Pathology and Disease States
Valvular and myocardial disease
Know the echo hallmarks of aortic stenosis (thickened, restricted leaflets; increased velocity; reduced area), mitral stenosis (doming, reduced orifice), mitral regurgitation (eccentric jet, vena contracta, PISA), and aortic regurgitation (diastolic jet, pressure half-time). For cardiomyopathy, distinguish dilated (reduced EF, spherical LV), hypertrophic (asymmetric septal hypertrophy, SAM, dynamic obstruction), and restrictive (bi-atrial enlargement, normal EF, abnormal filling).
Pericardial and thoracic disease
Recognize pericardial effusion (echo-free space, swinging heart, tamponade physiology with RA/RV collapse), constrictive pericarditis (septal bounce, annulus reversus), and aortic dissection (intimal flap, true/false lumen). Know pulmonary hypertension signs and right-heart strain.
Traps
Questions often conflate hypertrophic cardiomyopathy with hypertensive hypertrophy-look for asymmetric septal hypertrophy and SAM. Another trap: calling any effusion tamponade; tamponade is a physiologic diagnosis with chamber collapse. Watch for confusing constrictive pericarditis with restrictive cardiomyopathy; annulus reversus favors constriction.
Rule of thumb
If the stem describes asymmetric septal hypertrophy with systolic anterior motion of the mitral leaflet, the answer is hypertrophic obstructive cardiomyopathy.
Worked example
A patient with a large effusion shows right atrial systolic collapse and right ventricular diastolic collapse; this indicates tamponade physiology and warrants urgent drainage, not observation.