CARDIAC Section 7: NON-Ischemic Heart

Question 1

Describe Dilated Cardiomyopathy

Answer 1

Dilatation with an end diastolic diameter of >55mm,
+ Decreased Ejection Fraction

Question 2

Give the causes of Dilated Cardiomyopathy

Answer 2

Idiopathic
Ischemic
Other random crap (alcohol, Doxorubicn, Cyclosporine, Chagas, etc..)

Question 3

What does the ischemic variety of Dilated Cardiomyopathy show?

Answer 3

Subendocardial enhancement

Question 4

What does the Idiopathic variety of Dilated Cardiomyopathy Show?

Answer 4

either no enhancement
OR linear mid-myocardial enhancement.

Question 5

Dilated Cardiomyopathy is often associated with mitral regurgitation due to?

Answer 5

Dilatation of the mitral ring

Question 6

What are the causes of restrictive cardiomyopathy?

Answer 6

1. Myocardium replaced by Fibtrotic tissue (Endocardial Fibroelastosis)
2. Infiltration of the myocardium (Amyloidosis)
3. Damage by iron (Hemochromatosis)

Question 7

This is basically anything that causes a decrease in diastolic function (inability to “fill”)-

Answer 7

Restrictive cardiomyopathy

Question 8

Myocardium replaced by Fibrotic tissue

Answer 8

Endocardial fibroelastosis

Question 9

Restrictive cardiomyopathy - damaged by iron

Answer 9

Hemochromatosis

Question 10

What is the most common cause of Restrictive Cardiomyopathy?

Answer 10

Amyloidosis

Question 11

What does amyloid deposits in the myocardium do?

Answer 11

1. Abdormal diastolic function
2. with biatrial enlargement
3. Coincentric thickening of the left ventricle
4. Reduced diastolic function of usually both ventricles.

Question 12

Cardiac amyloidosis is seen _% of systemic amyloidosis

Answer 12

50%

Question 13

Whats the prognosis of Cardiac amyloidosis

Answer 13

TERRIBLE!

Question 14

What can you see in the late Gd enhancement in Amyloidosis?

Answer 14

Gd enhancement over the entire subendocardial circumference.

Question 15

What diseases is Amyloidosis associated?

Answer 15

Mulitple Myeloma
RA
Crohn’s

Question 16

What is teh Amyloid CLASSIC scenario?

Answer 16

A long TI is needed (like 350 milliseconds, normal would be like 200). TI will be so long that the blood pool may be darker than the myocardium.

Question 17

Buzzword “Difficult to suppress myocardium”

Answer 17

Amyloid

Question 18

Buzzword: “Abnormal urinary light chains (AL)

Answer 18

Amyloid

Question 19

“BILATERAL VENTRICULAR THROMBUS”

Answer 19

Eosinophilic Cardiomyopathy (Loeffler -Loeffler’s syndrome: A type of eosinophilic pneumonia mimicking community-acquired pneumonia and asthma that arises from Ascaris lumbricoides in a child.)

Question 20

What is needed to show the thrombus is Eosinophilic Cardiomyopathy?

Answer 20

Long T1

Question 21

What is the most common cause of Constrictive Pericarditis?

Answer 21

FIrst world: Iatrogenic Secondary to CABG/Viral 0

Developing countries: TB

Question 22

Diagnosis?

Describe

Answer 22

Thickened pericardium (>0.4 cm)

Question 23

Constrictive pericarditis is definitive on what CT findings?

Answer 23

Thick and Calcified pericardium

Question 24

Where is the Constrictive Pericarditis calcification usually the largest?

Answer 24

Over the AV groove

Question 25

What is "Sigmoidization on Constrictive Pericardium and where is it seen?

Answer 25

The ventricular septum moves toward the left ventricle in a wavy pattern during early diastole (“Diastolic Bounce”). - MOre pronounced during inspiration - indicating ventricular interdependence seen in SFFP (Steady-state free precession MRI)

Question 26

Classic finding of Constrictive Pericarditis on CXR or CT =

Answer 26

Pericardial calcifications

Question 27

Classic finding of Constrictive Pericarditis on MRI =

Answer 27

Diastolic bounce on CINE imaging

Question 28

TRUE or FALSE: Abnormal Late Gd Myocardial Enhancement is seen on Constrictive Disease

Answer 28

FALSE No Abnormal Late Gd Myocardial Enhancement on Constrictive Disease

Question 29

What type of pattern of enhancement is seen in Myocarditis?

Answer 29

Epicardial or Mid wall

Question 30

Cardiac involvment is seen in __% of Sacriodosis patients?

Answer 30

5%

Question 31

Describe Cardiac Sacroidosis

Answer 31

Late Gd pattern may be middle and epicardial in a non-coronary distribution. Focal wall thickening from edema can mimic hypertrophic cardiomyopathy. It often involves the septum. The RV and papillaries are RARELY affected.

Question 32

Identify

Answer 32

Takotsubo Cardiomyopathy

Question 33

A condition with Chest pain and EKG changes seen in post menopausal women after they either break up with their boyfriend , win the lottery, or some other stressful event

Answer 33

Takotsubo CArdiomyopathy

Question 34

Buzzword for Takotsubo Cardiomyopathy?

Answer 34

BAllooning of the left ventricle apex.

Question 35

Describe Takostubo CArdiomyopathy

Answer 35

There is transient akinesia or dyskinesia of the left ventricular apex without coronary stenosis.

Question 36

TRUE/FALSE: There is delayed enhancement in TAKOTSUBO CARDIOMYOPATHI

Answer 36

FALSE