CCI Review Echo 2 Exam Practice Questions And
Answers With Rationales|Already Graded A+
61 year old male with idiopathic hypertrophic sub aortic stenosis (IHSS) and a resting
gradient of 144 mm Hg. Admitted to the hospital with chest pain. The next day the
resting gradient was 15 mmHg. What happened? - ANSWER- Left Ventricular infarct
Idiopathic Hypertrophic Sub-aortic Stenosis (IHSS) is a hyperdynamic contractile state
with near-cavity obliteration during systole. It is also characterized by dynamic motion of
the anterior mitral leaflet toward the interventricular septum during systole. This dynamic
narrowing of the left ventricular outflow tract produces a pressure gradient during
systole detectible by Doppler. The m-mode shows the forward motion during systole. In
some patients, the myocardial hypertrophy is more symmetric than the asymmetric
arrangement which usually occurs in this disorder.
What is Chagas' disease? - ANSWER- -posterior and apical thinning, septum usually
normal
-most common in South America
Reduvid bug bite.
What causes the B-notch? - ANSWER- increased LVEDP
NOTE: THIS IS SEEN ON THE M MODE OF THE MITRAL VALVE
MR, PHTN , systemic HTN ARE CAUSES OF elevated LVEDP
What is hemochromatosis? - ANSWER- Excess amount of iron in the myocardium
A restrictive cardiomyopathy has which of the following?
A. Increased afterload
B. Decreased Left Ventricle compliance
C. Increased preload
D. Decreased Left Atrium pressure - ANSWER- B. Decreased Left Ventricle
compliance- Myocardial deposits cause restrictive diastolic filling
A typical ejection fraction in a dilated cardiomyopathy patient might be (for a HCM
patient?) - ANSWER- 15-25%
Choose the lowest ejection fraction of the choices
The majority of ventricular filling occurs during:
A. IVRT
B. IVCT
,C. first third diastole
D. atrial contraction - ANSWER- C. first third diastole 70%
Atrial contraction is 30%
Know that in elderly (>60) patients the A-wave is normally equal to or higher than the E
wave - ANSWER- ...
How does the normal Doppler waveform at the mitral annulus differs from flow at the
mitral leaflets tips? - ANSWER- E and A are reversed at these two sample sites
How would you determine if a patient has constrictive versus restrictive disease?
A. 2D strain imaging
B. pulmonary venous flow
C. Mitral Valve inflow with respiratory variation
D. Tricuspid Valve inflow with respiratory variation - ANSWER- C. Mitral Valve inflow
with respiratory variation
A pericardial effusion can often be seen in patients with: - ANSWER- D. Renal failure
Pericardial Effusion Grading Criteria: - ANSWER- Small=posterior fluid <1cm
Med=anterior and posterior <1cm
Large=surround the heart>1cm
**measure during diastole
What is beck's triad? - ANSWER- -elevated venous pressure
-hypotension -quiet
heart
associated with acute tamponade
*** IT IS THE CLINICAL DIAGNOSIS OF CARDIAC TAMPONADE**
Becks triad ( cardiac tamponade ) 3 Ds
Distant heart sounds
Distended jugular veins
Decreased arterial pressure
The most sensitive way to diagnosis cardiac tamponade is:
A. Right Ventricle diastolic collapse
B. Right Ventricle systolic collapse
C. M-mode of the Left Atrium wall motion
D. respiratory variation - ANSWER- D. Respiratory variation or pulsus paradoxus
(variation of 10 mmHg/or > 25% or more upon inspiraton in TV and MV)
,What cardiac condition would prevent diastolic right ventricular collapse?
A. concentric Left Ventricular Hypertrophy
B. high systemic hypertension
C. pulmonary hypertension
D. tricuspid regurgitation - ANSWER- C. Pulmonary hypertension
What other pericardial abnormality also causes impaired ventricular filling? - ANSWER-
Constrictive pericarditis
Pericardial knock, leads to tamponade
A huge, dilated PA, severe Tricuspid Regurgitation and Right Ventricle enlargement
best describes?
A. pulmonary emboli
B. pulmonary hypertension
C. myocardial infarction
D. mitral regurgitation - ANSWER- B. Pulmonary hypertension
Tricuspid reguritation. Is a preload, volume overload affects chambers ahead of it.
pulmonary emboli effects on the heart - ANSWER- Small Emboli-normal no effect large
emboli=Right Ventricle/Right Atrium will dilate, pulmonary hypertension or Right
Ventricle systolic dysfunction may be present
Given tricuspid regurgitation with 60 mmHg gradient grade the severity of pulmonary
hypertension: a. none
b. mild
c. moderate
d. severe - ANSWER- d. Severe (60 or > is severe)
Your patient has pulmonary hypertension with dilated IVC (3cm) which collapsed 50%
with sniff. Estimate the Right Atrium pressure: - ANSWER- 15mmHg
NOTE: THIS IS BASED ON EST. RAP BASED ON IVC COLLAPSE.
