall during expiration.
- Hepatic vein flow reversal increases during expiration in constrictive pericarditis; hepatic vein blood flow decreases.
Echocardiographic Anatomy and Imaging
- Thoracic aorta is visualized by tilting the transducer posteriorly; dilated coronary sinus is noted in long axis.
- Posterior and anterior tricuspid leaflets can be identified on echo images.
- The inferior vena cava (IVC) can be distinguished from the right atrium, right ventricle, and superior vena cava in RVIT view.
Congenital Heart Disease
- Epstein’s anomaly involves an atrialized right ventricle and the tricuspid valve displaced by 10 mm from the mitral valve.
Chamber Dilation
- With severe mitral regurgitation (MR), right ventricle dilates first due to backflow from left atrium to lungs to right heart.
Key Terms & Definitions
- VSD (Ventricular Septal Defect) — an opening in the septum between ventricles.
- Tamponade — compression of the heart by pericardial fluid.
- Constrictive Pericarditis — thickened pericardium limiting heart movement.
- Epstein’s Anomaly — tricuspid valve displaced towards the apex, atrializing part of the right ventricle.
- Non-compaction Cardiomyopathy — myocardium appears spongy due to prominent trabeculations.
- Supercrystal VSD — a VSD located near the aortic and pulmonary valves.
Action Items / Next Steps
- Review types and echocardiographic features of cardiomyopathies and VSDs.
- Study pericardial disease effects on heart physiology using echo findings.
- Practice anatomical identification on echocardiographic images.
- Prepare for additional questions and mock exams as recommended.