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Adult Echocardiography > Cardiomyopathy > Flashcards

Cardiomyopathy Flashcards

0
Q

Patients w a hypertrophic cardiomyopathy usually have an ejection fraction in the range of?

A

70-80 percent

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1
Q

Pulsus alternans is a clinical sign of which of the following?

A

LV failure

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2
Q

Patients w lvh?

A

Have bright myocardium and a pericardial effusion might have an infiltrative cardiomyopathy

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3
Q

Patients w a congestive cardiomyopathy usually have an ejection fraction in the range of?

A

10-20 percent

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4
Q

Does inderal (beta blocker) increase Sam?

A

No decreases heart rate, reduces Sam w excercise

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5
Q

What is associated w a late peaking Doppler jet (dagger shape) ?

A

HOCM and IHSS

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6
Q

What is the etiology of HCM?

A

Idiopathic (unknown)

Maybe transmitted by a autosomal dominant gene with variable penetrance

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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)

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8
Q

Which cardiomyopathy is autosomal dominant?

A

Hypertrophic

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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
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10
Q

Name some Pathophysiology of HCM?

A

Myocardial fiber disarray.
LA enlargement results from diastolic dysfunction and or mitral regurg
Diastolic dysfunction

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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

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12
Q

Normal etiology for HOCM

A

Genetic

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13
Q

What is the ratio for assessing asymmetric hypertrophy?

A

1:3:1 (septum thicker than lat wall) all around concentric

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14
Q

In HCM what is the appearance of the myocardium?

A

Bright from fiber disarray

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15
Q

The Venturi effect can be associated with which cardiomyopathy?

A

Hypertrophic (vel up pressure down)

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16
Q

LVOT obstruction causes the aov to ?

A

Close in mid systole

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17
Q

What does it mean when A > E? A wave greater than e wave

A

Some degree of diastolic dysfunction, ABNORMAL RELAXAtion

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18
Q

The arrow is pointing to where ( during the t wave ) ?

A

Isovolumic relaxation

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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

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20
Q

Pt with IHSS will have what?

A

Late peaking jet / dagger shape (dynamic obstruction), they will also have mitral regurg

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21
Q

Does inderal (beta blocker) increase SAM?

A

No decreases heart rate reduces SAM with exercise

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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

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23
Q

Global longitudinal strain in pts w HOCM is typically?

A

-10

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24
Q

What is the normal global longitudinal strain ?

A

19-19 percent or more

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25
Q

What is strain?

A

Strain measures the deformation within the myocardium

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26
Q

What is another name for congestive?

A

Dilated

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27
Q

What is another name for dilated?

A

Congestive

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28
Q

Name some etiology for congestive (dilated) cardiomyopathy?

A

Idiopathic
Infective (viral, bacterial, fungal, parasitic)
Ischemic
Toxic (alcohol adriamycin, lead, cobalt)
Peripartum
Metabolic (thiamin deficiency)

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29
Q

What is Chagas disease?

A

Posterior and apical thinning, septum usually nl (most common in s America)

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30
Q

What is a b-notch on m-mode?

A

Increased LVEDP.
(B-notch is a shelf after M)
(Increased epss)

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31
Q

What type of CM might you see in a pt w AIDS?

A

Dilated (congestive) CM

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32
Q

What are some echo signs of congestive CM?

A

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

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33
Q

What are some Doppler findings in dilated CM?

A

MV and TV regurg are usually seen.

AV and PV regurg may be present.

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34
Q

What is the appearance of a post transplant 2-d echo?

A

Double atria (leaving IVC and SVC alone)

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35
Q

What might the double atria show in ECG?

A

Might have 2 p waves

1 from native atria and other from donor atria

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36
Q

What is hemochromatosis?

A

Excessive iron

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37
Q

Etiology of restrictive (infiltrative) CM?

A 
Amyloidosis (most common) 10/1. 
Sarcoidosis. 
Endomyocardial fibrosis (endocardial thickening). 
Hemochromatosis. 
Glycogen storage (pompes disease)
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38
Q

Pathophysiology for restrictive (infiltrative) CM?

A

Infiltration of myocardium resulting in rigid ventricular walls impeding diastolic filing.
Biatrial enlargement.
Sarcoidosis may infiltrate conduction system leading to AV block.

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39
Q

Physical signs of restrictive CM?

A

Symptoms include fatigue, dyspnea and angina.

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40
Q

Echo findings in infiltrative (restrictive) CM?

A

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.

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41
Q

Protein = ?

