AE-Adult-Echocardiography Dumps with Practice Exam Questions Answers

Marfan syndrome is a connective tissue disorder characterized by abnormalities in the fibrillin-1 gene, leading to cardiovascular manifestations including aortic root and annular dilatation. Aortic annular dilatation predisposes to aortic valve insufficiency (regurgitation) and aortic aneurysm formation.

Coarctation of the aorta is more commonly associated with Turner syndrome. Parachute mitral valve and cleft mitral valve are congenital abnormalities linked to other syndromes or defects but not typical in Marfan syndrome.

This association is described in the "Textbook of Clinical Echocardiography, 6e", Chapter on Genetic Syndromes and Cardiovascular Manifestations【20:120-125†Textbook of Clinical Echocardiography】.QUESTION NO: 91

Which condition causes both tricuspid stenosis and tricuspid regurgitation?

A. Pulmonary hypertension

B. Cor pulmonale

C. Carcinoid heart disease

D. Amyloid heart disease

Answer: C

Comprehensive and Detailed Explanation From Exact Extract:

Carcinoid heart disease results from the deposition of fibrous plaques on the endocardium of right-sided heart valves, predominantly affecting the tricuspid and pulmonary valves. This leads to both tricuspid stenosis (valve leaflet thickening and immobility causing obstruction) and tricuspid regurgitation (incomplete coaptation due to leaflet retraction).

Pulmonary hypertension and cor pulmonale cause primarily functional tricuspid regurgitation without stenosis. Amyloid heart disease can cause restrictive cardiomyopathy but rarely causes combined tricuspid valve stenosis and regurgitation.

These pathological changes are detailed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Carcinoid Heart Disease and Right Heart Valve Disease【20:335-340†Textbook of Clinical Echocardiography】.

Comprehensive and Detailed Explanation From Exact Extract:

Constrictive pericarditis is characterized by thickening and fibrosis of the pericardium which restricts diastolic filling of the ventricles. Key echocardiographic features include a characteristic interventricular septal "bounce" or shift during early diastole due to the abrupt cessation of ventricular filling imposed by the rigid pericardium. This septal bounce reflects rapid early diastolic filling followed by a sudden halt as filling pressures equalize, a hallmark of constriction physiology.

Additionally, Doppler studies show marked respiratory variation in mitral and tricuspid inflow velocities (>25%), with an inspiratory increase in tricuspid inflow and a decrease in mitral inflow velocity, reflecting ventricular interdependence caused by the noncompliant pericardium. The mitral inflow typically shows a large E-wave with a small or absent A-wave and a steep deceleration slope, but importantly these velocities vary significantly with respiration, which is not the case in restrictive cardiomyopathy.

Hepatic vein Doppler often reveals a prominent a-wave and a deep y-descent with increased diastolic flow reversal during expiration, indicating elevated right atrial pressures and constrictive physiology.

The inferior vena cava (IVC) is usually dilated and shows no inspiratory collapse (i.e., no normal collapse with sniff test) because of elevated right atrial pressure and impaired venous return.

Therefore:

Option A is incorrect because mitral inflow in constrictive pericarditis shows significant respiratory variation, not absence of it.

Option B is incorrect because the hepatic vein is typically dilated with abnormal flow patterns, not normal size.

Option C is incorrect because the IVC is dilated and does NOT collapse normally with inspiration/sniff in constrictive pericarditis.

Option D is correct because the interventricular septal bounce is a classic feature reflecting ventricular interdependence and constrictive physiology.

These findings are summarized in the "Textbook of Clinical Echocardiography, 6e" (Catherine M. Otto, MD), Chapter 10 (Pericardial Disease), pages 280–285, with key illustrations showing septal bounce, Doppler inflow variations, hepatic vein flow patterns, and IVC findings in constrictive pericarditis. The "Mayo Clinic criteria" for echocardiographic diagnosis also emphasize ventricular septal shift as a critical feature, often combined with tissue Doppler annular velocity patterns and hepatic vein diastolic flow reversal for high diagnostic accuracy.

The subcostal view is the preferred transthoracic echocardiographic window to assess atrial situs, especially in congenital heart disease. This view provides a cross-sectional look at the abdominal organs and atrial chambers, helping determine the relative position of the inferior vena cava and aorta, which aids in defining atrial situs (solitus, inversus, or ambiguous).

Short axis and long axis views provide excellent cardiac anatomy but are less informative for visceral situs. The suprasternal notch window is mainly used to visualize the great vessels but does not provide adequate assessment of atrial situs.

The subcostal view's ability to demonstrate abdominal situs and systemic venous return makes it essential in congenital cardiac evaluations and is recommended in echocardiography protocols for congenital heart disease assessment .

Comprehensive and Detailed Explanation From Exact Extract:

The P wave on the ECG corresponds to atrial depolarization, which precedes atrial contraction (atrial systole). On echocardiography, atrial contraction can be observed as the atrial "kick," contributing to ventricular filling during late diastole.

Ventricular contraction (QRS complex) and ventricular relaxation (T wave) correspond to other phases of the cardiac cycle. Atrial relaxation occurs during ventricular systole but is not represented by the P wave.

This timing relationship is critical for correlating echocardiographic Doppler inflow patterns, such as the late diastolic A wave, with the ECG. These concepts are outlined in the foundational echocardiography references, including ASE guidelines and the "Textbook of Clinical Echocardiography"【16:Textbook of Clinical Echocardiography, 6e†p.150-155】【12:ASE Echocardiography Guidelines†p.50-55】.

The two-chamber apical view allows visualization of the left ventricle's anterior and inferior walls, including the apical lateral segment. It is ideal for assessing wall thickness and segmental wall motion abnormalities in this region.

The four-chamber view visualizes septal and lateral walls but does not optimally display the apical lateral segment. Parasternal long axis primarily visualizes the anterior septum and posterior wall but is limited for lateral apex. The mid-parasternal short axis focuses on mid-ventricular segments and does not visualize the apex.

This anatomical and echocardiographic detail is described in the "Textbook of Clinical Echocardiography, 6e", Chapter on Left Ventricular Segmental Analysis【20:120-125†Textbook of Clinical Echocardiography】.