Cardiomyopathy Flashcards
0
Q
Patients w a hypertrophic cardiomyopathy usually have an ejection fraction in the range of?
A
70-80 percent
1
Q
Pulsus alternans is a clinical sign of which of the following?
A
LV failure
2
Q
Patients w lvh?
A
Have bright myocardium and a pericardial effusion might have an infiltrative cardiomyopathy
3
Q
Patients w a congestive cardiomyopathy usually have an ejection fraction in the range of?
A
10-20 percent
4
Q
Does inderal (beta blocker) increase Sam?
A
No decreases heart rate, reduces Sam w excercise
5
Q
What is associated w a late peaking Doppler jet (dagger shape) ?
A
HOCM and IHSS
6
Q
What is the etiology of HCM?
A
Idiopathic (unknown)
Maybe transmitted by a autosomal dominant gene with variable penetrance
7
Q
What are some aliases associated w HCM? Must have 3 to be hypertrophic
A
ASH(asymmetric septal hypertrophy) most common
SAM (systolic anterior motion of MV)
IHSS (idiopathic hypertrophic subaortic stenosis (SAM & ASH)
HOCM (hypertrophic obstructive cardiomyopathy (SAM & HCM)
8
Q
Which cardiomyopathy is autosomal dominant?
A
Hypertrophic
9
Q
What are some physical signs of HCM?
A
DOE, angina, arrhythmias, syncope, sudden death. Systolic murmur (crescendo decrescendo) that increase w valsalva or amyl nitrate
10
Q
Name some Pathophysiology of HCM?
A
Myocardial fiber disarray.
LA enlargement results from diastolic dysfunction and or mitral regurg
Diastolic dysfunction
11
Q
What is referred to as the ace of spades on 2d?
A
Apical hypertrophic cardiomyopathy ( more common in japan 20% of all hcm versus 2% in USA) increased qrs voltage and giant negative t waves in v2-v5
12
Q
Normal etiology for HOCM
A
Genetic
13
Q
What is the ratio for assessing asymmetric hypertrophy?
A
1:3:1 (septum thicker than lat wall) all around concentric
14
Q
In HCM what is the appearance of the myocardium?
A
Bright from fiber disarray
15
Q
The Venturi effect can be associated with which cardiomyopathy?
A
Hypertrophic (vel up pressure down)
16
Q
LVOT obstruction causes the aov to ?
A
Close in mid systole
17
Q
What does it mean when A > E? A wave greater than e wave
A
Some degree of diastolic dysfunction, ABNORMAL RELAXAtion
18
Q
The arrow is pointing to where ( during the t wave ) ?
A
Isovolumic relaxation
19
Q
What are some Doppler findings in HCM?
A
Increased a-e ratio on mitral valve inflow velocity. Mid ventricular or subaortic gradient may be present . Mitral regurg might b present . Doppler spectrum shows a late peaking systolic jet
20
Q
Pt with IHSS will have what?
A
Late peaking jet / dagger shape (dynamic obstruction), they will also have mitral regurg
21
Q
Does inderal (beta blocker) increase SAM?
A
No decreases heart rate reduces SAM with exercise
22
Q
61 y/o male w IHSS and a resting gradient of 144 mmhg. Admitted to the hospital with chest pain. The next day the resting gradient was 15 mmhg. What happened?
A
LV infarct
23
Q
Global longitudinal strain in pts w HOCM is typically?
A
-10
24
What is the normal global longitudinal strain ?
19-19 percent or more
25
What is strain?
Strain measures the deformation within the myocardium
26
What is another name for congestive?
Dilated
27
What is another name for dilated?
Congestive
28
Name some etiology for congestive (dilated) cardiomyopathy?
Idiopathic
Infective (viral, bacterial, fungal, parasitic)
Ischemic
Toxic (alcohol adriamycin, lead, cobalt)
Peripartum
Metabolic (thiamin deficiency)
29
What is Chagas disease?
Posterior and apical thinning, septum usually nl (most common in s America)
30
What is a b-notch on m-mode?
Increased LVEDP.
(B-notch is a shelf after M)
(Increased epss)
31
What type of CM might you see in a pt w AIDS?
Dilated (congestive) CM
32
What are some echo signs of congestive CM?
Multichannel enlargement.
Globally impaired LV contractility.
B-notch on mitral valve m-mode (increased LVEDP).
Reduced aortic root excursion.
Increased e-point to septal seperation.
Thrombus and small pericardial effusion may be present.
Reduced mitral valve excursion (double diamond) on m-mode
33
What are some Doppler findings in dilated CM?
MV and TV regurg are usually seen.
| AV and PV regurg may be present.
34
What is the appearance of a post transplant 2-d echo?
