AE-Adult-Echocardiography AE Adult Echocardiography Examination Questions and Answers

Comprehensive and Detailed Explanation From Exact Extract:

The video shows a parasternal long-axis view of the left ventricle and mitral valve with the anterior leaflet of the mitral valve moving abnormally toward the interventricular septum during systole. This systolic anterior motion (SAM) of the mitral valve is characteristic of hypertrophic obstructive cardiomyopathy (HOCM) and contributes to left ventricular outflow tract obstruction.

Aortic root dilatation and left atrial elongation are structural findings seen in other views. Mid-anteroseptal hypokinesis is a regional wall motion abnormality not clearly visualized in this clip.

This echocardiographic sign is critical in diagnosing and managing HOCM and is discussed extensively in ASE guidelines and clinical echocardiography texts【16:Textbook of Clinical Echocardiography, 6e†p.350-355】【12:ASE Cardiomyopathy Guidelines†p.120-130】.

The peak Doppler velocity of mitral regurgitation (MR) reflects the instantaneous pressure gradient between the left ventricle (LV) and left atrium (LA) during systole. The higher the velocity, the greater the pressure difference.

However, the velocity itself does not quantify severity directly; severity depends on the size and volume of the regurgitant jet. The mechanism is determined by valve morphology and motion, not velocity. The LV to aorta gradient relates to aortic valve pathology.

This principle is discussed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Mitral Regurgitation and Doppler Evaluation【20:390-395†Textbook of Clinical Echocardiography】.

Severe mitral regurgitation (MR) is typically characterized by significant left atrial dilation due to volume overload, and systolic flow reversal in the pulmonary veins caused by retrograde flow from the left ventricle into the left atrium during systole.

An eccentric mitral regurgitant jet is common in severe MR, often due to leaflet prolapse or flail, resulting in directed jets that hug the atrial wall.

Mitral regurgitant jet velocity, however, is usually significantly higher in severe MR due to the high pressure gradient between the left ventricle and left atrium during systole. A jet velocity less than 0.5 cm/sec is extremely low and inconsistent with severe MR. Typically, MR jet velocities are in the range of several meters per second.

Thus, a mitral regurgitant jet velocity less than 0.5 cm/sec is NOT associated with severe MR.

This is detailed in echocardiography literature discussing MR quantification and Doppler findings, emphasizing high-velocity regurgitant jets in severe MR and hemodynamic consequences seen on pulmonary vein flow and LA size .

In cardiac tamponade, there is a characteristic reciprocal respiratory variation in transvalvular flow velocities due to ventricular interdependence and impaired cardiac filling. During expiration, the intrathoracic pressure increases, which leads to decreased right ventricular filling and thus decreased transtricuspid flow velocity. Simultaneously, left ventricular filling increases, causing an increase in transmitral flow velocity.

Therefore, during expiration, the transmitral gradient increases while the transtricuspid gradient decreases. This phenomenon reverses during inspiration, where transtricuspid flow increases and transmitral flow decreases. These respiratory variations are diagnostic hallmarks of tamponade physiology and help distinguish it from other conditions.

This principle is illustrated in Doppler echocardiographic studies of ventricular inflow and is described with diagrams in the "Textbook of Clinical Echocardiography, 6e" (Chapter 10: Pericardial Disease), highlighting the changes in transmitral and transtricuspid velocities during the respiratory cycle in tamponade .

The image is a suprasternal or high parasternal echocardiographic view of the aortic arch and its branches. The arrow points to the first large branch arising from the aortic arch, which is the brachiocephalic artery (also called the innominate artery). This vessel courses superiorly and bifurcates into the right common carotid and right subclavian arteries.

The left common carotid artery is the second branch from the arch, the left subclavian artery is the third branch, and the right common carotid is a branch of the brachiocephalic artery, not directly off the arch.

