The pericardium (yellow) is most reflective (i.e., least negative) and the cavity (turquoise) is least reflective (most negative). The subendocardium (green) is slightly more reflective than the epicardium (red), but the epicardium thickens, and fiber thickening causes increased reflectivity. LV = left ventricle; PW = posterior wall subendocardium but most references describe the subendocardial layer as that supplied by the coronary arteries deep in the myocardium. Literally, it means below the endocardium so presumably is..

Assessment of Subendocardial Structure and Function

What is subendocardium? - Answer

The endocardium underlies the much more voluminous myocardium, the muscular tissue responsible for the contraction of the heart. The outer layer of the heart is termed epicardium and the heart is surrounded by a small amount of fluid enclosed by a fibrous sac called the pericardium Editor's Note: This is Part One article of a two-part Expert Analysis.Click here for Part Two.. Sarcoidosis is an inflammatory disorder characterized by the formation of noncaseating granulomas. Its etiology is unknown, and any organ may be affected, although cardiac involvement is associated with worse prognosis. 1 Appropriately diagnosing and treating cardiac sarcoidosis remains an important. Subendocardium meaning (anatomy) The layer of tissue beneath the endocardium

References in the ICD-10-CM Index to Diseases and Injuries applicable to the clinical term subendocardium. Subendocardium - See: condition; Previous Term: Subdural. Next Term: Subependymoma The stimulating electrode was placed within ventricular subepicardium and subendocardium. 刺激 电极 放置 在 心室 皮下 和心 内膜下。 精选例句. Results Among the 25 cases, 19 cases were ischemic heart diseases, in which the delayed enhancement was subendocardium, nontransmural or transmural

subendocardium are greater than the in y are the epicardiu in transmuram l infarctio (1) n and in coronary insufficiency (2), suggesting that antegrade coronary blood flow in the sub-endocardial layer is less s than i than thte epicardium becaus ofe th proximite y of the former to intracavitary left ventricular pres 1. Am J Physiol Heart Circ Physiol. 2014 Apr 1;306(7):H1054-65. doi: 10.1152/ajpheart.00414.2013. Epub 2014 Jan 31. Type 2 diabetes induces subendocardium-predominant reduction in transient outward K+ current with downregulation of Kv4.2 and KChIP2

The subendocardium is too far away from the blood in the ventricular cavity and the oxygen level in the coronary artery is reduced because oxygen has been extracted during the passage through the myocardium. In case of STE-ACS, the entire cross section becomes ischemic/infarcted Purkinje fibers are clearly identified on the inner ventricular walls of the heart, just underneath the endocardium in an area named the subendocardium. The Purkinje fibers are functional conducting fibers, that are comprised of electrically excitable cells and are larger than the normal myocardial fibers. The Purkinje fibers are of the huge number of mitochondria [ Subendocardium is the most sensitive area to ischemia, and is the first area to suffer oxygen deficiency. Delayed repolarization causes tall T waves (peaked Twaves), accompanied by a lengthening of QTc. These peaked T waves are observed at the beginning of ST-segment elevation myocardial infarction (STEMI) The heart is an extraordinary organ. It is about the size of a clenched fist, weighs about 10.5 ounces and is shaped like a cone. Along with the circulatory system, the heart works to supply blood and oxygen to all parts of the body. The heart is located in the chest cavity just posterior to the breastbone, between the lungs, and superior to the diaphragm In a setting where ischemic heart disease is the number one cause of death nationally, the subendocardium of the left ventricle is the weakest link in the chain of survival. Fully 60 percent of myocardial infarctions are subendocardial in nature,1 with the vast preponderance of these unassociated with recent coronary arterial occlusion.2 Granted, almost all of these victims exhibited varying.

During contraction of the ventricular myocardium (systole), the subendocardial coronary vessels (the vessels that enter the myocardium) are compressed due to the high ventricular pressures Subendocardial and subepicardial segmental function changes in the dog heart due to gradual coronary flow reduction by an acutely developing thrombus. 1. Cardiovasc Res. 1985 Aug;19 (8):495-506. Subendocardial and subepicardial segmental function changes in the dog heart due to gradual coronary flow reduction by an acutely developing thrombus

