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A 62-year-old patient presents with progressive dyspnea, a history of hypertension, and mild lower extremity edema.<\/p>\n\n

You are performing a transthoracic echocardiogram. As you begin the study, consider which echocardiographic features will best guide your initial differential diagnosis.<\/p>\n"},"subContentId":"d7da90bf-8acc-4b83-8101-029420dce84a","metadata":{"contentType":"Text","license":"U","title":"Case Introduction"}},"showContentTitle":false,"proceedButtonText":"Continue","forceContentFinished":"useBehavioural","feedback":{"title":"","subtitle":""},"contentBehaviour":"useBehavioural","nextContentId":1},{"type":{"library":"H5P.BranchingQuestion 1.0","params":{"branchingQuestion":{"alternatives":[{"nextContentId":-1,"feedback":{"title":"","subtitle":"

While these measurements may be useful later, they are not typically the first step when forming an initial differential diagnosis in a patient with dyspnea and hypertension.<\/p>\n"},"text":"Global longitudinal strain"},{"nextContentId":2,"feedback":{"title":"

Correct!<\/p>\n","subtitle":"

Assessing chamber size and ventricular wall thickness is an important early step when evaluating dyspnea in patients with hypertension.<\/p>\n"},"text":"Chamber size and ventricular wall thickness"},{"nextContentId":-1,"feedback":{"title":"","subtitle":"

While these measurements may be useful later, they are not typically the first step when forming an initial differential diagnosis in a patient with dyspnea and hypertension.<\/p>\n"},"text":"LVOT Doppler velocity"},{"nextContentId":-1,"feedback":{"title":"","subtitle":"

Which echocardiographic feature should be assessed first to guide the differential diagnosis?<\/p>\n"}},"subContentId":"7821abed-8258-4d6b-aa98-2ad06b596e2f","metadata":{"contentType":"Branching Question","license":"U","title":"Question 1"}},"showContentTitle":false,"proceedButtonText":"Continue","forceContentFinished":"useBehavioural","feedback":{"title":"","subtitle":""},"contentBehaviour":"useBehavioural"},{"type":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Initial echocardiographic findings:<\/p>\n\n

