Latest ARDMS AE-Adult-Echocardiography Practice Questions BY Holland

The apical sparing pattern of global longitudinal strain (GLS) is a characteristic echocardiographic finding in cardiac amyloidosis. This pattern appears as a relative preservation of longitudinal strain in the apical segments compared to markedly reduced strain in basal and mid-ventricular segments, resulting in a 'cherry on top' bullseye plot appearance.

This distinctive pattern helps differentiate amyloidosis from other causes of left ventricular hypertrophy and dysfunction, such as hypertensive heart disease, hypertrophic cardiomyopathy, or athlete's heart, which generally show more uniform or different regional strain impairments.

This diagnostic feature has been validated in numerous studies and is included in the ASE guidelines on strain imaging and the 'Textbook of Clinical Echocardiography,' providing a sensitive and specific noninvasive marker for amyloid infiltration of the myocardium12:ASE Strain Imaging Guidelinesp.130-14016:Textbook of Clinical Echocardiography, 6ep.320-325.

Intravenous drug use is a major risk factor for infective endocarditis, particularly involving the tricuspid valve and sometimes left-sided valves. Symptoms like fever, flu-like illness, dyspnea, and chest pain suggest possible septic emboli or valve destruction.

Echocardiographic findings associated with endocarditis include mobile echogenic masses attached to valve leaflets (vegetations), valve thickening, or destruction. These findings are diagnostic and guide treatment.

Aortic dissection, hypertrophic cardiomyopathy, and mitral valve prolapse can present with different clinical features and echocardiographic findings not consistent with infectious vegetations.

These clinical and echocardiographic correlations are detailed in the ASE guidelines on infective endocarditis and the 'Textbook of Clinical Echocardiography'16:Textbook of Clinical Echocardiography, 6ep.470-47512:ASE Infective Endocarditis Guidelinesp.380-390.