首页 临床医学 心血管病学 超声心动图 第三阶段 DCM

# Clinical Cases Part 1

# Case 1


  1. Mild, moderate or severe LV systolic dysfunction?

    Severe

  2. What is wrong with the interventricular septum?

    scarred

  3. What can be seen with LV contrast?

    Thrombus or Clot

# Case 2

  1. What do we think is the cause of the doppler trace?

    Aortic Stenosis


  1. Is the aortic valve normal or abnormal?

    Abnormal

  2. Is the aorta normal or abnormal?

    Normal

  3. Is the colour doppler normal or abnormal?

    Abnormal

# Case 3

  1. Is LV function normal or abnormal?

    Normal

  1. Are there LV wall motion abnormalities?

    Yes (Apical inferior/Anterior)

  1. Are there LV wall motion abnormalities?

    Yes (anterior/septal)

  1. Are the wall motion abnormalities?

    Yes (middle Apical inferior/anterior)

  2. Is there LV thrombus?

    No

# Case 5

  1. What is the highlighted feature?

    LV Gradient

  2. What is the diagnosis?

    Apical Hypertrophic Cardiomyopathy

  1. What are the abnormalities?

    LV Hypertrophy, Systolic Anterior motion (SAM) of Mitral Valve

  2. What is the diagnosis?

    Hypertrophic Cardiomyopathy

# Quiz

  1. The next operation?

    • Needs urgent pericardiocentesis
    • Await surgery
    • Diuretics are used with a pericardial effusion
    • Shows possible heart failure.

  2. Which is true

    • Normal aortic and mitral valve
    • TAVI valve, well seated
    • Low TAVI valve
    • Shows normal mitral valve.

  3. Which is true

    • Mitraclip is used in pts with I.E.
    • Mitraclip used in rheumatic heart disease
    • Mitraclip is optimal in pts with functional mitral regurgitation
    • Mitraclip is first choice in low risk patients as it is non-invasive.

  4. Which is true

    • This shows AR of the aortic valve
    • This shows central regurgitation
    • This shows paravalvular AR
    • Pt should have a paravalvular plug inserted

  5. Which is true

    • This shows primary MR
    • This shows central regurgitation
    • This is suitable for mitraclip
    • LV function is likely to be normal.

  6. Which is true

    • This shows tamponade
    • Shows RV diastolic collapse
    • This is suitable for mitraclip
    • LV function is normal.

  7. Where is the septum punctured?


    • Anterior and superior
    • Posterior and superior
    • Anterior and inferior
    • Posterior and inferior

  8. Which is true

    • The speed of accumulation is the most important
    • If the size is > 1.5cm effusion should be drained urgently
    • There is a fall in BP on expiration > 30mmHg
    • If there is tamponade without inflammatory signs, it is more likely to be due to cancer.

  9. Which is true


    • This shows functional mitral regurgitation
    • This shows eccentric mitral regurgitation
    • This shows central regurgitation
    • This pathology is not amenable to clip.

  10. Which is true

    • If there is residual MR after clip insertion - Must operate
    • If there is residual MR after clip, release and regrasp
    • If there is residual MR after clip, insert a second clip
    • Mitraclip is first choice in tissue MVR transvalvular regurgitation.

  11. Which is true

    • This shows a DCM
    • This shows an athletes heart
    • A dilated RV is due to an ASD
    • The aorta is mildly dilated – This is normal.

  12. Which is true

    • TAVI is superior to surgery as overall less pacemaker insertion
    • TAVI is superior to surgery as less vascular problems
    • TAVI should be considered in moderate risk patients
    • TAVI complications include perforation of the right ventricle

  13. Which is true

    • The LVOT VTI will be around 1m/s
    • If the AV Vmax is 3m/s, pt should not be offered a TAVI
    • This is an athletic heart
    • There will likely be primary MR.

  14. Which is true


    • There is no mitral regurgitation
    • There is mild MR
    • There is moderate MR
    • There is severe MR

# Clinical Cases Part 2

# Case 1

A 62-year-old male presents to the medical unit with breathlessness.
ECG: LBBB
CXR: pulmonary oedema
You perform an echocardiogram.

  1. The LVIDd measures at 6cm. What does the patient have?

    • Normal LV
    • Mildly dilated LV
    • Moderately dilated LV
    • Severely dilated LV

  2. The LVIDs is 5.5cm. What is the fractional shortening?

    • 8%
    • 16%
    • 32%
    • 24%
    • 30%

  1. What is the visual ejection fraction?

    • 45-50%
    • 35-40%
    • 15-20%
    • 20-25%
    • 40-45%

  2. The MAPSE is around:

    • 10mm
    • 5mm
    • 15mm
    • 20mm

  1. This patient has evidence of:
    • Mild eccentric MR
    • Severe functional MR
    • Mild functional MR
    • Moderate functional MR

  1. A similar patient presents a few days later. What is the diagnosis?

    • Moderate MR
    • Severe MR
    • Mild MR
    • Moderate – severe MR

  2. You review the patient’s diastolic function. The E/A ratio is 1.5, DT 200ms. E/E’ 16. The patient’s left atrium is 21cm2. The patient has evidence of:

    • Normal diastolic function
    • Mild diastolic dysfunction
    • Moderate diastolic dysfunction
    • Severe diastolic dysfunction

# Case 2

A 72-year-old female initially presented with chest pain. She is awaiting an angiogram.

ECG: Anterior ST elevation
CXR: Normal

You perform an echocardiogram.

  1. This patient has RWMA consistent with:

    • LAD infarction
    • LCx infarction
    • Takotsubo’s cardiomyopathy
    • RCA infarction

  2. What is the overall LV ejection fraction?

    • > 55%
    • 40-45%
    • 45-50%
    • 35-40%

# Case 3

A 72-year-old male presents with a collapse episode.

ECG: Second degree AV block
CXR: Cardiomegaly, clear lung fields

You perform an echocardiogram.

  1. This patient has evidence of:
    • Concentric LVH
    • Cardiac sarcoidosis
    • Cardiac amyloidosis
    • Hypertrophic cardiomyopathy
    • Severe systolic dysfunction

MV E peak 1.1 m/s
MV A peak 0.4 m/s
E’med 0.04 m/s
A’med 0.05 m/s

  1. Which of the following are true?
    • E:A = 2.75
    • E/E’ (med) = 27.5
    • E/E’ (med) = 2.75
    • This patient has restrictive diastolic function
    • This patient has normal diastolic function

  1. What are the key features seen on this subcostal window?
    • Normal wall thickness
    • LV hypertrophy
    • Thickened IAS
    • Preserved systolic function
    • RV hypertrophy

# Case 4

A 43-year-old male under investigation for breathlessness is referred for an echocardiogram. He had an abnormal CT of his chest.

ECG: AF
CXR: Hilar lymphaedenopathy

You perform an echocardiogram.

  1. This patient has evidence of:
    • Severe left ventricle systolic dysfunction
    • Thinned and akinetic inferoseptum
    • Dilated left ventricle
    • Dilated atria

  1. This patient has signs consistent with:
    • Cardiac amyloidosis
    • Normal echocardiogram
    • Cardiac sarcoidosis
    • Hypertrophic cardiomyopathy
    • Haemosiderosis

# Case 5

An 82-year-old male presents with a stroke.

ECG: Normal sinus rhythm
CXR: Normal

You perform an echocardiogram.

  1. What are the key findings on this image?

    • Severe systolic dysfunction
    • Global hypokinesia
    • Apical thrombus
    • Diastolic impairment
    • Endomyocardial fibrosis