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Echo 3 Final > Cardiomyopathy/Pericardial Effusion > Flashcards

Cardiomyopathy/Pericardial Effusion Flashcards

1
Q

Dilated cardiomyopathy

A

Most common
Multi chamber enlargement, starts with lv dilation

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2
Q

Dilated cardiomyopathy causes

A

• Idiopathic
• Genetics
• Alcoholism
• Drug abuse
• Toxin exposure
• Endocrine disorders
• Chagas disease
• Systemic hypertension
• Viral infections
• Immune disorders
• Valvular disease
• Chemotherapy
• Carnitine deficiency
• Ischemic disease
• Myocardial infarction
• Pregnancy

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3
Q

Dilated cardiomyopathy symptoms

A

• Heart failure
• Chest pain
• Palpitations, dysrhythmias
• Cyanosis
• Murmurs
• Pulsus alternansàstrong and weak pulses • Thrombus
• Death

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4
Q

2D of dilated cardiomyopathy

A

Spherical lv
Decreased EF
Decreased systolic and diastolic function
Smoke

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5
Q

M mode for dilated cardiomyopathy

A

Increase in e point to septal separation
B bump after a peak
Decreased MV excursion
Double diamond MV

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6
Q

Hypertrophic cardiomyopathy

A

Thickened walls become stiff

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7
Q

Hocm

A

Thick Ivs blocks or reduces the blood flow from LV to aorta
More common

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8
Q

Non obstructive Hcm

A

The heart muscle is thickened but doesn’t block blood flow out of the heart

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9
Q

Types of HOCM

A

Subaortic stenosis : Ash , Sam
Concentric LVH
Mid cavity obstruction

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10
Q

Type of non obstructive HCM

A

Apical or any other without LVOT obstruction

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11
Q

SAM

A

Systolic anterior motion
AMVL could make contact with the septum
Elongated leaflets may also be noted

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12
Q

ASH

A

Asymmetrical septal hypertrophy

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13
Q

Cause for HCM

A

Genetics
Idiopathic
Microscopic disorganization of myocardial fibers

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14
Q

Symptoms of HCM

A

• LV with thick walls and narrowed internal diameter
• Hyperdynamic LV contractility – EF is > 75%
• LA enlargement from MR and LV diastolic dysfunction
• Dyspnea on exertion – also may have orthopnea or
sleep apnea
• Chest pain
• Fatigue
• Syncope
• Systolic murmur
• Dysrhythmias, palpitations
• Sudden death – most common in athletes

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15
Q

HOCM M mode of MV

A

Elongated MV LEAFLETS
May see a b bump which indicates increased LVEDP

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16
Q

HOCM M mode of the AV

A

Mid systolic notching of the AV due to obstruction
Reduction of pressure gradient

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17
Q

PW doppler for HOCM

A

PW throughout the LV from apex to lvot
the spectral tracing will be dagger shaped
may use valsalva to increase the velocity

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18
Q

HOCM with CW

A
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19
Q

dynamic obstruction with HOCM cw

A

will have late systolic dagger shape using CW

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20
Q

HOCM w/ AS waveform

A

see both dagger shape waveform and smooth early speaking AS waveform

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21
Q

HOCM vs MR waveform

A

mr waveform is wider
usually MR velocity is greater than LVOT obstruction velocity

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22
Q

HOCM EKG

A

dagger like septal Q waves
a fib may be present

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23
Q

septal HOCM ekg

A
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24
Q

apial variant ekg

A
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25
Q

hocm mid cavity obstruction

A

lv apex segments are aneurysmal thin or hypo/akinetic
sam is typically not present
lv wall thickening is present mid or basal segments

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26
Q

hocm mid cavity CW

A
27
Q

apical non obstructive HCM

A

apical segments are thicker
lv will be hyperdynamic
no lvot obstruction

28
Q

lv noncompaction cardiomyopathy signs

A

both ventricles dilated
trabeculations are more than twice as thick

29
Q

Takotsubo Cardiomyopathy

A

symptoms similar to a heart attack
emporary, often severe, change in the heart’s pumping ability
• a.k.a. stress induced cardiomyopathy or broken heart syndrome

30
Q

Takotsubo Cardiomyopathy causes

A

• Idiopathic
• Severe emotional stress or trauma
• Severe physical stress or trauma
• Asthma attack

31
Q

Takotsubo Cardiomyopathy signs

A

• Chest pain
• Chest tightness
• Pain in arm/shoulder
• Breathlessness
• Normal cath: no CAD
• New EKG abnormality: T-inversion
or ST-segment elevation
• Elevated troponin

32
Q

echo findings for Takotsubo Cardiomyopathy

A

• Apical ballooning
• Apical dyskinesis
• Normal basal segments • Decrease in LVEF

33
Q

symptoms of restrictive cardiomyopathy

A

o Fatigue, poor exercise tolerance
o Swelling of feet, ankles, abdomen
o SOB/cough, especially with exertion

34
Q

types of restrictive cardiomyopathy

A

• AMYLOIDOSIS
• SARCOIDOSIS
• HEMOCHROMATOSIS
• POMPE DISEASE
• ENDOMYOCARDIAL FIBROSIS

35
Q

amyloidosis

A

• Amyloid protein infiltrates multiple organs
• Often accompanied by pericardial effusion and irregular rhythms
• Can mimic constrictive pericarditis

36
Q

sarcoidosis

A

• Groups of immune cells form inflammatory masses called granulomas that infiltrate multiple organs
• Cardiac complications: HF, pulmonary HTN, irregular rhythms