This anatomic arrangement and its echocardiographic depiction are well documented in adult echocardiography references and vascular ultrasound guidelines【12:ASE Vascular Imaging Guidelines†p.270-275】【16:Textbook of Clinical Echocardiography, 6e†p.400-405】.

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The echocardiographic image shows a short-axis view of the left ventricle at the mid-papillary muscle level with segmental strain values. The arrow points to the wall segment located inferiorly (towards the bottom of the image in standard orientation), which corresponds to the inferior wall of the left ventricle.

According to the standardized 17-segment model endorsed by the American Society of Echocardiography (ASE), the inferior wall is situated posteriorly and inferiorly in the short-axis view. The other options represent adjacent walls: anterior is opposite the inferior wall, anterolateral and inferolateral correspond to lateral wall segments.

This segmental anatomy and nomenclature are detailed in adult echocardiography textbooks and ASE chamber quantification guidelines, which emphasize precise segmental identification for accurate regional function assessment【12:ASE Chamber Quantification Guidelines†p.90-95】【16:Textbook of Clinical Echocardiography, 6e†p.140-145】.

The echocardiographic image shows a mobile, highly echogenic, mesh-like structure within the right atrium consistent with the Chiari network. The Chiari network is an embryologic remnant of the right valve of the sinus venosus, appearing as a fenestrated, reticulated membrane that is usually thin and mobile, found near the orifice of the inferior vena cava or the coronary sinus.

This structure is benign and often an incidental finding but can be confused with thrombus or atrial tumors. Unlike left atrial thrombus, which appears as a more solid, immobile mass often located in the left atrial appendage, the Chiari network is mobile and located in the right atrium. Cor triatriatum is a rare congenital membrane dividing the left atrium into two chambers and appears differently on echocardiography. Artifact refers to non-anatomic echoes which do not persist or move consistently.

Recognition of Chiari network is important to avoid misdiagnosis, and its characteristics are well described in echocardiography literature such as the "Textbook of Clinical Echocardiography" and ASE imaging guidelines【16:Textbook of Clinical Echocardiography, 6e†p.400-402】【12:ASE Guidelines on Cardiac Masses†p.150-155】.

The echocardiographic video shows a prosthetic ring-like structure attached to the mitral annulus with preserved native leaflet motion, consistent with an annuloplasty ring repair. Annuloplasty rings are used to reduce the mitral annulus size and improve leaflet coaptation in mitral regurgitation without replacing the valve.

Bioprosthetic or mechanical valve replacements would show distinctly different echogenic valve structures with leaflet or disc motion replacing the native valve. Extensive calcification of a native valve appears as echogenic, thickened leaflets without a discrete ring.

This is described in the "Textbook of Clinical Echocardiography, 6e", Chapter on Mitral Valve Repair Techniques【20:400-405†Textbook of Clinical Echocardiography】.

Systemic blood pressure should be documented during every echocardiogram because blood pressure influences cardiac loading conditions, hemodynamics, and interpretation of valvular lesions and ventricular function.

Blood pressure affects Doppler velocities, gradients across valves, and myocardial performance; therefore, it is essential to record it routinely to interpret echocardiographic findings accurately.

This guideline is stated in the "Textbook of Clinical Echocardiography, 6e", Chapter on Echocardiographic Examination Standards and Reporting【20:15-20†Textbook of Clinical Echocardiography】.

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The apical two-chamber echocardiographic view displays the inferolateral wall (also called posterior lateral). The arrow points to this inferolateral segment, which is located inferiorly and laterally in the left ventricle.

Anteroseptum and inferoseptum relate to the interventricular septum, while anterolateral is the anterior lateral wall, opposite the inferolateral wall. Correct regional wall motion assessment is essential for ischemic disease evaluation.

This identification and terminology are described in ASE stress echocardiography and chamber quantification guidelines【12:ASE Stress Echocardiography Guidelines†p.310-315】【16:Textbook of Clinical Echocardiography, 6e†p.380-385】.

