Echo Hemodynamics

PSCC Fifth Cardiology

Board Review Course
October 6, 2016

Bahaa M. Fadel, MD, FACC

Director, Adult Echocardiography Laboratory
King Faisal Specialist Hospital & Research Center
Riyadh, Saudi Arabia
 Question 1

This continuous wave Doppler is suggestive of the following

mitral valve area:
A. 0.8 cm2
B. 1.0 cm2
C. 1.2 cm2
D. 1.4 cm2
E. Cannot determine MV area based on data provided
 Question 1

This continuous wave Doppler is suggestive of the following

mitral valve area:
A. 0.8 cm2
B. 1.0 cm2 MV area = 220/PHT
PHT = 0.29 x DT
C. 1.2 cm2
D. 1.4 cm2
E. Cannot determine MV area based on data provided
 Question 2
The following signal was obtained
from the apical window. What is
the most likely origin of this signal?

A. Mitral valve prolapse

B. Rheumatic mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Subaortic membrane
E. Severe aortic stenosis
 Question 2
Late peaking high velocity flow
indicative of dynamic obstruction
“Dagger shape signal”

A. Mitral valve prolapse

B. Rheumatic mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Subaortic membrane
E. Severe aortic stenosis
 Question 3
The following data were obtained from a 72-year-old man
with a calcified aortic valve: left ventricular outflow tract
velocity (V1) = 0.8 m/s, transaortic velocity (V2) = 4 m/s,
LVOT diameter = 2 cm, heart rate = 75 bpm.
The calculated aortic valve area is:
A. 0.4 cm2
B. 0.6 cm2
C. 0.8 cm2
D. 1 cm2
E. 1.2 cm2
 Question 3
• Continuity equation: A1 x V1 = A2 x V2
[3.14 x (2)2/4] x 0.8 = A2 x 4
A2 = 0.6 cm2

A. 0.4 cm2
B. 0.6 cm2
C. 0.8 cm2
D. 1 cm2
E. 1.2 cm2
 Question 4
A patient has an LVOT velocity of 1 m/s, LVOT TVI of 25 cm,
LVOT diameter 2 cm, aortic transvalvular velocity of 1.5
m/s, heart rate 70 bpm and body surface area of 2.0 m2.
The cardiac output in this patient is:
A. 2.7 L/min/m2
B. 2.1 L/min/m2
C. 3.4 L/min/m2
D. 4.2 L/min/m2
E. Cannot determine the cardiac index based on the
given data
 Question 4
Cardiac output = stroke volume x heart rate
= LVOT area x TVI x heart rate
= [3.14 x (2)2/4] x 25 x 70
Cardiac index = Cardiac output / BSA

A. 2.7 L/min/m2
B. 2.1 L/min/m2
C. 3.4 L/min/m2
D. 4.2 L/min/m2
E. Cannot determine cardiac index
based on the given data
 Question 5
The following pulmonary vein Doppler is suggestive of
which diagnosis:

A. Pulmonary hypertension
B. Severe mitral regurgitation
C. Atrial fibrillation
D. Normal left atrial pressure
E. Abnormal LV relaxation
 Question 5
Systolic flow reversal in pulmonary vein
S
D

Normal PV
Doppler
A. Pulmonary hypertension
B. Severe mitral regurgitation
C. Atrial fibrillation
D
D. Normal left atrial pressure
E. Abnormal LV relaxation

SR
 Question 6
The following criteria are all indicative of severe
aortic regurgitation except:
A. Diastolic flow reversal in the pulmonary veins
B. Regurgitant fraction > 50%
C. Effective regurgitant orifice area of 0.3 cm2
D. Vena contracta diameter of 6 mm
E. Regurgitant volume of 60 ml/beat
 Question 6
The following criteria are all indicative of severe
aortic regurgitation except:
A. Diastolic flow reversal in the pulmonary veins
B. Regurgitant fraction > 50%
C. Effective regurgitant orifice area of 0.4 cm2
D. Vena contracta diameter of 7 mm
E. Regurgitant volume of 60 ml/beat
 Question 7

The patient shown here has:

A. Severe mitral regurgitation
B. Severe mitral stenosis
C. Severe aortic stenosis
D. Mild mitral regurgitation
E. Severe pulmonary valve
stenosis
 Question 7

The patient shown here has:

A. Severe mitral regurgitation
B. Severe mitral stenosis
C. Severe aortic stenosis
D. Mild mitral regurgitation
E. Severe pulmonary valve
stenosis
 Question 8

The M-mode shown is indicative of:

A. Mitral valve prolapse
B. Infective endocarditis
C. Ebstein anomaly
D. Hypertrophic obstructive cardiomyopathy
E. Left atrial myxoma
 Question 8

Systolic anterior motion

of MV

The M-mode shown is indicative of:

A. Mitral valve prolapse
B. Infective endocarditis
C. Ebstein anomaly
D. Hypertrophic obstructive cardiomyopathy
E. Left atrial myxoma
 Question 9