subendocardium (Endo) versus the subepicardium (Epi), which result in higher subendocardial compliance (i.e., D-P slope). Hence, under similar transvascular pressures ( P), reductions (from shaded to open symbols) will induce a higher diameter decrease in subendocardial vessels (circles) than in subepicardial vessels (rectangles) Subendocardial ischemia can be improved by a reduction of heart rate and left ventricular pressure. myocardial ischemia, a major cause of morbidity and mortality, is transmurally heterogeneous where the subendocardium is at higher risk than the midwall or epicardium (22) - Subendocardium The endocardium is composed of an endothelium resting on a thin connective tissue layer. This connective tissue, in turn, blends with a thicker, denser connective tissue, which composes the bulk of the endocardium subendocardial: /sub·en·do·car·di·al/ ( sub″en-do-kahr´de-al ) beneath the endocardium What is the endocardium? What is the endocardium? The heart's endocardium is a smooth tissue layer that lines its chambers. One of three layers making up the heart wall, the thin membrane covers the left atrium, the right atrium, the left ventricle, and the right ventricle.. In addition to lining the atria and the ventricles, the endocardium covers and forms the surface of the four heart valves

The relative distribution of resistances in arteries, microvessels, and veins was also different between the subepicardium and subendocardium. Specifically, in the subendocardium, arterial and venous resistances were higher, percentage-wise, but microvascular resistance was proportionately lower than that in the subepicardium (p less than 0.05) TrueFISP cine images from current MRI demonstrating hypointense regions within the subendocardium corresponding to scattered areas of fat deposition: (a) still image with arrows, (b) corresponding cine image. Figure 6. First pass perfusion imaging in the 4 chamber (a) and 2 chamber (b) views showing the subendocardial perfusion abnormality. There don't seem to be a lot of good definitions of subendocardium but most references describe the subendocardial layer as that supplied by the coronary arteries deep in the myocardium By contrast, the conductance of the subendocardium decreases the most by shortened diastolic fraction compared to the midmyocardium, while the subepicardium is independent of diastolic time fraction [14]. Thus, studies of human septic shock showing increased coronary conductance, blood flow and diminished oxygen extraction [17, 18] could. The differences between the myocardial-perfusion reserve index in patients with syndrome X and in controls were of borderline significance for both the subendocardium (1.10±0.23 vs. 1.38±0.4, P.

The Radiology Assistant : Ischemic and non-ischemic

subendocardium - Wiktionar

Subendocardial Medical Definition Merriam-Webster

Viral myocarditis (adenovirus) images, diagnosis

Myocardial ischemia is transmurally heterogeneous where the subendocardium is at higher risk. Stenosis induces reduced perfusion pressure, blood flow redistribution away from the subendocardium, and consequent subendocardial vulnerability. We propose that the flow redistribution stems from the higher compliance of the subendocardial vasculature Knowledge of the location of late gadolinium enhancement (usually mid myocardium with DCM, subepicardium with left-dominant arrhythmogenic cardiomyopathy, and subendocardium with old MI) may help in differentiation of these three conditions. Figure 21 Clinically diagnosed DCM in a 51-year-old man. The DCM was proved with endocardial biopsy While a 12-leaded ECG is recorded, the patient is asked to walk on a treadmill and the work level is stepped up by increasing speed and incline to mimic exercise. If the increase in coronary blood flow is insufficient for the increase in myocardial oxygen demand, the myocardium becomes hypoxic, particularly in the ventricular subendocardium File:Endocardium and subendocardium histology.png Metadata This file contains additional information such as Exif metadata which may have been added by the digital camera, scanner, or software program used to create or digitize it Myofibrils are sparse and restricted to the periphery of the cells. The cytoplasm is rich in mitochondria and glycogen, the glycogen-rich center portion of the cell stains palely with hematoxylin and eosin. After traveling in the subendocardium, Purkinje fibers penetrate the ventricular myocardium to innervate cardiac muscle fibers. 1000x. Nuclei

Stunned myocardium. Stunned myocardium refers to a situation in which an acute transient myocardial ischemic event results in a prolonged wall motion abnormality which eventually resolves. The term is usually distinguished from hibernating myocardium, in which a chronic ischemic process leads to chronic left ventricular dysfunction It is characterized by focal or diffuse endocardial thickening within one or both ventricles secondary to diffuse fibrous tissue in the subendocardium 3. It typically involves the apices and then extends further basal typically including the posterior (inferior) wall in the left ventricle, can involve the papillary muscles and the chordae tendinae