A

Amyloidosis (10/1 more common than sarcoidosis)

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42
Q

What is Amyloidosis?

A

Amyloidosis involves abnormal proteins. Some may describe it as a translucent waxy protein build up on the myofibrils.

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43
Q

Pt w sinus tachy will most likely have what CM?

A

Congestive (dilated)

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44
Q

What is associated w pulsus alternans?

A

Congestive CM

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45
Q

What is ground glass appearance?

A

Very bright myocardium associated w restrictive CM. And is related to infiltrative myocarditis.

46
Q

A restrictive cardiomyopathy has which of the following?

A

Decreased LV compliance

47
Q

Name the types of cardiomyopathies?

A

Normal, congestive (dilated), hypertrophic, restrictive (infiltrative)

48
Q

A typical ejection fraction in a dilated cardiomyopathy patient might be? For a HCM patient?

A

15-25 percent

49
Q

Echo findings associated with idiopathic hypertrophic subaortic stenosis?

A

Systolic anterior motion of mitral valve, asymmetric septal hypertrophy, IHSS

50
Q

Patients with IHSS and high resting outflow gradient may be offered all of the following treatments Except:?

A

Surgical septal myectomy, this will decrease gradient.

51
Q

Contradictions to amyl nitrite inhalation include all of the following Except:?

A

Moderate to severe mitral regurgitation, amyl nitrite provokes outflow in LVH patients.

52
Q

A cardiomyopathy is a disease that ____ , resulting in enlargement and or ventricular dysfunction?

A

Myocardium, disease of heart muscle

53
Q

If your patient has right heart failure, what classic sign/symptom would you expect to see?

A

Lower extremity edema

54
Q

All of the following may be a physical symptom in patients with congestive(dilated) CM Except:?

A

Systematic hypertension is not usually seen with dilated CM.

55
Q

All of the following are echo findings in patients with HOCM Except:?

A

Decreased ejection fraction.

56
Q

Patients with hypertrophic obstructive CM will often have a bright appearance due to?

A

Myocardial fiber disarray.

57
Q

Patients with a dilated CM frequently experience multiple symptoms, such as:?

A

Migraine headaches

58
Q

Which of the following is not a common symptom of congestive(dilated) heart failure(CHF)?

59
Q

All of the following are etiologies for restrictive(infiltrative) CM Except:?

A

Renal failure

60
Q

All of the following are Doppler findings on PT’s with HOCM Except:?

A

Outflow gradient that decreases with a valsalva maneuver

61
Q

Common echo findings in dilated CM include all of the following Except:?

A

Increased left ventricular wall thickness

62
Q

A speckled or ground glass appearance of the left ventricle myocardium by 2D echo is commonly seen in patients with?

A

Amyloid heart disease

63
Q

All of the following are etiologies for congestive(dilated) CM Except:?

A

Hemochromatosis.. Too much iron proteins are infiltrative

64
Q

Patients of amyl nitrite might be used to demonstrate which of the following?

65
Q

What might be the first indication of metastatic disease?

A

Pericardial effusion

66
Q

All of the following are echo findings in PT’s with a dilated CM Except:?

A

Exaggerated aortic root excursion

67
Q

A cardiomyopathy is disease that diffusly affects the _______, resulting in enlargement and or ventricular dysfunction?

A

Myocardium

68
Q

Which echo findings are typically associated with IHSS (idiopathic hypertrophic subaortic stenosis?

A

Systolic anterior motion of the mitral valve and assymestric septal hypertrophy (SAM & ASH)

69
Q

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?

A

Hypertrophic obstructive cardiomyopathy (HOCM) dynamic obstruction (dagger shape)

70
Q

Patients with IHSS and a high resting outflow gradient may be offered all of the following treatments except ?

A

Sublingual nitroglycerin .. Not used for IHSS but for pts w angina.

71
Q

Echo features of Amyloid heart disease include all of the following Except?

A

Mitral valve prolapse

72
Q

What is the proper technique for Dopplering the mitral inflow looking for dialstolic dysfunction?

A

Apical 4 ch pulsed Doppler at mitral tips

73
Q

In a pt with IHSS?

A

Mitral regurg is often present ( pts w IHSS always have Sam and ash and Sam usually leads

74
Q

Contraindications to amyl nitrate inhilation include all of the following except?

A

Moderate mitral regurg

75
Q

A common valvular regurg found in pts w a dilated (congestive) CM is ?

A

Mitral .. Most common in dilated CM

76
Q

Pts w IHSS demonstrates?