This pulse wave Doppler flow signal obtained from the suprasternal
window across the descending thoracic aorta is indicative of:
A. Coarctation of the aorta
B. Occlusion of the distal abdominal aorta
C. Severe aortic regurgitation
D. Hypertrophic obstructive cardiomyopathy
E. Supravalvular aortic stenosis
 Question 9

High velocity
continuous jet

This pulse wave Doppler flow signal obtained from the suprasternal
window across the descending thoracic aorta is indicative of:
A. Coarctation of the aorta
B. Occlusion of the distal abdominal aorta
C. Severe aortic regurgitation
D. Hypertrophic obstructive cardiomyopathy
E. Supravalvular aortic stenosis
 Question 10
SR

This hepatic vein Doppler is indicative of:

A. Pulmonary hypertension
B. Severe tricuspid regurgitation
C. Severe pulmonary stenosis
D. RV systolic dysfunction
E. Constrictive pericarditis
Question 10
Systolic flow reversal in hepatic vein
SR

This hepatic vein Doppler is indicative of:

A. Pulmonary hypertension
B. Severe tricuspid regurgitation
C. Severe pulmonary stenosis
D. RV systolic dysfunction
E. Constrictive pericarditis
 Question 11

This Doppler of the abdominal aorta is indicative of:

A. Ventricular septal defect
B. Coarctation of the aorta
C. Abdominal aortic aneurysm
D. Severe aortic regurgitation
E. Supravalvular aortic stenosis
 Question 11

Holodiastolic flow reversal

in the abdominal aorta

This Doppler of the abdominal aorta is indicative of:

A. Ventricular septal defect
B. Coarctation of the aorta
C. Abdominal aortic aneurysm
D. Severe aortic regurgitation
E. Supravalvular aortic stenosis
 Question 12
This M-mode across the mitral valve
indicates the following:
A. Mitral stenosis
B. Aortic regurgitation
C. Elevated LV end-diastolic pressure
D. Mitral valve prolapse
E. Hypertrophic cardiomyopathy
 Question 12

B-bump

This M-mode across the mitral valve

indicates the following:
A. Mitral stenosis
B. Aortic regurgitation
C. Elevated LV end-diastolic pressure
D. Mitral valve prolapse
E. Hypertrophic cardiomyopathy
 Question 13

This M-mode across the RV and LV suggests the following:

A. Constrictive pericarditis
B. Restrictive cardiomyopathy
C. Hypertrophic cardiomyopathy
D. Mitral valve prolapse
E. Severe mitral regurgitation
 Question 13
Inspiratory shift of the septum towards LV

Exaggerated LV-RV
interdependence

This M-mode across the RV and LV

suggests the following:
A. Constrictive pericarditis
B. Restrictive cardiomyopathy
C. Hypertrophic cardiomyopathy
D. Mitral valve prolapse
E. Severe mitral regurgitation
 Question 14

This Doppler of mitral regurgitation indicates the following

diagnosis:
A. Associated aortic stenosis
B. Reduced LVEF
C. Mitral valve prolapse
D. Severe mitral regurgitation
E. Moderate mitral regurgitation
 Question 14

Late systolic MR *

This Doppler of mitral regurgitation indicates the following

diagnosis:
A. Associated aortic stenosis
B. Reduced LVEF
C. Mitral valve prolapse
D. Severe mitral regurgitation
E. Moderate mitral regurgitation
 Question 15

This Doppler from the suprasternal window is indicative of:

A. Subaortic membrane
B. Severe aortic regurgitation
B. Obstruction to SVC flow
C. Severe tricuspid regurgitation
D. Supravalvular aortic stenosis
 Question 15

Holodiastolic flow reversal

in the descending
thoracic aorta

This Doppler from the suprasternal window is indicative of:

A. Subaortic membrane
B. Severe aortic regurgitation
B. Obstruction to SVC flow
C. Severe tricuspid regurgitation
D. Supravalvular aortic stenosis
 Question 16

This Doppler of mitral regurgitation indicates the following

diagnosis:
A. Associated aortic stenosis
B. Severe LV systolic dysfunction
C. Mitral valve prolapse
D. Severe mitral regurgitation
E. Moderate mitral regurgitation
 Question 16

Reduced dp/dt

This Doppler of mitral regurgitation indicates the following

diagnosis:
A. Associated aortic stenosis
B. Severe LV systolic dysfunction
C. Mitral valve prolapse
D. Severe mitral regurgitation
E. Moderate mitral regurgitation
 Question 17

This Doppler across the pulmonary valve and pulmonary artery

from the parasternal short axis view is indicative of:
A. Severe pulmonary regurgitation
B. Patent ductus arteriosus
C. Atrial septal defect
D. Ross procedure
E. Pulmonary valve stenosis
Patent ductus arteriosus
 Question 18

This Doppler across the pulmonary valve and pulmonary artery

from the parasternal short axis view in indicative of:
A. Severe pulmonary valve regurgitation
B. Branch pulmonary artery stenosis
C. Acute pulmonary embolism
D. Pulmonary artery aneurysm
E. Severe pulmonary valve stenosis
 Question 18
Peak gradient
across PV = 100 mmHg
+
Elevated RVEDP