Myocardial Mechanics: Structure and Function of Myocardial

  1. The subendocardium is the first and most susceptible region to ischemia. FIGURE 2 Factors influencing myocardial oxygen supply and demand. View Large Image Figure Viewer; Download (PPT) CORONARY ARTERY DISEASE AND SUPPLY AND DEMAND. Coronary atherosclerosis causes gradual reduction in vascular cross-section area..
  2. Subendocardial regions have relatively few territories of about 0.5 ml in volume having their own penetrating artery at the epicardium, whereas the subepicardium is perfused by a multitude of small perfusion territories, in the order of 0.01 ml. Vascular volume density of small arteries up till 400 μm was 3.2% at the subendocardium territories.
  3. this can occur over hours to days and it is really going to depend on how quickly somebody seeks medical care in the interventions that we implement Subendocardium - ischemic first The Subendocardium is just beneath the inner surface layer of the heart; it is the area FIRST impacted because it is furthest away from those major coronary vessels; we would say it gets ischemic first Entire.
  4. The heart wall is comprised of three layers, the epicardium (outer), myocardium (middle), and endocardium (inner). These tissue layers are highly specialized and perform different functions. During ventricular contraction, the wave of depolarization from the SA and AV nodes moves from within the endocardial wall through the myocardial layer to.
ST elevation myocardial infarction case study four - wikidoc

Endocardium - an overview ScienceDirect Topic

High-resolution Ca 2+ imaging of the subendocardium shows the increased number of SCRs (green dots) in the region bordering the injured tissue. The frequency of SCRs and ectopic contractions can be reduced by CaMKII inhibition. SCRs have been extensively studied in isolated cardiomyocytes,. subendocardium (subendocardial pattern) in 13% of the canine episodes and 6% of the swine episodes (p b 0.05). Conclusions: Our findings suggest that the spatial distribution of acute ischemia is a complex phenomenon arising throughout the myocardial wall and is not limited to the subendocardium Quantitative histology of tissue blocks demonstrated that fiber angles varied linearly across the wall in this region from -37 degrees in the subepicardium to +18 degrees in the subendocardium. Sheet angles exhibited a pleated-sheet behavior, alternating sign from subepicardium to subendocardium

Restrictive cardiomyopathy is not always a primary cardiac disorder. Although the cause is usually unknown, it may arise as the consequence of systemic or genetic disorders; identified causes are listed in the table Causes of Restrictive Cardiomyopathy.Some disorders that cause restrictive cardiomyopathy also affect other tissues (eg, amyloidosis, hemochromatosis) Two models were constructed; the model which assumed a quadratic relation between depth (d) and systolic excursion (EX) (EX = 0.498 + 0.176d + 0.006d 2) fit the data better than did a model which assumed a linear relation (EX = -0.0716 + 0.254d).Conclusions - These data support the prediction from geometric models that systolic excursion. The alteration of GLS was more prominent in the subepicardium than in the subendocardium (P < 0.001). GLS was correlated to mean serum pulse oxygen saturation (SpO2, RR = 0.42, P < 0.0001), high.

Nitroglycerin's (as well as isosorbide dinitrate's) ability to improve myocardial oxygen demand has been shown to be from: Redistribution of blood flow to the subendocardium of ischemic areas while maintaining flow in normal areas. The net improvement myocardial oxygen demand occurs despite an average increase in the pulse by 10 bpm Even though the endocardium is a thin layer of tissue, it serves three huge functions for the cardiovascular system. 1. First, the endocardium provides a smooth surface for the inside of the heart. Clinical Presentation for Acute Coronary Syndrome. Chest pain is the classic symptom of acute coronary syndrome. It may appear with a physical effort or abruptly in the retrosternal region, of variable intensity (from simple tightness to very intense), oppressive, it usually radiates to the shoulder, left arm, jaw and back

  1. Simple ECG Dr. Lora Khalil P a g e | 38 In summary, myocardial ischemia involving primarily the subendocardium usually produces ST segment depression, whereas acute ischemia involving the epicardium usually produces ST elevation. Angina The term angina pectoris refers to transient attacks of chest discomfort caused by myocardial ischemia. Angina is a symptom of coronary artery disease
  2. of reperfusion and were distributed from the epicardium to the subendocardium
  3. A condition characterized by the thickening of the ventricular endocardium and subendocardium (myocardium), seen mostly in children and young adults in the tropical climate. The fibrous tissue extends from the apex toward and often involves the heart valves causing restrictive blood flow into the respective ventricles (cardiomyopathy, restrictive)

