A 68-year-old woman presents with exertional dyspnea and signs of right heart failure. Echocardiogram shows biatrial enlargement, normal LV systolic function (LVEF 55%), thickened ventricular walls with granular sparkling appearance, and impaired diastolic filling. Simultaneous measurement of left and right ventricular pressures during cardiac catheterization would show which characteristic finding?
- A LVEDP exceeding RVEDP by >5 mmHg (Kussmaul sign)
- B Square root sign (dip-and-plateau) with RVEDP and LVEDP within 5 mmHg of each other ✓
- C RV systolic pressure >60 mmHg with V waves on pulmonary capillary wedge pressure
- D LVEDP < RVEDP by >5 mmHg with inspiratory increase in RV pressure
Correct answer: B. Square root sign (dip-and-plateau) with RVEDP and LVEDP within 5 mmHg of each other
Explanation
The clinical picture (normal LVEF, biatrial enlargement, diastolic dysfunction, granular sparkling myocardium) describes restrictive cardiomyopathy, likely cardiac amyloidosis. The hemodynamic hallmark of restrictive physiology is the square root sign (rapid early diastolic dip followed by plateau) with near-equalization of LVEDP and RVEDP (within 5 mmHg). LVEDP exceeding RVEDP by >5 mmHg favors constrictive pericarditis.
Reference: Braunwald's Heart Disease, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.