Which of the following is a feature of constrictive pericarditis?
A.
Mitral inflow pattern has a large E-wave and a small A-wave without respiratory changes
B.
Normal hepatic vein size
C.
Dilated inferior vena cava with inspiratory collapse during sniff test
D.
Interventricular septal bounce
Correct Answer: D
Explanation:
Comprehensive and Detailed Explanation From Exact Extract:
Answer: D
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.
Question #2 (Topic: demo questions)
Which syndrome is associated with pulmonic stenosis?
A.
Turner
B.
Eisenmenger
C.
Noonan
D.
Marfan
Correct Answer: C
Explanation:
Pulmonic stenosis is a congenital valve abnormality often seen in genetic syndromes with cardiac
manifestations. Among these, Noonan syndrome is the most frequently associated with pulmonic
stenosis. Noonan syndrome is a genetic disorder characterized by distinctive facial features, short
stature, and congenital heart defects, with pulmonic valve stenosis being the predominant cardiac
lesion. The stenosis is usually valvular and caused by dysplastic pulmonary valve leaflets, leading to
obstruction of right ventricular outflow.
Other syndromes listed do not typically present with pulmonic stenosis:
Turner syndrome is more commonly linked with bicuspid aortic valve and coarctation of the aorta,
not pulmonic stenosis. Eisenmenger syndrome refers to the advanced phase of congenital heart defects with significant
pulmonary hypertension and is not a genetic syndrome.
Marfan syndrome is predominantly associated with aortic root dilation and mitral valve prolapse, but
not with pulmonic stenosis.
This association is well documented in adult echocardiography guidelines and texts, such as the
"Textbook of Clinical Echocardiography" by Catherine Otto, which clearly identifies Noonan syndrome
as the syndrome most commonly associated with pulmonic stenosis among congenital heart
defects
【
16:Chapter on Congenital Heart Disease†Textbook of Clinical Echocardiography, 6e
】
.
Question #3 (Topic: demo questions)
Which view is most appropriate for measuring right ventricular dimensions?
A.
Subcostal four-chamber
B.
Parasternal short axis at the base
C.
Apical lateral right ventricular-focused
D.
Parasternal long axis
Correct Answer: C
Explanation:
The most appropriate echocardiographic view to measure right ventricular (RV) dimensions is the
apical four-chamber view with a right ventricular-focused modification. This RV-focused apical four-
chamber view is optimized by shifting the transducer laterally and slightly anteriorly to better
visualize the entire right ventricle in a single plane. This approach allows for accurate assessment of
RV basal and mid cavity diameters, RV longitudinal dimension, and RV area measurements.
The standard apical four-chamber view often underestimates RV size because of its complex
geometry and position in the chest. The subcostal four-chamber view may give some information on
RV size but is limited by image quality and angle. Parasternal short axis views at the base focus more
on the left ventricle and may not capture the entire RV adequately. Parasternal long axis views
primarily visualize the left heart structures and do not adequately show the RV.
Adult echocardiography guidelines, including the American Society of Echocardiography (ASE