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A continuous murmur is a heart murmur that occurs throughout both systole and diastole. Among the options, a ruptured sinus of Valsalva aneurysm produces a continuous murmur due to persistent flow between the aorta and a cardiac chamber (usually the right atrium or ventricle) during both systole and diastole.

Aortic regurgitation causes a diastolic murmur, mitral stenosis causes a diastolic murmur, and a muscular ventricular septal defect typically causes a holosystolic murmur but not continuous.

Ruptured sinus of Valsalva aneurysm causes a continuous shunting of blood, resulting in the characteristic continuous murmur, often described as “machinery-like.”

This clinical correlation is covered in the "Textbook of Clinical Echocardiography, 6e", Chapter on Aortic Root and Sinus of Valsalva Pathology【20:420-425†Textbook of Clinical Echocardiography】.

The M-mode image shows characteristic diastolic doming or “hockey stick” appearance of the anterior mitral leaflet with restricted leaflet motion. This is a classic sign of mitral stenosis, where leaflet thickening and fusion cause limited opening during diastole.

Dilated cardiomyopathy shows increased chamber sizes and decreased systolic function but not mitral leaflet doming. Hypertrophic cardiomyopathy is characterized by septal thickening and SAM of the mitral valve. Mitral valve prolapse shows leaflet billowing into the left atrium during systole.

This pattern is well described in ASE valvular heart disease guidelines and echocardiography texts【12:ASE Valve Imaging Guidelines†p.180-185】【16:Textbook of Clinical Echocardiography, 6e†p.200-205】.

The Doppler waveform shows pulmonary vein flow with several components. The arrows point to small reversed flow spikes just after the atrial contraction wave, which corresponds to the atrial reversal (AR) flow component. Atrial reversal occurs as blood briefly flows backward into the pulmonary veins during atrial contraction.

Ventricular reversal is not typically seen in pulmonary veins. Diastolic flow reversal is abnormal and usually not part of normal pulmonary vein flow. Systolic forward flow is the major forward component during ventricular systole.

This interpretation is standard in ASE guidelines on diastolic function assessment and pulmonary vein Doppler evaluation【12:ASE Diastolic Function Guidelines†p.85-90】【16:Textbook of Clinical Echocardiography, 6e†p.130-135】.

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】.

Comprehensive and Detailed Explanation From Exact Extract:

This M-mode echocardiographic image shows thickened mitral valve leaflets with a characteristic "doming" or "hockey-stick" appearance during diastole, which is classic for rheumatic mitral stenosis. Rheumatic mitral stenosis leads to leaflet thickening, restricted opening, and calcification, which alters the normal mitral valve motion on M-mode.

Mitral valve prolapse would show systolic displacement of the leaflets into the left atrium, typically later in systole, not doming in diastole. Mitral valve annuloplasty ring would appear as a bright echogenic line around the annulus but is not seen in this image. Systolic anterior motion (SAM) of the mitral valve is usually seen in hypertrophic cardiomyopathy and presents as anterior motion during systole, not the diastolic pattern shown.

This classical M-mode appearance is described in "Textbook of Clinical Echocardiography, 6e", Chapter on Rheumatic Valve Disease【20:385-390†Textbook of Clinical Echocardiography】.

Mitral valve prolapse (MVP) occurs during ventricular contraction (systole). Specifically, during systole, the increased pressure in the left ventricle causes the mitral valve leaflets to billow or prolapse back into the left atrium. This abnormal systolic displacement of the mitral leaflets beyond the annular plane leads to mitral regurgitation in many cases.

The echocardiographic hallmark of MVP is systolic bowing or displacement of the mitral leaflets into the left atrium, best visualized in parasternal long-axis or apical views during ventricular contraction. MVP is not seen during ventricular filling phases such as early filling, atrial systole, or diastasis because the leaflets are normally open or positioned differently.

