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echo boards > Pericarditis and Cardiomyopathy > Flashcards

Pericarditis and Cardiomyopathy Flashcards

1
Q

Class 1 recommendations for pericardial disease echo

A

pts with suspected pericardial disease including effusion, constriction
pations with suspected bleeding in pericardium
follow up for recurrence
pericardial friction rub in MI with symptoms like pain nausea and hypotension

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2
Q

Thickened pericardium measurement

A

greater than 4mm

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3
Q

Pericardial anatomy

A

normally contains 5-30mL serous fluid
reflections create oblique and transverse sinus
fused with diaphragm

congenital absence of pericardium
mulibrey nanism
leads to CHF, constrictive pericarditis

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4
Q

normal spontaneous respirophasic variation

A

transtricuspid inflow increase by 20% on inspiration and decrease by 20% on expiration
transmitral inflow increase by 10% on expiration and decrease by 10% on inspiration

intrathoracic pressure from -3 to -6 with normal respirations

gradient for filling RV is RAP - negative intrathoracic pressure. Increased RV filling, decreased LV filling during inspiration

increased LV filling , decreased RV filling during expiration

Septum shifts to left

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5
Q

negative pressure inspiration

A

less rv afterlaod
increased rv filling
decreased lv filling
increased lv afterload

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6
Q

negative pressure expiration

A

decreased systemic venous return
decreased rv filling
increased rv afterload
increased LV filling
decreased LV afterload

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7
Q

CP and tamponade with spontaneous variation

A

changes of inspiration and expiration exaggerated in both with spontaneous ventilation

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8
Q

Tamponade changes with ppv

A

decrease in variation. So much that you can end up causing arrest

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9
Q

Constrictive pericarditis

A

increased resp variation with both spont and ppv
elevated and equalized CVP , Pulm vein and LVEDP
prominent early filling (exagerrated Y descent)
pulus paradoxus uncommon but kussmauls sign common

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10
Q

tamponade

A

increased resp variation with spontaneous
decreased resp variation with ppv
elevated and equalized cvp, pulm vein and LVEDP pressures
prominent systolic filling (loss of y descent)
pulsus paradoxus common
kussmauls sign uncommon

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11
Q

congenital pericardial problems

A

rare
partial or total absence
mulibery nanism (muscle liver brain eye nanism) = chf and CP

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12
Q

pericarditis

A

inflammation of pericardium
Triad : chest pain, ekg changes (diffuse st elevation) , friction rub at left sternal border with pt leaning forward. Pain better leaning forward
Chronic can lead to constrictive

Often idiopathic / viral
infection
neoplastic
autoimmune
post surgical
post radiation
drugs/ trauma/ uremia

thickness usually greater than 4mm but not always. Use MRI>CT=TEE>TTE

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13
Q

CP vs RICM

A

peak velocity pulm vein D wave variation > 18%
peak velocity TM E wave variation >10% in CP
color m mode Vp >100cm/sec in CP
Tissue doppler e’<8 cm/sec in RICM
Tissue doppler septal velocity > lateral velocity in CP
pericardial knock in cp, s3 in RICM
BNP <100 pg/ml in CP but elevated in RICM
thickness >4mm favors CP

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14
Q

tissue doppler cp vs ricm

A

e’<8cm/sec in ricm
e’>10 cm/sec in cp
annulus reversus lat e’<sep e’ in CP
annulus paradoxus E/e’ <15 in CP

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15
Q

hepatic venous reversal spontaneous

A

cp- reversal during expiration
ricm- reversal during inspiration

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16
Q

pulm venous resp variation spontaneous

A

peak velocity d wave variation >18% in cp

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17
Q

MRI comparison of cp vs ricm

A

late gad enhancement of pericardium and thick - cp
lge of sub endocardium - ricm
LA : RA volume CP»RICM
Max septal excurtion b/w in and ex cp>RICM

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18
Q

speckle tracking differences

A

cp- ratio of LV free wall strain to septal wall strain and RV were less in CP than RICM

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19
Q

Vp

A

<50 cm/sec = ricm
>100 cm/sec=cp

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20
Q

cardiac cath cp vs ricm

A

elevation and equalization of diastolic pressures in cp

lvedp>rvedp in ricm

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21
Q

dip and plateau sign

A

square root sign seen in both cp and ricm that indicates rapid early filling

22
Q

tamponade findings

A

tachycardia
chest pain/fullness
dyspnea, tachypnea
peripheral edema
hypotension
Elevated JvP without kussmaul
pulsus paradoxus but may be absent if regional/loculated

23
Q

chamber collapse for tamponade

A

absence = very unlikely there is tamponade
RA collapse >1/3 cycle is nearly 100% sens and specific
RV collapse occurs iin diastole
RA collapse in diastole can be normal

