AE-Adult-Echocardiography Exam Dumps - ARDMS RDCS Questions and Answers

Cardiac catheterization with coronary angiography is considered the gold standard for the assessment and diagnosis of coronary artery disease (CAD). It provides direct visualization of coronary artery luminal stenosis and allows for therapeutic intervention if needed.

While cardiac magnetic resonance imaging (MRI), stress echocardiography, and myocardial perfusion imaging are valuable non-invasive modalities for ischemia detection and functional assessment, none replace the anatomical and interventional capabilities of invasive angiography.

This is well established in the "Textbook of Clinical Echocardiography, 6e", Chapter on Ischemic Heart Disease and Diagnostic Modalities【20:400-405†Textbook of Clinical Echocardiography】.

The image is a parasternal long axis M-mode echocardiographic tracing demonstrating the interventricular septum and posterior left ventricular wall. The arrow points to the septal “bounce” or “shudder,” which is an abnormal early diastolic septal motion.

This septal bounce is a classic echocardiographic finding in constrictive pericarditis, caused by rapid early diastolic filling with abrupt cessation due to pericardial constraint, resulting in paradoxical septal motion.

Cardiac tamponade usually shows pericardial effusion with chamber collapse but not septal bounce. Pulmonary embolism and pulmonary hypertension have different echocardiographic signs such as right ventricular dilatation and pressure overload but no septal bounce.

These features are well described in the "Textbook of Clinical Echocardiography" and ASE pericardial disease guidelines【16:Textbook of Clinical Echocardiography, 6e†p.280-285】【12:ASE Pericardial Disease Guidelines†p.300-305】.

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or "broken heart syndrome," predominantly affects postmenopausal women (usually older than 50 years) and often presents with acute chest pain and ST-segment elevation on the ECG mimicking acute myocardial infarction. However, coronary angiography reveals normal or non-obstructive coronary arteries.

Echocardiographically, Takotsubo cardiomyopathy is characterized by transient left ventricular systolic dysfunction with a typical pattern of apical ballooning and basal hyperkinesis. The wall motion abnormality extends beyond a single coronary artery territory, differentiating it from ischemic cardiomyopathy.

The diagnosis is supported by the clinical presentation, typical echocardiographic findings, and exclusion of obstructive coronary artery disease. The condition is usually reversible over days to weeks.

This is extensively described in the "Textbook of Clinical Echocardiography, 6e" (Chapter 8: Coronary Artery Disease and Takotsubo Syndrome), which highlights the typical patient demographics, presentation, echocardiographic features, and prognosis .

Compreh ensive and Detailed Explanation From Exact Extract:

In a normal heart, the ascending aorta arises from the left ventricle and courses superiorly and posteriorly to the right of the pulmonary artery, which arises anteriorly from the right ventricle. The aorta is positioned posterior and to the right of the main pulmonary artery, reflecting the normal spatial relationship.

The pulmonary artery is anterior and to the left of the aorta, and the coronary sinus lies posteriorly in the atrioventricular groove.

This anatomical relationship is detailed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Cardiac Anatomy and Echocardiographic Landmarks【20:50-55†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 .

During dobutamine stress testing, a normal physiological response includes increased myocardial contractility leading to a decrease in left ventricular (LV) cavity size during systole due to more effective ejection. Concurrently, systolic blood pressure increases due to the inotropic and chronotropic effects of dobutamine.

An increase in LV cavity size during stress would suggest impaired contractility or ischemia, which is abnormal.

This normal response is detailed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Stress Echocardiography and Hemodynamic Responses【20:400-405†Textbook of Clinical Echocardiography】.

In the early stages of aortic stenosis, the left ventricle adapts to increased afterload by concentric remodeling, which is characterized by increased wall thickness without a proportional increase in chamber size. This adaptation helps normalize wall stress.

As the disease progresses, concentric hypertrophy develops with thickened walls and decreased compliance. Eccentric hypertrophy and global systolic dysfunction occur later with decompensation and ventricular dilation.

This progression is explained in the "Textbook of Clinical Echocardiography, 6e", Chapter on Left Ventricular Adaptations to Pressure Overload【20:365-370†Textbook of Clinical Echocardiography】.

Acoustic shadowing is the artifact caused by calcified structures like the mitral annulus, resulting in attenuation or loss of echoes from structures posterior to the calcification. The calcification absorbs or reflects the ultrasound waves, preventing them from reaching deeper structures and causing a "dropout" or dark shadow behind the calcified area.

Reverberation involves repeated reflections creating multiple echoes. Side lobe artifacts arise from off-axis beams. Ring-down artifacts result from resonance in fluid or gas bubbles, not calcifications.

This artifact is explained in the "Textbook of Clinical Echocardiography, 6e", Chapter on Ultrasound Artifacts【20:75-80†Textbook of Clinical Echocardiography】.QUESTION NO: 134

What is the range of the aortic valve area in normal adults?

A. 1 - 2 cm2

B. 3 - 4cm2

C. 5 - 6cm2

D. 7- 8cm2

Answer: B

Comprehensive and Detailed Explanation From Exact Extract:

The normal aortic valve area (AVA) in adults typically ranges from 3 to 4 cm². This measurement is important for assessing aortic stenosis severity; values below this range suggest valve narrowing.

AVA values of 1-2 cm² indicate mild to moderate stenosis, while less than 1 cm² reflects severe stenosis. Larger areas like 5-6 or 7-8 cm² are not physiologically typical.

This normal range is documented in the "Textbook of Clinical Echocardiography, 6e", Chapter on Aortic Valve Anatomy and Function【20:360-365†Textbook of Clinical Echocardiography】.

The continuity equation calculates aortic valve area (AVA) by equating stroke volume through the left ventricular outflow tract (LVOT) to stroke volume through the aortic valve. The equation is:

AVA = (Cross-sectional area of LVOT) × (LVOT VTI) / (Aortic valve VTI)

The cross-sectional area of the LVOT is derived from the LVOT diameter, using the formula π × (diameter/2)^2. Because the diameter is squared in this calculation, even a small error in measurement leads to a significant error in the calculated valve area.

This makes the LVOT diameter measurement the greatest source of error when calculating AVA by the continuity equation. Errors in Doppler velocity measurements (LVOT velocity or aortic jet velocity) are also important but less impactful compared to diameter measurement error.

Aortic valve planimetry is a direct measurement method, not part of the continuity equation. LVOT velocity recorded with pulsed Doppler and aortic jet velocity by continuous wave Doppler are important but not the greatest error source.

This is a well-established concept described in the "Textbook of Clinical Echocardiography, 6e", Chapter on Valvular Stenosis and Continuity Equation Methodology【20:370-375†Textbook of Clinical Echocardiography】.