Echocardiographic Criteria of Pulmonary Hypertension
🩺 Echocardiographic Criteria of Pulmonary Hypertension – 20 Advanced MCQs
📋 20 Echocardiographic Criteria of Pulmonary Hypertension (Click to Expand)
| # | Echocardiographic Finding | PH Relevance |
|---|---|---|
| 1 | TR jet velocity > 2.8 m/s | Suggests elevated PASP |
| 2 | TR jet velocity > 3.4 m/s | High probability of PH (ESC) |
| 3 | D-shaped LV in systole | RV pressure overload |
| 4 | PA acceleration time < 105 ms | Shortened due to elevated PAP |
| 5 | IVC > 2.1 cm with < 50% collapse | Elevated RA pressure |
| 6 | McConnell’s sign | Regional RV dysfunction |
| 7 | RV/LV basal diameter > 1 | RV dilation due to PH |
| 8 | RV free wall thickness > 5 mm | Chronic RV pressure overload |
| 9 | RV FAC < 35% | RV systolic dysfunction |
| 10 | TAPSE < 17 mm | Reduced RV longitudinal function |
| 11 | Mid-systolic notch in PV Doppler | Raised PAP indicator |
| 12 | Pericardial effusion | Seen in severe PH or RV failure |
| 13 | RA area > 18 cm² | RA dilation in PH |
| 14 | Tricuspid regurgitation (qualitative) | Severity helps estimate RVSP |
| 15 | Paradoxical septal motion | From RV pressure overload |
| 16 | Contrast delay in LA | Delayed contrast bubble appearance due to PH |
| 17 | Shortened RVOT VTI | Reduced RV output in PH |
| 18 | RA pressure estimation via IVC | Used in PASP calculation |
| 19 | RV Tei Index > 0.54 | Increased with RV dysfunction |
| 20 | Septal flattening during systole | RV pressure overload sign |
| Feature | Restrictive ASD | Non-Restrictive ASD |
|---|---|---|
| Size of Defect | Small or partially covered | Moderate to large |
| Flow of Blood | Limited left-to-right shunting | Significant left-to-right shunting |
| Right Heart Dilation | Minimal or absent | Present due to volume overload |
| Pulmonary Hypertension | Rare | More common over time |
| Symptoms | Often asymptomatic | Exertional dyspnea, fatigue, palpitations |
| Auscultation | Soft or absent murmur; fixed S2 splitting may be subtle | Prominent systolic murmur with fixed splitting of S2 |
| ECG Findings | Normal or mild right atrial enlargement | Right axis deviation, RVH signs possible |
| Chest X-ray | Usually normal | Prominent pulmonary vasculature, cardiomegaly |
| Bubble Study | Small or delayed bubbles crossing atria | Readily visible contrast shunting |
| Management | Observation in most cases | May require closure (device or surgical) |
| Risk of Paradoxical Embolism | Possible if transient right-to-left flow occurs | Possible, especially during Valsalva |
| Long-Term Outlook | Excellent with follow-up | Risk of complications if untreated |
| Common Associated Lesion | Flap valve or aneurysmal septum | Primum or sinus venosus variants |
| Use of TEE | Helpful for better visualization of small defect | Confirms size and morphology pre-closure |
| Surgical/Device Closure | Rarely required | Frequently required if symptomatic or large |
