Echo & Cardiac Imaging

Echo Quiz 2019

Echo Quiz 2019- Round 1 (16th April, 2019)

Clinical Data: 42 Year old Female with dyspnea, chest discomfort, peripheral edema and easy fatigability

Cardiac Tamponade

The electrocardiogram (ECG) in cardiac tamponade typically shows

  • Sinus tachycardia.
  • Low voltage QRS complexes.
  • Electrical alternans (is relatively specific but not very sensitive for cardiac tamponade; rarely, this phenomenon is seen with very large pericardial effusions alone.

The 3 major echocardiographic signs of cardiac tamponade consist of

  • Chamber collapse
    • Late diastolic RA collapse, especially when it persists for more than one-third of the cardiac cycle, is highly sensitive and specific for cardiac tamponade.
    • Early diastolic RV collapse is less sensitive for the presence of cardiac tamponade than RA diastolic collapse, but is very specific for cardiac tamponade.
    • Left atrial collapse is seen in approximately 25 percent of patients with hemodynamic compromise and is very specific for cardiac tamponade. Left ventricular collapse is less common.
  • Respiratory variation in volumes and flows:
    • Doppler echocardiography by way of PWD shows increased tricuspid inflow and pulmonary outflow velocities and decreased mitral inflow and aortic outflow velocities with inspiration and vice versa.
    • Greatest increase of mitral “E” velocity is seen at first beat of expiration and greatest decrease is seen at first beat of inspiration, while greatest increase of tricuspid “E” velocity is seen at first beat of inspiration and greatest decrease is seen at first beat at expiration. Maximal changes seen at first beat during inspiration and expiration are recorded, and a respiratory variation of more than 25–30% for mitral inflow and more than 60% for tricuspid inflow is considered significant (normal respiratory variation is about 5%). Percentage respiratory variation is calculated as: (expiration – inspiration)/expiration.
  • IVC plethora:
    • Dilatation and less than a 50 percent reduction in the diameter of the dilated inferior vena cava (IVC) during inspiration, reflecting a marked elevation in central venous pressure, is frequently seen in patients with cardiac tamponade
Compiled by: Dr. Sunil Bohra, Associate Director

Winners are:

First Place: Dr. Sanjivani Inamdar from Pune.

Second Place: Dr. Davinder Pal Singh from Jalandhar.

Third Place: Dr. Satyasheel Reddy from Hyderabad (Joint Winners).
Ms. Shital Patil from Navi Mumbai (Joint Winners).