Less than 50 % is 15 mmHg
10 mmHg= NORMAL
The size of aneurysms during systole: - ANSWER- Increase
What is the most common (mechanical) complication of an MI. - ANSWER- Aneurysm
formation
, Which of the following occurs first in the setting of severe mitral regurgitation due to a
flail leaflet? - ANSWER- Dilated Right Ventricle
FLAIL LEAFLET WILL CAUSE MITRAL REGURGITATION
This is a sudden onset (acute) and the heart does not have time to adjust yo the
pressure difference.
What type of MI causes papillary muscle rupture? - ANSWER- inferior MI
-Inferior pap muscle has a single blood supply (Medial papillary muscles receives dual
blood supply and is less likely to rupture)
** posterior papillary muscle single blood supply is most likely to rupture**
Does the wall of a pseudoaneurysm contain endocardium? - ANSWER- No, it's a
rupture across both endocardium and myocardium
-2-walls are involved
-it is more serious than a true anuerysm (3 layers) life threatening (emergent surgery)
-wide neck
-mosy common location is inferior basal (not apical)
What information do you need pre op in a patient with a Left Ventricle aneurysm? -
ANSWER- Movement of other walls
if akenisis spresent the patient is not a surgical candiate
Color Doppler in ischemic disease can be good for? - ANSWER- VSD, because you can
use PW and CW Doppler for detecting Mitral Regurgitation
What do you look for in a patient with Kawasaki Disease? - ANSWER- Coronary artery
aneurysms
What is the IVS motion in a patient with LBBB? - ANSWER- Dyskinetic
From where do the coronaries originate? - ANSWER- In the LEFT and RIGHT aortic
sinus of Valsalva
What is meant by "right dominance'? - ANSWER- When the right coronary gives rise to
the "posterior descending artery" (86% of the time)
Which coronary supplies the Interatrial septum? - ANSWER- Right (also usually
supplies the SA and AV nodes)
Answers With Rationales|Already Graded A+
61 year old male with idiopathic hypertrophic sub aortic stenosis (IHSS) and a resting
gradient of 144 mm Hg. Admitted to the hospital with chest pain. The next day the
resting gradient was 15 mmHg. What happened? - ANSWER- Left Ventricular infarct
Idiopathic Hypertrophic Sub-aortic Stenosis (IHSS) is a hyperdynamic contractile state
with near-cavity obliteration during systole. It is also characterized by dynamic motion of
the anterior mitral leaflet toward the interventricular septum during systole. This dynamic
narrowing of the left ventricular outflow tract produces a pressure gradient during
systole detectible by Doppler. The m-mode shows the forward motion during systole. In
some patients, the myocardial hypertrophy is more symmetric than the asymmetric
arrangement which usually occurs in this disorder.
What is Chagas' disease? - ANSWER- -posterior and apical thinning, septum usually
normal
-most common in South America
Reduvid bug bite.
What causes the B-notch? - ANSWER- increased LVEDP
NOTE: THIS IS SEEN ON THE M MODE OF THE MITRAL VALVE
MR, PHTN , systemic HTN ARE CAUSES OF elevated LVEDP
What is hemochromatosis? - ANSWER- Excess amount of iron in the myocardium
A restrictive cardiomyopathy has which of the following?
A. Increased afterload
B. Decreased Left Ventricle compliance
C. Increased preload
D. Decreased Left Atrium pressure - ANSWER- B. Decreased Left Ventricle
compliance- Myocardial deposits cause restrictive diastolic filling
A typical ejection fraction in a dilated cardiomyopathy patient might be (for a HCM
patient?) - ANSWER- 15-25%
Choose the lowest ejection fraction of the choices
The majority of ventricular filling occurs during:
A. IVRT
B. IVCT
,C. first third diastole
D. atrial contraction - ANSWER- C. first third diastole 70%
Atrial contraction is 30%
Know that in elderly (>60) patients the A-wave is normally equal to or higher than the E
wave - ANSWER- ...
How does the normal Doppler waveform at the mitral annulus differs from flow at the
mitral leaflets tips? - ANSWER- E and A are reversed at these two sample sites
How would you determine if a patient has constrictive versus restrictive disease?