Endocardium - Wikipedi

T2 - Detection of substantially uncontaminated cardiac spectra and differentiation of subepicardium and subendocardium. AU - Menon, Ravi S. AU - Hendrich, Kristy. AU - Hu, Xiaoping. AU - Ugurbil, Kamil. PY - 1992/8. Y1 - 1992/ In our case, although endocardial fibrosis is the main cause that leads to the progress of the disease, a great amount of adipose tissue accumulated in subendocardium may be an important contributor to rapid deterioration of her clinical condition. This case highlights an exceedingly rare form of restrictive cardiomyopathy In this sixth video, we discuss ST Elevation Myocardial Infarction and how it looks on the ECG A. Subendocardium B. Myocardium C. Epicardium D. All of the above 16. Cardinal symptom in aortic stenosis is ? A. Exertional dyspnea B. Angina pectoris C. Syncope D. All of the above 17. Which of the following excludes the possibility of pure or predominant severe aortic stenosis ? A. Atrial fibrilation B. Absence of systolic thrill C.

bundle [bun´d'l] a collection of fibers or strands, as of muscle fibers or nerve fibers. See also tract and fasciculus. atrioventricular bundle bundle of His. fundamental bundle (ground bundle) that part of the white matter of the spinal cord bordering the gray matter and containing fibers that travel for a distance of only a few segments of the cord. Ultrastructure of Purkinje cells in the subendocardium and false tendons in early experimental myocardial infarction complicated by fibrillation in the dog. Victor G. Sharov 1, Nina N. Beskrovnova 1, Sergey A. Kryzhanovsky 2, Juriy G. Bobkov 2, Valdur A. Saks 1 & Natalia V. Kaverina 2 Virchows Archiv B volume 57, pages 131-139 (1989)Cite this.

Subendocardium. contains CT + purkinje fibers to help create contraction of the heart. endocardium slide. endocardium valves? it can form valves made of connective tissue, lined by endothelium to prevent thrombosis. myocardium slide. normal muscle structure. pericardial sac According to Armour and Randall [16], this contraction constitutes an outer shell within which the apical loop is to contract. In this shell the stimulation goes from the subepicardium to the subendocardium. Then it runs through the descending segment and, according to our studies, the ascending segment is stimulated at an average of 25.8 ms

Cardiac MRI vs. PET for the Evaluation of Cardiac ..

  1. ation of patients with coronary artery disease, before and after single vessel coronary angioplasty. SETTING--A tertiary referral centre for cardiac diseases with facilities for invasive and.
  2. Consequently, infarcts typically begin in the subendocardial myocardium and spread outward given prolonged periods of myocardial ischemia. Infarctions limited to the subendocardium are termed a Subendocardial Infarct whereas those that grow to encompass the entire thickness of the ventricular wall are termed Transmural infarcts
  3. The symptoms of endocardial fibroelastosis begin rapidly, generally between the ages of 4 and 12 months. Symptoms are due to the overgrowth of fibrous tissue and thickening of the lining of the hearts' chambers (i.e., endocardium and subendocardium), especially the left ventricle
  4. In general, reentrant circuits in ischemic cardiomyopathy have largely been localized to the endocardium or subendocardium. One of the explanations for this is the anatomy of the coronary artery. Specifically, blood in the coronary artery flows from the epicardium to endocardium; therefore, the endocardium is the most downstream tissue relative.
  5. This leads to reduced blood flow to the subendocardium distal and to the site of the stenosed coronary artery. In severe proximal subclavian artery stenosis or occlusion, insufficient blood flow may be available to withstand the ipsilateral arm, resulting in low pressure in the distal subclavian artery
  6. Cardiac involvement of sarcoidosis is a manifestation of sarcoidosis which is often asymptomatic, although can be associated with high mortality 8 . Autopsy studies show prevalence of ~25% cardiac involvement, yet only 5-10% are found symptomatic 1,2 . Sarcoidosis is a multisystem disorder characterized by the presence of non-caseating granulomas
  7. Cardiac tumors represent a heterogeneous group, potentially involving any of the heart structures. Secondary malignancies (metastatic) are the most frequent, with a 20 - 40 times higher incidence than primary tumors. Primary cardiac tumors have an incidence of 0.02% in autopsy series, seventy five percent of them being benign [1]

