Cardiomyopathy & Other Test Flashcards
Define CARDIOMYOPATHY
primary disease of the myocardium excluding myocardial dysfunction due to ischemia or chronic valvular disease
What are the 3 categories of CARDIOMYOPATHY?
- dilated
- restrictive
- hypertrophic
Define DILATED cardiomyopathy
all four chambers are enlarged with impaired systolic function of both the LV and RV due to a wide range of underlying causes
What are the CAUSES of DILATED?
- idiopathic
- infections ( post viral myocarditis, AIDS, chagas)
- toxins ( alcohol, cocaine, chemo)
- peripartum
- metabolic
- inherited
- tako-tsubo (stress induced)
- autoimmune/systemic inflammatory disease
What are the SYMPTOMS of DILATED?
symptoms of congestive heart failure
1. SOB
2. fatigue/weakness
3. rapid HR
4. cough
5. wheezing
What are the TREATMENTS of DILATED CM?
- treatments to try to prevent LV remodeling and MR:
1. periodic echos to tailor therapy
2. conventional medications
3. sizing down the annulus
4. implantable defibs
5. Bi Vent pacemakers
6. LVAD and transplant
7. MV repair
What are the 2D FINDINGS for DILATED?
- significant 4 chamber enlargement
- depressed right and left global systolic function
- MR/TR
- PHTN
- LV Thrombus
- Color can show swirling LV filling pattern
What are the M MODE FINDINGS for DILATED?
- significant 4 chamber enlargement
- increased EPSS on mitral
- “B” wave on mitral = increased in LVEDP
- decreased anteroposterior aortic root motion on AV/LA m mode
- tapered AV closure on AV/LA m mode
Define RESTRICTIVE cardiomyopathy
presents as fibrotic stiff ventricles with significantly impaired diastolic function due to altered myocardium
What are the CAUSES of RESTRICTIVE CM?
- infiltrative/deposition/scarring to organs
- endomyocardial fibrosis
- myocardial fibrosis
What are the types of INFILTRATIVE/DEPOSITION/SCARRING to organs?
- amyloidosis - starchlike protein
- hemochromatosis - iron
- sarcoidosis - granulomatous nodular lesions
- fabry - lipid
- gaucher - fatty substance
- scleroderma - autoimmune response
What are the 2 types of ENDOMYOCARDIAL FIBROSIS and WHAT IS IT?
- hypereosinophilia - granulocytes in blood effect brain, marrow, lungs and heart
- without eosinophilia - tropical endomyocardial fibrosis
How can we differentiate HYPEREOSINOPHILIA to W/OUT EOSINOPHILIA?
hyper has a marker = where WBCs easily stain with eosin
What are the SYMPTOMS of RESTRICTIVE CM?
symptoms of heart failure due to impaired diastolic filling and inability to maintain cardiac output; right sided heart failure predominates
What are the TREATMENTS of RESTRICTIVE CM?
- treat underlying etiology if possible
- treat CHF (meds/pacer)
- transplant
What are the 2D FINDINGS for RESTRICTIVE CM?
- thickened to fibrotic appearance of ventricular walls
- abnormal diastolic function
- decrease systolic function
- obvious biatrial enlargement with associated MR or TR
What are the DIFFERENCES from RCM to CONSTRICTIVE PERCARDITIS?
- RCM does not demonstrate significant respiratory variations in Doppler inflows
- RCM will have low medial and lateral TDI E’ velocities
- RCM will have reduced regional and global longitudinal strain
- RCM will have low color m mode propagation velocity
Define HYPERTROPHIC cardiomyopathy
an autosomal dominant inherited disease of the myocardium related to abnormalities in gene coding for contractile proteins
What are the CAUSES of HCM?
autosomal dominant inherited disease
What are the SYMPTOMS of HCM?
- angina
- exercise intolerance
- syncope or presyncope on exertion
- DOE, PND, orthopnea
- late systolic murmur
- high prevalence of A Fib
What are the TREATMENTS for HCM?
- echo is procedure of choice for accurate diagnosis
- doppler can be used to assess the effectiveness of medical therapy
- AICD for those with risk for sudden death
- echo used to assess PTSMA (alcohol introduced)
- echo used during myotomy-myectomy to eval the adequacy of the procedure
- Camzyos
What are the 2D ECHO FINDINGS of HCM?
- asymmetric LV hypertrophy
- typically, normal contractility
- impaired diastolic LV function
- dynamic LVOT obstruction
HOW does an AMYLOID appear on ECHO?
- myocardium, valves, IAS appear thick granular; “sparkling” appearance
- significant biventricular hypertrophy
What are the ECHO FINDINGS for HTN HEART DISEASE?
- concentric LV hypertrophy
- diastolic dysfunction
- aortic root dilation
- aortic valve sclerosis
- MAC
- LAE
What are the ECHO FINDINGS for DIABETES?
- ventricular walls look thick
- myocardium seems reflective ; hyperechoic
- diastolic dysfunction
- eventual LVE & systolic dysfunction
- abnormal strain and TDI
What are the ECHO FINDINGS for POST CARDIAC TRANSPLANT?
- abnormal septal motion with slight decrease in septal contractility
- slightly increased wall thickness
- mild MR, TR, PI
- small pericardial effusion post op
- some degree of elevated PASP
What are the PATTERNS of HYPERTROPHY?
- Type 1: hypertrophy confined into antero septum (10%)
- Type 2: hypertrophy of both the antero and infero septum (20%)
- Type 3: hypertrophy of the septum and the anterolateral free wall (52%)
- Type 4: hypertrophy of other regions including apical (ace of spades) (18%)
What are the ECHO FINDINGS for LVOT OBSTRUCTION?
- systolic anterior motion of the anterior mitral leaflets “SAM” (2D/Color/Mmode)
- mid-systolic fluttering and closure of the AV (Mmode)
- mid to late peaking high velocity flow in the outflow tract (color)
- PW A5 mapping determines the location of the LVOT obstruction
- CW A5 PPG determines the severity
What are the CW FINDINGS for LVOT OBSTRUCTION
- demonstrates a mid to late systolic high velocity jet
- LVOT envelope is dagger shaped
How do we determine the severity of the OUTFLOW TRACT OBSTRUCTION?
(once we do PW and CW)
1. Nonobstructive:
PPG < 30 mmHg at rest and with provocation
- Obstructive:
PPG > 30 mmHg at rest - Inducible or latent:
PPG < 30 mmHg at rest but > 30 mmHg with provocation
When is MID CAVITARY OBSTRUCTION seen?
- patients with concentric LVH (due to HTN/AS/old age) demos near cavity obliteration late systole
- often seen in dehydrated patients with LVH
How do you find MID CAVITARY OBSTRUCTION?
CW A4 thru LV chamber will pick up this late peaking higher velocity systolic waveform
What is the DOPPLER FINDING for MID CAVITARY OBSTRUCTION?
- waveform is typically late peaking and saw toothed
Athletes Heart vs Pathological Heart
- in athletes heart - all the mild changes
( RVH,LVH,RVE,LVE,LAE, IVC ENLARGEMENT) reverses with deconditioning - TDI and strain values will be normal
- if steroids - significant LVH