A

Mid systolic closure of ao valve

77
Q

Which of following is a common etiology for a pt to develop a congestive dilated CM?

A

Toxic ( are often caused my toxins such as alcohol or chemotherapy drugs such a adriamycin.

78
Q

Systemic hypertension is not a physical sign of what CM ?

79
Q

Amyloid and sarcoid are what type of cardiomyopathy?

A

Infiltrative (amyloid and sarcoid infiltrate the myocardium so it is more accurate to classify these as infiltrative not restrictive.

80
Q

A speckled or ground glass appearance of the LV myocardium by 2d echo is commonly seen in pts w?

A

Amyloid heart disease

81
Q

Pts w HOCM will often have “bright” myocardial appearance by echo due to?

A

Myocardial fiber disarray (increased reflectance )

82
Q

What is noonan syndrome?

A

Classified as a cardiofacial syndrome with ps, hcm, and asd (30 percent)

83
Q

The restrictive transmitral filing pattern is most consistently associated w which physiological parameters?

A

Elevated LA pressures, increased LV stiffness

84
Q

Pts w a dilated can may develop apical thrombi. When looking for them in the LV apex you should use?

A

Higher frequency transducer

85
Q

Which of the following is an echo finding in PT’s with a dilated CM?

A

B-notch, due to LVEDP.

86
Q

All of the following are frequent echo findings in PT’s with IHSS Except:?

A

Mitral valve prolapse(MVP)

87
Q

PT’s with restrictive CM typically have a Doppler finding of:?

A

Large E wave, little A wave

88
Q

PT’s with Changas disease might develop which type of CM?

A

Congestive(dilated), epidemic in South Africa

89
Q

The classic motion of the aortic valve by M-mode in PT’s with HOCM is:?

A

Mid systolic closure

90
Q

Which of the following is the most common type of CM?

A

Dilated(congestive)

91
Q

Which of the following is true regarding mitral Doppler trace in PT’s with restrictive/infiltrative CM?

A

Resembles constrictive pericarditis I

92
Q

Common Doppler findings in PT’s with restrictive CM?

A

Greater E, sm A wave

93
Q

PT’s with HOCM might have which type of murmur?

A

Systolic crescendo-decrescendo that increases with valsalva

94
Q

Which of the following is the most common etiology for a PT to develop restrictive CM?

A

Amyloidosis

95
Q

When amyl nitrite is administered to a PT who has HOCM CM it is likely to:?

A

Increase the systolic anterior motion of mitral valve.

96
Q

In PT’s with asymmetric septal hypertrophy(ASH), what is the septal to posterior wall ratio?

97
Q

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?

A

Dagger shape

98
Q

Hemochromatosis is the most commonly associated with which of the following CM?

A

Infiltrative

99
Q

The restrictive transmittal filling pattern is most consistently associated with which physiological parameters?

A

Elevated LA pressures, increased ventricular stiffness

100
Q

If a patient with IHSS has a resting outflow velocity of 3 m/sec, what is the peak gradient?

A

36.. Bernoulli equation

101
Q

Which of the following is a common echo finding in PT’s with restrictive CM?

A

Pericardial effusion

102
Q

All of the following might be a physical symptom in PT’s with HOCM except:?

A

Systemic hypertension

103
Q

PT’s with advanced symptoms from having a dilated CM might benefit from all of the following Except:?

A

Mitral valve replacement

104
Q

All of the following are echo findings in PT with congestive(dilated) CM Except:?

A

Increased aortic root excursion

105
Q

The ratio of a early transmitral(E) to atrial(A) Doppler filling velocities are influenced by all if the following factors:?

A

Transducer frequency

106
Q

All of the following are echo findings in PT with restrictive(infiltrative) CM Except:?

A

Hypercontractile left ventricle

107
Q

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?

108
Q

PT’s with a restrictive CM typically have Doppler findings of?

A

Lg E, small A wave

109
Q

Of the following is a common etiology for a PT with congestive(dilated) CM?

110
Q

PT’s with a dilated CM may demonstrate a Doppler pattern of the mural inflow with?

A

Abnormal relaxation

111
Q

Patients with a dilated CM frequently experience multiple symptoms Except:?

A

Migraine headaches

112
Q

PT’s with HOCM may have what type of murmur?

A

Systolic crescendo/decrescendo that increases with valsalva. A diamond shaped murmur

113
Q

Myxomas commonly are attached to what?

A

Fossa ovalis

Adult Echocardiography (13 decks)

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