Cardiomyopathy Disease States

Question 1

What is the most common CMO?

Answer 1

Dilated Cardiomyopathy

Question 2

Dilated Cardiomyopathy is also referred to as _____

Answer 2

Congestive CMO

Question 3

What is a disease that diffusely affects the myocardium, resulting in enlargement and/or ventricular dysfunction?

Answer 3

Cardiomyopathy

Question 4

What are the three main categories of CMO?

Answer 4

Dilated CMO, Hypertrophic CMO (Obstructive & Non-Obstructive), and Restrictive/Infiltrative CMO.

Question 5

Dilated CMO is known for its _____ and ______ systolic and diastolic function.

Answer 5

“Multi-Chamber” enlargement and “Decreased” systolic and diastolic function.

Question 6

When evaluating 2-D echo of a patient with Dilated CMO what may be present due to the decreased flow pattern?

Answer 6

Spontaneous echo contrast

“Smoke”

Question 7

What are the causes for Dilated CMO?

Answer 7

(Numerous)
-Idiopathic
-Ischemic; CAD
-Infections/viral- AIDS, others
-Toxic; Alcohol, cocaine
        Chemo-Adriamycin, others
-Parasitic Diseases
-Pregnancy (peripartum)
-Hemochromatosis
-Ventricular noncompaction

Question 8

What are the clinical symptoms for Dilated CMO?

Answer 8

• Heart failure (pulmonary or systemic congestion)
• Low cardiac output/low BP
• Valvular regurgitation
• Arrythmias, afib
• Embolic events

Question 9

What are the 2-D findings of DCM?

Answer 9

• Dilated chambers, increased volumes/mass, spherical shaped
• Normal to thinned wall thickness
• Reduced global systolic & diastolic function
• Reduced Co
• LV smoke

Question 10

In M-Mode of DCM the increased EPSS is proportional to the _____

Answer 10

Reduced EF

Question 11

On DCM M-Mode what does a B-Bump indicate?

Answer 11

Increased LVEDP

Typically >15 mmHg

Question 12

With what CM is the double diamond pattern of MV on M-Mode associated with?

Answer 12

DCM

Question 13

What are some other causes of DCM?

Answer 13

Long-standing HTN heart disease

LV non-compaction (honey comb apex; spongy)

Question 14

(DCM) Aortic cusps that have a tapered appearance at closure vs. a crisp closure is due to what?

Answer 14

Reduced forward flow from poor systolic function; note reduced aortic root motion

Question 15

Which CM is known for its hypertrophic, hyperdynamic, non-dilated left ventricle that is frequently, but not necessarily, associated with a left ventricular outflow tract obstruction (LVOTO)?

Answer 15

HCMO

Question 16

What is an inherited autosomal dominant disease of the myocardium?

Answer 16

HCMO

Question 17

Does HCMO primarily affect diastolic or systolic function?

Answer 17

Diastolic Function

Question 18

ASH and SAM are hallmark findings of what CM?

Answer 18

HOCM

Question 19

What is ASH?

Answer 19

asymmetric septal hypertrophy

Question 20

What is SAM?

Answer 20

Systolic Anterior Motion of the mitral valve apparatus seen during systole.

Question 21

With HOCM a LVOTO is created by ______

Answer 21

The small, hyperdynamic left ventricular cavity, ASH, and SAM.

Question 22

Which CM presents a high risk of sudden death during exercise?

Answer 22

HOCM

Question 23

What are the clinical symptoms of HCM?

Answer 23

• Asymptomatic (HCM)
• Dyspnea, PND, orthopnea
• Angina
• Arrythmias
• Exercise Intolerance
• Heart Failure
• Syncope

Question 24

Myocardial fiber disarray is a hallmark finding for which CM?

Answer 24

HOCM

especially seen in IVS-speckling, ground glass reflection

Question 25

Aortic valve notching (partial mid-systolic closure) of the aortic valve due to a sudden decrease in cardiac output is a M-Mode finding associated with which CM?

Answer 25

HOCM

Question 26

A dagger shaped aortic flow profile is associated with which CM?

Answer 26

HOCM

Question 27

Which CM is more common in Asian populations?

Answer 27

Asymmetic Apical Hypertrophy

Question 28

Which CM has an "Ace of Spades" appearance of the LV at end diastole?

Answer 28

AAH | Asymmetric Apical Hypertrophy

Question 29

Which CM presents with massive hypertrophy which only affects the apex?

Answer 29

AAH No LVOT obstruction Check for apical aneurysm

Question 30

Which CMO involves the infiltration of the myocardium that results in stiff, rigid ventricular walls that impede diastolic fillinf?

Answer 30

Restrictive/Infiltrative

Question 31

Which is the least common of all the CMO disease states?

Answer 31

RCMO

Question 32

What are some 2-D findings associated with RCM?

Answer 32

``` Nml-small LV size Normal systolic function Bi-atrial enlargement Abnml texture; granular myocardium Concentric LVH possible ```

Question 33

Which is the most common of the Restrictive/Infiltrative CMOs?

Answer 33

Amyloidosis

Question 34

What is associated with Classic Amyloidosis?

Answer 34

``` Symmetric hypertrophied walls Abn myocardial texture Diffuse Valve thickening Bi-Atrial enlargement Restrictive Doppler pattern ```

Question 35

RCM Doppler includes ____

Answer 35

- Short early filling, little atrial contribution Big E, little A - Shortened Mdt - Shortened IVRT - E/A ratio >2.0

Question 36

Which RCM is marked by abnormal inflammatory masses (granulomas) that infiltrate various organs?

Answer 36

Sarcoidosis

Question 37

Which RCM is the most common iron overload disease that may result in multiple organ and tissue damage?

Answer 37

Hemochromatosis

Question 38

What is a rare form of CM, which includes a fatty infiltration of RV muscle?

Answer 38

Arrythmogenic RV Dysplasia | ARVD (ACM)

Question 39

ARVD

Answer 39

``` 50% familial RV failure can result RVE, aneurysm,arrythmias Dilated RVOT RV wall motion abn's TR ```

Question 40

Which CM is endemic to South & Central America?

Answer 40

Chagas' Disease

Question 41

Which CM is associated with a bite from a trypanosoma cruzi parasite?

Answer 41

Chagas'

Question 42

What appearance does Chagas have on echo?

Answer 42

Apical aneurysm with a narrow neck

Question 43

What are some treatments for CM's?

Answer 43

``` Drug therapy of underlying cause Surgical myectomy/myotomy (HOCM) Bi-ventricular pacing Alcohol septal ablation Transplant ```

Question 44

What presents as an acute infection with acute onset of LV systolic dysfx?

Answer 44

Acute myocarditis