Heart Murmur, Systemic Hypertension, and History of Cerebrovascular Accident

A 75-year-old man with a heart murmur since childhood, hypertension, and a history of a cerebrovascular accident had an echocardiogram to evaluate his heart murmur.

Figure 72-1.

Figure 72-2.

Figure 72-3.

Figure 72-4. Continuous wave Doppler across right ventricular outflow tract (RVOT).

QUESTION 1. The 2D echocardiogram (Fig. 72-1) and the color motion (M)-mode echo (Fig. 72-2) show (select all that apply):

A. Severe tricuspid regurgitation

B. A ventricular septal defect (VSD)

C. An overriding aorta

D. Eisenmenger syndrome

View Answer

ANSWER 1: B, C. An overriding aorta is seen in Figure 72-1. The color M-mode (Fig. 72-2) demonstrates flow through the VSD (see also Fig. 72-11).

Figure 72-1.

Figure 72-2.

Figure 72-11.

QUESTION 2. Figure 72-3 demonstrates:

A. A double outlet right ventricle (RV)

B. An atrial septal defect

C. Aortic regurgitation

D. Truncus arteriosus

View Answer

ANSWER 2: C. This diastolic frame demonstrates aortic regurgitation.

QUESTION 3. Figures 72-1, 72-2, 72-3 and 72-4 are consistent with which of the following in this 75-year-old man?

A. Nonrestricted VSD

B. Gerbode defect

C. Truncus arteriosus

D. Endocardial cushion defect

E. Tetralogy of Fallot

View Answer

ASNWER 3: E. There is an overriding aorta, a VSD, an RVOT obstruction, as well as RVH (see Figs. 72-5, 72-6, 72-7, 72-8, 72-9 and 72-10 and 72-12 and Videos 72-1 and 72-2).

Figure 72-5. Parasternal long-axis view demonstrating: (A) the VSD and (B) overriding aorta. IVS, intraventricular septum; LA, left atrium; LV, left ventricle; MV, mitral valve; RV, right ventricle.

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