24
Q

pericardial effusion

A

0.5 and less is small
.5-2 cm moderate (200-500 mL)
>2cm large

25
Q

tamponade doppler changes

A

prolongation IVRT
decrease or reversal of hepatic d waves w expiration

26
Q

when is pulsus paradoxus seen besides tamponade

A

copd, asthma, vigorous positive pressure ventilation

27
Q

mitral inflow patterns for tamponade and constrictive pericarditis

A

tamponade - impaired relaxation with a >e
cp - restrictive pattern with e»a

28
Q

pericardial tumors

A

not high yield
primary: benign more comon. teratoma, lipoma, fibroma ,hemangioma, lymphangioma
malignant-mesothelioma, angiosarcoma
Secondary: metastatic, more common than primary. Lymphoma, melanoma, lung ,breast carcinoma. usually present with pericardial effusion

29
Q

pericardial cysts

A

congenital or infectious
enclosed spaces taht do not communicate with pericardial space. manage conservatively

30
Q

How much fluid is normal in pericardium?

A

25-50 mL

31
Q

Does VSD typically cause RV or LV enlargement

A

usually LV , especially at first. All flow goes from LV to RV and out pulmonic valve during systole

32
Q

what is pulsus alternans

A

alternating strong and weak beats seen on arterial line. Associated with severe LV systolic dysfunction

33
Q

what is kussmaul sign

A

paradoxical rise in RAP during inspiration. Commonly seen in constrictive pericarditis and RICM as there is a decrease in RV compliance.

34
Q

E/e’ ratio for CP

A

usually less than 15
Annulus paradoxus

35
Q

LVDP in CP

A

unchanged. LV is shielded from decrease in pressure due to constrictive pericarditis.
There is an exaggerated decrease in LV filling

36
Q

3 major types of cardiomyopathy

A

Dilated- not enough stuff. 100% have systolic dysfunction. Carpentier 3B. Most common cardiomyopathy

Hypertrophic-Too much stuff. AD variable penetrance and expresivity. LVOT obstruction 25% pts. 100% have diastolic dysfunction. Have subendocardial ischemia and vtach. Get pacemakers that cause RBBB to reduce obstruction. Associated with cardiac death sudden

RICM- the wrong stuff. Amyloidosis most common. 100% have diastolic dysfunction. Prognosis related to thickness of walls and diastolic dysfunciton. Systolic function also eventually gets worse.
ONce symptoms appear 2-3 year survival is less than 50%

37
Q

Dilated cardiomyopathy

A

causes 3b carpentier mitral motion.
Caused by: idopathic, peripartum, infectious, toxin, genetics.

Associated with low EF, low flow leading to LAA clot / LV clot

38
Q

Toxic causes of dilated cardiomyopathy

A

cobalt, doxorubicin, alcohol, snake bites

39
Q

infectious causes of dilated cardiomyopathy

A

chagas, post viral

Children can get severe acute form after virus that can improve and return to basically normal

40
Q

Higher mortality in D CM

A

EDD of >4cm/m2

41
Q

HOCM / HCM

A

Obstuction occurs in 25%. AD with variable penetrance and expressivity

4 types based on pattern of hypertrophy. Basal inferolateral wall is spared in all

usually normal systolic function but 100% have diastolic dysfunction

Reguritant jet is posteriorly directed (y sign)

42
Q

CWD of HOCM

A

Late systolic peaking , dagger shaped

43
Q

M mode of HOCM aortic valve

A

Early systolic closure and fluttering

44
Q

RICM

A

Infiltration of myocardium from abnormal substances. Leading to stiff myocardium.

Primary; loefflers hypereosinophillic, endomyocardial fibrosis, idiopathic

Secondary: amyloid, sarcoid, glycogen storage disease, hemochromotosis, Drugs, radiation

45
Q

Echo appearance of RICM

A

granular speckled , starry sky appearance of myocardium

46
Q

Transmitral inflow velocities in ricm

A

restrictive pattern like CP but also has reduced tissue doppler

47
Q

4 types of HCM

A

sigmoidal (most common basal septal )
reverse curve - entire septum
apical
neutral-concentric

48
Q

other findings often seen in addition to enlarged septum in HCM

A

elongated leaflet and apically displaced papillary muscle

49
Q

Different gradients seen in HCM

A

LVOT (web, SAM)
Mid Cavitary
Diastolic apical gradient

50
Q

Gradient of LVOT at rest that pt need to go on for surgical consult

A

greater than 50

51
Q

LVOT gradient with exercise or provocation (dobutamine) indicating SAM/MR

A

greater than 30

echo boards (11 decks)

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