A. 2D strain imaging
B. pulmonary venous flow
C. Mitral Valve inflow with respiratory variation
D. Tricuspid Valve inflow with respiratory variation - ANSWER- C. Mitral Valve inflow
with respiratory variation
A pericardial effusion can often be seen in patients with: - ANSWER- D. Renal failure
Pericardial Effusion Grading Criteria: - ANSWER- Small=posterior fluid <1cm
Med=anterior and posterior <1cm
Large=surround the heart>1cm
**measure during diastole
What is beck's triad? - ANSWER- -elevated venous pressure
-hypotension -quiet
heart
associated with acute tamponade
*** IT IS THE CLINICAL DIAGNOSIS OF CARDIAC TAMPONADE**
Becks triad ( cardiac tamponade ) 3 Ds
Distant heart sounds
Distended jugular veins
Decreased arterial pressure
The most sensitive way to diagnosis cardiac tamponade is:
A. Right Ventricle diastolic collapse
B. Right Ventricle systolic collapse
C. M-mode of the Left Atrium wall motion
D. respiratory variation - ANSWER- D. Respiratory variation or pulsus paradoxus
(variation of 10 mmHg/or > 25% or more upon inspiraton in TV and MV)
,What cardiac condition would prevent diastolic right ventricular collapse?
A. concentric Left Ventricular Hypertrophy
B. high systemic hypertension
C. pulmonary hypertension
D. tricuspid regurgitation - ANSWER- C. Pulmonary hypertension
What other pericardial abnormality also causes impaired ventricular filling? - ANSWER-
Constrictive pericarditis
Pericardial knock, leads to tamponade
A huge, dilated PA, severe Tricuspid Regurgitation and Right Ventricle enlargement
best describes?
A. pulmonary emboli
B. pulmonary hypertension
C. myocardial infarction
D. mitral regurgitation - ANSWER- B. Pulmonary hypertension
Tricuspid reguritation. Is a preload, volume overload affects chambers ahead of it.
pulmonary emboli effects on the heart - ANSWER- Small Emboli-normal no effect large
emboli=Right Ventricle/Right Atrium will dilate, pulmonary hypertension or Right
Ventricle systolic dysfunction may be present
Given tricuspid regurgitation with 60 mmHg gradient grade the severity of pulmonary
hypertension: a. none
b. mild
c. moderate
d. severe - ANSWER- d. Severe (60 or > is severe)
Your patient has pulmonary hypertension with dilated IVC (3cm) which collapsed 50%
with sniff. Estimate the Right Atrium pressure: - ANSWER- 15mmHg
NOTE: THIS IS BASED ON EST. RAP BASED ON IVC COLLAPSE.
Less than 50 % is 15 mmHg
10 mmHg= NORMAL
The size of aneurysms during systole: - ANSWER- Increase
What is the most common (mechanical) complication of an MI. - ANSWER- Aneurysm
formation
, Which of the following occurs first in the setting of severe mitral regurgitation due to a
flail leaflet? - ANSWER- Dilated Right Ventricle
FLAIL LEAFLET WILL CAUSE MITRAL REGURGITATION
This is a sudden onset (acute) and the heart does not have time to adjust yo the
pressure difference.
What type of MI causes papillary muscle rupture? - ANSWER- inferior MI
-Inferior pap muscle has a single blood supply (Medial papillary muscles receives dual
blood supply and is less likely to rupture)
** posterior papillary muscle single blood supply is most likely to rupture**
Does the wall of a pseudoaneurysm contain endocardium? - ANSWER- No, it's a
rupture across both endocardium and myocardium
-2-walls are involved
-it is more serious than a true anuerysm (3 layers) life threatening (emergent surgery)
-wide neck
-mosy common location is inferior basal (not apical)
What information do you need pre op in a patient with a Left Ventricle aneurysm? -
ANSWER- Movement of other walls
if akenisis spresent the patient is not a surgical candiate
Color Doppler in ischemic disease can be good for? - ANSWER- VSD, because you can
use PW and CW Doppler for detecting Mitral Regurgitation
What do you look for in a patient with Kawasaki Disease? - ANSWER- Coronary artery
aneurysms
What is the IVS motion in a patient with LBBB? - ANSWER- Dyskinetic
From where do the coronaries originate? - ANSWER- In the LEFT and RIGHT aortic
sinus of Valsalva
What is meant by "right dominance'? - ANSWER- When the right coronary gives rise to
the "posterior descending artery" (86% of the time)
Which coronary supplies the Interatrial septum? - ANSWER- Right (also usually
supplies the SA and AV nodes)