This is well-documented in the "Textbook of Clinical Echocardiography, 6e", Chapter on Mitral Valve Disease, explaining the pathophysiology of MVP and its timing during the cardiac cycle【20:390-395†Textbook of Clinical Echocardiography】.

A heterograft (also called xenograft) cardiac valve is derived from an animal species, commonly porcine or bovine, and implanted into a human. These bioprosthetic valves are treated to reduce immunogenicity.

Option A describes an allograft (homograft). Option B refers to bioprosthetic valves but does not specify species. Option C describes an autograft, such as the Ross procedure.

This classification is standard in cardiac surgery and echocardiography literature【16:Textbook of Clinical Echocardiography, 6e†p.450-455】【12:ASE Valve Prosthesis Guidelines†p.200-205】.

Ventricular depolarization begins with the electrical impulse traveling from the atrioventricular (AV) node to the Bundle of His, which then bifurcates into the right and left bundle branches. From the bundle branches, the impulse travels to the Purkinje fibers, which rapidly distribute the impulse to ventricular myocardium causing ventricular contraction.

Option A is incorrect because the impulse does not travel from the right to the left bundle branch; they run parallel. Option B describes atrial conduction. Option C is incorrect because the AV node precedes the Bundle of His, not the reverse.

This conduction pathway is detailed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Cardiac Electrophysiology【20:40-45†Textbook of Clinical Echocardiography】.

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Coarctation of the aorta (CoA) causes obstruction of blood flow in the descending aorta leading to increased afterload on the left ventricle. This pressure overload results in left ventricular hypertrophy (LVH) as the heart compensates for the increased resistance.

Atrial septal defect and ventricular septal defect are separate congenital defects not necessarily associated with CoA. Right ventricular hypertrophy occurs mainly with pulmonary hypertension or right heart pressure overload.

LVH is a well-recognized echocardiographic finding in CoA and is used to assess severity and chronic effects of the lesion in adult echocardiography references and ASE congenital heart disease guidelines【16:Textbook of Clinical Echocardiography, 6e†p.550-555】【12:ASE Congenital Guidelines†p.410-420】.

The image is a parasternal long-axis echocardiographic view focusing on the mitral valve annulus with a highly echogenic, dense, and well-defined structure located at the base of the posterior mitral leaflet. This appearance is characteristic of mitral annular calcification (MAC), a degenerative process resulting in calcium deposition along the mitral valve annulus.

Vegetations appear as irregular, mobile masses attached to valve leaflets and are less dense. Tumors and thrombi have different echogenicity and locations (tumors often in atria, thrombi in atrial appendages). MAC is usually more echogenic and localized to the annulus.

This description and differentiation are found in adult echocardiography textbooks and ASE guidelines on cardiac masses and valvular calcifications【16:Textbook of Clinical Echocardiography, 6e†p.460-465】【12:ASE Guidelines on Cardiac Masses†p.150-160】.

Comprehensive and Detailed Explanation From Exact Extract:

The echocardiographic image shows an apical four-chamber view of the left ventricle. The arrows point to the lateral wall of the left ventricle, which in this view corresponds to the anterolateral wall. The anterolateral wall is located opposite the septum and posterior to the left atrium.

Anteroseptum and inferoseptum refer to different segments of the interventricular septum. The inferior wall is visualized better in other views.

This segmental wall nomenclature and identification are described in ASE chamber quantification and stress echocardiography guidelines【12:ASE Chamber Quantification Guidelines†p.90-95】【16:Textbook of Clinical Echocardiography, 6e†p.140-145】.

Comprehensive and Detailed Explanation From Exact Extract:

The sniff maneuver is commonly used in echocardiography to assess right atrial pressure (RAP) indirectly by observing changes in the size and collapsibility of the inferior vena cava (IVC). During a sniff or rapid inspiration, negative intrathoracic pressure normally causes the IVC to collapse. The degree of IVC collapse during the sniff test correlates with RAP.