This Doppler across the pulmonary valve and pulmonary artery

from the parasternal short axis view in indicative of:
A. Severe pulmonary valve regurgitation
B. Branch pulmonary artery stenosis
C. Acute pulmonary embolism
D. Pulmonary artery aneurysm
E. Severe pulmonary valve stenosis
 Question 19
Based on this tricuspid regurgitation signal and
assuming a right atrial pressure of 20 mmHg,
what is the systolic pulmonary artery pressure?
A. 50 mmHg
B. 70 mmHg
C. 90 mmHg
D. 100 mmHg
E. 120 mmHg
 Question 19
Based on this tricuspid regurgitation signal and
assuming a right atrial pressure of 20 mmHg,
what is the systolic pulmonary artery pressure?
A. 50 mmHg
B. 70 mmHg
C. 90 mmHg
D. 100 mmHg
E. 120 mmHg
 Question 20

This pulse wave Doppler across the mitral valve may indicate
which of the following diagnoses:
A. Hypoventilation syndrome
B. Pericardial tamponade
C. Acute mitral regurgitation
D. Constrictive pericarditis
E. B and D
 Significant inspiratory
decrease in transmitral flow velocity

This pulse wave Doppler across the mitral valve may indicate
which of the following diagnoses:
A. Hypoventilation syndrome
B. Pericardial tamponade
C. Acute mitral regurgitation
D. Constrictive pericarditis
E. B and D
 Question 21

This continuous wave Doppler across the aortic valve

indicates the following diagnoses:

A. Acute severe aortic regurgitation

B. Chronic severe aortic regurgitation
C. Acute hypertensive crisis
D. Low flow severe aortic stenosis
E. Associated mitral regurgitation
 Question 21

Very rapid deceleration

time of AR signal

A. Acute severe aortic regurgitation

B. Chronic severe aortic regurgitation
C. Acute hypertensive crisis
D. Low flow severe aortic stenosis
E. Associated mitral regurgitation
 Question 22

This continuous wave Doppler across a VSD has a peak velocity of

6 m/s. Based on a systolic blood pressure of 164 mmHg, what
would be the systolic pulmonary artery pressure?

A. 20 mmHg
B. 35 mmHg
C. 50 mmHg
D. 70 mmHg
E. Cannot determine PA pressure
 Question 22
This continuous wave Doppler across a VSD has a peak velocity of
6 m/s. Based on a systolic blood pressure of 164 mmHg, what
would be the systolic pulmonary artery pressure?

A. 20 mmHg
B. 35 mmHg
C. 50 mmHg
D. 70 mmHg
E. Cannot determine PA pressure

LV systolic pressure - RV systolic pressure = 4 V2 = 4 (62) = 144 mmHg

LV systolic pressure = Aortic systolic pressure
RV systolic pressure = PA systolic pressure = 164 -144 = 20 mmHg
 Question 23

This pulse wave Doppler across the mitral

valve in this 72-year old male with LVEF of
30% indicates all of the following except:

A. Presence of mitral regurgitation

B. Elevated LA pressure
C. Relatively poor prognosis
D. Presence of pulmonary hypertension
E. This pattern can potentially be reversed
with appropriate therapy
 Question 23
Restrictive filling pattern

A. Presence of mitral regurgitation Valsalva

B. Elevated LA pressure maneuver
C. Relatively poor prognosis
D. Presence of pulmonary hypertension
E. This pattern can be reversed with
appropriate therapy

Elevated and reversible

LA pressure
 Question 24

This continuous wave Doppler across the pulmonary valve is

indicative of which diagnosis?
A. Mild-moderate pulmonary valve regurgitation
B. Mild pulmonary valve stenosis
C. Aorto-pulmonary window
D. Severe pulmonary valve regurgitation
E. Moderate pulmonary valve stenosis
 Question 24
Dense PR signal with rapid DT

Premature opening of PV with

diastolic forward flow into the PA
indicative of high RVEDP

This continuous wave Doppler across the pulmonary valve is

indicative of which diagnosis?
A. Mild-moderate pulmonary valve regurgitation
B. Mild pulmonary valve stenosis
C. Aorto-pulmonary window
D. Severe pulmonary valve regurgitation
E. Moderate pulmonary valve stenosis
 Question 1
The mitral flow measurements in a 62-year-old man are: left
ventricular (LV) isovolumic relaxation time (IVRT) = 50 msec,
E/A ratio = 1.5 and E-wave deceleration time = 140 msec.

This is suggestive of:

A. Normal left atrial (LA) pressure
B. Abnormal LV relaxation
C. High LA pressure
D. Cannot determine LA pressure
E. None of the above
 Question 2
Which feature is consistent with severe MR:
A. Mitral jet area size of 10 cm2
B. PISA radius of 1.2 cm at an aliasing velocity
of 50 cm/s
C. Effective regurgitant orifice area of 0.8 cm2
D. Vena contracta diameter of 9 mm
E. All of the above