EchoDx Hub

03/08/2025

03/08/2025

02/08/2025

🫀 Ostium Secundum ASD (OS-ASD)
🔹 Most common type of Atrial Septal Defect (≈70% of ASDs)
🔹 Occurs in the fossa ovalis region – central part of the interatrial septum
🔹 Caused by deficient or fenestrated septum primum

🧬 Key Features:
✅ Left-to-right shunt (usually)
✅ RA and RV dilation due to volume overload
✅ Paradoxical septal motion (in large shunts)
✅ Can be isolated or part of syndromes (e.g., Holt-Oram)

🔍 Echo Findings:
🖥️ Best Views:

Subcostal 4CH (most sensitive for septal dropout)

Apical 4CH (see shunt with color Doppler)

Parasternal short axis (partial visualization)

TEE (if TTE suboptimal)

🎨 Color Doppler:

Left-to-right turbulent flow across the IAS

Use multiple sweeps to confirm location and size

🧪 Additional Clues:

RA/RV enlargement

Increased pulmonary venous return to RV

Pulmonary artery dilation

Estimate Qp:Qs if needed

📏 Classification (based on size):
Small 10 mm

🚨 When to Close?
✅ Significant left-to-right shunt (Qp:Qs ≥ 1.5:1)
✅ RA/RV enlargement
✅ Symptoms (fatigue, breathlessness, arrhythmias)
✅ Paradoxical embolism

📌 Don’t Confuse With:
PFO (flap, usually no RA/RV enlargement)

Sinus venosus ASD (near SVC or IVC entry)

Ostium primum ASD (low in IAS, part of AV canal)

02/08/2025

Q56. Which of the following echocardiographic patterns is most characteristic of Takotsubo cardiomyopathy?
A. Apical ballooning with basal hyperkinesia
B. Global hypokinesia of all LV segments
C. Mid-septal hypertrophy with SAM of the mitral valve
D. Inferobasal akinesia with preserved apical motion

✅ Correct Answer: A. Apical ballooning with basal hyperkinesia
🩺 Explanation:
Takotsubo Cardiomyopathy is often triggered by emotional or physical stress and mimics myocardial infarction clinically and on ECG — but without obstructive CAD.

Classic echo findings include:

Apical akinesia/dyskinesia (ballooning)

Hypercontractile basal segments

This gives the "takotsubo" (octopus trap) appearance in systole on apical 4CH and 2CH views.

This pattern typically resolves within days to weeks, unlike ischemic cardiomyopathy.

Why others are incorrect:
B – Global hypokinesia suggests cardiomyopathy (e.g., viral or toxic), not Takotsubo

C – Seen in HOCM, not stress cardiomyopathy

D – Could occur in posterior MI, not typical of Takotsubo

🧠 Clinical Tip:
Always consider Takotsubo in post-menopausal females with acute chest pain, ST changes, and echo showing apical ballooning without coronary occlusion. Coronary angiography is needed to rule out MI.

02/08/2025

01/08/2025

01/08/2025

Q55. Which echocardiographic finding is most characteristic of apical hypertrophic cardiomyopathy (Apical HCM)?
A. Mid-systolic notching of the LV outflow Doppler envelope
B. Systolic anterior motion of the mitral valve with posterior jet
C. Spade-like configuration of the LV cavity in apical views
D. Concentric LV hypertrophy with small LV cavity and thickened septum

✅ Correct Answer: C. Spade-like configuration of the LV cavity in apical views
🩺 Explanation:
Apical HCM is a subtype of hypertrophic cardiomyopathy where the hypertrophy is confined to the apex of the left ventricle.

Classic echocardiographic feature:

In apical 4-chamber or 2-chamber views, the LV cavity takes a "spade-like" or "ace-of-spades" appearance in systole due to:

Marked apical thickening

Relative sparing of the basal and mid-segments

Other helpful signs:

May have deep T-wave inversions on ECG (especially in precordial leads)

Doppler may show diastolic dysfunction, but usually no LVOT obstruction

Why others are incorrect:
A – Seen in dynamic LVOT obstruction, not apical HCM

B – Feature of classic HCM with LVOT obstruction, not apical variant

D – Suggestive of concentric hypertrophy (e.g., HTN or AS), not focal apical thickening

🧠 Clinical Tip:
Always evaluate apical segments thoroughly in suspected HCM cases — standard views may miss apical thickening, so use contrast echo or CMR if image quality is suboptimal.

01/08/2025

🫀 Tricuspid Regurgitation (TR): What is it?
Backflow of blood from RV to RA during systole due to poor coaptation of the tricuspid valve leaflets.

⚙️ Types of Tricuspid Regurgitation:
1️⃣ Primary (Organic):
🔹 Structural abnormality of the valve or chordae
🔸 Causes:

Rheumatic heart disease

Infective endocarditis

Carcinoid syndrome

Ebstein anomaly

Myxomatous degeneration

Congenital valve clefts

2️⃣ Secondary (Functional):
🔹 Normal valve structure
🔸 Due to annular dilation or RV dysfunction
🔸 Causes:

Pulmonary hypertension

Left heart disease (MR, MS, etc.)

RV infarction or DCM

Atrial fibrillation (isolated RA enlargement)

🧪 Grading Severity of TR (Echo Parameters):
📌 Jet Area (Apical 4CH – Color Doppler):

Mild: 10 cm²
(less specific alone – use in combination)

📌 Vena Contracta (PLAX-RV Inflow or Apical 4CH):

21 mm/m² = Suggests annular dilation

📌 PISA Method (Optional, more precise)

EROA >0.4 cm², Regurgitant Volume >45 mL = Severe TR

🔍 Key Echo Views to Assess TR:
🔸 Apical 4CH: Jet origin, vena contracta, RA & RV size
🔸 PLAX RV Inflow View: Leaflet structure, vena contracta
🔸 Subcostal 4CH: Evaluate annulus, IVC, hepatic veins
🔸 TEE (if available): For better leaflet morphology

📌 Echo Clues of Severe TR:
✅ Dilated RA & RV
✅ Septal flattening or paradoxical motion
✅ Hepatic vein systolic flow reversal
✅ Dilated IVC with reduced collapse
✅ Tricuspid leaflet tethering or flail

01/08/2025

31/07/2025

Let’s test your knowledge! 🔍👇

💬 1. What is DCRV?
💬 2. How many types of DCRV are there?
💬 3. What are the common causes or associations?
💬 4. How do you identify DCRV in echocardiography?
💬 5. Which echocardiographic view is most helpful in diagnosing DCRV?

Drop your answers in the comments! 🗨️ Let’s learn together!

31/07/2025