37
Q

hemochromatosis

A

• Most common iron overload disease that may cause multiple organ and tissue damage
• Biopsy will diagnose iron deposits in the myocytes
• Cardiac complications: HF, arrhythmia

38
Q

endomyocardial fibrosis

A

• Fibrotic tissue lines the myocardium; may be diffuse or local
• Areas of necrosis (ischemia) are prone to apical thrombus
• LV function is usually preserved
• May cause severe MR and TR,
leading to dilated atria
• Endocardium, MV and TV may be
scarred or echogenic

39
Q

restrictive CM echo findings

A

• Biventricular hypertrophy: LVH & RVH
• Ground glass appearance of myocardium
• Small-to-normal LV size with decreased-to-
normal LV systolic function
• Biatrial enlargement
• Pericardial effusion

40
Q

spectral doppler for restrictive CM

A

• Regurgitation of all valves
• Restrictive MV inflow pattern: large E-wave and
small A-wave without respiratory variations

41
Q

pericardial effusion

A

abnormal amount of fluid between the parietal and visceral layer of the pericardium

42
Q

symptoms of pericardial effusion

A

Asymptomatic (if small)
▪ Chest pain, pressure
▪ Shortness of breath
▪ Palpitations
▪ Syncope
▪ Cough
▪ Anxiety
▪ Nausea
▪ Lightheadedness
▪ Feeling of abdominal fullness

43
Q

when do you measure pericardial effusion

A

end diastole

44
Q

how do you distinguish pleural and pericardial effusion

A

fluid posterior to the descending thoracic aorta in PLAX indicates left pleural effusion

45
Q

tamponade

A

significant compression and dysfunction

46
Q

etiology of tamponade

A

▪ Cardiac surgery or perforation
▪ Chest trauma
▪ Infectious disease
▪ Malignant disease
▪ Ascending aortic dissection
▪ Cardiomyopathy
▪ Pericarditis
▪ Hypothyroidism
▪ Myocardial infarct
▪ Autoimmune or connective
▪ Radiation therapy or chemotherapy
tissue disease

47
Q

symptoms of tamponade

A

becks triad
pulsus paradoxus
pericardial friction rub
tachycardia
dyspnea
hepatomegaly

48
Q

what is becks triad

A

hypotension and weak pulse
muffled heart sounds
elevate venous pressures

49
Q

what is pulsus paradoxus

A

exaggerated decrease in systolic BP with inspiration

50
Q

pericardial friction rub

A

parietal and visceral layers scratch against one another
low pitched harsh grating sound

51
Q

echo findings for tamponade

A

swinging heart
decrease in LV diastolic and systolic dimension
paradoxical septal motion
▪ Inspiratory interventricular septal bounce
▪ Right ventricular early diastolic collapse
▪ Right atrial late diastolic collapse
▪ Dilated IVC and hepatic veins with
reduced collapsibility

52
Q

m mode showing rv diastolic collapse

A
53
Q

respiratory variation for cardiac tamponade

A

variation is exaggerated so velocities are exaggerated

54
Q

myocarditis

A

inflammation of the myocardium
causes the muscle to weaken and enlarge
Begins as a viral infiltration that produces a myocardial toxic response from the T-lymphocytes that causes degeneration and/or necrosis of the myocardium

55
Q

myocarditis symptoms

A

▪ Chest pain
▪ Shortness of breath
▪ Palpitations
▪ Dizziness or fainting
▪ Fever
▪ Dull heart sounds
▪ Arrhythmia
▪ Damage to heart cells
▪ Mimicking MI, due to coronary inflammation but without blockage

56
Q

myocarditis echo findings

A

▪ Dilated or hypertrophied ventricles
▪ Ventricular dysfunction, systolic and
diastolic
▪ Regional wall motion abnormalities
▪ Valvular disease

57
Q

pericarditis etiology

A

most common in men 20-50 yrs old
▪ Acute injury
▪ Cardiac surgery
▪ HIV/AIDS
▪ Infectious (most viral)
▪ Post radiation therapy
▪ Kidney failure
▪ Cancer
▪ Autoimmune disease
▪ Tuberculosis
▪ Idiopathic

58
Q

pericarditis symptoms

A

pericardial friction rub
chest pain
obstruction of venous and lymphatic system
pericardial effusion
tamponade from effusion

59
Q

Constrictive Pericarditis

A

▪ Parietal and/or visceral layers of pericardium thicken, scar and may calcify.
▪ The thickened, fibrotic pericardium forms a noncompliant shell around the heart.
▪ Tense pericardial effusion develops, which further impedes diastolic filling

60
Q

Constrictive Pericarditis symptoms

A

▪ Dyspnea
▪ Kussmaul’s sign
▪ Edema
▪ Pericardial knock – rare third heart sound (S3)
▪ Ascites
▪ Heart failure

61
Q

what is kussmauls sign

A

a paradoxical rise in jugular venous pressure on inspiration or a failure in the appropriate fall of the JVP with inspiration

62
Q

Constrictive Pericarditis on echo

A

▪ Ventricular size and function are normal but WMA may be present
▪ Bilateral atrial enlargement – due to impaired filling
▪ Flat diastolic LV inferior wall motion – heart cannot expand
▪ Pericardium is bright and thick
▪ IVS bounce – from constriction
▪ Pericardial effusion – between 2 layers
▪ Dilated IVC and hepatic veins

63
Q

Constrictive Pericarditis M mode

A

▪ Left atrial enlargement
▪ Flat inferolateral wall in diastole
▪ Thick, bright pericardium
▪ Respiratory variation in septal motion

64
Q

Constrictive pericarditis Doppler

A

Large E and small A wave with respiratory variation

Echo 3 Final (3 decks)

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