Pakistan Society of Echocardiography

A 53 years old man presented with shortness of breath. A 4/6 Ejection systolic murmur was heard in right second ICS radiating to carotids. ECG showed LBBB. Transthoracic study revealed severely calcific and stenotic aortic valve with peak velocity of 4.7 m/s (PG = 88 mmHg), mean gradient = 50 mmHg and aortic valve area = 0.58 cm.sq.

Strain echo showed typical pattern of “Cherry on top”. Besides Amyloidosis other conditions can show the same pattern on Bull’s map like Aortic stenosis, hypertension, ischemic heart disease, constrictive pericarditis and Fabry’s disease.