Pericardial dz

Question 1

Dx?

Answer 1

RV dominates center of apex

Question 2

Dx?

Answer 2

congenital abscence of pericardium (notive RV dominating apex and teardrop shape)

Question 3

in constrictive pericarditis, is the starred mitral inflow pattern during inspiration or expiration?

Answer 3

inspiration

Question 4

in constrictive pericarditis, what will you see with doppler flow through hepatic veins?

Answer 4

expiratory, diastolic flow reversal

Question 5

in constrictive pericarditis, in what respiratory cycle will pulmonary vein flow and mitral inflow (i.e. left heart) increase?

Answer 5

expiration

Question 6

when the septum is moving abnormally, but doesnt seem to correlate with heart beats, what should you think of?

Answer 6

respiratory variaton –> constrictive pericarditis

Question 7

Dx?

Answer 7

constrictive pericarditis (note inspiratory decrease of all left heart flows)

Question 8

Dx from this hepatic vein doppler

Answer 8

Hepatic vein diastolic flow reversal in constriction, seein in expiration

Question 9

name the diastoic pattern

Answer 9

grade 3

Question 10

name the diastolic pattern

Answer 10

grade 2

Question 11

name the diastolic pattern

Answer 11

grade 1

Question 12

name the 3 E’ patterns

Answer 12

normal, grade 1, constriction (exaggerated E’)

Question 13

in CHF, at what E’ do you consider constriction?

Answer 13

E’ > 8

Question 14

usually lateral e’ > medial e’, if its switched, what should you think of?

Answer 14

constrictive pericarditis (septum can move more since lateral wall tethered to pericardium)

Question 15

Dx?

Answer 15

pericardial cyst

Question 16

is septal E’ exaggeration seen in tamponade?

Answer 16

no (just constriction)

Question 17

like with constriction, what happens to PV, MV inflow during inspiration? HV flow during expiration?

Answer 17

PV, MV DECREASE during inspiration (b/c of left shift of septum)

HV diastolic flow reversal

Question 18

Dx?

Answer 18

tamponade (note PE, subtle septal shift to RV on inspiration)

Question 19

Dx?

Answer 19

tamponade (mitral inflow resp variation, HV dias flow rev, IVC plethora)

Question 20

per guidelines, what % inspiratory drop in mitral inflow = constriction? tamponade?

Answer 20

25%, 30%

Question 21

what is the only difference in dopplers b/w tamponade and constriction?

Answer 21

exaggerated septal E’ with constriction

Question 22

if you see respirometer tracings or phasic respiratory changes, what should you think of?

Answer 22

pericardial disease

Question 23

Answer 23

expiration

Question 24

in afib, what is the best way to diagose constriction?

Answer 24

TDI, look for medial e’ > lateral e’ (also HV diastolic flow reversal)

Question 25

what medial e’ suggests constriction? restriction?

Answer 25

constriction e’ > 8cm/s, restriction e’ < 6 cm/s

Question 26

Dx?

Answer 26

constriction (LV/RV discordance during respiration)

Question 27

asthma or constriction?

Answer 27

asthma (IVC and HV normal)

Question 28

which one is COPD and which is constriction

Answer 28

left = COPD (suck in lots of air and therefore lots of venous flow), right = constriction (diastolic flow reversal, otherwise normal flow during insp)

Question 29

what are the 2 Ddx of medial e’ > 8, which is high?

Answer 29

constriction or young pt with asthm