CARDIAC Section 7: NON-Ischemic Heart Flashcards
Describe Dilated Cardiomyopathy
Dilatation with an end diastolic diameter of >55mm,
+ Decreased Ejection Fraction
Give the causes of Dilated Cardiomyopathy
Idiopathic
Ischemic
Other random crap (alcohol, Doxorubicn, Cyclosporine, Chagas, etc..)
What does the ischemic variety of Dilated Cardiomyopathy show?
Subendocardial enhancement
What does the Idiopathic variety of Dilated Cardiomyopathy Show?
either no enhancement
OR linear mid-myocardial enhancement.
Dilated Cardiomyopathy is often associated with mitral regurgitation due to?
Dilatation of the mitral ring
What are the causes of restrictive cardiomyopathy?
- Myocardium replaced by Fibtrotic tissue (Endocardial Fibroelastosis)
- Infiltration of the myocardium (Amyloidosis)
- Damage by iron (Hemochromatosis)
This is basically anything that causes a decrease in diastolic function (inability to “fill”)-
Restrictive cardiomyopathy
Myocardium replaced by Fibrotic tissue
Endocardial fibroelastosis
Restrictive cardiomyopathy - damaged by iron
Hemochromatosis
What is the most common cause of Restrictive Cardiomyopathy?
Amyloidosis
What does amyloid deposits in the myocardium do?
- Abdormal diastolic function
- with biatrial enlargement
- Coincentric thickening of the left ventricle
- Reduced diastolic function of usually both ventricles.
Cardiac amyloidosis is seen _% of systemic amyloidosis
50%
Whats the prognosis of Cardiac amyloidosis
TERRIBLE!
What can you see in the late Gd enhancement in Amyloidosis?
Gd enhancement over the entire subendocardial circumference.
What diseases is Amyloidosis associated?
Mulitple Myeloma
RA
Crohn’s
What is teh Amyloid CLASSIC scenario?
A long TI is needed (like 350 milliseconds, normal would be like 200). TI will be so long that the blood pool may be darker than the myocardium.
Buzzword “Difficult to suppress myocardium”
Amyloid
Buzzword: “Abnormal urinary light chains (AL)
Amyloid
“BILATERAL VENTRICULAR THROMBUS”
Eosinophilic Cardiomyopathy (Loeffler -Loeffler’s syndrome: A type of eosinophilic pneumonia mimicking community-acquired pneumonia and asthma that arises from Ascaris lumbricoides in a child.)
What is needed to show the thrombus is Eosinophilic Cardiomyopathy?
Long T1
What is the most common cause of Constrictive Pericarditis?
FIrst world: Iatrogenic Secondary to CABG/Viral 0
Developing countries: TB
Diagnosis?
Describe
Thickened pericardium (>0.4 cm)
Constrictive pericarditis is definitive on what CT findings?
Thick and Calcified pericardium
Where is the Constrictive Pericarditis calcification usually the largest?
Over the AV groove
What is “Sigmoidization on Constrictive Pericardium and where is it seen?
The ventricular septum moves toward the left ventricle in a wavy pattern during early diastole (“Diastolic Bounce”). - MOre pronounced during inspiration - indicating ventricular interdependence
seen in SFFP (Steady-state free precession MRI)
Classic finding of Constrictive Pericarditis on CXR or CT =
Pericardial calcifications
Classic finding of Constrictive Pericarditis on MRI =
Diastolic bounce on CINE imaging
TRUE or FALSE:
Abnormal Late Gd Myocardial Enhancement is seen on Constrictive Disease
FALSE
No Abnormal Late Gd Myocardial Enhancement on Constrictive Disease
What type of pattern of enhancement is seen in Myocarditis?
Epicardial or Mid wall
Cardiac involvment is seen in __% of Sacriodosis patients?
5%
Describe Cardiac Sacroidosis
Late
Gd pattern may be middle and epicardial in a non-coronary distribution.
Focal wall thickening from edema can mimic hypertrophic cardiomyopathy.
It often involves the septum.
The RV and papillaries are RARELY affected.
Identify
Takotsubo Cardiomyopathy
A condition with Chest pain and EKG changes seen in post menopausal women after they either break up with their boyfriend , win the lottery, or some other stressful event
Takotsubo CArdiomyopathy
Buzzword for Takotsubo Cardiomyopathy?
BAllooning of the left ventricle apex.
Describe Takostubo CArdiomyopathy
There is transient akinesia or dyskinesia of the left ventricular apex without coronary stenosis.
TRUE/FALSE: There is delayed enhancement in TAKOTSUBO CARDIOMYOPATHI
FALSE