If the IVC is dilated and fails to collapse significantly with a sniff, this suggests elevated right atrial pressure, which can be caused by right heart failure, pulmonary hypertension, or volume overload.

This maneuver is not used to evaluate left atrial pressure or outflow tract obstructions, which require other echocardiographic parameters.

This assessment method is described in the "Textbook of Clinical Echocardiography, 6e", Chapter on Right Heart Evaluation and Hemodynamics【20:300-305†Textbook of Clinical Echocardiography】.

The color Doppler image in the four-chamber view shows a jet across the interatrial septum, indicating a shunt at the atrial level. In a patient with left atrial enlargement, the most common incidental finding causing such flow is a patent foramen ovale (PFO). A PFO is a small communication between the right and left atria that can open under certain pressure conditions, leading to shunting.

Muscular ventricular septal defect is a ventricular level defect and would be seen in different views. Coronary-cameral fistula is a rare anomaly involving abnormal connections between coronary arteries and cardiac chambers, not typical in this setting. Sinus venosus defect is an atypical atrial septal defect located near the superior vena cava and would require different imaging planes for detection.

This finding and its implications are discussed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Atrial Septal Defects and Shunts【20:115-120†Textbook of Clinical Echocardiography】.

Acute severe aortic regurgitation causes rapid volume overload of the left ventricle during diastole, leading to a marked increase in left ventricular end-diastolic pressure (LVEDP). This elevated LVEDP results from the sudden return of blood into the ventricle and impaired compliance.

End-systolic pressure is not primarily affected. Early-diastolic pressure changes relate to aortic pressure but LVEDP is critical. Early-systolic pressure is not typically affected by AR.

This hemodynamic effect is discussed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Aortic Regurgitation and Hemodynamics【20:375-380†Textbook of Clinical Echocardiography】.

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 arrow points to the left anterior descending (LAD) coronary artery, which runs in the anterior interventricular groove toward the apex of the heart. It supplies the anterior wall of the left ventricle.

The right coronary artery runs in the right atrioventricular groove. The left main coronary artery is proximal to the LAD and circumflex arteries. The circumflex artery runs in the left atrioventricular groove posteriorly.

This identification is detailed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Coronary Artery Anatomy and Echocardiographic Visualization【20:150-155†Textbook of Clinical Echocardiography】.

The two-chamber apical view allows visualization of the left ventricle's anterior and inferior walls, including the apical lateral segment. It is ideal for assessing wall thickness and segmental wall motion abnormalities in this region.

The four-chamber view visualizes septal and lateral walls but does not optimally display the apical lateral segment. Parasternal long axis primarily visualizes the anterior septum and posterior wall but is limited for lateral apex. The mid-parasternal short axis focuses on mid-ventricular segments and does not visualize the apex.

This anatomical and echocardiographic detail is described in the "Textbook of Clinical Echocardiography, 6e", Chapter on Left Ventricular Segmental Analysis【20:120-125†Textbook of Clinical Echocardiography】.

During early rapid filling, when the mitral valve opens at the onset of diastole, the pressure gradient between the left atrium (LA) and left ventricle (LV) is at its peak, allowing blood to flow into the ventricle. As filling progresses during this phase, the left ventricular diastolic pressure rises rapidly and quickly approaches and equalizes with left atrial pressure.

The equalization of pressures is critical to facilitate ventricular filling and is reflected in the mitral inflow Doppler pattern, where the E-wave corresponds to early rapid filling. Diastasis is the mid-diastolic slow filling phase where pressures are nearly equal and little flow occurs. Atrial contraction is the late filling phase, adding a small volume to the ventricle.

This physiological timing is detailed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Diastolic Function and Hemodynamics, with emphasis on pressure changes during the cardiac cycle【20:210-215†Textbook of Clinical Echocardiography】.

