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Echo 2 > Module 15 : Dilated and Hypertrophic Cardiomyopathies > Flashcards

Module 15 : Dilated and Hypertrophic Cardiomyopathies Flashcards

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1
Q

definition of cardiomyopathy CMO

A
  • primary disease of the myocardium

- excluding myocardial dysfunction due to ischemia or chronic valve disease

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2
Q

what are the 2 classifications of CMOs

A
  • 1st physiology

- 2nd etiology

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3
Q

what are the 4 main types of CMOs

A
  • dilated
  • hypertrophic
  • restrictive
  • other
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4
Q

what are 2 main characteristics of dilated CMO DCMO

A
  • biatrial and biventricular dilation

- ventricular systolic and diastolic dysfunction of the LV and RV

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5
Q

what are 2 main characteristics of hypertrophic CMO. HCMO

A
  • idiopathic asymmetric hypertrophy of heart

- hypertrophic hyper dynamic non dilated left ventricle

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6
Q

what are 3 main characteristics of restrictive CMO RCMO

A
  • increased resistance to ventricular filling due to lack of compliance
  • heart failure with increased LVEDP, LAP
  • global systolic function preserved
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7
Q

what are 3 main characteristics of other CMOs

A
  • arrhythmogenic RV dysplasia
  • LV non compaction
  • idiopathic
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8
Q

what is dilated CMO called when there is no known cause

A
  • idiopathic dilated CMO
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9
Q

what will all 4 chambers of the heart look like with dilated CMO

A
  • all 4 may be dilated
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10
Q

what will the systolic and diastolic function be of the LV and RV with dilated CMO

A
  • reduced CO and EF
  • elevated LVEDP
  • grade 3 DD
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11
Q

what are the 8 main causes of DCMO

A
  • infectious
  • toxic
  • peripartum
  • metabolic
  • genetic
  • endocrine disease
  • idiopathic
  • stress induced
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12
Q

what are 3 infectious causes of DCMO

A
  • viral myocarditis
  • parasitic
  • AIDSq
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13
Q

what are 3 toxic causes of DCMO

A
  • alcohol abuse
  • chemotherapy
  • drugs
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14
Q

what is perpartum DCMO caused by

A
  • immune system reaction
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15
Q

what is metabolic DCMO caused by

A
  • thiamine deficiency
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16
Q

what is genetic DCMO caused by

A
  • x linked familial disorder
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17
Q

what are the 3 causes of endocrine DCMO

A
  • hypothyroidism
  • hyperthyroidism
  • pheochromocytoma
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18
Q

what are the signs and symptoms of DCMO related to CHF

A
  • Low BP, fatigue, weaknes
  • peripheral cyanosis
  • dyspnea/SOB
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19
Q

what are 5 other symptoms of DCMO related to underlying disease

A
  • chest pain
  • palpitations
  • afib/PVCs
  • wet cough
  • embolic events
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20
Q

what are 4 complications of DCMO

A
  • systolic embolization
  • sys-synchrony of contraction
  • cardiac death
  • consequences of underlying disease
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21
Q

what will the ECG look like with dCMO

A
  • sinus tach
  • conduction defects
  • LVH (large QRS complex)
  • afib
  • LAE
  • ventricular arrhythmias
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22
Q

