CICM SAQ 2015.2 Q2
Question
- a) List four assessments of the RIGHT ventricle that can be made on transthoracic echocardiography. (20% marks)
- b) List four clinical signs of right heart failure. (20% marks)
- c) Classify the causes of pulmonary hypertension with examples. (60% marks)
Answer
Answer and interpretation
a) List four assessments of the RIGHT ventricle that can be made on transthoracic echocardiography. (20% marks)
- RV size: LV size on apical 4-chamber view
- RV diameter
- RV wall thickness
- Tricuspid annular plane systolic excursion (TAPSE) or S-PRIME on apical 4-chamber view
- Right ventricular systolic pressure gradient to right atrium using tricuspid regurgitation (TR) jet.
- Ventricular septal motion (D-shaped septum) that can indicate pressure or volume overload
- Tissue Doppler and E/E’ ratios
b) List four clinical signs of right heart failure. (20% marks)
- Elevated Jugular venous pressure
- Right ventricular heave
- Right ventricular third heart sound
- Pleural effusion
- Peripheral oedema
- Enlarged liver edge
- Ascites
c) Classify the causes of pulmonary hypertension with examples. (60% marks)
- Pulmonary arterial hypertension (PAH)Idiopathic PAH, Heritable-genetic disease, Drugs and toxins induced: appetite suppressants e.g. fenfluramine, Associated with systemic disease: Connective tissue diseases e.g. scleroderma, HIV infection, Porto-pulmonary hypertension
- Pulmonary hypertension due to left heart diseaseSystolic dysfunction, Diastolic dysfunction, Valvular disease: Mitral stenosis, Mitral Regurgitation, Congenital abnormalities
- Pulmonary hypertension due to lung diseases and/or hypoxiaChronic obstructive pulmonary disease, Interstitial lung disease, Sleep-disordered breathing, Alveolar hypoventilation disorders, Chronic exposure to high altitude
- Chronic thromboembolic pulmonary hypertension
- PH with unclear and/or multifactorial mechanismsHematological disorders: myeloproliferative disorders, Systemic disorders: sarcoidosis, vasculitis, Metabolic disorders: glycogen storage disease, Others: tumour obstruction, fibrosing mediastinitis, chronic renal failure on dialysis
- Pass rate: 65%
- Highest mark: 8.5
Additional Examiners’ Comments:
- Some candidates provided more than four answers for parts a) and b) and it should be noted that only the first four answers are considered. Part c) in general was poorly answered and many candidates confused acute elevations in pulmonary pressure with the disease entity of pulmonary hypertension.
Examination Library
CICM
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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