Double atria (leaving IVC and SVC alone)
35
What might the double atria show in ECG?
Might have 2 p waves
| 1 from native atria and other from donor atria
36
What is hemochromatosis?
Excessive iron
37
Etiology of restrictive (infiltrative) CM?
```
Amyloidosis (most common) 10/1.
Sarcoidosis.
Endomyocardial fibrosis (endocardial thickening).
Hemochromatosis.
Glycogen storage (pompes disease)
```
38
Pathophysiology for restrictive (infiltrative) CM?
Infiltration of myocardium resulting in rigid ventricular walls impeding diastolic filing.
Biatrial enlargement.
Sarcoidosis may infiltrate conduction system leading to AV block.
39
Physical signs of restrictive CM?
Symptoms include fatigue, dyspnea and angina.
40
Echo findings in infiltrative (restrictive) CM?
Ventricular hypertrophy with small or normal ventricular cavity.
"Ground glass" appearance of myocardium.
Ventricular systolic function may be normal or decreased.
Pericardial effusion may be present.
41
Protein = ?
Amyloidosis (10/1 more common than sarcoidosis)
42
What is Amyloidosis?
Amyloidosis involves abnormal proteins. Some may describe it as a translucent waxy protein build up on the myofibrils.
43
Pt w sinus tachy will most likely have what CM?
Congestive (dilated)
44
What is associated w pulsus alternans?
Congestive CM
45
What is ground glass appearance?
Very bright myocardium associated w restrictive CM. And is related to infiltrative myocarditis.
46
A restrictive cardiomyopathy has which of the following?
Decreased LV compliance
47
Name the types of cardiomyopathies?
Normal, congestive (dilated), hypertrophic, restrictive (infiltrative)
48
A typical ejection fraction in a dilated cardiomyopathy patient might be? For a HCM patient?
15-25 percent
49
Echo findings associated with idiopathic hypertrophic subaortic stenosis?
Systolic anterior motion of mitral valve, asymmetric septal hypertrophy, IHSS
50
Patients with IHSS and high resting outflow gradient may be offered all of the following treatments Except:?
Surgical septal myectomy, this will decrease gradient.
51
Contradictions to amyl nitrite inhalation include all of the following Except:?
Moderate to severe mitral regurgitation, amyl nitrite provokes outflow in LVH patients.
52
A cardiomyopathy is a disease that ____ , resulting in enlargement and or ventricular dysfunction?
Myocardium, disease of heart muscle
53
If your patient has right heart failure, what classic sign/symptom would you expect to see?
Lower extremity edema
54
All of the following may be a physical symptom in patients with congestive(dilated) CM Except:?
Systematic hypertension is not usually seen with dilated CM.
55
All of the following are echo findings in patients with HOCM Except:?
Decreased ejection fraction.
56
Patients with hypertrophic obstructive CM will often have a bright appearance due to?
Myocardial fiber disarray.
57
Patients with a dilated CM frequently experience multiple symptoms, such as:?
Migraine headaches
58
Which of the following is not a common symptom of congestive(dilated) heart failure(CHF)?
Syncope
59
All of the following are etiologies for restrictive(infiltrative) CM Except:?
Renal failure
60
All of the following are Doppler findings on PT's with HOCM Except:?
Outflow gradient that decreases with a valsalva maneuver
61
Common echo findings in dilated CM include all of the following Except:?
Increased left ventricular wall thickness
62
A speckled or ground glass appearance of the left ventricle myocardium by 2D echo is commonly seen in patients with?
Amyloid heart disease
63
All of the following are etiologies for congestive(dilated) CM Except:?
Hemochromatosis.. Too much iron proteins are infiltrative
64
Patients of amyl nitrite might be used to demonstrate which of the following?
MVP
65
What might be the first indication of metastatic disease?
Pericardial effusion
66
All of the following are echo findings in PT's with a dilated CM Except:?
Exaggerated aortic root excursion
67
A cardiomyopathy is disease that diffusly affects the _______, resulting in enlargement and or ventricular dysfunction?
Myocardium
68
Which echo findings are typically associated with IHSS (idiopathic hypertrophic subaortic stenosis?
Systolic anterior motion of the mitral valve and assymestric septal hypertrophy (SAM & ASH)
69
If you obtain a systolic, high velocity and late peaking jet in the LV outflow tract by continuous wave Doppler from the apex the likely diagnosis is?
Hypertrophic obstructive cardiomyopathy (HOCM) dynamic obstruction (dagger shape)
70
Patients with IHSS and a high resting outflow gradient may be offered all of the following treatments except ?
Sublingual nitroglycerin .. Not used for IHSS but for pts w angina.
71
Echo features of Amyloid heart disease include all of the following Except?