The video shows a transthoracic echocardiographic apical four-chamber or modified view focusing on the left atrium and adjacent structures. The arrow points to a vessel entering the left atrium from the right side of the image, which corresponds anatomically to the right upper pulmonary vein. The right upper pulmonary vein returns oxygenated blood from the right lung to the left atrium and is visualized in echocardiography as entering the superior-lateral aspect of the left atrium.

The left upper pulmonary vein enters the left atrium on the opposite side. The right and left pulmonary arteries are located anteriorly and superiorly in the mediastinum and are visualized mainly in the parasternal or suprasternal views, not the apical four-chamber.

This identification aligns with standard adult echocardiography anatomy as described in the "Textbook of Clinical Echocardiography" and ASE guidelines on pulmonary vein imaging【12:ASE Pulmonary Vein Imaging Guidelines†p.110-115】【16:Textbook of Clinical Echocardiography, 6e†p.120-125】.

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 .

Patent foramen ovale (PFO) is a common congenital cardiac anomaly found in approximately 25-30% of the adult population. It represents incomplete closure of the foramen ovale after birth and is usually asymptomatic.

Cleft mitral valve and bicuspid aortic valve are less common congenital anomalies, and hypertrophic cardiomyopathy is a genetic myocardial disease, not an anomaly.

This prevalence and clinical significance are discussed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Atrial Septal Defects and Common Anomalies【20:110-115†Textbook of Clinical Echocardiography】.

In cardiac tamponade, pericardial fluid accumulation restricts cardiac filling leading to decreased stroke volume and cardiac output. As a compensatory mechanism, the heart rate increases (tachycardia) to maintain cardiac output.

Oxygen saturation typically does not increase; it may be normal or decreased if tamponade leads to hypoperfusion. Systolic and diastolic blood pressures often decrease due to reduced cardiac output.

This physiological response is well described in clinical cardiology texts and ASE pericardial disease guidelines【12:ASE Pericardial Disease Guidelines†p.300-305】【16:Textbook of Clinical Echocardiography, 6e†p.280-285】

The first image shows a bullseye plot of global longitudinal strain (GLS) with marked reduction in strain values (less negative numbers) most prominently in the apical segments (central red zone), with an overall GLS of -8.2% (normal is about -20%) and a reduced ejection fraction of 41%. This pattern is characteristic of Takotsubo cardiomyopathy, which typically demonstrates regional wall motion abnormalities that predominantly involve the apex and mid segments of the left ventricle with basal sparing.

The 2D echocardiographic images show apical ballooning, a hallmark of Takotsubo cardiomyopathy, where the apex is akinetic or dyskinetic and the basal segments contract normally or hypercontract. Doppler images show findings consistent with impaired ventricular function.

In contrast:

Apical hypertrophic cardiomyopathy (HCM) would show increased wall thickness localized to the apex but not apical ballooning or reduced strain in that typical pattern.

Hypertrophic obstructive cardiomyopathy (HOCM) involves basal septal hypertrophy with outflow obstruction, not apical akinesis or ballooning.

Restrictive cardiomyopathy from amyloidosis involves diffuse infiltration and generally a different strain pattern with more uniform reduction and “apical sparing” rather than apical involvement.

This interpretation aligns with the diagnostic criteria and echocardiographic features described in the adult echocardiography literature, including the "Textbook of Clinical Echocardiography" (Chapter on Cardiomyopathies) and ASE guidelines, which highlight apical ballooning and regional strain abnormalities as diagnostic features of Takotsubo cardiomyopathy【16:Cardiomyopathy Chapter†Textbook of Clinical Echocardiography, 6e】【12:ASE Guidelines on Strain Imaging†p.130-135】.

Cardiac contusion is a myocardial injury resulting from blunt chest trauma, typically affecting the right ventricle more commonly than the left ventricle because of its anterior location and proximity to the chest wall. The injury can range from mild bruising to severe myocardial damage and dysfunction.

