Image Question-55
Echocardiographic findings of RCM
What is the most likely diagnosis from Echocardiogram?
https://drive.google.com/file/d/1v_RTwbM4Uy-lt173_vNlwYUz_TCSFNLy/view?usp=sharing
[A] RCM
[B] HOCM
[C] DCM
[D] ASD
Characteristic echocardiographic findings of RCM include:
- Biatrial enlargement: The atria are strikingly enlarged
- Diastolic dysfunction
- Normal or near-normal systolic function: The left ventricular (LV) and right ventricular ejection fraction are normal or mildly reduced
- Hypertrophy: The ventricles are hypertrophied with decreased compliance
- Mass-like apical lesions: These lesions are associated with restriction of LV and RV filling
- Mitral and tricuspid valve leaflet tethering: This may result in regurgitation
- Nondilated ventricles
- Doppler imaging shows a restrictive filling pattern with tissue Doppler showing an elevated E/e’ ratio.
Echocardiographic findings of RCM
1. Which echocardiographic feature is most characteristic of restrictive cardiomyopathy?
RCM typically presents with normal ventricular dimensions and marked biatrial enlargement from chronically elevated filling pressures.
2. In restrictive cardiomyopathy, diastolic dysfunction is usually:
Advanced RCM shows a restrictive filling pattern with high E/A ratio and short deceleration time reflecting elevated left atrial pressure.
3. Which echocardiographic finding helps differentiate RCM from constrictive pericarditis?
In RCM E’ is reduced (myocardial problem); in constriction E’ is often preserved and there may be a septal bounce and marked respiratory variation.
4. Which Doppler pattern is common in advanced restrictive cardiomyopathy?
Restrictive filling: high early (E) velocity, low atrial (A) velocity, E/A >2 and deceleration time <150 ms are typical.
5. Typical left atrial size in RCM on echo is:
Chronic elevation of filling pressures produces marked biatrial enlargement — a hallmark of RCM.
6. Which is typically preserved in early RCM?
Systolic function is often preserved early; the primary abnormality is diastolic (stiff ventricle → poor filling).
7. M-mode feature suggestive of RCM:
M-mode may show rapid early diastolic leaflet motion but reduced overall excursion consistent with restrictive physiology.
8. Which is NOT typical for RCM?
Pericardial thickening points toward constrictive pericarditis rather than RCM.
9. Most useful tissue Doppler parameter to differentiate RCM from constriction:
Low E’ suggests impaired myocardial relaxation (RCM); E’ is often preserved in constriction.
10. Which infiltrative disease commonly causes RCM with increased wall thickness?
Amyloid infiltration causes increased wall thickness and typical echo signs (speckled myocardium, diastolic dysfunction, apical sparing on strain).
11. Pulmonary vein Doppler in RCM typically shows:
Elevated LVEDP causes a large atrial reversal wave reflecting increased atrial pressures.
12. Respiratory variation in mitral inflow in RCM is usually:
RCM shows minimal respiratory variation; marked variation suggests constrictive pericarditis.
13. Ventricular dimensions in RCM are usually:
RCM usually has normal-sized ventricles; stiffness (not chamber dilatation) causes filling impairment.
14. Which echo sign suggests an infiltrative etiology?
Infiltrative diseases (eg. amyloid) create a characteristic speckled or “granular” myocardial texture on 2D echo.
15. Speckle-tracking strain pattern often seen in cardiac amyloid:
Relative apical sparing is a classic red flag for cardiac amyloidosis on longitudinal strain maps.
16. Which Doppler parameter reflects rapid early LV filling in RCM?
Elevated LA pressure drives a high early (E) velocity despite impaired ventricular compliance.
17. What happens to mitral deceleration time in advanced RCM?
A short deceleration time indicates a restrictive filling physiology and high LVEDP.
18. Which RV / IVC finding may be present in RCM?
Elevated right-sided pressures (common when RCM involves the RV) lead to a plethoric IVC with poor inspiratory collapse.
19. Which finding helps differentiate early RCM from constrictive physiology?
Reduced E’ is a myocardial relaxation problem (RCM) whereas E’ is often preserved in pericardial constriction.