Subendocardium Meaning Best 1 Definitions of Subendocardiu

  1. The subendocardium contains a vast population of cells types. It contains fibroblasts, myofibroblasts, smooth muscle cells, nerves, elastic and collagenous fibers. The connective tissue of the subendocardium is continuous with the connective tissue of the myocardial layer
  2. Myocardial Ischaemia Background. Non-ST-elevation acute coronary syndrome (NSTEACS) encompasses two main entities: Non-ST-elevation myocardial infarction (NSTEMI).Unstable angina pectoris (UAP).The differentiation between these two conditions is usually retrospective, based on the presence/absence of raised cardiac enzymes at 8-12 hours after the onset of chest pain
  3. g of intervention in aortic stenosis (AS) is crucial. It is evident that severe AS is associated with poor survival when left untreated. 1 Although current guidelines recommend aortic valve replacement (AVR) in patients with symptomatic severe AS or evidence of left ventricular dysfunction (left ventricular ejection fraction [LVEF] <50%), there is growing evidence that this treatment.
  4. Explain the general histologic structure of a cardiac valve Heart Wall Epicardium Myocardium Endocardium Endocardium Innermost layer Composed of: Simple squamous epithelium (endothelium) Connective Tissue Subendocardium: in contact with cardiac muscle and contains small vessels, nerves, and Purkinje Fibers

Subendocardium - ICD-10-CM Index to Diseases and Injurie

Terminal conducting fibers in the subendocardium; Conduct cardiac AP faster than any other cardiac cells; Ensure synchronized contraction of the ventricles; Purkinje fibers have a long refractory period. Form functional syncytium: forward incoming stimuli very quickly via gap junctions to allow coordinated contraction; ca. 30-40/mi in the subendocardium and progresses as a wave-front of necrosis from subendocardium to subepicardium over the course of several hours. Transient coronary occlusion may cause only subendocardial necrosis, whereas persistent occlusion eventually leads to transmural necrosis. The goal of acut POOLE, DAVID C., AND ODILE MATHIEU-COSTELLO. Ady~k and subendocardium. Am. J. Physiol. 259 ( Circ. Physiol. 28): H204-H210, 1990.-The sustaed high-energy turnover of cardiac muscle presents a formidable challenge to the O2 delivery systems. One major determant of blood-tissue gas exchange potential is surface area per volume of muscle fiber, Sv(c,f). Estimation of &(c,f) necessitates. The key difference between brain hemorrhage and stroke is that the strokes are either due to an arterial occlusion or due to the rupturing of an artery. A brain hemorrhage occurs following such an arterial rupture. Thus, brain hemorrhage is actually a cause of stroke. Strokes are one most of the commonest causes of deaths in the developed countries


Essentially, the heart muscle becomes thick enough that the blood supply to the subendocardium cannot keep pace with demand. In times of increased demand, small areas can infarct, but subsequent. Dr. Mark P. Anstadt is a Thoracic Surgeon in Dayton, OH. Find Dr. Anstadt's phone number, address, insurance information, hospital affiliations and more subendocardium, and myocardial injury spreads toward the epicardium. 2 2 to 24 hours (1st day) By 3 hours, two-thirds of the myocardial cells within the affected myocardium become necrotic. By 6 hours, only a small percentage of the cells remain viable. The evolution of the transmural MI is complete. 3 24 to 72 hours (2nd to 3rd day Apart from the anaesthesia textbook mentioned below, the other useful reference is Christ et al (2005), which is a discussion of the anaesthetic perioperative management of aortic stenosis patients.By combining anaesthetic agents, blood loss and various cross-clamps and Valsalvas, the perioperative environment is a good model for all the various shock states and physiological bewilderments one.

College Of Medicine (com) 02 &gt; Cardio/resp &gt; FlashcardsCh

Retrograde cardioplegia has been shown to be superior at protecting the hypertrophied subendocardium than antegrade cardioplegia alone. Other advantages of the retrograde approach include an allowance for performing longer or more involved procedures with complete cardiac standstill. Through cannulation of the coronary sinus, clinicians can run. subendocardium as presented by our patient. First, perfusion of chemotherapeutic agents into the subendocardium through the endocardium during chemotherapy might have negatively impact-ed adjacent myocytes. Second, compared with the epicardium, the subendocardium is more vulnerable to various stressors includin Abundant fibromyxoid tissue is present within the subendocardium, giving the valve a pale, basophilic, mucoid appearance. Figure 3 of 5. Heart, Valve - Degeneration, Myxomatous in a male Wistar Han rat from a chronic study. The spongiosa of the valve leaflet is expanded with myxomatous material (arrow)

Subendocardial Distribution of Coronary Blood Flow and the

1. The circulatory system is composed of two major systems: the cardiovascular system and the lymphatic system. a. The cardiovascular system consists of arteries (carry blood away from heart), arterioles The area of infarction is the darker red (hypereosinophilic area) along the subendocardium (3). This higher-power photomicrograph shows endocardium on the right side of this image. Directly beneath the endocardium is a pale area consisting of cardiac myocytes exhibiting vacuolar degeneration (1) These often involve epicardium towards myocardium, typically sparing the subendocardium, while myocardial infarction displays a pattern of enhancement involving the subendocardium [8-10]. Using the Lake Louise Consensus criteria [ 10 ], our patients' findings were consistent with myocarditis by displaying early gadolinium enhancement ratios.

