Pass the ARDMS RDCS AE-Adult-Echocardiography Questions and answers with ExamsMirror

The image is a parasternal long-axis echocardiographic view focusing on the mitral valve annulus with a highly echogenic, dense, and well-defined structure located at the base of the posterior mitral leaflet. This appearance is characteristic of mitral annular calcification (MAC), a degenerative process resulting in calcium deposition along the mitral valve annulus.

Vegetations appear as irregular, mobile masses attached to valve leaflets and are less dense. Tumors and thrombi have different echogenicity and locations (tumors often in atria, thrombi in atrial appendages). MAC is usually more echogenic and localized to the annulus.

This description and differentiation are found in adult echocardiography textbooks and ASE guidelines on cardiac masses and valvular calcifications【16:Textbook of Clinical Echocardiography, 6e†p.460-465】【12:ASE Guidelines on Cardiac Masses†p.150-160】.

Comprehensive and Detailed Explanation From Exact Extract:

The image shows a pulsed-wave Doppler waveform with respiratory phasicity and distinct forward and reversed flow components characteristic of hepatic vein flow patterns. Hepatic vein Doppler typically displays a biphasic waveform with systolic (S) and diastolic (D) forward flow toward the heart and brief reversed flow during atrial contraction (A wave reversal), reflecting right atrial pressure changes.

Mitral and tricuspid inflow Doppler patterns show distinct E and A waves representing early and late diastolic ventricular filling but do not have the same flow reversal pattern. Pulmonary vein Doppler waveforms also differ, showing systolic and diastolic forward flows into the left atrium without the prominent reversed flow seen here.

The hepatic vein Doppler is commonly used in echocardiography to assess right atrial pressure and compliance, especially in conditions like constrictive pericarditis and right heart failure, where characteristic flow reversals and expiratory changes are observed.

This pattern and its clinical significance are detailed in adult echocardiography references, including the "Textbook of Clinical Echocardiography" and ASE guidelines on Doppler imaging【16:Hepatic Vein Doppler†Textbook of Clinical Echocardiography, 6e】【12:ASE Doppler Guidelines†p.95-100】.

The arrow points to the left anterior descending (LAD) coronary artery, which runs in the anterior interventricular groove toward the apex of the heart. It supplies the anterior wall of the left ventricle.

The right coronary artery runs in the right atrioventricular groove. The left main coronary artery is proximal to the LAD and circumflex arteries. The circumflex artery runs in the left atrioventricular groove posteriorly.

This identification is detailed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Coronary Artery Anatomy and Echocardiographic Visualization【20:150-155†Textbook of Clinical Echocardiography】.

In the calculation of the shunt ratio Qp/Qs, Qp represents pulmonary blood flow, which is calculated as the stroke volume of the right ventricular outflow tract (RVOT). Stroke volume is obtained by measuring the RVOT cross-sectional area and the RVOT time velocity integral (VTI).

Qp (pulmonary flow) divided by Qs (systemic flow) quantifies the magnitude of left-to-right shunting in atrial septal defects and other congenital heart diseases.

This method is described in the "Textbook of Clinical Echocardiography, 6e", Chapter on Shunt Quantification and Flow Calculations【20:360-365†Textbook of Clinical Echocardiography】.

A respirometer monitors the respiratory cycle and is essential when evaluating diseases in which respiratory variation affects echocardiographic measurements, such as pericardial effusion and cardiac tamponade. In tamponade, respiratory changes in mitral and tricuspid inflows, as well as variations in inferior vena cava size, are key diagnostic features.

Congestive heart failure, ischemic cardiomyopathy, and mitral valve diseases do not require synchronization with respiration for diagnosis or quantification and are not reliant on respirometer use.

This recommendation is outlined in ASE pericardial disease guidelines and echocardiography procedural protocols【16:Textbook of Clinical Echocardiography, 6e†p.280-285】【12:ASE Pericardial Disease Guidelines†p.300-305】.

