Untitled Deck Flashcards
(28 cards)
- Be able to diagnose cardiomyopathies from a given image. Know how each looks like on a 2D image and what it is caused by?
Dilated cardiomyopathy:
1) All 4 chambers are enlarged with thinned walls and impaired systolic function.
2) Functional MR and TR are usually present.
Remember to look at the images in pp1 #5 & 15
Hypertrophic cardiomyopathy:
1) LV hypertrophy (commonly IVS),
2) small hyperdynamic LV
3) Increase echogenicity of due to “myocardial fibers in disarray.”
4) LA enlargement is due to MR or diastolic dysfunction
Restrictive cardiomyopathy:
1) Stiff, rigid ventricular walls
2) Ventricular hypertrophy (typical both ventricles)
3) Biatrial enlargement small to normal LV size
4) ↓Decreased systolic function
Or pp1 page3
Dilated
Results in dilatation of all 4 cardiac chambers and decreased systolic (and later diastolic) function
CAUSES BY : most common Idiopathic & alchol
Hypertrophic:
* Results in hypertrophy of the IVS or the wall of the LV and decreased diastolic function
CAUSED BY: Idiopathich & gene mutation
Restrictive
Results in infiltration of the LV wall that causes it to be stiff and have diastolic function
CAUSED BY: Infiltrative diseases
- EF normal but 3/4 grade diastolic dysfunction*
- Know what the LVID, IVS and LVPW should measure?
**LVID(d): ** (3.5-5.6 cm)
men 4.2 -5.8 cm
women: 3.8-5.2 cm
**LVID(s): **2.0-4.0
men: 2.5-4.0 cm
women 2.2-3.5 cm
**IVS: **
men: 0.6-1.1 cm
women 06-0.9 cm
LVPW: 0.6-1.1 cm
- What is pulsus alternans and what is it associated with?
1) Arterial pulse waveform with alternating strong and weak beats
2) indicative of reduced LV systolic function.
ASSOCIATED with: DCM
- Know the complications of dilated cardiomyopathy?
1) Arrhythmias
2) LA & LV thrombus
3) Left & Right heart failure
4) MR & TR
5) Pericardial effusion
6) Stroke
- Know the sonographic appearance of dilated cardiomyopathy?
1) Abnormal IVS motion if LBBB present
2) Decreased systolic & diastolic function (low EF% and generalized hypokinesia or RWMA)
3) Dilatation of all 4 chambers usually (increased volume and mass)
4) Dilated IVC.
5) Dilated mitral annulus & incomplete coaptation of the MV leaflets
6) Spontaneous echo contrast in the chambers
7) Thin walls of the ventricles
8) Thrombus in LV apex
- What are the IVC findings with dilated cardiomyopathy?
- Dilated IVC with reduced respiratory collapse.
- What is sigmoid septum?
- Septal thickening with prominent bulge in the basal area.
- What is the most common cause of sudden death in patients under 30 yrs?
- Hypertrophic cardiomyopathy (HCM)
- What does the LVOT waveform of a patient with IHSS look like?
1) LVOTO waveform is dagger shaped (late peak)
2) the velocity will increase >2 m/s
- Which maneuvers/medications would increase the LVOT gradient in a patient with HCM?
Maneurvers
1) Supine exercise,
2) amyl nitrite
3) Valsalva maneuver will ↑ increase the gradient across the obstruction
On ECHO:
on echo the AMVL will be obstructing the LVOT in systole
Medications:
- Beta blockers reduce the gradient through the outflow tract
11 How is HOCM treated?
**Medical therapy
1) Beta blockers
2) Calcium channel blockers
3) Other medications
4) Dual chamber pacemakers: Promote paradoxical septal motion which will reduce the outflow gradient
**Surgery –
1) left ventricular septal myectomy
2) Alcohol induced septal ablation
- What is SAM? How does it appear on echo? What is it associated with?
SAM) Systolic anterior motion
1) AMVL moves into the LVOT by drag forces due to hyperdynamic LV
2) MV leaflets coaptation is disrupted resulting in MR
Associated
1) IHSS (Idiopathic Hypertrophic Subaortic Stenosis)
2) HOCM with concentric hypertrophy
- How is the cause of restrictive cardiomyopathy determined?
- Myocardial biopsy is necessary to determine the type of infiltrative disease causing cardiac changes.
14.What is Amyloidosis? What is it associated with?
1) Most common cause of restrictive cardiomyopathy
2) extracellular deposition of amyloid protein in multiple organs system causing damage & malfunction, affects kidneys, liver, nerves, skin.
** Associated**
- with pericardial effusion & irregular rhythms.
Mimcis constrictive pericardits
15 What is Pompe disease?
1) Autosomal recessive disorder
2) Type of glycogen storage disease
3) Leads to thickened ventricular walls with normal to poor function
4) Tumor-like appearance of the papillary muscles
- What are the 2D echo findings of restrictive cardiomyopathy?
1) Ventricular hypertrophy (typically both, varying degree)
2) Ground glass appearance of the myocardium in amyloidosis
3) Small to normal LV size with normal to decreased systolic function
4) Bi-Atrial enlargement
** or **
5) Pericardial effusion
6) Dilated IVC & HV
7) Endomyocardial Fibosis
8) Fibrotic AV valves & endocardium
- What is non compaction of LV myocardium cardiomyopathy?
1) Uncommon cardiomyopathy
2) Characterized by a hypertrophied LV with multiple trabeculations & deep intertrabecular recesses
3) Involves predominantly the distal (apical) portion of the LV
4) May be associated with other congenital heart anomalies
Causes DCM, systolic dysfunction & HF
- What is Tako-Tsubo cardiomyopathy? What is another name for it?
1) Aka “Broken heart syndrome”
2) Acute, transient, stress-induced cardiomyopathy
3) Characterized by “apical ballooning”
4) Apical dyskinesis with dilation but preserved dimensions & function of the cardiac base
- What is hemochromatosis?
1) Iron deposits in myocardium
2) Results in multiple organs and tissue damage
3) Can cause HF & irregular rhythms
4) Causes dilated cardiomyopathy with restrictive filling
5) Severity correlates with LV dysfunction
- How does restrictive cardiomyopathy present on Doppler?
1) Pulmonary venous flow demonstrates low velocity
2) Blunted systolic flow (S) with increased diastolic flow velocity (D)
3) Diastolic flow reversal in hepatic veins with expiration
4) AV valvular regurgitation
5) Pulmonary hypertension
6) Large E waves & small A waves
Stiffness causing restive filling
a) Grade III & IV
b) E/A ratio > 2
c) Septal E’ <8 cm/s
d) E/E’ > 14
e) DT < 140
f) Large E waves & small A waves
g) No Exaggerated respiratory variation
- peak E is 1.5x more than A wave
- short deceleration time <160
- What does SAM cause?
1) MR
2) left ventricular outflow tract (LVOT) obstruction and mitral regurgitation
or LVOT obstriction
- SAM disrupts MV coaptation resulting in MR.
- In the United States, what is the most common etiology of secondary dilated cardiomyopathy?
- Alcohol and drug (cocaine) abuse.
- Which cardiomyopathy can cause an increase in the E point septal separation measurement?
- Dilated cardiomyopathy (DCM): EPSS >0.7 cm.
- What are the MV Doppler findings of HCM?
1) Rule out LVOTO: dagger-shaped waveform
2) MR symmetric diastolic dysfunction typically grade I.
Done in Apical 5 or 3
Or
typically grade I:
a) E/A ratio <0;8
b) DT >200
c) IVRT >100
d) E/E’ <10
e) E’ less than A