Flashcards - Cardiomyopathies - Dilated cardiomyopathy

Type 2 diabetes induces subendocardium-predominant

Different respiratory activities of mitochondria isolated from the subendocardium and subepicardium of the canine heart. P. Camici M.D. nAff1, F. Ursini 2,3, F. Galiazzo 2,3, L. Bellitto 1, G. Pelosi 1, M. Marzilli 1, A. L'Abbate 1 & R. Barsacchi 4 Basic Research in Cardiology volume 79, pages 454-460 (1984)Cite this articl This leads to ischemia of the LV subendocardium. Ischemia can progress from the subendocardium to more superficial layers of the LV myocardium and result in poor contractile function -> hypotension; Also, diffuse ischemia can produce heterogeneous myocyte repolarization patterns -> re-entrant arrhythmia or fibrillation Diffuse ST-segment elevation in precordial and limb leads. Hyperacute T waves are seen in leads V2 and V3 (A) asymmetric thickening consistent with extensive myocardial oedema in the inferior and inferolateral segments of the left ventricle. (B) extensive enhancement of mid-wall and epicardium with sparing of the subendocardium. 32

All results are in ml/g/min. The 6 myocardial segments yielded mostly comparable values (Fig 1), except for hyperaemic AMBF (Fig 1B).The mean AMBF of all 6 segments at rest was lower in the subendocardium than the subepicardium (1.70 ± 0.13 vs. 2.00 ± 0.16 p = 0.005), Fig 1A.The mean AMBF during hyperaemia was 4.41 ± 0.33 (subepicardium) and 3.93 ± 0.13 (subendocardium), P < 0.001, Fig 1B Endocardial myxomatous change occurs in older rats and is recognized by focal or diffuse thickening in the subendocardium due to the presence of myxomatous tissue (Ruben 2000). Hypertrophy and hyperplasia of the endocardium may be seen in conjunction with the myxomatous valvular changes

Magnesium has been advocated for the treatment of a variety of conditions seen in emergency medicine. The authors present a systematic review and advice on appropriate indications for its use. Evidence supports its use in severe asthma, eclampsia, and torsade de pointes. There is insufficient evidence to justify its routine use in other emergencies Blood flow to the LV papillary muscles and subendocardium was significantly less than that recorded at 200 beats . min-1. The LV endo:epi perfusion ratio with ventricular pacing at 250 beats . min-1 during adenosine infusion resulted in a decrease in mean aortic pressure (63% of control value) and a marked further reduction in blood flow to the. Myocardial infarction (MI), or heart attack, is an interruption of blood supply to part or all of the heart, causing the muscle cells to die. The most common cause is an occlusion (blockage) of a coronary artery due to rupture of an atherosclerotic plaque (an unstable collection of lipids and white blood cells in the wall of an artery). The ruptured plaque causes platelet aggregation and.

The endomyocardial biopsy (EMB) remains the gold standard mode of investigation for diagnosing many primary and secondary cardiac conditions. Through a percutaneous and transvenous route, tissue fragments are generally procured from the right ventricular septum, with very few complications. Widespread use of EMB followed the development of heart transplantation as a means to follow allograft. CMR will show diffuse LGE throughout both ventricles, particularly the subendocardium with a characteristic zebra-stripe appearance of the subendocardial enhancement of the LV and RV endocardium, sparing the mid-wall of the interventricular septum . Sometimes there is a patchy transmural pattern [36-38]. There is a faster contrast washout. The Multiple choice questions about Valvular Heart Disease - Part 5. Select the ONE answer that is BEST in each question Endomyocardial Fibrosis- there is dense diffuse fibrosis of the ventricular endocardium and subendocardium. It involves the tricuspid and mitral valves. The fibrous tissue markedly diminishes the volume and compliance. Endomyocardial fibrosis is associated with nutritional deficiencies and inflammation related to helminthic infections. Malignanc