Comprehensive and Detailed Explanation From Exact Extract:

The video shows a parasternal long-axis view of the left ventricle and mitral valve with the anterior leaflet of the mitral valve moving abnormally toward the interventricular septum during systole. This systolic anterior motion (SAM) of the mitral valve is characteristic of hypertrophic obstructive cardiomyopathy (HOCM) and contributes to left ventricular outflow tract obstruction.

Aortic root dilatation and left atrial elongation are structural findings seen in other views. Mid-anteroseptal hypokinesis is a regional wall motion abnormality not clearly visualized in this clip.

This echocardiographic sign is critical in diagnosing and managing HOCM and is discussed extensively in ASE guidelines and clinical echocardiography texts【16:Textbook of Clinical Echocardiography, 6e†p.350-355】【12:ASE Cardiomyopathy Guidelines†p.120-130】.

Comprehensive and Detailed Explanation From Exact Extract:

The echocardiographic image shows a short-axis view of the left ventricle at the mid-papillary muscle level with segmental strain values. The arrow points to the wall segment located inferiorly (towards the bottom of the image in standard orientation), which corresponds to the inferior wall of the left ventricle.

According to the standardized 17-segment model endorsed by the American Society of Echocardiography (ASE), the inferior wall is situated posteriorly and inferiorly in the short-axis view. The other options represent adjacent walls: anterior is opposite the inferior wall, anterolateral and inferolateral correspond to lateral wall segments.

This segmental anatomy and nomenclature are detailed in adult echocardiography textbooks and ASE chamber quantification guidelines, which emphasize precise segmental identification for accurate regional function assessment【12:ASE Chamber Quantification Guidelines†p.90-95】【16:Textbook of Clinical Echocardiography, 6e†p.140-145】.

The echocardiographic video shows hypokinesis or akinesis of the inferolateral wall of the left ventricle. This myocardial territory is predominantly supplied by the left circumflex coronary artery.

The right coronary artery primarily supplies the inferior wall and right ventricle. The left anterior descending artery supplies the anterior and septal walls. The posterior descending artery supplies the inferior wall, usually supplied by the right coronary artery or sometimes the circumflex.

These segmental coronary territories are described in ASE stress echocardiography and regional wall motion assessment guidelines【12:ASE Stress Echocardiography Guidelines†p.300-310】【16:Textbook of Clinical Echocardiography, 6e†p.380-385】.

Contrast agents used in echocardiography can rarely cause anaphylactoid reactions, which are non-IgE-mediated hypersensitivity reactions that can mimic anaphylaxis. Therefore, sonographers must be prepared to manage such reactions.

Contrary to option B, reactions can be severe though rare. Even patients without prior allergies can react. It is incorrect to say the exam poses no risk; proper precautions and monitoring are essential.

These precautions are emphasized in ASE contrast echocardiography guidelines and safety protocols【12:ASE Contrast Echocardiography Guidelines†p.190-195】【16:Textbook of Clinical Echocardiography, 6e†p.575-580】.

Comprehensive and Detailed Explanation From Exact Extract:

Tetralogy of Fallot (TOF) is a congenital heart defect characterized by four key anatomical abnormalities: an outlet (malalignment) ventricular septal defect (VSD), an overriding aorta that receives blood from both ventricles, right ventricular outflow tract (RVOT) obstruction (commonly infundibular stenosis), and resultant right ventricular hypertrophy. These defects cause cyanosis due to right-to-left shunting and impaired pulmonary blood flow.

Option A describes Ebstein anomaly, characterized by a displaced tricuspid valve and atrialization of the right ventricle.

Option B describes features more consistent with Shone complex or other left heart obstructive lesions.

Option C describes atrioventricular septal defect (AVSD), seen in conditions like Down syndrome.

In unrepaired TOF, echocardiography demonstrates the large malalignment VSD, overriding aorta, RVOT obstruction, and hypertrophied right ventricle. These are classic textbook findings described in adult and pediatric echocardiography literature, including “Textbook of Clinical Echocardiography” (Chapter on Congenital Heart Disease) and ASE guidelines【16:Textbook of Clinical Echocardiography, 6e†p.560-565】【12:ASE Adult Congenital Guidelines†p.400-410】.