Flashcards in Cardiomyopathy Deck (114):
Pulsus alternans is a clinical sign of which of the following?
Patients w a hypertrophic cardiomyopathy usually have an ejection fraction in the range of?
Patients w lvh?
Have bright myocardium and a pericardial effusion might have an infiltrative cardiomyopathy
Patients w a congestive cardiomyopathy usually have an ejection fraction in the range of?
Does inderal (beta blocker) increase Sam?
No decreases heart rate, reduces Sam w excercise
What is associated w a late peaking Doppler jet (dagger shape) ?
HOCM and IHSS
What is the etiology of HCM?
Maybe transmitted by a autosomal dominant gene with variable penetrance
What are some aliases associated w HCM? Must have 3 to be hypertrophic
ASH(asymmetric septal hypertrophy) most common
SAM (systolic anterior motion of MV)
IHSS (idiopathic hypertrophic subaortic stenosis (SAM & ASH)
HOCM (hypertrophic obstructive cardiomyopathy (SAM & HCM)
Which cardiomyopathy is autosomal dominant?
What are some physical signs of HCM?
DOE, angina, arrhythmias, syncope, sudden death.
Systolic murmur (crescendo decrescendo) that increase w valsalva or amyl nitrate
Name some Pathophysiology of HCM?
Myocardial fiber disarray.
LA enlargement results from diastolic dysfunction and or mitral regurg
What is referred to as the ace of spades on 2d?
Apical hypertrophic cardiomyopathy ( more common in japan 20% of all hcm versus 2% in USA) increased qrs voltage and giant negative t waves in v2-v5
Normal etiology for HOCM
What is the ratio for assessing asymmetric hypertrophy?
1:3:1 (septum thicker than lat wall) all around concentric
In HCM what is the appearance of the myocardium?
Bright from fiber disarray
The Venturi effect can be associated with which cardiomyopathy?
Hypertrophic (vel up pressure down)
LVOT obstruction causes the aov to ?
Close in mid systole
What does it mean when A > E? A wave greater than e wave
Some degree of diastolic dysfunction, ABNORMAL RELAXAtion
The arrow is pointing to where ( during the t wave ) ?
What are some Doppler findings in HCM?
Increased a-e ratio on mitral valve inflow velocity. Mid ventricular or subaortic gradient may be present . Mitral regurg might b present . Doppler spectrum shows a late peaking systolic jet
Pt with IHSS will have what?
Late peaking jet / dagger shape (dynamic obstruction), they will also have mitral regurg
Does inderal (beta blocker) increase SAM?
No decreases heart rate reduces SAM with exercise
61 y/o male w IHSS and a resting gradient of 144 mmhg. Admitted to the hospital with chest pain. The next day the resting gradient was 15 mmhg. What happened?
Global longitudinal strain in pts w HOCM is typically?
What is the normal global longitudinal strain ?
19-19 percent or more
What is strain?
Strain measures the deformation within the myocardium
What is another name for congestive?
What is another name for dilated?
Name some etiology for congestive (dilated) cardiomyopathy?
Infective (viral, bacterial, fungal, parasitic)
Toxic (alcohol adriamycin, lead, cobalt)
Metabolic (thiamin deficiency)
What is Chagas disease?
Posterior and apical thinning, septum usually nl (most common in s America)
What is a b-notch on m-mode?
(B-notch is a shelf after M)
What type of CM might you see in a pt w AIDS?
Dilated (congestive) CM
What are some echo signs of congestive CM?
Globally impaired LV contractility.
B-notch on mitral valve m-mode (increased LVEDP).
Reduced aortic root excursion.
Increased e-point to septal seperation.
Thrombus and small pericardial effusion may be present.
Reduced mitral valve excursion (double diamond) on m-mode
What are some Doppler findings in dilated CM?
MV and TV regurg are usually seen.
AV and PV regurg may be present.
What is the appearance of a post transplant 2-d echo?
Double atria (leaving IVC and SVC alone)
What might the double atria show in ECG?
Might have 2 p waves
(1 from native atria and other from donor atria)
What is hemochromatosis?
Etiology of restrictive (infiltrative) CM?
Amyloidosis (most common) 10/1.