It does not result from myocardial infarction (which is ischemic injury), nor does it cause hypertrophy or hypercontractility. Instead, it may cause wall motion abnormalities, arrhythmias, or even rupture.

These features are detailed in echocardiography and trauma cardiology literature, including the "Textbook of Clinical Echocardiography" and clinical guidelines on blunt cardiac injury【16:Textbook of Clinical Echocardiography, 6e†p.600-605】【12:ASE Trauma Cardiology Guidelines†p.500-505】.

Comprehensive and Detailed Explanation From Exact Extract:

The video suggests an atrial septal abnormality possibly a patent foramen ovale or interatrial shunt. To evaluate for right-to-left shunting across an atrial septal defect, the administration of agitated saline contrast with a Valsalva maneuver is the next best step.

Valsalva increases right atrial pressure transiently, promoting transient right-to-left shunting, making microbubbles visible in the left atrium if a shunt is present. Administration without Valsalva reduces sensitivity. The choice of arm vein (right or left) is less critical.

This diagnostic technique is well described in ASE adult congenital heart disease guidelines and echocardiography contrast protocols【12:ASE Contrast Echocardiography Guidelines†p.190-195】【16:Textbook of Clinical Echocardiography, 6e†p.575-580】.

Frame rate in echocardiography is affected by the sector width, depth, and line density. Narrowing the sector width reduces the number of scan lines per frame, thus increasing the frame rate and temporal resolution. This improves the ability to capture rapid cardiac motion.

Decreasing overall gain affects image brightness, not frame rate. Increasing dynamic range increases the number of gray shades, which may slightly decrease frame rate due to processing load. Increasing transducer frequency improves resolution but reduces penetration depth and can decrease frame rate due to longer pulse duration.

This principle is emphasized in echocardiography physics and instrumentation texts and ASE imaging guidelines【16:Textbook of Clinical Echocardiography, 6e†p.40-45】【12:ASE Imaging Protocols†p.10-15】.

The echocardiographic images show prominent trabeculations and deep intertrabecular recesses communicating with the left ventricular cavity, best seen on contrast-enhanced images. This finding is characteristic of left ventricular noncompaction (LVNC), a cardiomyopathy resulting from arrested myocardial compaction during embryogenesis.

LVNC is diagnosed by visualizing a two-layered myocardium with a thin compacted epicardial layer and a thicker noncompacted endocardial layer with deep trabecular recesses. The use of contrast echocardiography enhances endocardial border delineation and recess visualization, increasing diagnostic accuracy.

Loeffler syndrome (hypereosinophilic cardiomyopathy) often shows endomyocardial fibrosis and restrictive physiology but not prominent trabeculations. Hypertrophic cardiomyopathy shows asymmetric septal hypertrophy without deep recesses. Ischemic cardiomyopathy shows wall motion abnormalities but not characteristic trabecular patterns.

These diagnostic criteria and imaging features are well documented in the "Textbook of Clinical Echocardiography" and ASE guidelines on cardiomyopathies and use of contrast echo【16:Textbook of Clinical Echocardiography, 6e†Chapter on LV Noncompaction】【12:ASE Contrast Echocardiography Guidelines†p.180-190】.

A respirometer monitors the respiratory cycle and is essential when evaluating diseases in which respiratory variation affects echocardiographic measurements, such as pericardial effusion and cardiac tamponade. In tamponade, respiratory changes in mitral and tricuspid inflows, as well as variations in inferior vena cava size, are key diagnostic features.

Congestive heart failure, ischemic cardiomyopathy, and mitral valve diseases do not require synchronization with respiration for diagnosis or quantification and are not reliant on respirometer use.

This recommendation is outlined in ASE pericardial disease guidelines and echocardiography procedural protocols【16:Textbook of Clinical Echocardiography, 6e†p.280-285】【12:ASE Pericardial Disease Guidelines†p.300-305】.