Adult Echocardiography Practice Exam

What type of valve abnormality would you expect to see with inferior vena cava, superior vena cava, and hepatic veins demonstrating systolic flow reversal?

1. Mild mitral regurgitation

2. Severe mitral regurgitation

3. Mild tricuspid regurgitation

4. Severe tricuspid regurgitation

The correct answer is: Severe tricuspid regurgitation

The observation of systolic flow reversal in the inferior vena cava, superior vena cava, and hepatic veins is indicative of significant right heart pressure elevation, which commonly occurs in the setting of severe tricuspid regurgitation. When the right ventricle is unable to efficiently push blood forward due to the regurgitant flow across the tricuspid valve, there can be a notable increase in right atrial pressure. This pressure increase causes abnormal flow patterns in the major veins returning blood to the heart, leading to the reversed flow seen during systole in the inferior and superior vena cavae, as well as the hepatic veins. In contrast, mild forms of tricuspid or mitral regurgitation typically do not produce this significant pressure gradient and would not lead to such pronounced hemodynamic changes, so less severe forms of regurgitation would be unlikely to cause this symptom. Severe tricuspid regurgitation is specifically associated with these flow reversals due to the volume overload of the right atrium and subsequent right heart failure, resulting in marked dilation and poor function of the right side of the heart.