EchoDx Hub

25/10/2025

Comment?

25/10/2025

Q100:
In echocardiography, which of the following is the most specific finding of cardiac tamponade?

A) Dilated inferior vena cava with reduced respiratory collapse
B) Diastolic collapse of the right atrium and right ventricle
C) Pericardial effusion with swinging heart motion
D) Tachycardia with low-voltage ECG

✅ Answer: B) Diastolic collapse of the right atrium and right ventricle

📘 Explanation:
In cardiac tamponade, intrapericardial pressure exceeds the pressure within the cardiac chambers during diastole.
This leads to early diastolic collapse of the right ventricle and late diastolic collapse of the right atrium, which are highly specific echocardiographic signs of tamponade.
While IVC plethora (A) and pericardial effusion (C) suggest raised pericardial pressure, they are not diagnostic by themselves.

25/10/2025

“Echo Quiz 📊 — Pericardial Effusion”
👉 This echo shows a large pericardial effusion.
🤔 Do you think there is cardiac tamponade? What are your clues?

💬 “Doctors & Sonographers — share your interpretation in the comments 👇”

24/10/2025

Q99: In echocardiography, which parameter is most specific for identifying restrictive left ventricular filling pattern (Grade III diastolic dysfunction)?

A) E/A ratio < 1
B) Deceleration time (DT) > 220 ms
C) E/A ratio ≥ 2 with E/e’ > 14
D) Pulmonary vein S > D

✅ Answer: C) E/A ratio ≥ 2 with E/e’ > 14

📘 Explanation:
A restrictive LV filling pattern shows very high early diastolic filling (E wave) and minimal atrial contribution (A wave). The E/A ratio ≥ 2 and E/e’ > 14 indicate markedly elevated LV filling pressures, characteristic of advanced diastolic dysfunction (Grade III).

🔖 Hashtags:

24/10/2025

🎯 Tip 11: Record Sweep Speed Wisely

👉 Sweep speed controls how Doppler or M-mode data unfold over time — directly influencing waveform detail and the number of visible cycles.
⚙️ How It Works

🔹 High Sweep Speed (100–150 mm/s)
➡️ Expands each cardiac cycle (time axis stretched).
➡️ Fewer cycles, but better detail and timing accuracy.
✅ Ideal for PHT measurements, M-mode timing, and arrhythmia analysis.

🔹 Low Sweep Speed (25–50 mm/s)
➡️ Compresses the trace (time axis shortened).
➡️ More cardiac cycles fit on screen.
✅ Best for rhythm overview or trend observation.
⚠️ Remember
✔ High sweep = fewer beats, better detail.
✔ Low sweep = more beats, less detail.
🎯 Adjust sweep speed based on rhythm and measurement needs.

23/10/2025

23/10/2025

Q98 : During echocardiography, a patient presents with inferior wall akinesia and a posteriorly directed MR jet on color Doppler. Which mechanism best explains the mitral regurgitation in this scenario?

A) Primary structural mitral valve disease
B) Ischemic MR due to papillary muscle dysfunction
C) Rheumatic involvement of the mitral valve
D) Functional MR due to LV dilatation

✅ Answer: B) Ischemic MR due to papillary muscle dysfunction

📘 Explanation:
Inferior wall infarction affects the posteromedial papillary muscle, leading to restricted leaflet motion (Type IIIb MR) and a posteriorly directed MR jet. The mitral leaflets themselves are structurally normal—regurgitation results from ischemic tethering and annular distortion.

23/10/2025

🫀 Dilated Cardiomyopathy (DCMP) with Large LV Apical Thrombus – Echo Case

🎥 Echocardiographic Focus:
This video clip demonstrates a dilated and globally hypokinetic left ventricle with a large, echodense thrombus adherent to the LV apex — a classic finding in advanced DCMP with severe LV dysfunction.

🔹 Echo Findings

LV cavity: Markedly dilated

LV systolic function: Severely reduced (EF < 30%)

Regional wall motion: Global hypokinesia or akinesia

LV apex: Echodense, non-contractile mass consistent with mural thrombus

Color Doppler: No flow within the thrombus

LA: Often dilated due to chronic volume overload

🔹 Pathophysiology

In DCMP, severe systolic dysfunction leads to stasis of blood in LV apex, promoting thrombus formation — part of Virchow’s Triad (stasis, endothelial injury, hypercoagulability).

🔹 Clinical Significance

Risk of systemic embolization (stroke, limb ischemia)

Requires anticoagulation and treatment of underlying LV dysfunction

Must differentiate mural thrombus from apical trabeculation or false tendon using multiple echo views or contrast echo.

🔹 Key Echo Views

Apical 4-Chamber & 2-Chamber: Show the thrombus morphology

Apical Long-Axis (3CH): Confirms attachment to LV apex

Off-axis apical views: Help exclude artifacts

💡 Key Point

📍 Always check LV apex carefully in every DCMP — a mural thrombus may hide in a non-contractile apex.

22/10/2025

Q97.On echocardiography, diastolic doming of the anterior mitral leaflet with a “hockey-stick” appearance is most characteristic of which condition?