Mitral valve prolapse
72
What is the proper technique for Dopplering the mitral inflow looking for dialstolic dysfunction?
Apical 4 ch pulsed Doppler at mitral tips
73
In a pt with IHSS?
Mitral regurg is often present ( pts w IHSS always have Sam and ash and Sam usually leads
74
Contraindications to amyl nitrate inhilation include all of the following except?
Moderate mitral regurg
75
A common valvular regurg found in pts w a dilated (congestive) CM is ?
Mitral .. Most common in dilated CM
76
Pts w IHSS demonstrates?
Mid systolic closure of ao valve
77
Which of following is a common etiology for a pt to develop a congestive dilated CM?
Toxic ( are often caused my toxins such as alcohol or chemotherapy drugs such a adriamycin.
78
Systemic hypertension is not a physical sign of what CM ?
HOCM
79
Amyloid and sarcoid are what type of cardiomyopathy?
Infiltrative (amyloid and sarcoid infiltrate the myocardium so it is more accurate to classify these as infiltrative not restrictive.
80
A speckled or ground glass appearance of the LV myocardium by 2d echo is commonly seen in pts w?
Amyloid heart disease
81
Pts w HOCM will often have "bright" myocardial appearance by echo due to?
Myocardial fiber disarray (increased reflectance )
82
What is noonan syndrome?
Classified as a cardiofacial syndrome with ps, hcm, and asd (30 percent)
83
The restrictive transmitral filing pattern is most consistently associated w which physiological parameters?
Elevated LA pressures, increased LV stiffness
84
Pts w a dilated can may develop apical thrombi. When looking for them in the LV apex you should use?
Higher frequency transducer
85
Which of the following is an echo finding in PT's with a dilated CM?
B-notch, due to LVEDP.
86
All of the following are frequent echo findings in PT's with IHSS Except:?
Mitral valve prolapse(MVP)
87
PT's with restrictive CM typically have a Doppler finding of:?
Large E wave, little A wave
88
PT's with Changas disease might develop which type of CM?
Congestive(dilated), epidemic in South Africa
89
The classic motion of the aortic valve by M-mode in PT's with HOCM is:?
Mid systolic closure
90
Which of the following is the most common type of CM?
Dilated(congestive)
91
Which of the following is true regarding mitral Doppler trace in PT's with restrictive/infiltrative CM?
Resembles constrictive pericarditis I
92
Common Doppler findings in PT's with restrictive CM?
Greater E, sm A wave
93
PT's with HOCM might have which type of murmur?
Systolic crescendo-decrescendo that increases with valsalva
94
Which of the following is the most common etiology for a PT to develop restrictive CM?
Amyloidosis
95
When amyl nitrite is administered to a PT who has HOCM CM it is likely to:?
Increase the systolic anterior motion of mitral valve.
96
In PT's with asymmetric septal hypertrophy(ASH), what is the septal to posterior wall ratio?
1, 3;1
97
Another echo term for a systolic, high velocity and late peaking jet in the left ventricle outflow tract by continuos wave Doppler from the apex is?
Dagger shape
98
Hemochromatosis is the most commonly associated with which of the following CM?
Infiltrative
99
The restrictive transmittal filling pattern is most consistently associated with which physiological parameters?
Elevated LA pressures, increased ventricular stiffness
100
If a patient with IHSS has a resting outflow velocity of 3 m/sec, what is the peak gradient?
36.. Bernoulli equation
101
Which of the following is a common echo finding in PT's with restrictive CM?
Pericardial effusion
102
All of the following might be a physical symptom in PT's with HOCM except:?
Systemic hypertension
103
PT's with advanced symptoms from having a dilated CM might benefit from all of the following Except:?
Mitral valve replacement
104
All of the following are echo findings in PT with congestive(dilated) CM Except:?
Increased aortic root excursion
105
The ratio of a early transmitral(E) to atrial(A) Doppler filling velocities are influenced by all if the following factors:?
Transducer frequency
106
All of the following are echo findings in PT with restrictive(infiltrative) CM Except:?
Hypercontractile left ventricle
107
A PT with IHSS and a high resting gradient may benefit from a surgical septal myectomy to decrease the gradient. What is a common complication from this procedure?
VSD
108
PT's with a restrictive CM typically have Doppler findings of?
Lg E, small A wave
109
Of the following is a common etiology for a PT with congestive(dilated) CM?
Toxic
110
PT's with a dilated CM may demonstrate a Doppler pattern of the mural inflow with?
Abnormal relaxation
111
Patients with a dilated CM frequently experience multiple symptoms Except:?
Migraine headaches
112
PT's with HOCM may have what type of murmur?
Systolic crescendo/decrescendo that increases with valsalva. A diamond shaped murmur
113
Myxomas commonly are attached to what?
Fossa ovalis
