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Flashcards in Cardiomyopathies Deck (17):
1

Dilated Cardiomyopathy characterized by

-impaired LV contractility, then diastolic dysfunction
-Reduced cardiac output
-Elevated LV end-diastolic pressure
-all four chambers are dilated
-impaired systolic function of RV and LV
-

2

Dilated Cardiomyopathy clinically has...

-functional mitral regurgitation is present secondary to LV and mitral dilation
-pulmonary hypertension develops in response to chronically elevated LV pressure

3

Exceptions for DCM....
-fulminant myocarditis
-chagas heart disease
-tako-tsubo cardiomyopathy

-fulminant myocarditis: may be little ventricular dilation, despite severe systolic dysfunction
-chagas heart disease: LV apical anyeursm is seen in half of patients, often thrombus formation,
-tako-tsubo: acute, transient stress-induced characterized by "apical balloning" with apical dilation and dyskinesis but preserved dimensions and function of the cardiac base

4

If echocardiography shows no significant impairment of LV systolic function, other possible diagnoses include...

-coronary artery disease
-valve disease
-hypertensive heart disease
-pericardial disease
-pulmonary heart disease

5

Hypertrophic Cardiomyopathy basic characteristics

-asymmetric hypertrophy of the LV
-Normal LV systolic function
-Impaired diastolic LV function
-Subaortic dynamic obstruction
-sparing of the basal posterior wall
-SAM: systolic anterior motion (m-mode)

6

Hypertrophic Cardiomyopathy clinical features...

-high risk of sudden death (with exertion)
-symptoms of angina
-exercise intolerance
-syncope: fainting
-high prevalence of atrial fibrillation
-systolic murmur on cardiac auscultation

7

Hypertrophic cardiomyopathy is classified as...

-nonobstructive: 1/3 of patients, outflow gradient is 30 mm Hg
provocable: resting gradient is <30 mm Hg, but obstruction occurs with exercise

8

the degree of hypertrophic obstruction is increased by...

-a reduction in preload
-an increase in contractility
-a decrease in afterload

9

Restrictive Cardiomyopathy basic principles...

-nondilated, thick-walled LV
-normal LV systolic function
-abnormal LV diastolic function
-RV free wall thickening
-biatrial enlargement
-moderate pulmonary hypertension
-elevated right atrial pressure (dilated inferior vena cava)

10

Amyloidosis

In restrictive cardiomyopathy
- the classic "speckled" myocardium of amyloidosis is non specific , particularly with harmonic imaging

11

RCM: pseudonormal pattern of LV filling can be distinguished from normal by:

-the rapid early-diastolic deceleration time (LV inflow)
-reduced E' velocity
-increased PVa velocity and duration
-the patient's age, clinical presentation, adn other associated echocardiographic findings

12

recommended parameters for echocardiographic evaluation of a patient with an Left Ventricle Assistance Device include:

-record LVAD type, mode, and pump speed
-measure LV dimensions and volumes in standard image planes
-Record aortic valve motion with M-mode for several cardiac cycles to document aortic valve opening frequency and duration
-record LVAD inflow from the apical conduit using color and pulsed doppler
-record LVAD outflow into the ascending aorta with color and pulsed doppler

13

Common problems encountered in patients after cardiac transplantation

-pericardial effusion
-RV systolic dysfunction
-LV systolic dysfunction

14

Hypertensive Heart Disease basic principles

-LV hypertrophy
-Diastolic dysfunction
-ascending aorta dilation
-aortic valve sclerosis
-mitral annular calcification
-LA enlargement
-Atrial enlargement
-Atrial Fibrilation

15

Increased pulmonary arterial pressure due to...

-reduction in the caliber of the pulmonary vasculature
-an increase in pulmonary blood flow or both

16

Dilated Cardiomyopathy Important to Note...

-dilated cardiomyopathy is a dilatation of both ventricles, atria with contractile failure
-minimally dilated cardiomyopathy represents a subgroup of patients with poor ventricular function but with normal or mildly dilated ventricles
-prognosis of patients with biventricular dilatation and failure is worse than in patients with only left sided involvement

17

Restrictive Cardiomyopathy Important to Note...

-cardiac hemochromatosis is an iron storage disease meaning that the iron is stored within the cardiac cell rather than extracellular
-a high index of suspicion should be afforded a young patient who presents with a dilated cardiomyopathy