A) Mitral valve prolapse
B) Rheumatic mitral stenosis
C) Functional mitral regurgitation
D) Congenital parachute mitral valve

✅ Answer: B) Rheumatic mitral stenosis

Explanation:

Rheumatic mitral stenosis (MS) causes fusion of commissures and chordae, leading to:

Diastolic doming of the anterior mitral leaflet

“Hockey-stick” or bowing appearance on PLAX view

Reduced posterior leaflet motion

Thickened leaflets with restricted opening

MVP (A): shows systolic billowing into the LA.

Functional MR (C): normal leaflets with annular dilatation.

Parachute MV (D): all chordae attached to a single papillary muscle — congenital, not doming.

🔑 Classic hallmark: Doming anterior mitral leaflet = Rheumatic MS.

22/10/2025

🫀 2D ECHO VIEWS – QUICK REFERENCE SERIES
🎥 A complete guide for your Echo learning and practice!

1️⃣ Parasternal Long Axis (PLAX)
📍 Probe: Left 3rd–4th ICS, marker → right shoulder
👁️ LA, LV, RVOT, IVS, MV, AV
💡 LV function, MV/AV morphology, pericardial effusion
⚠️ Keep LV horizontal

2️⃣ PSAX – Aortic Valve Level
📍 Rotate probe 90° clockwise from PLAX
👁️ AV, RA, LA, RVOT, TV
💡 AV cusp morphology, TR, RVOT gradients
⚠️ Center aortic valve

3️⃣ PSAX – Mitral Valve Level
📍 Slight tilt toward apex
👁️ LV, MV leaflets, partial papillary muscles
💡 MV motion (MS, MVP), LV concentricity
⚠️ LV should appear circular

4️⃣ PSAX – Papillary Muscle Level
📍 Tilt more toward apex
👁️ LV cavity, papillary muscles
💡 LV regional wall motion
⚠️ Avoid basal/apical cuts

5️⃣ Apical 4-Chamber (A4C)
📍 Probe at apex, marker → left
👁️ RA, RV, LA, LV, IAS, IVS, MV, TV
💡 LV/RV function, AV valve regurgitation, ASD
⚠️ Avoid LV foreshortening

6️⃣ Apical 5-Chamber (A5C)
📍 From A4C, tilt anteriorly
👁️ LVOT, AV, ascending aorta
💡 LVOT velocity, AV gradients
⚠️ Too much tilt loses LA

7️⃣ Apical 2-Chamber (A2C)
📍 From A4C, rotate 60° counterclockwise
👁️ LA, LV, anterior & inferior walls
💡 LV wall motion (anterior/inferior)
⚠️ Avoid foreshortening

8️⃣ Apical 3-Chamber (A3C / Long Axis)
📍 From A2C, rotate 30° more counterclockwise
👁️ LV, LA, LVOT, AV, MV
💡 AV/MV continuity, LVOT obstruction
⚠️ AV–MV axis must align

9️⃣ Subcostal 4-Chamber (Sub4C)
📍 Subxiphoid, marker → left
👁️ All 4 chambers, IAS
💡 ASD, pericardial effusion, pediatric echo
⚠️ Use in poor transthoracic windows

🔟 Subcostal IVC View
📍 Subxiphoid, marker → head
👁️ IVC entering RA
💡 RA pressure estimation
⚠️ Use M-mode for IVC collapse

11️⃣ Suprasternal Long Axis of Aortic Arch
📍 Suprasternal notch, marker → left
👁️ Ao arch, branches, descending aorta
💡 Coarctation, interrupted arch, dissection
⚠️ Use pediatric probe if needed

🧠 Learn | Identify | Master every 2D Echo View
Follow 👉 for more Echo-based learning and clinical cases.

21/10/2025

Q96.In echocardiography, which finding best supports the diagnosis of severe mitral regurgitation (MR)?

A) Small central color jet confined near the mitral valve
B) Vena contracta width < 0.3 cm
C) Effective regurgitant or***ce area (EROA) ≥ 0.4 cm²
D) Regurgitant volume < 30 mL

✅ Answer: C) Effective regurgitant or***ce area (EROA) ≥ 0.4 cm²

Explanation:

Quantitative parameters for severe MR:

EROA ≥ 0.4 cm²

Regurgitant volume ≥ 60 mL

Regurgitant fraction ≥ 50%

Color Doppler clues:

Large central or eccentric jet reaching posterior LA wall

Systolic flow reversal in pulmonary veins

Dense, holosystolic MR signal on CW Doppler

Small jet and vena contracta < 0.3 cm indicate mild MR.

🔑 EROA ≥ 0.4 cm² = gold-standard cutoff for severe MR.

21/10/2025

“Echo Quiz 📊 — Mitral Valve Assessment”
👉 Can you identify if Mitral Annular Disjunction (MAD) is present in this view?
🤔 What findings do you observe related to the mitral valve motion or annular behavior?

💬 “Doctors & Sonographers — share your thoughts in the comments 👇”