Cardiomyopathies Flashcards
Dilated Cardiomyopathy characterized by
-impaired LV contractility, then diastolic dysfunction
-Reduced cardiac output
-Elevated LV end-diastolic pressure
-all four chambers are dilated
-impaired systolic function of RV and LV
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Dilated Cardiomyopathy clinically has…
- functional mitral regurgitation is present secondary to LV and mitral dilation
- pulmonary hypertension develops in response to chronically elevated LV pressure
Exceptions for DCM….
- fulminant myocarditis
- chagas heart disease
- tako-tsubo cardiomyopathy
- fulminant myocarditis: may be little ventricular dilation, despite severe systolic dysfunction
- chagas heart disease: LV apical anyeursm is seen in half of patients, often thrombus formation,
- tako-tsubo: acute, transient stress-induced characterized by “apical balloning” with apical dilation and dyskinesis but preserved dimensions and function of the cardiac base
If echocardiography shows no significant impairment of LV systolic function, other possible diagnoses include…
- coronary artery disease
- valve disease
- hypertensive heart disease
- pericardial disease
- pulmonary heart disease
Hypertrophic Cardiomyopathy basic characteristics
- asymmetric hypertrophy of the LV
- Normal LV systolic function
- Impaired diastolic LV function
- Subaortic dynamic obstruction
- sparing of the basal posterior wall
- SAM: systolic anterior motion (m-mode)
Hypertrophic Cardiomyopathy clinical features…
- high risk of sudden death (with exertion)
- symptoms of angina
- exercise intolerance
- syncope: fainting
- high prevalence of atrial fibrillation
- systolic murmur on cardiac auscultation
Hypertrophic cardiomyopathy is classified as…
- nonobstructive: 1/3 of patients, outflow gradient is 30 mm Hg
provocable: resting gradient is <30 mm Hg, but obstruction occurs with exercise
the degree of hypertrophic obstruction is increased by…
- a reduction in preload
- an increase in contractility
- a decrease in afterload
Restrictive Cardiomyopathy basic principles…
- nondilated, thick-walled LV
- normal LV systolic function
- abnormal LV diastolic function
- RV free wall thickening
- biatrial enlargement
- moderate pulmonary hypertension
- elevated right atrial pressure (dilated inferior vena cava)
Amyloidosis
In restrictive cardiomyopathy
- the classic “speckled” myocardium of amyloidosis is non specific , particularly with harmonic imaging
RCM: pseudonormal pattern of LV filling can be distinguished from normal by:
- the rapid early-diastolic deceleration time (LV inflow)
- reduced E’ velocity
- increased PVa velocity and duration
- the patient’s age, clinical presentation, adn other associated echocardiographic findings
recommended parameters for echocardiographic evaluation of a patient with an Left Ventricle Assistance Device include:
- record LVAD type, mode, and pump speed
- measure LV dimensions and volumes in standard image planes
- Record aortic valve motion with M-mode for several cardiac cycles to document aortic valve opening frequency and duration
- record LVAD inflow from the apical conduit using color and pulsed doppler
- record LVAD outflow into the ascending aorta with color and pulsed doppler
Common problems encountered in patients after cardiac transplantation
- pericardial effusion
- RV systolic dysfunction
- LV systolic dysfunction
Hypertensive Heart Disease basic principles
- LV hypertrophy
- Diastolic dysfunction
- ascending aorta dilation
- aortic valve sclerosis
- mitral annular calcification
- LA enlargement
- Atrial enlargement
- Atrial Fibrilation
Increased pulmonary arterial pressure due to…
- reduction in the caliber of the pulmonary vasculature
- an increase in pulmonary blood flow or both
