Cardiomyopathy/Pericardial Effusion Flashcards
Dilated cardiomyopathy
Most common
Multi chamber enlargement, starts with lv dilation
Dilated cardiomyopathy causes
• 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
Dilated cardiomyopathy symptoms
• Heart failure
• Chest pain
• Palpitations, dysrhythmias
• Cyanosis
• Murmurs
• Pulsus alternansàstrong and weak pulses • Thrombus
• Death
2D of dilated cardiomyopathy
Spherical lv
Decreased EF
Decreased systolic and diastolic function
Smoke
M mode for dilated cardiomyopathy
Increase in e point to septal separation
B bump after a peak
Decreased MV excursion
Double diamond MV
Hypertrophic cardiomyopathy
Thickened walls become stiff
Hocm
Thick Ivs blocks or reduces the blood flow from LV to aorta
More common
Non obstructive Hcm
The heart muscle is thickened but doesn’t block blood flow out of the heart
Types of HOCM
Subaortic stenosis : Ash , Sam
Concentric LVH
Mid cavity obstruction
Type of non obstructive HCM
Apical or any other without LVOT obstruction
SAM
Systolic anterior motion
AMVL could make contact with the septum
Elongated leaflets may also be noted
ASH
Asymmetrical septal hypertrophy
Cause for HCM
Genetics
Idiopathic
Microscopic disorganization of myocardial fibers
Symptoms of HCM
• 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
HOCM M mode of MV
Elongated MV LEAFLETS
May see a b bump which indicates increased LVEDP
HOCM M mode of the AV
Mid systolic notching of the AV due to obstruction
Reduction of pressure gradient
PW doppler for HOCM
PW throughout the LV from apex to lvot
the spectral tracing will be dagger shaped
may use valsalva to increase the velocity
HOCM with CW
dynamic obstruction with HOCM cw
will have late systolic dagger shape using CW
HOCM w/ AS waveform
see both dagger shape waveform and smooth early speaking AS waveform
HOCM vs MR waveform
mr waveform is wider
usually MR velocity is greater than LVOT obstruction velocity
HOCM EKG
dagger like septal Q waves
a fib may be present
septal HOCM ekg
apial variant ekg
hocm mid cavity obstruction
lv apex segments are aneurysmal thin or hypo/akinetic
sam is typically not present
lv wall thickening is present mid or basal segments
hocm mid cavity CW
apical non obstructive HCM
apical segments are thicker
lv will be hyperdynamic
no lvot obstruction
lv noncompaction cardiomyopathy signs
both ventricles dilated
trabeculations are more than twice as thick
Takotsubo Cardiomyopathy
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
Takotsubo Cardiomyopathy causes
• Idiopathic
• Severe emotional stress or trauma
• Severe physical stress or trauma
• Asthma attack
Takotsubo Cardiomyopathy signs
• Chest pain
• Chest tightness
• Pain in arm/shoulder
• Breathlessness
• Normal cath: no CAD
• New EKG abnormality: T-inversion
or ST-segment elevation
• Elevated troponin
echo findings for Takotsubo Cardiomyopathy
• Apical ballooning
• Apical dyskinesis
• Normal basal segments • Decrease in LVEF
symptoms of restrictive cardiomyopathy
o Fatigue, poor exercise tolerance
o Swelling of feet, ankles, abdomen
o SOB/cough, especially with exertion
types of restrictive cardiomyopathy
• AMYLOIDOSIS
• SARCOIDOSIS
• HEMOCHROMATOSIS
• POMPE DISEASE
• ENDOMYOCARDIAL FIBROSIS
amyloidosis
• Amyloid protein infiltrates multiple organs
• Often accompanied by pericardial effusion and irregular rhythms
• Can mimic constrictive pericarditis
sarcoidosis
• Groups of immune cells form inflammatory masses called granulomas that infiltrate multiple organs
• Cardiac complications: HF, pulmonary HTN, irregular rhythms
hemochromatosis
• 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
endomyocardial fibrosis
• 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
restrictive CM echo findings
• 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
spectral doppler for restrictive CM
• Regurgitation of all valves
• Restrictive MV inflow pattern: large E-wave and
small A-wave without respiratory variations
pericardial effusion
abnormal amount of fluid between the parietal and visceral layer of the pericardium
symptoms of pericardial effusion
Asymptomatic (if small)
▪ Chest pain, pressure
▪ Shortness of breath
▪ Palpitations
▪ Syncope
▪ Cough
▪ Anxiety
▪ Nausea
▪ Lightheadedness
▪ Feeling of abdominal fullness
when do you measure pericardial effusion
end diastole
how do you distinguish pleural and pericardial effusion
fluid posterior to the descending thoracic aorta in PLAX indicates left pleural effusion
tamponade
significant compression and dysfunction
etiology of tamponade
▪ 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
symptoms of tamponade
becks triad
pulsus paradoxus
pericardial friction rub
tachycardia
dyspnea
hepatomegaly
what is becks triad
hypotension and weak pulse
muffled heart sounds
elevate venous pressures
what is pulsus paradoxus
exaggerated decrease in systolic BP with inspiration
pericardial friction rub
parietal and visceral layers scratch against one another
low pitched harsh grating sound
echo findings for tamponade
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
m mode showing rv diastolic collapse
respiratory variation for cardiac tamponade
variation is exaggerated so velocities are exaggerated
myocarditis
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
myocarditis symptoms
▪ 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
myocarditis echo findings
▪ Dilated or hypertrophied ventricles
▪ Ventricular dysfunction, systolic and
diastolic
▪ Regional wall motion abnormalities
▪ Valvular disease
pericarditis etiology
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
pericarditis symptoms
pericardial friction rub
chest pain
obstruction of venous and lymphatic system
pericardial effusion
tamponade from effusion
Constrictive Pericarditis
▪ 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
Constrictive Pericarditis symptoms
▪ Dyspnea
▪ Kussmaul’s sign
▪ Edema
▪ Pericardial knock – rare third heart sound (S3)
▪ Ascites
▪ Heart failure
what is kussmauls sign
a paradoxical rise in jugular venous pressure on inspiration or a failure in the appropriate fall of the JVP with inspiration
Constrictive Pericarditis on echo
▪ 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
Constrictive Pericarditis M mode
▪ Left atrial enlargement
▪ Flat inferolateral wall in diastole
▪ Thick, bright pericardium
▪ Respiratory variation in septal motion
Constrictive pericarditis Doppler
Large E and small A wave with respiratory variation
