Case No 1
History:65 year old lady, not diabetic or hypertensive, presents with one month history of gradual and progressive shortness of breath with PND and orthopnea. She also reports having had an upper respiratory tract illness and cough six weeks ago.

Past medical history : Non.

Social History: Non-smoker.

Physical examination: Positive for 10 cm JVP. PR 105 BPM. BP 110/65 mmhg. Halfway up bilateral chest rales. Diffuse point of maximal apical impulse, regular soft S1 , S3 and grade 3/6 holosystolic murmur over the apex. 2+ LLE.
 
Question 3


Which statement is false?

Eccentric wall jets can underestimate the degree of MR
 Color Doppler assessment of MR can be affected by gain and Nyquist limit settings
 Flow convergence method is based on isovelocity of hemispheric shells
 Systolic blunting of the pulmonary venous pattern is consistent with significant MR
 Severe MR is always accompanied by systolic flow reversal of the pulmonary veins
Although systolic flow reversal is associated with severe MR , its presence is not sensitive for severe MR, as there can be a large regurgitant volume without systolic flow reversal of the pulmonary veins.
 
 

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