Endomyocardial fibrosis (endocardial thickening).
Glycogen storage (pompes disease)
Pathophysiology for restrictive (infiltrative) CM?
Infiltration of myocardium resulting in rigid ventricular walls impeding diastolic filing.
Sarcoidosis may infiltrate conduction system leading to AV block.
Physical signs of restrictive CM?
Symptoms include fatigue, dyspnea and angina.
Echo findings in infiltrative (restrictive) CM?
Ventricular hypertrophy with small or normal ventricular cavity.
"Ground glass" appearance of myocardium.
Ventricular systolic function may be normal or decreased.
Pericardial effusion may be present.
Protein = ?
Amyloidosis (10/1 more common than sarcoidosis)
What is Amyloidosis?
Amyloidosis involves abnormal proteins. Some may describe it as a translucent waxy protein build up on the myofibrils.
Pt w sinus tachy will most likely have what CM?
What is associated w pulsus alternans?
What is ground glass appearance?
Very bright myocardium associated w restrictive CM. And is related to infiltrative myocarditis.
A restrictive cardiomyopathy has which of the following?
Decreased LV compliance
Name the types of cardiomyopathies?
Normal, congestive (dilated), hypertrophic, restrictive (infiltrative)
A typical ejection fraction in a dilated cardiomyopathy patient might be? For a HCM patient?
Echo findings associated with idiopathic hypertrophic subaortic stenosis?
Systolic anterior motion of mitral valve, asymmetric septal hypertrophy, IHSS
Patients with IHSS and high resting outflow gradient may be offered all of the following treatments Except:?
Surgical septal myectomy, this will decrease gradient.
Contradictions to amyl nitrite inhalation include all of the following Except:?
Moderate to severe mitral regurgitation, amyl nitrite provokes outflow in LVH patients.
A cardiomyopathy is a disease that ____ , resulting in enlargement and or ventricular dysfunction?
Myocardium, disease of heart muscle
If your patient has right heart failure, what classic sign/symptom would you expect to see?
Lower extremity edema
All of the following may be a physical symptom in patients with congestive(dilated) CM Except:?
Systematic hypertension is not usually seen with dilated CM.
All of the following are echo findings in patients with HOCM Except:?
Decreased ejection fraction.
Patients with hypertrophic obstructive CM will often have a bright appearance due to?
Myocardial fiber disarray.
Patients with a dilated CM frequently experience multiple symptoms, such as:?
Which of the following is not a common symptom of congestive(dilated) heart failure(CHF)?
All of the following are etiologies for restrictive(infiltrative) CM Except:?
All of the following are Doppler findings on PT's with HOCM Except:?
Outflow gradient that decreases with a valsalva maneuver
Common echo findings in dilated CM include all of the following Except:?
Increased left ventricular wall thickness
A speckled or ground glass appearance of the left ventricle myocardium by 2D echo is commonly seen in patients with?
Amyloid heart disease
All of the following are etiologies for congestive(dilated) CM Except:?
Hemochromatosis.. Too much iron proteins are infiltrative
Patients of amyl nitrite might be used to demonstrate which of the following?
What might be the first indication of metastatic disease?
All of the following are echo findings in PT's with a dilated CM Except:?
Exaggerated aortic root excursion
A cardiomyopathy is disease that diffusly affects the _______, resulting in enlargement and or ventricular dysfunction?
Which echo findings are typically associated with IHSS (idiopathic hypertrophic subaortic stenosis?
Systolic anterior motion of the mitral valve and assymestric septal hypertrophy (SAM & ASH)
If you obtain a systolic, high velocity and late peaking jet in the LV outflow tract by continuous wave Doppler from the apex the likely diagnosis is?
Hypertrophic obstructive cardiomyopathy (HOCM) dynamic obstruction (dagger shape)
Patients with IHSS and a high resting outflow gradient may be offered all of the following treatments except ?
Sublingual nitroglycerin .. Not used for IHSS but for pts w angina.
Echo features of Amyloid heart disease include all of the following Except?
Mitral valve prolapse
What is the proper technique for Dopplering the mitral inflow looking for dialstolic dysfunction?