20. Most consistent with advanced RCM:
Advanced disease shows marked biatrial dilation plus Doppler evidence of restrictive filling (high E/A, short DT, low E’).
| No. | Question | Answer |
|---|---|---|
| 1 | What is the hallmark diastolic dysfunction pattern in RCM on Doppler echocardiography? | Restrictive filling pattern with high E/A ratio (>2) and short deceleration time (<150 ms). |
| 2 | What happens to the ventricular wall thickness in RCM? | It is usually normal or mildly increased, depending on the etiology (e.g., amyloidosis). |
| 3 | How is ventricular systolic function usually affected in early RCM? | Preserved or near-normal systolic function in early stages. |
| 4 | What atrial changes are seen on echocardiography in RCM? | Biatrial enlargement due to chronically elevated filling pressures. |
| 5 | What does tissue Doppler imaging show in RCM? | Reduced e′ velocities (<8 cm/s) despite normal EF. |
| 6 | How does strain imaging appear in cardiac amyloidosis-related RCM? | Apical sparing pattern on longitudinal strain imaging. |
| 7 | Is there ventricular dilatation in RCM? | No, ventricles are typically small or normal in size. |
| 8 | What is the typical E/e′ ratio in RCM? | Elevated E/e′ ratio (>15) indicating high filling pressures. |
| 9 | How is pulmonary artery pressure usually affected? | Elevated due to chronic left-sided filling pressure elevation. |
| 10 | What happens to the inferior vena cava (IVC) size in RCM? | Dilated with reduced respiratory variation due to elevated right atrial pressures. |
| 11 | How does RCM differ from constrictive pericarditis on echocardiography in terms of ventricular interaction? | RCM shows minimal respiratory variation in mitral/tricuspid inflow compared to marked variation in constrictive pericarditis. |
| 12 | What role does myocardial texture play in RCM diagnosis? | Speckled or granular sparkling appearance may be seen in amyloidosis. |
| 13 | How does color Doppler help in RCM? | Detects mild to moderate mitral and tricuspid regurgitation secondary to annular dilation. |
| 14 | Which valve abnormalities are often seen in RCM? | Functional MR and TR due to annular dilation and atrial enlargement. |
| 15 | How does RV systolic function appear in advanced RCM? | Often reduced in later stages. |
| 16 | Which echocardiographic parameter is best for detecting early diastolic dysfunction in RCM? | Tissue Doppler e′ velocity. |
| 17 | What is the role of 3D echocardiography in RCM? | Provides accurate atrial volume measurements and better visualization of structural abnormalities. |
| 18 | How is the LV mass index in RCM compared to hypertrophic cardiomyopathy? | Usually normal or mildly elevated in RCM, significantly elevated in HCM. |
| 19 | How does pericardial thickness appear in RCM? | Normal, helping to differentiate from constrictive pericarditis. |
| 20 | How is Doppler hepatic vein flow pattern altered in RCM? | Shows blunted systolic forward flow and increased diastolic reversal due to elevated RA pressures. |
| No. | Important Point |
|---|---|
| 1 | Restrictive filling pattern on Doppler with high E/A ratio (>2) and short deceleration time (<150 ms). |
| 2 | Normal or mildly increased ventricular wall thickness. |
| 3 | Preserved systolic function in early stages. |
| 4 | Marked biatrial enlargement due to chronically elevated filling pressures. |
| 5 | Tissue Doppler shows reduced e′ velocities (<8 cm/s) despite normal EF. |
| 6 | Apical sparing pattern on longitudinal strain imaging in amyloidosis. |
| 7 | Ventricles are typically small or normal in size, not dilated. |
| 8 | Elevated E/e′ ratio (>15) indicating increased filling pressures. |
| 9 | Elevated estimated pulmonary artery pressures. |
| 10 | Dilated IVC with reduced inspiratory collapse. |
| 11 | Minimal respiratory variation in mitral/tricuspid inflow (helps differentiate from constrictive pericarditis). |
| 12 | Speckled or granular myocardial texture in amyloidosis. |
| 13 | Color Doppler often shows mild to moderate MR and TR. |
| 14 | Functional AV valve regurgitation due to annular dilation. |
| 15 | RV systolic function often preserved early, may decline later. |
| 16 | Tissue Doppler e′ velocity is an early marker of diastolic dysfunction. |
| 17 | 3D echocardiography helps in accurate atrial volume measurement. |
| 18 | LV mass index usually normal or mildly increased, unlike HCM. |
| 19 | Normal pericardial thickness helps exclude constrictive pericarditis. |
| 20 | Hepatic vein Doppler shows blunted systolic flow and increased diastolic reversal. |
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