Answer: apical pouch with paradoxical diastolic flow. Importantly, the pouch may not always be obvious on non-enhanced imaging, so the Doppler findings should prompt appropriate contrast use.

Early-onset AF (<50) is often the first sign of inherited cardiomyopathy/channelopathy. Genetic testing = high yield ➜ impact on treatment decisions 🫀 #AtrialFibrillation #Genomics #PrecisionMedicine

This is an important case for diastolic function assessment that was corrected in 2025 guideline. A main lesson is " Diastolic Function can be normal with reduced EF and/ or myocardial infarction." We should not adjudicate diastolic dysfunction based on clinical data. Always use

Coronary artery fistula Differential Diagnosis of Main Pulmonary Flow •Aorta → PA, continuous (systole + diastole) → PDA •Coronary → PA, continuous (diastole-predominant) → Coronary fistula •PA → RV, diastole → PR

For those who doubt the ability of handgrip maneuver to cause ischemia, observe this case.

#Echofirst gurus. What is happening at the apex? Recovered EF in DCM. Annual TTE for the last 3 yrs shown this same finding. Atypical non compaction if we still have that? @iamritu @dr_benoy_n_shah @NMerke @argulian @CASivaram1 @VerwerftJan @GARCIAEDINSON95 @alexsfelixecho

Congratulations to @echo_batman for introducing a simple, pathophysiologically relevant and reproducible Doppler parameter of CW envelope shape that correlates with TR severity and outcomes, to complement quantitative assessment @lpbadano @hahn_rt @iamritu https://t.co/vnkbwpxbKu

#ESCCongress Peripartum cardiomyopathy updates from the 2025 ESC Guidelines on cardiovascular disease and pregnancy (based on the slide) 🌸🫀✨: 1️⃣ Modified WHO 2.0 Classification 🟢 More granular risk stratification for maternal CV risk: Mild LV impairment (EF >45%) 🟢

Echo challenge for fellows. What could be the likely aetiology of aortic regurgitation?

Lifetime benefits of combination therapy in HFpEF: actuarial analysis of DELIVER, FINEARTS-HF and PARAGON-HF: - 3.6 years of additional event-free survival with SGLT2i + MRA - 4.9 years of additional event-free survival with SGLT2i + MRA + ARNI Don’t delay 💊 implementation!

#ESCCongress GENETIC MATTERS! @fernidom on genetic testing in #myocarditis 🧬 family hx of cardiomyopathies/ 'familial myocarditis' 🧬 high-risk CMR patterns -💍like pattern/septal LGE 🧬 recurrent episodes 🧬 severe episodes / slow recovery ❗️8% of cases w/ genetic background!!

@divaka_perera makes a strong case: routine #PCI should not be performed in asymptomatic pts with LV dysfunction (even with viability). It does NOT improve prognosis ‼️ Evidence should guide practice: The earth is not flat 🌎 #ESCCongress @escardio @drjohnm

See how a case of Eisenmenger VSD in a 22 year old first trimester pregnant woman is missed in echo done by a cardiologist. If the patient was clinically examined before echo, this disaster could have been avoided. There was a loud S2 and hypertensive PR murmur.

2025 ESC/EACTS Guidelines for the management of valvular heart disease: @ESC_Journals 🥸Few highlights - dense document, please read full document for details. 😱 Summary 👇👇👇

Echo for fellows. What is the mechanism/aetiology of MR?

🌟😳Mobile mass in the inferior interventricular septum? Thrombus? Tumor? Vegetation (bacterial or NTBE)? Young, previously healthy, furunculosis, fever + atyp chest pain AoV prolapse (NC) + (mild-to) moderate AR Blood cultures negative 🤔 Contrast (UEA) no perfusion.

Why is it so easy to miss partial aortic cusp fusion on 2D imaging? When the 2D cut is closer to the belly of the leaflets (as opposed to commissures), it gives impression of full commissural opening, as seen on this MPR

Findings? See carefully

#echofirst has seen this before 👉 mobile mass attached to the “Warfarin ridge”. 👉 surgical removal in minimally invasive MIC approach @ASE360 @EACVIPresident

A patient with advanced cardiac amyloidosis. PW Doppler of the hepatic vein is obtained in the subcostal view. What is the finding?