what 2 characteristics will an X-ray have of DCMO

A
  • cardiomegaly

- pulmonary congestion

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23
Q

what are the 2 different treatments of DCMO

A
  • medical

- surgical

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24
Q

what are the medical treatments of DCMO

Study These Flashcards
A
  • treat etiology if known
  • dietary changes (less salt)
  • alcohol cessation
  • drugs
  • biventricular pacing
  • cardioverter
25
what are the surgical treatments of DCMO
- mitral valvulolasty/replacemtn - ventricular reduction - revascularization - LVAD - cardiomyoplasty - transplant
26
what are 4 general echo findings of DCMO
- 4 chamber dilation - pericardial effusion - aneurysmal apex - decreased global LV and RV systolic and diastolic function
27
what are 5 m mode findings of DCMO
- reduced wall excursion (PW < 10mm) - MV B bump from high LVEDP - increased EPSS (e point to septum separation) - decreased AV cusp excursion or opening - early AV closure
28
what is the normal EPSS meauremtn
- < 7mm
29
what would an EPSS of > 20mm indicate about the EF
< 30%
30
what are 8 2D findings associated with DCMO
- increased LV diameter both systolic and diastolic - RV enlarged - decreased EF,FS,CO - sphericity index > 0.76 - spontaneous contrast in LA and LV - LV thrombus - MV tenting - biatrial enlargement
31
what are 7 doppler findings with DCMO
- MR 100% of the time - TR - PR - AR - decreased LVOT velocity - color doppler fill reduced - decreased PV acceleration time
32
what are the 5 doppler measurements for DCMO
- CO - severity of regurge - SPAp, MPAP, PAEDP - LV EDP - LV Dp/Dt
33
why is the LV Dp/Dt measurement so important for DCMO
- MR always present and reduced afterload which will make EF higher than is - can asses global systolic function way better
34
how does the angle of MV inflow change with DCMO
- normal = inflow < 20º lateral to apex | - dilates = inflow up to 40º from apex
35
what are 3 other structs that might occur at the apex other than thrombi
- aberrant chordae - ruptured chordae or pap - prominent LV trabeculations
36
what are 7 tips for detecting LV thrombus
- highest frequency - harmonics - reduce depth - focal zone - pan through LV - confirm thrombus in 2 or more planes - color doppler
37
what is the etiology of hypertrophic CMO HCMO
- inherited disease = X linked autosomal dominant | - increased muscle mass due to myofibril disarray producing symmetric hypertrophy of the heart
38
what are the 2 sub groups of HCMO and what are they based on
- non obstructive - hypertrophic obstructive CMO + HOCMO - base on whether hypertrophy is causing any LV outflow obstruction
39
which area of the heart will most likely result in HOCMO
- basal anterior septum
40
what are 3 characteritcs of non obstructive HCMO
- LVOT PG < 30mmHg at rest - potential for LVOT obstruction to develop wth time - VALSALVA EVERY PATIENT
41
what are 4 characteritcs of HOCMO
- dynamic obstruction + occurs when MV leaflets com in contact with thick IVS - LVOT PG > 30mmHg at rest - latent obstruction discoverable with valsalva - if obstruction present at rest then present always
42
what are 7 clinical signs of HCMO
- angina - exercise intolerance - arrhythmias - AV blocks - systolic murmur - syncope - sudden death
43
what are 3 M mode characteristics of HCMO
- systolic anterior motion of MV SAM - wall thickness IVS basal vs LVW basal + high risk > 30mm - mid systolic closure of AV
44
what are the 2D findings of HCMO
- ASH - narrowed LVOt - IVS > 1.3 - IVS:LVPW > 1.3 - thickened ground glass IVS - decreased systolic IVS thickening - hyper dynamic LV motion
45
what are the 3 forms of HCMO
- basal IVS segment - mid ventricular hypertrophy - apical hypertrophy
46
what are the 3 types of HOCMO
- persistance obstruction - provocable obstruction - latent obstruction
47
what is persistant HOCMO
- obstruction at rest no provocation | - high velocity LVOT
48
what is provable HOCMO
- mild obstruction at rest that increases with provocation | - gets worse with valsalva
49
what is latent HOCMO
- near normal velocity at rest that increases with provocation - obstruction only during valsalva
50
what 2 factors is obstructive CMO dependant on
- preload | - afterload
51
what will increase the obstruction
- lower preload lower LV volume increased contractiliyc and decreased afterload
52
what are the 3 provocative maneuver to uncover latent obstruction
- amyl nitrate - valsalva - stress test
53
what will a dynamic flow obstruction look like on doppler
- mid to late systolic peaking of LVOT flow - gradient across LVOT - use PW to map level of obstruction - CW to display peak velocity - as gradient increases the degree or severity increases
54
characteristics of mid ventricular HCMO
``` - entire LV extremely thick + concentric - obstruction in mid ventricular cavity - LV contracts on itself - lv cavity obliterates duding systole - ```
55
echo findings of mid ventricular HCMO
- very thick LV - small LV cavity - color doppler increase velocityes - MR - LVOT obstruction at higher heart rates - saw tooth waveforms
56
characteristics of apical HCMO
- similar to mid ventricle - need to image true apex - heart cavity globular inchape - color doppler to identify obstruction - look for apical infarction, clot, aneurysm
57
what are the 2 main treatments of HCMO
- medical | - surgical
58
what are the 2 medical treatments of HCMO
- improve diastolic function with meds | - prevention of sudden death (Cardiac defibrillator)
59
what are the 3 surgical treatments of HCMO
- spatial ablation - myectomy - percutaneous intervention

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