Apical 4 ch pulsed Doppler at mitral tips
In a pt with IHSS?
Mitral regurg is often present ( pts w IHSS always have Sam and ash and Sam usually leads
Contraindications to amyl nitrate inhilation include all of the following except?
Moderate mitral regurg
A common valvular regurg found in pts w a dilated (congestive) CM is ?
Mitral .. Most common in dilated CM
Pts w IHSS demonstrates?
Mid systolic closure of ao valve
Which of following is a common etiology for a pt to develop a congestive dilated CM?
Toxic ( are often caused my toxins such as alcohol or chemotherapy drugs such a adriamycin.
Systemic hypertension is not a physical sign of what CM ?
Amyloid and sarcoid are what type of cardiomyopathy?
Infiltrative (amyloid and sarcoid infiltrate the myocardium so it is more accurate to classify these as infiltrative not restrictive.
A speckled or ground glass appearance of the LV myocardium by 2d echo is commonly seen in pts w?
Amyloid heart disease
Pts w HOCM will often have "bright" myocardial appearance by echo due to?
Myocardial fiber disarray (increased reflectance )
What is noonan syndrome?
Classified as a cardiofacial syndrome with ps, hcm, and asd (30 percent)
The restrictive transmitral filing pattern is most consistently associated w which physiological parameters?
Elevated LA pressures, increased LV stiffness
Pts w a dilated can may develop apical thrombi. When looking for them in the LV apex you should use?
Higher frequency transducer
Which of the following is an echo finding in PT's with a dilated CM?
B-notch, due to LVEDP.
All of the following are frequent echo findings in PT's with IHSS Except:?
Mitral valve prolapse(MVP)
PT's with restrictive CM typically have a Doppler finding of:?
Large E wave, little A wave
PT's with Changas disease might develop which type of CM?
Congestive(dilated), epidemic in South Africa
The classic motion of the aortic valve by M-mode in PT's with HOCM is:?
Mid systolic closure
Which of the following is the most common type of CM?
Which of the following is true regarding mitral Doppler trace in PT's with restrictive/infiltrative CM?
Resembles constrictive pericarditis I
Common Doppler findings in PT's with restrictive CM?
Greater E, sm A wave
PT's with HOCM might have which type of murmur?
Systolic crescendo-decrescendo that increases with valsalva
Which of the following is the most common etiology for a PT to develop restrictive CM?
When amyl nitrite is administered to a PT who has HOCM CM it is likely to:?
Increase the systolic anterior motion of mitral valve.
In PT's with asymmetric septal hypertrophy(ASH), what is the septal to posterior wall ratio?
Another echo term for a systolic, high velocity and late peaking jet in the left ventricle outflow tract by continuos wave Doppler from the apex is?
Hemochromatosis is the most commonly associated with which of the following CM?
The restrictive transmittal filling pattern is most consistently associated with which physiological parameters?
Elevated LA pressures, increased ventricular stiffness
If a patient with IHSS has a resting outflow velocity of 3 m/sec, what is the peak gradient?
36.. Bernoulli equation
Which of the following is a common echo finding in PT's with restrictive CM?
All of the following might be a physical symptom in PT's with HOCM except:?
PT's with advanced symptoms from having a dilated CM might benefit from all of the following Except:?
Mitral valve replacement
All of the following are echo findings in PT with congestive(dilated) CM Except:?
Increased aortic root excursion
The ratio of a early transmitral(E) to atrial(A) Doppler filling velocities are influenced by all if the following factors:?
All of the following are echo findings in PT with restrictive(infiltrative) CM Except:?
Hypercontractile left ventricle
A PT with IHSS and a high resting gradient may benefit from a surgical septal myectomy to decrease the gradient. What is a common complication from this procedure?
PT's with a restrictive CM typically have Doppler findings of?
Lg E, small A wave
Of the following is a common etiology for a PT with congestive(dilated) CM?
PT's with a dilated CM may demonstrate a Doppler pattern of the mural inflow with?
Patients with a dilated CM frequently experience multiple symptoms Except:?
PT's with HOCM may have what type of murmur?
Systolic crescendo/decrescendo that increases with valsalva. A diamond shaped murmur