\n\t
Concentric LV hypertrophy <\/p>\n\t<\/li>\n<\/ul>\n\n
- \n\t
  Preserved LVEF <\/p>\n\t<\/li>\n<\/ul>\n\n
  - \n\t
    Left atrial enlargement <\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"76cf5de0-afd3-4a88-8290-a0f03b9a70fd","metadata":{"contentType":"Text","license":"U","title":"Initial echocardiographic findings:"}},"showContentTitle":false,"proceedButtonText":"Continue","forceContentFinished":"useBehavioural","feedback":{"title":"","subtitle":""},"contentBehaviour":"useBehavioural","nextContentId":3},{"type":{"library":"H5P.BranchingQuestion 1.0","params":{"branchingQuestion":{"alternatives":[{"nextContentId":-1,"feedback":{"title":"","subtitle":"
    At this stage, several conditions can produce increased wall thickness and preserved ejection fraction. Additional clinical and echocardiographic information is required before narrowing the diagnosis.<\/p>\n"},"text":"Hypertensive heart disease"},{"nextContentId":-1,"feedback":{"title":"","subtitle":"
    At this stage, several conditions can produce increased wall thickness and preserved ejection fraction. Additional clinical and echocardiographic information is required before narrowing the diagnosis.<\/p>\n"},"text":"Hypertrophic cardiomyopathy"},{"nextContentId":-1,"feedback":{"title":"","subtitle":"
    At this stage, several conditions can produce increased wall thickness and preserved ejection fraction. Additional clinical and echocardiographic information is required before narrowing the diagnosis.<\/p>\n"},"text":"Athletic heart"},{"nextContentId":4,"feedback":{"title":"
    Correct!<\/p>\n","subtitle":"
    At this stage, several conditions can produce increased wall thickness and preserved ejection fraction. Additional clinical and echocardiographic information is required before narrowing the diagnosis.<\/p>\n"},"text":"All of the above"}],"question":"
    Based on the current findings, which conditions should remain in your differential?<\/p>\n"}},"subContentId":"aff9e134-2dfc-4e63-834a-0a823198def4","metadata":{"contentType":"Branching Question","license":"U","title":"Question 2"}},"showContentTitle":false,"proceedButtonText":"Continue","forceContentFinished":"useBehavioural","feedback":{"title":"","subtitle":""},"contentBehaviour":"useBehavioural"},{"type":{"library":"H5P.AdvancedText 1.1","params":{"text":"
    Additional Findings:<\/p>\n\n
    - \n\t
      Abnormal diastolic function<\/p>\n\t<\/li>\n\t
    - \n\t
      Reduced longitudinal strain<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"8674edd8-561a-4bae-a342-eb4a835a8211","metadata":{"contentType":"Text","license":"U","title":"Additional Findings:"}},"showContentTitle":false,"proceedButtonText":"Continue","forceContentFinished":"useBehavioural","feedback":{"title":"","subtitle":""},"contentBehaviour":"useBehavioural","nextContentId":5},{"type":{"library":"H5P.BranchingQuestion 1.0","params":{"branchingQuestion":{"alternatives":[{"nextContentId":-1,"feedback":{"title":"
      Incorrect<\/p>\n","subtitle":""},"text":"Physiologic athletic remodelling"},{"nextContentId":6,"feedback":{"title":"
      Correct!<\/p>\n","subtitle":"
      Hypertensive heart disease commonly produces concentric LV hypertrophy, left atrial enlargement, diastolic dysfunction, and reduced longitudinal strain despite preserved ejection fraction.<\/p>\n"},"text":"Hypertensive heart disease"},{"nextContentId":-1,"feedback":{"title":"
      Incorrect<\/p>\n","subtitle":""},"text":"Acute pulmonary embolism"},{"nextContentId":-1,"feedback":{"title":"
      Incorrect<\/p>\n","subtitle":""},"text":"Constrictive pericarditis"}],"question":"
      With this additional information, what is the most likley diagnosis?<\/p>\n"}},"subContentId":"a9b8f5c7-b971-4910-85d5-21b083910ad7","metadata":{"contentType":"Branching Question","license":"U","title":"Question 3"}},"showContentTitle":false,"proceedButtonText":"Proceed","forceContentFinished":"useBehavioural","feedback":{"title":"","subtitle":""},"contentBehaviour":"useBehavioural"},{"type":{"library":"H5P.AdvancedText 1.1","params":{"text":"
      Key Learning Point:<\/p>\n\n
      This case demonstrates how clinical history, structural findings, and functional measurements must be integrated<\/strong> when forming a differential diagnosis.<\/p>\n\n
      Avoid anchoring on a single imaging feature. Instead, evaluate the overall clinical and echocardiographic pattern<\/strong>.<\/p>\n"},"subContentId":"e8740c41-7196-4651-9f73-a17f62808098","metadata":{"contentType":"Text","license":"U","title":"Key Learning Point"}},"showContentTitle":false,"proceedButtonText":"Proceed","forceContentFinished":"useBehavioural","feedback":{"title":"","subtitle":""},"contentBehaviour":"useBehavioural","nextContentId":-1}],"endScreens":[{"endScreenTitle":"","endScreenSubtitle":"","contentId":-1,"endScreenScore":0}],"scoringOptionGroup":{"scoringOption":"no-score","includeInteractionsScores":true},"startScreen":{"startScreenTitle":"","startScreenSubtitle":""},"behaviour":{"enableBackwardsNavigation":false,"forceContentFinished":false,"randomizeBranchingQuestions":false},"l10n":{"startScreenButtonText":"Start the course","endScreenButtonText":"Restart the course","backButtonText":"Back","disableProceedButtonText":"Require to complete the current module","replayButtonText":"Replay the video","scoreText":"Your score:","fullscreenAria":"Fullscreen"}}}

Echo Case Walkthrough: Building the Differential Diagnosis

Description

Vanessa Johnson